A brief history of honey

It’s the year 1702. You want to eat something sweet.  What are your options?  Can you hit up Whole Foods for xylitol or agave?  Nope. You don’t even have table sugar. But if you’re lucky, and it’s the right time of year, you might get a little bit of honey.

Honey has been humans’ main sweetener for thousands of years. People didn’t really have sugar until intercontinental trade in the 18^th century made cane sugar available.

Honeybees, which originated in Africa, have probably been around for 100 million years. So it’s no surprise that nearly every world culture uses honey.

For instance:

• Honey appears in Spanish cave paintings about 10-15,000 years old (see image below).
• Honey is part of Buddhist rituals and traditional Indian and Chinese medicine.
• Honey is mentioned often in the Jewish Talmud (honeybees are not kosher, but honey is), the Old and New Testaments of the Bible, and the Koran.  In fact, the word honey appears 56 times in the King James version of the Bible; Biblical references to “the land of milk and honey,” probably refer to Tel Rehov, one of the most important cities in Israel and a beekeeping center.
• Bees and honey appear in Egyptian hieroglyphics (see image below).
• Ancient Greeks revered honey. The Greek physician Hippocrates used honey to treat skin ailments, while the philosopher Aristotle thought honey was deposited from the atmosphere..
• Honey was used for mead – the first known alcoholic drink in mythology.
• Old Scandinavian texts, such as the Kalevala, the ancient Finnish epic poem, also refer to honey. The term honeymoon originated with the Norse practice of consuming large quantities of mead during the first month of a marriage.  This practice was believed to ensure fertility during the lunar cycle.

In 1866 Franz von Hruschka invented the first device to extract honey from the honeycomb using centrifugal force (after watching milkmaids swinging buckets).

In modern times, honey is often used in Middle Eastern/Mediterranean, African, northern and southern European cuisine.

Ancient Spanish cave painting showing honey gathering	Ancient Egyptian hieroglyphic of bees

Americans now consume 156 pounds of added sweeteners per year. Roughly 1.3 pounds of that — or 0.8% — is honey. (Comparatively, China only consumes about 0.4 to 0.6 pounds per person per year.)

Things have changed.

35% of honey is consumed at home and in restaurants.  65% is purchased by the industry and used in processed foods/drinks: Honey is a preservative.

Honey types & variations

Comb honey is the purest, rawest form of honey.  The beeswax is edible.

Raw honey often contains wax, pollen, and other bee parts.

Liquid honey is often pasteurized (which decreases the chance of crystallization), and the beeswax has been filtered out.

Chunk honey is liquid honey with chunks of honeycomb.

Dry honey is dehydrated, and can be sold as powder, flakes, granules, etc.  Usually contains additives.

Creamed/whipped honey is intentionally crystallized to allow for spreading.

Organic honey must be produced without certain pesticides, insecticides, and herbicides.  This is hard to control since bees can travel up to 2 miles from the hive to gather nectar and pollen.  Only nontoxic paints can be used on the beehives and no medications can be used on the bees.

Fair trade honey: if you’re getting honey from small local farmers, this won’t be an issue.  But if you are buying honey from outside the U.S., ensuring Fair Trade is important so beekeepers get proper compensation.

Single flower species honey comes from nectar gathered from a single flower (e.g. orange blossom or clover honey). This honey must contain at least 51% of the specific type of nectar to be labeled as such.

Honey is produced across the U.S., and there are over 300 varieties of American honey.

Natural honey is diverse. For instance:

• Colour can depend on mineral, pollen and phenol content.
• Honey is often cloudy due to air bubbles, pollen, or other particles.
• The smell of honey depends on the amount and type of acids it contains.
• The taste of honey varies from hive to hive and from year to year.
• Different types of honey can vary 20 fold in their antioxidant content.

Honey is graded in the U.S. by the USDA based on a system accounting for water content, flavor, aroma, clarity, and absence of defects.

Honey colour variations

How honey is made

Honey is made from flower nectar.

Bees collect nectar from flowering plants, pollinating the plants in the process as they wiggle around in the flower. This makes bees crucial links in the food chain. For instances, 80% of cotton relies on honeybees. Many plants, such as squash, have specialized bees that only collect nectar from that particular plant.

A bee visits about 1,500 flowers to gather enough nectar to fill up her honey sac stomach (which holds about 70 mg of nectar – almost as much as a bees body weight), which is different than their digestive stomach.

Bees then carry the nectar back to the hive in their honey sac stomach. Here, a younger bee will suck the honey from the honey sac stomach, via the mouth (kind of like they are kissing).

Bees navigate using an exceptional spatial sense, and can fly up to 15 mph. Back at the homestead, they may do a little “bee dance” for their hive mates to communicate where the nectar was found.

The bees deposit (OK, regurgitate) the nectar into the waxen honeycomb, where invertase (aka sucrase) from salivary glands thickens it and splits sucrose into glucose and fructose, so that the bees are able to digest the honey when they consume it later.

Once honey is in the honeycomb, worker bees flap their wings to encourage water evaporation until the nectar fluid becomes syrupy.  Then the bees cap the honeycomb with wax.  If honey is harvested before the water is evaporated, moisture content will be too high and naturally occurring yeast cells will ferment.  This honey will be runny and taste like vinegar.

A single worker bee makes less than a teaspoon of honey in her 6-week lifetime (assuming she doesn’t sting anyone, as bees die after they sting).  They work themselves to death, literally.

One colony can produce 44 pounds of honey during a typical summer. This requires more than 1 million foraging trips, and is roughly the amount necessary to sustain the colony during winter.

Nectar transfer

Why do bees produce honey?

Honey feeds the bee colony in the winter. Bees eat honey for carbohydrates and pollen for protein, vitamins and fat.  Worker bees metabolize honey to generate heat for the hive, so it must be present at all times.

Just like you defend your lunch, bees defend their honey.

Bees can die of starvation during the winter without enough. Drones (male bees) are not allowed to spend the winter in the bee hive, as they would eat all the honey. Way to go, fellas.

Technically, honey is taken from the bees, which is why some folks try to avoid consuming it.

Beekeepers

There are between 140,000 and 212,000 beekeepers in the U.S. with 2.4 million honeybee colonies.

U.S. beekeepers can only supply 48% of American honey needs.  The remaining 52% comes from outside the U.S., with a majority imported from Asian countries.  Asian honey can be cheap, and it can also be contaminated with metals and antibiotics. (Read more about tainted and counterfeit Asian honey here and here)

A typical honeybee colony in the summer has 80,000 bees with one queen.  Queens are marked by beekeepers for tracking.

“Educated” beekeepers don’t remove honey from the main hive where the bees live, because bees eat this honey, and feed it to their larvae. Instead, beekeepers provide larger hives and harvest the excess honey.  Beekeepers often feed bees a sugar water solution before the fall/winter to ensure the bees have enough stored honey.

Honey extraction and bottling

• Honey – From the Hive to the Jar
• Honey Extraction & Bottling

To access honey, beekeepers will use a one-way bee escape or a fume board (that smells like almonds).  The bees often get defensive here.  Beekeepers might also use smokers to neutralize odours and access hives.

Some modern industrialized beekeeping can subject honeybees to unnatural living conditions, genetic manipulation, and stressful transportation.  To prevent swarms, some beekeepers clip the wings of bees.

Why do bees matter?

Before certain plants can grow they need to be pollinated.  Bees (along with butterflies, moths, hummingbirds, bats, and wind) help transfer this pollen.  90% of pollination is performed by managed honeybees; beekeepers transport honeybee colonies to different agricultural areas depending on the need for pollination.

Thus, 1/3 of all food grown depends to some degree on honeybees. If honeybees were to go extinct, we (humans) probably wouldn’t die off completely.  But since honeybees are the most important pollinators worldwide, our food choices would be dismal. (Or we’d have to spend a lot of time out in the fields with Q-tips, poking flowers.)

Why are bee populations declining?

With more people, we need more food.  To grow more food, we need more bees.

Bee populations are decreasing for many reasons:

• the Varroa mite
• Colony Collapse Disorder
• insecticides (neonicotinoids)
• chemicals
• antibiotics

Artificial diets provided to bees might leave bees susceptible to illness and harassment from other insects (because honey that the bees would normally eat is harvested).  These problems vary from region to region.

For more, see this useful infographic.

Ali’s Potion & the health properties of honey

Muhammad Ali drank a mixture of honey, bee pollen and other ingredients before a 1978 fight. He claimed it helped.  But beyond Muhammad’s anecdote, does honey do anything for our health?

Indeed, honey has antiseptic, antioxidant, anti-inflammatory, antibiotic, antifungal, antibacterial and prebiotic properties.

However, many studies use substantial amounts of honey (like 50 to 80 grams/day, which supplies 40-65 grams of sugar). Luckily, we can also derive health benefits from topically applied honey.

When comparing sweetener intake in rodents, honey appears to be less harmful than others (notice we said “less harmful” – because lots of any sweetener consumption tends to be harmful).

Skin

Honey can stimulate tissue growth, collagen and new blood vessels in wounds.  It can also absorb moisture and fend off microbes.  The antibacterial action of honey might be attributable to sugars, low moisture, gluconic acid (which creates an acidic environment), and hydrogen peroxide.  Nitric oxide end products in honey might also be useful.

Allergies

Ingesting pure honey with traces of pollen may help build a better tolerance to local airborne allergens.

Sore throat & cough

Honey is said to soothe the throat and ease congestion.  A large review concluded that honey is better than no treatment for acute cough symptoms, and sometimes as good as commercial cough syrups.

Gastrointestinal illness

Honey may relieve indigestion and other GI ailments, helping to destroy bad bacteria in the gut. It may also help to protect against gastric ulcers.

Workout recovery

Honey appears to act like other forms of rapidly digesting carbohydrates when it comes to athletic performance, recovery and promoting muscle growth.  Honey has about the same amount of fructose as high fructose corn syrup and less than agave nectar (different varieties of honey vary slightly in their fructose content).

Honey gone bad

For food safety, store honey between 70 and 80 F in airtight containers.

Fermentation

Honey contains yeast cells.  When honey has more than 19% water, the yeast cells divide and fermentation occurs.

This happens when beekeepers harvest honey too early or you get water/saliva in your honey storage container.  If honey ever smells like vinegar, it’s fermenting/fermented. Chuck it.

Mad honey

Some honey is toxic to humans.  This “mad honey” is often found in the northern hemisphere in honey produced from rhododendrons, mountain laurels, oleander, and azaleas.  The nectar of these plants may contain grayanotoxin (psychoactive and poisonous).

Luckily (for us, not for the bees), bees act as filtering agents and any toxic levels of chemicals brought back to the hive would kill the bees before reaching humans.

Local honey

Locally produced honey tends to contain more bacteria than commercially blended honey.  This is probably because local honey undergoes less processing.

Teeth

Honey is bad news for cavities and dental erosion, comparable to table sugar, soda and juice.

Infants

Infants (less than 12 months old) should avoid honey due to the potential of Clostridium botulinum (aka botulism) bacteria to be present. Generally, adults’ more robust digestive systems can destroy any bacteria.

Allergy

Reactions to honey are uncommon, still it’s possible due to the pollen and proteins.

Toxic flowers

Toxic compounds occur in 3% of flowering plants and are harmful if ingested.  Commercial honey blends with no floral attribution tend to contain more of these harmful compounds.

According to risk assessments, levels of these toxic compounds could cause chronic diseases such as liver cirrhosis, pulmonary hypertension and cancer, assuming you eat a lot of honey regularly (daily intake of 15–25 grams).

Honey & the environment

From an environmental perspective, locally sourced honey is likely a better choice than commercial sweeteners that undergo high levels of processing and longer transport distances. So if you must put something sweet in your tea, try a little local honey.

When using honey in a recipe, reduce the amount of any other liquid by ¼ cup for each cup of honey and add ½ teaspoon of baking soda for each cup of honey used.  Reduce the temp of the oven by 25 F to prevent too much browning.

Summary & recommendations

Honey has been used throughout history because it was the only sweetener available.

Honey can be good for our skin, respiratory system, and GI tract. It has antiseptic, antioxidant, anti-inflammatory, antibiotic, antifungal, antibacterial and prebiotic properties.

Chemically, honey is not much different than other sweeteners like agave nectar and maple syrup. It’s still sugar. Use it sparingly.

Bees are important, both as honey producers and key links in food chains. If bees are healthy, our food system is healthy.

If you use honey, know your source.  If you aren’t sure you’re getting local sustainable honey, another sweetener might be a better option.

Resources

Colony: The Endangered World of Bees. 2011. (DVD)

The Great Vegan Honey Debate

Apitherapy is the ancient practice of using bee venom and other products of the honeybees, including honey.

USDA Honey Grading

References

Marchese C. Marina.  Honeybee: Lessons from an accidental beekeeper.  Black Dog & Leventhal Publishers, Inc.  2009.

Wilson Bee. The Hive: The story of the honeybee and us. Thomas Dunne Books. 2004.

Colony: The Endangered World of Bees. 2011. DVD

Schneider Andrew. Asian honey, banned in Europe, is flooding U.S. grocery shelves.  Accessed August 28^th, 2011.

Honey: From factory-farmed bees.  Accessed August 29^th, 2011.

Seeley Thomas D.  Honeybee Democracy.  Princeton University Press.  2010.

Vanata DF, et al.  Enumeration and identification of bacterial contaminants in commercial and locally produced honey.  J Am Diet Assoc 2010;110:A55.

Shaaban SY, et al.  Effect of honey on gastric emptying of infants with protein energy malnutrition.  Eur J Clin Invest 2010;40:383-387.

Bowen WH & Lawrence RA.  Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose.  Pediatrics 2005;116:921-926.

Mohamed M, et al.  Afr J Trad CAM 2010;7:59-63.

Genersch E. Honey bee pathology: current threats to honey bees and beekeeping. Appl Microbiol Biotechnol 2010;87:87-97.

Oduwole O, et al.  Honey for acute cough in children. Cochrane Database Syst Rev 2010;20:CD007094.

Bogdanov S, et al.  Honey for nutrition and health: A review. J Am Coll Nutr 2008;27:677-689.

Al- Waili NS, et al.  Honey for wound healing, ulcers, and burns; Data supporting its use in clinical practice. The Scientific World Journal 2011;11:766-787.

Ischayek JI & Kern M.  US honeys varying in glucose and fructose content elicit similar glycemic indexes.  J Am Diet Assoc 2006;106:1260-1262.

Tappy L & Le K.  Metabolic effects of fructose and the worldwide increase.  Physiol Rev 2010;90:23-46.

Nemoseck TM, et al.  Honey promotes lower weight gain, adiposity, and triglycerides than sucrose in rates.  Nutr Res 2011;31:55-60.

Khan FR, et al.  Honey: nutritional and medicinal value.  Int J Clin Pract 2007;61:1705-1707.

Edgar JA, et al.  Pyrrolizidine alkaloids in food: a spectrum of potential health consequences Food Additives & Contaminants 2011;A28:308-324

Schramm DD, et al.  Honey with high levels of antioxidants can provide protection to healthy human subjects.  J Agric Food Chem 2003;51:1732-1735.

Kreider RB, et al.  Effects of ingesting protein with various forms of carbohydrate following resistance-exercise on substrate availability and markers of anabolism, catabolism, and immunity.  JISSN 2007;4:18.

Casey J. The hidden ingredient that can sabotage your diet.  Medicine Net.  2005.

Melnick M. Tainted Chinese honey may be on U.S. store shelves.  Time.  2011.

Koca I & Koca AF.  Poisoning by mad honey: A brief review.  Food and Chemical Toxicology 2007;45:1315-1318.

To lose fat, you have to eat less. Simple enough. But it’s hard to get enough fibre when you’re eating less food. Inadequate fibre often means more hunger. More hunger means you want to eat more.

What to do?

Glucomannan, a soluble fibre from konjac root, may be one supplement that meets both these needs — adequate fibre plus greater satiety. It may have many other health benefits too.

What are soluble fibres?

Soluble fibres are a form of so-called “complex” carbohydrate (which means that their more elaborate molecular structure is harder for our bodies to break down) that are soluble in water. In liquid, soluble fibres form viscous gels. For instance, fruit pectin is used to thicken jams and jellies, while xanthan gum is used as an emulsifier that makes foods creamier.

Soluble fibres are also great bacteria food (which earns soluble fibre the term prebiotic). Our gastrointestinal bacteria eagerly ferment soluble fibres, creating byproducts such as valuable nutrients or not-so-desirable gases.

Soluble fibres are found in foods like:

• beans and legumes
• grains such as oats, rye, and barley
• some fruits such as plums/prunes, apples, pears, berries, and bananas
• some vegetables, such as the onion family; the brassica family; and Jerusalem artichokes (root vegetables/tubers are often high in soluble fibres)
• some seeds, such as chia and psyllium

For more on this, see All About Fibre.

From konjac root to glucomannan

Like many tubers, the root of the konjac plant (Amorphophallus konjac) is high in soluble fibre. This soluble fibre is used to manufacture glucomannan (GM) supplements.

Konjac roots

Konjac also appears in East Asian cuisine, often as shirataki noodles or a gel that is cut up and served with dipping sauce. It’s generally prized for its gelatinous texture rather than taste, and takes on the taste of whatever it’s cooked, marinated, or dipped in.

Sashimi konnyaku (konjac sashimi)

From konjac, manufacturers can produce flour or powder, along with “foods” such as noodles, gels, and even candies (although these aren’t recommended for consumption).

What does glucomannan do?

Although konjac has long been used in China, Japan and South East Asia as a food source and as a traditional medicine, Western researchers have only been interested in GM’s health benefits since about the 1980s.

Absorbs water

Glucomannan/konjac flour or powder is highly absorbent, and can suck up tremendous amounts of liquid. In an article on glucomannan, T-Nation included a video showing just how much a wee bit of GM expands when water is added.

Helps us feel fuller, longer

Because it can hold so much water and form a gel, GM helps us feel more satisfied with meals. This means we can eat less but feel more satisfied for longer. Eating less means fat loss.

Studies looking at adding GM to calorie-restricted diets have consistently found that GM groups lose more fat than the non-fibre’d up groups. In one study (Birketvedt GS, et al. 2005), the GM group dropped an additional .8/kg (1.75 lb) on average over 5 weeks compared to the control group.

This effect of feeling full is not necessarily obvious — having a full gut does not always leave one feeling satisfied.  As many dieters know, a stomach that’s simply stretched (e.g. from being full of water) doesn’t necessarily result in a lack of desire to eat more. “Mechanical” fullness doesn’t always mean “real” satisfaction.

However, a study of people with Type 2 diabetes (Grill 2010) showed that key hunger signals (such as ghrelin) decreased after taking a meal with GM in it. GM seems to trip sensors in the gut/brain to tell them that less food is more satisfying.

Better carbohydrate tolerance & lipid profile

Along with its effects on physical fullness, GM may improve satiety and fat loss by improving our blood sugar and lipid profile.

One review (Keithley and Swanson 2005) found that 2-4 g of GM each day enhanced dieters’ weight loss efforts, along with other positive side effects like improved blood lipids, carb tolerance, and satiety. Being better able to handle starchy carbs means better insulin sensitivity, which means better appetite control and fewer blood sugar swings or cravings.

One of the earliest findings with GM (Walsh 1984) showed lower serum cholesterol and LDL. And compared to one of the most popular soluble fibre supplements, psyllium, GM seems to have better overall results on blood lipids.

GI health

Gut health is an indicator of overall wellbeing. This includes good gastric motility (stuff moving through the pipes) and a healthy bacterial flora. (Indeed, gut dysbiosis, or an overgrowth/imbalance of the wrong bacterial types, has been connected to obesity.)

Lowcarb dieters know the nightmare that is a good bowel movement while the body adjusts to lower intakes of grains and other sources of fibre. Tolerable bowel movements while eating less food can be a challenge.

Lots of dieters try psyllium husk or bran as a solution to constipation. But along with choosing higher-fibre whole foods, going the soluble fibre route with GM may be a better choice.

Besides regular bowel movements, a study (Chen 2006) found that the group using GM also showed a significant increase in helpful bifidobacteria, lactobacilli and total bacteria — the friendly gut bacteria we want. The GM supplement also promoted colonic fermentation, as shown in the decreased fecal pH. That’s a good thing.

Acne

Probiotic foods (such as sauerkraut, kimchi, miso, etc.) along with GM have been shown to reduce acne. (Just FYI: Eat it, don’t smear it on your face.)

Cancer

No food/supplement overview would be complete without evaluating its influence on cancer. GM’s benefits for gastrointestinal flora may help reduce precancerous risk factors of colon cancer.

Hyperthyroid

GM may help with hyperthyroid symptoms, as Cassandra Forsythe suggests.

(Also check out the rest of Cassandra’s pieces on GM.)

Glucomannan safety

Because GM expands so readily in water, people have choked on the powder or GM candies by trying to swallow them dry. Imagine a balloon blowing up in your mouth and throat and you get the idea.

Thus, take GM either in food format (e.g. as shirataki noodles or konjac gel in your favourite Korean or Japanese dishes) or as a powder added to food or dissolved into a Supershake. You can also take it as capsules — be sure to have them with plenty of water. However, the pills aren’t as strongly recommended.

Otherwise, GM has been shown to be safe for both adults and kids.

Start slowly

Start with small doses of GM. Clinical studies used only about 1-3 g per meal on average. We recommend one very small dose per day to start.

Going overboard may cause bloating, gas and related discomfort.

How to take glucomannan

There are quite a few ways to get GM into one’s diet.

• Konjac flour (aka GM powder) is available from a variety of resellers – but it’s not exactly cheap, at around $18 USD/500 grams.
• Shirataki (or shiratake) noodles, which you can find in Asian grocery stores, can be used in traditional East Asian dishes or as a pasta substitute. Rinse noodles off first as they have a funky smell when first out of the package. You can also try the konjac gel (cut it up into little pieces and serve with dipping sauce), but it can be an acquired taste/texture.
• We don’t generally recommend GM pills, but one Canadian product that’s not bad is PGX, which is mostly GM along with sodium alginate, and alas, xanthan gum (and various stabilizers).
• If you do get GM pills, pop the capsules open and dissolve them in some water first, or mix them into some liquid-y food.

Again, be sure to drink lots of water with GM and/or dissolve well in liquid before ingesting.

Konnyaku (konjac) gel. You may, um, want to cut it up into chunks or something. Or throw a sprig of parsley on there.

Summary & recommendations

GM can improve many measures of bowel health, such as gastric motility (aka having healthy and appropriately frequent bowel movements) and the health of good GI bacteria.

GM can improve blood sugar control and blood lipids (e.g. serum cholesterol and lipoproteins).

GM can help you lose weight by keeping you fuller longer, and possibly affecting appetite hormones.

For safety, take GM with lots of liquid.

Check with your doctor if you’re on any medication that may be contraindicated, or if you have trouble swallowing.

References

Al-Ghazzewi FH, & Tester RF (2009). Effect of konjac glucomannan hydrolysates and probiotics on the growth of the skin bacterium Propionibacterium acnes in vitro. Int J Cosmet Sci 31:139-142.

Birketvedt GS, et al. (2005). Experiences with three different fiber supplements in weight reduction. Med Sci Monit 11:PI5-8.

Chen HL, et al. (2006). Konjac acts as a natural laxative by increasing stool bulk and improving colonic ecology in healthy adults. Nutrition 22:1112-1119.

deFonseka A & Kaunitz J. (2009). Gut sensing mechanisms. Curr Gastroenterol Rep 11:442-447.

Grill, H. (2010). Leptin and the systems neuroscience of meal size control. Front Neuroendocrinol 31:61-78.

Keithley J & Swanson B (2005). Glucomannan and obesity: a critical review. Altern Ther Health Med 11:30-34.

Chearskul S, et al.  (2009).  Brief report Immediate and long-term effects of glucomannan on total ghrelin and leptin in type 2 diabetes mellitus.  Diabetes Res Clin Pract 83:e40-e42.

Chua M, et al. (2010). Traditional uses and potential health benefits of Amorphophallus konjac Ethnopharmacol. 24;128(2):268-78. Epub 2010 Jan 15.

Marsicano LJ, et  al. (1995). Use of glucomannan dietary fiber in changes in intestinal habit G.E.N. 49:7-14.

Sartore G, et al. (2009). The effects of psyllium on lipoproteins in type II diabetic patients.  Eur J Clin Nutr 63:1269-1271

Walsh DE, et al (1984) A. Effect of glucomannan on obese patients: a clinical study. Int J Obes 8:289-293.

Wu WT, et al.  (2011) Ameliorative effects of konjac glucomannan on human faecal β-glucuronidase activity, secondary bile acid levels and faecal water toxicity towards Caco-2 cells. Br J Nutr 105:593-600.

What is acne?

Our skin is the largest organ in our body, and it’s a complex ecosystem made up of several layers and components.

The skin is semi-permeable, meaning that although it’s mostly a barrier between us and our environment, some stuff can get in and out. Sweat glands and hair follicles provide openings.

Hair originates in follicles deep in the subcutaneous layer, the deepest layer below the dermis. These hair follicles are paired with sebaceous glands, which secrete sebum, an oily substance that lubricates both hair and skin. (This is why your hair gets greasy if you don’t wash it.) Human sebum is primarily composed of triglycerides (40-60%), cerides (19-26%), squalene (11-15%), and small amounts of cholesterol.

We have hair follicles and sebaceous glands all over our body, except for the palms of our hands and soles of our feet.

Acne forms when pores become congested with old skin cells, which is more likely when the skin is oily and skin cells stick together. If we also have high levels of bacteria on the skin plus systemic inflammation, we have ourselves a full fledged acne party.

Acne vulgaris is the form of acne most of us are familiar with and accounts for nearly all acne experienced.

What contributes to acne?

Thus, anything that clogs pores, and/or creates or worsens infection and inflammation, contributes. The major players in acne production are:

• Excessive sebum (oil) production by the skin
• Rapid division of skin cells
• Delayed skin cell separation and death
• Bacteria on the skin surface
• Inflammatory response

The food we eat and our body fat cells play a role in sebum production, hormones, and inflammation. Hormonal changes likely have the greatest influence on acne (think birth control medications, anabolic steroids and puberty).

Hormonal factors

Growth hormone and IGF-1

Acne during puberty is often associated more with growth hormone (GH) than with testosterone and estrogens. GH goes from the brain to the liver and triggers the release of Insulin Like Growth Factor-1 (IGF-1). IGF-1 promotes skin cell growth/division, sebum production, efficacy of luteinizing hormone (LH) and the production of estrogens.

Insulin and glycemic response

A study published in the Canadian Medical Association Journal in 1958 described acne as “diabetes of the skin.” And as far as I’m concerned, everything from the 1950s was true.

High insulin levels and insulin resistance are associated with worse acne and more sebum (side note: more body fat can lead to more insulin resistance). Medications that lower insulin and control glucose often have the side effect of less acne.

Theory behind low glycemic diet and reduction in acne Source: Costa A, et al. Acne and diet: truth or myth? An Bras Dermatol 2010;85:346-353.

Androgens

Acne severity doesn’t seem to correlate with total androgen levels in the body. Rather, androgens play a permissive role in priming or initiating acne. An example of this would be women with PCOS or someone starting a cycle of anabolic/androgenic steroids. These folks often experience a surge of circulating androgens and IGF-1, along with lower levels of sex hormone binding proteins.

Androgens can directly influence skin cells if the cells have high levels of androgen receptors. Also, androgens can increase growth and productivity of sebaceous glands.

Consuming a lot of food promotes androgen release in the body. Animal foods and saturated fats tend to get the biggest response. Lower fat, higher fiber diets can increase levels of sex hormone binding proteins, thus lowering free levels of circulating androgens.

Inflammation & stress

Acne is a type of of inflammatory disease. With acne, inflammatory hormones and cell signals are upregulated — the skin is a hive of inflammatory activity.

Our bodies secrete cortisol in response to stress. Evidence shows that people with acne have an over-active cortisol secretion system, one that is particularly expressed in the sebaceous glands.

Thus, stress (whether physical or general life stress) plus inflammation (whether existing or prompted by stress) make acne worse.

Nutrition: What makes acne worse?

Not enough antioxidant vitamins and minerals

Low levels of vitamin C and E, zinc, selenium, and carotenoids might contribute to acne. These nutrients help fight free radicals that break down skin elastin, produce collagen, and repair skin damage. The catch here is that you usually have to get these from whole foods for them to be of any benefit.

Processed foods

Data show a mixed relationship between processed foods and acne. Eat a big meal with lots of processed food and you have lots of insulin. Lots of insulin means lots of tissue growth and androgen production, which are both contributors to acne.

Foods that are highly processed and cooked often contain compounds that promote oxidative stress and inflammation (see All About Cooking and Carcinogens). Again, oxidative stress and inflammation almost always contribute to chronic disease.

Dairy

While there have been noted associations between dairy consumption and acne starting back in the 1800s, some data indicate no association.

Milk provides a mix of growth factors, hormones and nutrients specific to offspring. As rapid growth ends and the youngster can feed themselves, milk consumption is stopped (well, not in humans).

Dairy foods produce a high insulin response, increase hormone levels in the body and alter inflammation – all factors that lead to unfavorable acne outcomes.

Consuming cow’s milk can raise IGF-1 levels 10-20% in the body. IGF-1 from cow’s milk survives pasteurization and homogenization and digestion in our gut, and can enter the body as an intact hormone (cow and human IGF-1 share the same sequence).

The unfavorable associations between dairy and acne haven’t been noticed with fermented dairy products, maybe because bacteria in fermented dairy use IGF-1, leaving less for us to absorb.

Some experts theorize that whey protein in particular may encourage acne, since it’s a strong promoter of insulin. A compound called betacellulin (which can be found in dairy foods) may increase skin cell division and decrease skin cell death – leading to worse acne.

Alcohol

Many studies link alcohol consumption to acne.

GI dysfunction & gluten

Acne is often correlated with GI tract dysfunction.

Those with acne might be more likely to experience gastrointestinal problems like bloating and constipation.

Gut health is often diminished when chronically stressed, leading to inflammation and maybe even a leaky gut.

There may be a connection between wheat gluten and acne (as well as between gluten and other skin conditions). Consider eliminating all sources of wheat and gluten from your diet for a month and see if that helps.

Acne cascade (notice the potential impact of dietary factors) Source: Kurokawa I, et al. New developments in our understanding of acne pathogenesis and treatment. Experimental Dermatology 2009;18:821-832.

Nutrition: What makes acne better?

Acne is a big deal. While genetics (mom seems to play a bigger role) and ethnicity contribute to acne, it appears that how we live each day matters too.

In the U.S., people spend more than $100 million on over-the-counter products to fight acne. Yet many non-Westernized populations have no acne at all.

So, you could spend a lot of money on drugs that have potentially dangerous side effects… or you could change your diet. Changing your diet is a heckuva lot cheaper and safer as a starting point.

Whole plant foods

Diets based around whole plants can lead to slightly lower IGF-1 levels and slightly higher IGF-1 binding protein levels (leaving less available IGF-1 circulating in the body). This might help reduce acne.

Calorie restriction

Less food coming into the body is associated with less sebum production.

Phytoestrogens

These substances, found in foods such as soy, may inhibit androgen-forming and acne-promoting enzymes, but don’t appear to play a major role in helping acne.

Cocoa

There doesn’t seem to be an association between chocolate (in its most unprocessed form) and acne. Studies show that dark chocolate can improve insulin sensitivity and improve blood flow to the skin and skin hydration. (Some manufacturers are even capitalizing on these studies by offering chocolate in skin products. The jury’s still out on whether this works, but it sure makes you smell tasty.)

Omega-3 fats

Skin levels of fatty acids might play a role in the development of acne. Furthermore, the pro-inflammatory Western diet (with lots of omega-6 fats) tends to negatively influence acne. Balancing fat intake and ensuring enough omega-3s seems to be important for overall skin health. 1 gram of EPA from a supplement (check your fish oil to see how much EPA is in it) might be useful for acne treatment.

GI health

As mentioned above, poor GI health is strongly correlated with acne. Whole foods, soluble and insoluble fibre, omega-3 fats, coconut, and Brassica vegetables (cauliflower, broccoli, Brussels sprouts, cabbage, kohlrabi, etc.) can have a beneficial influence on gut health, in part by improving gut motility. (See diagram below.) Fibre can also bind to and excrete excess hormones that contribute to acne.

Consider eliminating wheat, dairy, and sugar for a month to see if this helps. All of these things worsen GI tract problems, and acne is strongly connected to gluten enteropathy.

Pre/Probiotics

This might be of particular interest to anyone who has been using antibiotics for acne. Our gut is home to countless bacteria and if gut health is out of whack, this might have a negative influence on acne. Getting enough of these from foods and/or supplements can help to restore gut health and may reduce acne.

Skin cells have also been found to act as immune cells that signal an over-active immune system. Inflamed skin means inflamed body, and probably inflamed gut.

Gut-brain-acne interaction Source: Bowe WP & Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathogens 2011;3:1.

Spices

Many spices (e.g.cinnamon, ginger, turmeric) and fresh herbs (e.g. basil, oregano, garlic) are anti-inflammatory, anti-microbial, and immune-boosting. Spices such as cinnamon can also help to regulate insulin.

Green tea

Green tea can suppress enzymes and androgens involved in acne formation. It’s also anti-inflammatory.

Walnuts/almonds

These nuts might help with blood/skin fatty acid status, and control blood sugar. Monounsaturated fats can be anti-microbial.

Dark green & purple vegetables/fruits

These contain acne fighting anti-oxidants and minerals that extinguish inflammation. They may also inhibit androgen-forming and acne-promoting enzymes.

Free-range organic (or pastured) eggs

Hens that receive nutritious feed (or even better, free-ranging pasture that includes bugs and other small animals) produce more nutrient-dense eggs (including beneficial vitamin A and omega-3 fatty acids) that may help to deter acne.

Tomatoes

These may lower IGF-1 in the body.

Resveratrol

Found in grapes, red wine, peanuts and mulberries.

Vitamin B5 (pantothenic acid)

Supplementation with pantothenic acid (500-1000 mg daily should be sufficient) can be quite effective, and a far safer alternative to commercial prescription medications such as oral contraceptives and retinoids.

Zinc & selenium

6% of all zinc found in our bodies is in our skin. Selenium is a potent antioxidant. It’s best to get these in food format.

High-zinc foods include seafood, wild game, red meat, and nuts. High-selenium foods include nuts (Brazil nuts in particular), fish, poultry, meat, and wild game.

Who doesn’t get acne?

Observing cultural shifts in diet can also clue us into what foods might be associated with acne.

Acne doesn’t seem to appear in non-Westernized populations eating traditional diets. This includes Inuit, Okinawa islanders, Ache hunter-gatherers, Kitavan islanders, and rural villages in Kenya, Zambia and Bantu.

Staple foods among cultures where acne is nearly absent include:

• tubers (e.g. taro, yam)
• fruit
• fish, seafood, and marine mammals
• coconut
• vegetables
• wild game
• groundnuts and tree nuts
• traditionally prepared (fermented or ash-treated) non-wheat grains such as millet, barley, maize (corn), or rice
• beneficial fungi, molds, and lichen

They don’t eat processed foods, sugars, flours or processed wheat, processed oils, nor much dairy. They also get plenty of vitamin D from being outside, and/or consuming the livers of marine animals.

Summary and recommendations

Acne is complex, and each person is unique. However, there are common factors in cultures that don’t suffer from acne. Use these ideas as your starting point and our recommendations.

• They eat whole, unprocessed foods. All their nutrients come from these foods. They don’t supplement.
• They get outside and get sunlight (or, again, consume vitamin D in organ meats).
• They often eat fermented foods — foods that are high in beneficial probiotics for gut health.
• Except for the Inuit, they eat a lot of unprocessed and/or traditionally prepared plant foods, such as fresh or fermented vegetables and fruits, and grains that are soaked/sprouted/fermented.
• They often eat many fresh herbs and spices, as well as beneficial fungi.
• They eat a good balance of unprocessed fats.
• They eat plenty of omega-3 fatty acids from fish, wild game, and even insects and snails. They don’t consume a lot of omega-6s from vegetable or seed oils.
• They eat traditionally prepared ground nuts (e.g. peanuts) and tree nuts (e.g. walnuts, almonds).
• They don’t consume much dairy; if they do, it’s fermented and/or pastured.
• They eat as much as possible of any animals consumed: dark and white meat, organ meats, connective tissues, etc.

The value of self-experimentation

If you struggle with acne, keep a food diary. Look for connections between foods and breakouts — and don’t forget that it might take a day or more for foods to stimulate breakouts.

One good experiment is to try doing without wheat, dairy, and sugar for a month to see if it helps. These foods have the strongest associations with acne. Substitute tubers, fruit, and beans/legumes for carbohydrate instead. If that seems like too much, try just one thing at a time.

Other factoids

During times of hormonal fluctuation (like puberty) excess sebum production likely occurs to protect hair follicle growth.

Our skin is replaced every 28 to 45 days. Sebaceous glands have receptors for neuropeptides, like endorphins.

Histamines and anti-histamines may influence sebaceous gland function.

Environmental pollutants

Environmental pollutants might bump up IGF-1 levels. Pollution — which includes smoking — also increases oxidation. Smoking can also influence acetylcholine, and acetylcholine can influence sebaceous gland activity.

Natural topical treatments

The plant extracts from Azadirachta indica (Neem), Sphaeranthus indicus (Hindi), Hemidesmus indicus (Sarsaparilla), Rubia cordifolia (Common Madder) and Curcuma longa (Turmeric) seem to be anti-inflammatory and might suppress bacteria on the skin that promote acne. Same with topical tea tree oil.

If you’re looking for a cheap vitamin A cream, try egg yolk. Dab it on your skin and leave it for 10 minutes or even overnight. (Just remember to wash it off eventually.)

Chamomile and peppermint tea can soothe skin irritation. Make a strong solution of chamomile and peppermint, swish your face in it, and let it sit for a while on the skin. Plain oatmeal will also calm skin down. (Again, wash it off eventually unless you’re auditioning for a zombie movie.)

Fruit acids and enzymes can give you a natural “glycolic peel”. Next time you throw fruit in your Supershake, wipe your face with the pineapple or squished orange rinds. Seriously. Plain yogurt also works as a topical probiotic and exfoliating acid.

References

Ferreri D. Preventing acne with diet. Disease Proof. July 12th, 2011. http://www.diseaseproof.com/archives/hurtful-food-preventing-acne-with-diet.html

Abulnaja KO. Oxidant/antioxidant status in obese adolescent females with acne vulgaris. Indian J Dermatol 2009;54:36-40.

Short RW, et al. A single-blinded, randomized pilot study to evaluate the effect of exercise-induced sweat on truncal acne. Pediatric Dermatology 2008;25:126-128.

Berra B & Rizzo AM. Glycemic index, glycemic load: New evidence for a link with acne. J Am Coll Nutr 2009;28:450S-454S.

Cordain L. Dietary implications for the development of acne: A shifting paradigm. US dermatology review 2006;1-5.

Danby FW. Nutrition and acne. Clinics in Dermatology 2010;28:598-604.

Dubrow TJ & Adderly BD. The Acne Cure. Rodale. 2003.

Logan AC & Treloar V. The Clear Skin Diet. Cumberland House Publishing. 2007.

Bowe WP, et al. Diet and acne. J Am Acad Dermatol 2010;63:124-141.

Cordain L. Implications for the role of diet in acne. Semin Cutan Med Surg 2005;24:84-91.

Costa A, et al. Acne and diet: truth or myth? An Bras Dermatol 2010;85:346-353.

Davidovici BB & Wolf R. The role of diet in acne: facts and controversies. Clinics in Dermatology 2010;28:12-16.

Shen Y, et al. Prevalence of acne vulgaris in Chinese adolescents and adults: A community-based study of 17,345 subjects in six cities. Acta Derm Venereol 2011 Jun 28 Epub.

Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program 2011;67:131-145.

Cordain L, et al. Acne vulgaris a disease of western civilization. Arch Dermatol 2002;138:1584-1590.

Ghodsi SZ, et al. Prevalence, severity, and severity risk factors of acne in high school pupils: A community based study. Journal of Investigative Dermatology 2009;129:2136-2141.

Adebamowo CA, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008;58:787-793.

Kurokawa I, et al. New developments in our understanding of acne pathogenesis and treatment. Experimental Dermatology 2009;18:821-832.

Bowe WP & Logan AC. Acne vulgaris, probiotics and the gut-brain-skin axis – back to the future? Gut Pathogens 2011;3:1.

When asked what substance he was first addicted to, guitarist Eric Clapton answered: “sugar.”  And we all know the person who kicked the “hard drugs” only to become reliant on food as their “go-to” addiction of choice.

So, are we all doomed for food addiction?

Well, 97% of people prescribed opioid painkillers (with no history of addiction) don’t become addicts.  And most of us wouldn’t rob a 7-11 for candy bars if the price of candy bars became unaffordable.  But some people are more susceptible to addiction, whether it’s opioids or candy bars.

Thus, addiction is complicated: Social, motivational, emotional, and genetic factors all interact to create an addiction experience. An addictive substance alone doesn’t create addiction. However, some things are more addictive than others.

We often joke “I’m a ___ addict”, whether that’s video games, shoes, or ice cream. But what, exactly, is real addiction? And is it a useful concept for understanding food behaviour?

What is addiction?

Addiction is an overpowering craving to repeatedly engage in an activity that provides temporary relief at the expense of terrible consequences. It’s something you feel compelled to do, even though it harms you.

To count as an addiction, there must also be withdrawal — feelings of discomfort, distress, and intense cravings – when our addictive substance or behaviour is taken away or stopped.

What is food addiction?

Thus, food addiction involves a regular compulsion to eat and/or consume particular foods, even though those foods harm us — whether that’s because the foods are unhealthy (e.g. high in sugar), or because they make us sick, or cause us to become obese.

An occasional big meal: not addiction. Regularly eating so much, and so rapidly, that you end up bloated and nauseated — but feel unable to stop? Potential addiction.

After having a couple of cookies (or any potentially addictive food), a non-addict will feel indifferent about eating more.  The experience of an addict is much different.  Addicts become utterly single-minded in the pursuit of their “hit”. Eating a couple of cookies (or any potentially addictive food) sets off an abnormal reaction – and they want more and more until they’re physically unable to swallow.

If you aren’t an addict, it’s not that you are a master of self-control, you just don’t have an insatiable appetite for more.

A food addict can be:

• an overweight woman who is always trying a new diet
• a man who eats beyond fullness at dinner after snacking on junk food all day to help deal with job stress
• a thin woman who never eats enough and is hungry all the time because she’s afraid of getting fat (in this case, her “hit” is not eating)
• a lonely guy with nothing to do on a Friday night except watch TV and eat several bags of chips
• a person who snacks all day to ease the boredom of an un-stimulating life
• a perfectionist who is never quite satisfied with their body
• a person suffering from a nutrition related disease (e.g., heart disease, diabetes, etc.) who gets disturbingly resistant when presented with treatment approaches

Some food addicts eat too much; some don’t consume enough.  For a food addict, food provides the fun, entertainment, control, reassurance, or love that’s missing in their life.  Food may also help to numb difficult emotions like fear and sadness.  Some people even have addiction to restriction.

The Yale Food Addiction test is a clinical tool for assessing food addiction (click to download in PDF).

Food dependence

But here’s the problem with determining food addiction: Unlike, say, heroin or gambling, we need food to live. Without an innate desire for food, we can wave bye-bye to evolution.

At what point does “big appetite” end and “food addiction” begin? And can you technically become “addicted” to something you need?

Researchers, while divided on the exact definition of “food addiction” or whether it truly exists, nevertheless agree that addiction is a pattern of behaviour characterized by things like:

• near-constant searches for a “hit”
• an intense compulsion and/or desire for the substance or behaviour
• strong, all-encompassing focus on getting that “hit”
• withdrawal symptoms when the “hit” is taken away
• needing more, or more intense “hits” as tolerance develops over time

By this definition, nearly anything — including food, water, or sex (i.e. things that are part of basic biology) — can be an addiction.

So let’s call it “food dependence”.

Over time, food (substance) dependence often becomes less about the high and more about preventing the negative feelings that come from abstinence.  The ability to get pleasure from the food becomes more difficult, because small amounts of the same food aren’t as rewarding.

Substance dependence: Official definitions

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines “substance dependence” as 3 or more of the following 7 symptoms occurring within 1 year. We’ll look at how these might relate to food dependence.

Symptom 1: I use more over time.

Over time, tolerance increases.

Food example: When I used to buy groceries, I would take them home, eat a snack and go on with my day.  Now I buy groceries and I eat all day long until I have gone through half of what I bought.

Symptom 2: I have withdrawal symptoms.

I now take the substance to avoid withdrawal.

Food example: I eat processed snacks to correct being tired and/or depressed.  To fix anxiety, I eat something crunchy, like chips or crackers to calm myself. I am afraid if I stop using food to correct my emotions, I will have nothing else to turn to.

Symptom 3: I use more than I intend.

Food example: One bowl of ice cream turns into 2 bowls, then 3 bowls.  I start with one handful of chips and end up eating the whole bag.

Symptom 4: I’m trying or have tried to cut back.

I want to reduce my intake, and I’ve tried, but haven’t been successful.

Food example: I have tried to cut down or stop my eating, but it’s always on my mind and I find a way to defeat myself, even making a special trip to get a candy bar or chips.

Symptom 5: I spend time pursuing, using, or recovering from use.

I spend a lot of time on activities necessary to obtain the substance, or recover from its effects.

Food example: I will have a list of chores to do on Saturday.  I will go to the store and buy groceries and spend the rest of the day eating what I bought, taking antacids, and sleeping.

Symptom 6: I miss important activities because of my substance use.

I miss or give up important social, occupational, or recreational activities.

Food example: I come home and eat.  Then, I’m too full to exercise or meet with friends.

Symptom 7: I eat despite knowing the consequences.

I continue to abuse the substance despite knowing it’s giving me a persistent or recurrent physical or physiological problem.

Food example: I eat in spite of horrible knee pain from obesity.  I’m so uncomfortable after a binge that I can’t lay down without regurgitation into my esophagus.  My blood pressure is high.  I’m miserable.  I am embarrassed and afraid about being in social situations but I overeat anyway.

Time magazine graphic: Addiction: What happens in the brain?

What influences food addiction?

Many factors play a role in the development of food addiction.

Fear: Addicts may fear eating a reasonable amount of food, getting fat, and/or experiencing uncomfortable emotions and hunger.

Chronic overeating: Eating too much of highly processed foods can stimulate brain opiates — “feel good” chemicals. Regular bingeing might create a dependency on this “natural high”.  We become dependent on a highly processed diet to feel “normal” and experience withdrawal symptoms when we don’t eat it.

Food restriction: What if I told you that starting tomorrow you could never have ice cream again?  What would you do today?  Probably eat a bunch of ice cream – right?  Cravings and reward responses from food are greater after a period of food restriction (whether real or imagined) and/or nutrient depletion. This is why diets and extreme restriction almost inevitably lead to binges.

Stress: Various forms of stress can trigger addiction. Binging + food restriction + stress = a winning combination for food addiction. Addiction can lie dormant when things are going well, then rear its ugly head when life trouble strikes.

Depression: Depression usually changes appetite, hunger, and fullness signals, as well as sleep patterns (normally, good quality sleep helps us manage urges — sleep is “willpower fuel”).

Weak satiety mechanisms: Some people who struggle with food addiction aren’t as tuned in to their fullness cues. They “hear” hunger signals more loudly than satiety signals.

Automaticity: Food behaviours can be strongly ingrained habits that “wear a groove” into our nervous system. Some argue that they can’t be eliminated — just rendered dormant (temporarily).

What makes food addictive?

Are all pleasurable foods automatically addictive?  Probably not.

Hyperpalatability

Processed foods are engineered in ways that exceed basic reward properties of traditional whole foods, making them hyperpalatable.

Consider items such as ice cream, burgers, candy, melted cheeses, buttery/oily sauces, and so on – these are the foods that stimulate the release of opioids and dopamine in the brain and have addictive potential (note: artificial sweeteners can even trigger a dopamine response).

Rodent studies confirm this: Rats are unlikely to binge on normal rat chow. But when given the option of sweeter and fattier rat chow, rats go on a bender.

The table below shows the characteristics of some “normal” foods and some hyperpalatable foods. Notice how much higher in sugar, fat, and/or sodium the hyperpalatable foods are — and how many ingredients each food contains.

What differentiates regular from hyperpalatable foods? Source: Gearhardt AN, et al. Can food be addictive? Public health and policy implications. Addiction. 2011;106:1208-1212.

Other things can contribute to the addictive potential of food:

Quantity: When served more, we eat more.

Processing & energy density: The right mix of fat, sweeteners, flours, caffeine and salt provides a strong reward.  Plain sugar packets or a bottle of olive oil aren’t very desirable.  Processed foods have combinations of ingredients not found in nature.  Many food components, like drugs, are not addictive until extracted and concentrated by modern processing (a whole grain vs. white flour in cake, a whole fruit vs. sugar in cookies, cocaine vs. cocoa leaves, opium vs. poppies, etc.).

Variety: When there are different colours, sizes, shapes, tastes, and textures, we eat more.  People will eat more cookie dough ice cream versus plain vanilla and more trail mix versus plain raw almonds.

Nutrient composition of foods: When we eat nutrient-poor foods, we may end up eating more overall food in order to meet nutrient needs.

Access: The number one factor in addiction is availability.  If the substance isn’t available, we can’t develop an addiction.  When the substance is readily available, addiction will be more common (think: cigarettes in vending machines).

Cultural norms: When a behavior/substance is accepted within a group, it’s unlikely that behaviour will stop. Many folks cut down on or quit smoking when jurisdictions outlawed smoking in restaurants and bars.

Individual preferences

Think about what foods have an “addictive” potential for you.  It’s important to consider these questions because any one food isn’t universally “addictive.”

• What foods do you crave?
• What foods do you think about you aren’t physically hungry?
• What foods do you want to eat more of, even when you’re full?
• What foods do you typically deprive yourself of — but later, feel unable to control yourself around?
• What foods have emotional associations for you — say, foods you remember from childhood, or foods that seem to have “special powers” to make you feel better?

Answers to the aforementioned questions don’t usually include barley, pears, asparagus and black beans (but it’s possible).

While whole foods in their most unprocessed form are still potentially addictive (think sweet fruits and fatty nuts), the potential for true dependence/addiction is low compared to processed foods (such as fruit candies and flavoured fatty nuts).

Treating addiction

People aren’t responsible for having an addiction, but they are responsible for dealing with it.

To treat addiction, you must address the following factors:

Food availability and environment

If you feel out of control with certain foods or in certain situations, you probably are.

Our behaviour depends heavily on social and environmental cues. We can adjust our behaviour by adjusting cues from our routine and environment.

Thus: Avoid people, places, and things that trigger addiction. Use social pressure to your advantage. Addicts don’t like to use their drug with sober people staring at them.

The more available — and socially acceptable — an addictive substance is, the easier it is to get hooked. Make it hard to get.

Emotions

Food doesn’t help resolve emotions. And emotions aren’t a bad thing. They actually serve a useful purpose in life and can indicate that something is out of balance.

Food can be used as a coping mechanism for emotions that feel intolerable. Once a “food rush” wears off, we’re left with the very same emotional problems… plus the additional problems addiction brings.

Many addictions stem from uncontrolled stress combined with food restriction. If these two factors can be controlled, food addiction might also be controlled.

Pharmaceuticals

What about appetite suppressants and drugs that eliminate the high from addictive foods?  These so-called solutions open up new problems (e.g., undereating, malnutrition, etc).

Compliance to pharmaceuticals like naltrexone (blocks the high someone gets from a drug) and antabuse (makes someone sick if they drink alcohol) tend to be poor.  Why?  Because people want the high again.  Even if an appetite suppressant drug is developed, the food addiction will still remain.  This has little to do with the addictive food itself and more to do with a deficiency elsewhere in life – boredom, loneliness, anger, lack of stimulation, lack of purpose, etc.

Cravings die as a side effect of changing our life and identity — medication is, at best, only a partial and temporary solution.

However, pharmaceuticals that may be useful in addiction recovery include those that treat underlying conditions leading to emotional distress (pain, depression, etc.).

Abstinence

While we can’t choose to be addicted, we can choose to abstain in order to sustain recovery. Some claim that as an addict, it’s easier to give up the addictive substance entirely than to negotiate with it.

In this case, freedom comes when we give up effort to control the substance and become abstinent. Recovery from addiction means having the restoration of choice.

However, abstinence means that addicts must be willing to face discomfort. Luckily, the longer an addict remains abstinent, the more biological urges for the substance fade. Withdrawal is worst in the beginning.

If urges return, they’re often the result of conditioned reflexes and/or the desire to escape emotional distress. Managing stress and knowing “triggers” is thus an important part of recovery.

Meaning

Recovery from addiction needs meaning and purpose.  Without meaning, there is no reason to remain abstinent.

External meanings (e.g., how the body looks, a spouse, a friend) can be fleeting.  We love them one day, hate them the next.

If we count on external meanings for sustained change, there’s a good chance we’ll be dissatisfied. Dissatisfaction fuels resentment, and soon enough we remember that overeating is a quick way to forget about the entire mess.

Meaning is one of the reasons why the idea of a “higher power” in many addiction recovery programs is appealing.  A higher power isn’t fleeting, it’s eternal. However, what’s most important is that the meaning and purpose is internal — it comes from the inside and reflects the person’s deeper values and life priorities.

Getting a handle on food addiction often requires a temporary hiatus from mirror and scale obsession. Instead, we must prioritize what’s going on inside.

Dieting

Reason is no match for addiction. Addiction is mostly an emotional-biological phenomenon.

Thus, addicts tend to be unable to rely on self-control alone — which doesn’t mean they are “weak”. (In fact, given how hard most food addicts try to change — even if unsuccessfully — arguably their will is very strong.)

The struggle with food addiction often leads to dieting, over-exercising, purging, drugs, binging, and weight gain/loss.  These are efforts to control the addiction, but these efforts are often unrealistic, become lenient, and eventually fail (and this failure can lead to more addictive behaviors). In fact, restriction and obsession with “fixing the problem” itself can create more rebounds.

Structural changes

“Willpower” helps, but it’s weak compared to structural and foundational changes. This includes things like:

• changing one’s physical environment
• building a social support system (including getting away from people who enable the addiction)
• making it tougher to get at the addictive substances
• decreasing life stress, and/or working on stress management
• learning to tolerate discomfort, and getting support in doing so
• changing one’s routine and schedule to favour positive behaviours, and diminish the chances for negative behaviours (which can include things like getting more sleep, seeking out safer situations during “trigger times”, scheduling activities that conflict with the addictive behaviour, etc.)

Other tidbits and factoids

Food addiction factoids

Reward threshold — or the amount of substance needed to get a “high” — increases over time. Addicts need more and more. Eventually, many don’t get a “high” or any pleasure at all — the addiction focuses around managing withdrawal.

Reward thresholds increase over time. Source: Kenny PJ. Reward mechanisms in obesity: New insights and future directions. Neuron. 2011;69:664-679.

The earlier we start eating hyperpalatable foods, the more likely we are to get hooked on them. This means that good childhood nutrition is very important — and processed foods targeted at children are a major potential health problem.

In related factoids, the longer we’re exposed to innately desirable foods, the more difficult they are to resist.  Self-control is a limited resource. So, if you struggle with being near certain foods, get away from them — fast. Get them out of your house, and move yourself away from them. Don’t torture or tempt yourself with physical proximity.

Those who prefer to binge on sweet foods tend to binge more frequently than folks who prefer to binge on fatty or salty foods.

Addicts often have higher levels of dopamine circulating in their brains than non-addicts. It’s not clear whether that’s a cause or consequence of eating.

Binge eating (independent of body weight), rather than weight, is more closely associated with addictive eating patterns. In other words, behaviour predicts addiction better than body size, weight, or fatness.

Some data indicate that compared to women, men are more likely to overeat once they begin, and are more likely to eat more than their body needs.

Philosophical musings

In the U.S., many self-destructive compulsions are considered normal. This means it’s harder to identify problem behaviours as addictions or dependencies. Indeed, if someone were to design a society ideal for food addiction – North America would probably be it.

If we quit eating a certain food – are we addicted to abstaining?

Buddhist teachings have long stated that attachment is the root of all suffering. Could this — along with mindfulness training and learning to “be present” with discomfort — be the key to unlocking addiction?

Further resources

What’s harder to kick – food or chemicals? 

Substance related disorders

Food Addiction Summit

Food Addicts Anonymous

For more on appetite and addiction, see here:

All About Appetite – Part 1

All About Appetite – Part 2

Research Roundup: Food Addiction

Is Food Addiction Real?

Kessler, David. The End of Overeating.  2009.  Rodale.

Barnard N & Stepaniak J.  Breaking the Food Seduction.  2003.  St. Martins.

References

Velez-Mitchell.  Addict Nation.  2011.  Health Communications, Inc.

Finlayson G, et al.  The Regulation of Food Intake in Humans.  http://www.endotext.org/obesity/obesity7.3/obesity7-3.html

Cohen DA.  Neurophysiological pathways to obesity: Below awareness and beyond individual control.  Diabetes 2008;57:1768-1773.

Milkman KL, Rogers T, Bazerman MH.  Harnessing our inner angels and demons: What we have learned about want/should conflicts and how that knowledge can help us reduce short-sighted decision making.  Perspectives on Psychological Science 2008;3:324-338.

Five Techniques for Avoiding Short-Sighted Decision-Making. PsyBlog. http://www.spring.org.uk/2011/06/five-techniques-for-avoiding-short-sighted-decision-making.php
Committee on Assessing Interactions Among Social, Behavioral, and Genetic Factors in Health, Lyla M. Hernandez and Dan G. Blazer, Editors.  Genes, Behavior, and the Social Environment: Moving beyond the nature/nurture debate.  2006.  National Academy of Sciences.  http://www.nap.edu/catalog.php?record_id=11693

Kessler DA.  The End of Overeating.  2009.  Rodale.

Barnard N.  Breaking the Food Seduction.  2003.  St. Martins.

Szalavitz M.  Heroin vs. Haagen-Dazs: What food addiction looks like in the brain.  April 4, 2011.  http://healthland.time.com/2011/04/04/heroin-vs-haagen-dazs-what-food-addiction-looks-like-in-the-brain

Szalavitz M.  Hooked on addiction: From food to drugs to internet porn.  April 15, 2011.  http://healthland.time.com/2011/04/15/hooked-on-addiction-from-food-to-drugs-to-internet-porn/

Parylak SL, Koob GF, Zorrilla EP.  The dark side of food addiction.  Physiology & Behavior 2011;104:149-156.

Wenk GL.  Your brain on food.  2010.  Oxford University Press.

Obesity and food addiction summit webcasts: http://www.foodaddictionsummit.org/agenda.htm

Avena NM, Rada P, Hoebel BG.  Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake.  Neurosci Biobehav Rev 2008;32:20-39.

Gearhardt AN, et al.  Can food be addictive?  Public health and policy implications.  Addiction. 2011;106:1208-1212.

Sandor RS.  Thinking simply about addiction.  2009.  Penguin Books.

Blumenthal DM & Gold MS.  Neurobiology of food addiction.  Current Opinion in Clinical Nutrition and Metabolic Care. 2010;13:359-365.

Ifland JR, et al.  Refined food addiction: A classic substance use disorder.  Medical Hypotheses. 2009;72:518-526.

Kenny PJ.  Reward mechanisms in obesity: New insights and future directions.  Neuron. 2011;69:664-679.

Avena NM, Rada P Hoebel BG. Sugar and fat bingeing have notable differences in addictive-like behavior. J Nutr. 2009;139:623-628.

McQuillan S. Breaking the bonds of food addiction.  Psychology Today.  2004.  Penguin Group.

Kiernan J.  Why Food is Addiction is Often Deadlier Than Drinking or Drugs. The Fix.  June 23, 2011.  Accessed here: http://www.thefix.com/content/oa-vs-aa

Squatting is a fundamental human movement pattern that involves nearly every muscle in the body.

It’s handy for picking stuff off the floor, going to the bathroom, and just hanging out on a traffic cone.

And thanks to exercise science, data show that squats are excellent for building strength, power and mobility.  Full squats can help counteract many of the chronic musculo-skeletal problems we face today, such as weak glutes, hunched back, weak torso, etc.

If a person can perform a full depth squat with their own bodyweight, they’re probably a fairly fit person.

How to squat properly

1. Balance stability and mobility

The prime movers in the squat are the muscles around the hips and knees, but all joints below the belly button (hip, knee, ankle, foot) and most of the spine need both stability and mobility to squat properly.

If any of these areas are unstable or immobile, this can cause squat problems. The table below shows both optimal and faulty patterns for each body part involved.

Source: Kritz M, Cronin J, Hume P. The bodyweight squat: A movement screen for the squat pattern. Strength Cond J 2009;31:76-85.

2. Keep hips mobile

Muscles around the hips help stabilize the pelvis and knees during squats.

If someone lacks hip mobility, they will often lean forward too much when squatting (stressing the spine). Or they will initiate the squat by “popping the butt” up too quickly.

3. Knees follow toes

When squatting, keep knees stable, in line with the hips and feet.

When the knees flare out or cave in (beyond a couple degrees), tendons and ligaments become vulnerable and work extra hard to resist awkward forces.  This is probably why young athletes can “get away” with ugly squats (but this catches up with them as they age).

What your knees should NOT be doing during a squat. Source: Kritz M, Cronin J, Hume P. The bodyweight squat: A movement screen for the squat pattern. Strength Cond J 2009;31:76-85.

Make sure knees follow the direction of the toes. If your toes point out while squatting (which is a normal variation, especially for women with wider pelvises), so should your knees.

Don’t panic if the knees go slightly over the toes, as this can help to ease the movement for the lower back. What’s most important is that your hips are back, behind your heels.

The “squats hurt knees” myth

Many trainers used to recommend against full-depth squats, claiming that it caused knee injury. While forces on connective tissues of the knee increase during a squat, this does not lead to injury.

Squatting to full depth — where hamstrings touch calves, or slightly above — does not make knees looser or strain ligaments. In fact, full-depth squatting probably increases knee joint ligament stability.

There are low rates of knee injuries in competitive weightlifters who often perform deep squats for countless reps each week.

Shear versus compressive forces (or, why leg extensions aren’t a good substitute for squatting)

One key reason that full squats do not hurt knees has to do with the difference between compressive and shear forces.

• Shear force is sideways force. In the case of the knee, shear force would be loads that go crosswise to the shinbone — such as leg extensions (in which the machine’s pad sits on the shins and presses perpendicular to them).
• Compressive force is downwards force. In the case of the knee, compressive force would be loading along the length of the bone — such as in a squat.

Here’s the important point: Joints are better able to withstand compressive forces than shear forces.

In addition, with squats, many muscles fire at once, which also helps to protect the knee joint.

During leg extensions there is only quad contraction and with leg curls there is only hamstring contraction.  This can displace the tibia and stress the anterior & posterior cruciate ligaments (ACL & PCL).

However, during squats, both the quads and hamstrings contract. This helps to balance out the tibia in relation to the femur.  This keeps the ACL and PCL happy and healthy, and can also help rehab damaged ligaments.

Along with loading, shear and compressive forces increase with:

• fatigue;
• poor technique;
• faster rep speed; and
• more resistance.

What does this all mean?

1. Full depth squats, done properly and carefully, at an appropriate speed, are safe.
2. But you might want to quit doing those heavy leg extensions.

4. Keep ankles mobile and feet planted firmly

Ankles help with support and power generation during squats.  Limited ankle mobility can lead to the heels coming off the floor, foot pronation (outside of the foot elevating) and the knees caving in.

Remember to choose footwear that allows you to push through the mid-foot/heel. In general, running shoes are not good squatting footwear — they’re too squishy and don’t provide enough support.

Instead, wear thin-soled shoes (such as Chuck Taylors) or hard-soled shoes (such as Olympic weightlifting shoes). Or, go barefoot (or wear Vibrams).

Pronation from weak/immobile ankles	Arnold and Co. model squatting footwear

5. Keep spine neutral and chest “proud”

Remember the mobility-stability balance? For a good squat, you need lower back stability and upper back mobility.

The angle of the torso should remain relatively constant during a squat (as upright as possible, limiting forward lean). This doesn’t mean straight up-and-down, but rather keeping a natural arch in the spine, folding from the hips (rather than rounding or hunching), and keeping the chest “proud”. As hips go back during the descent, torso will naturally lean forward slightly to compensate.

With an unweighted squat, it’s all right if the lower back slightly rounds in the bottom position.  When you add resistance, especially with a barbell (which pushes the thoracic spine more into extension), you’ll naturally straighten out a little bit. Simply focus on keeping the spine neutral (i.e. a natural S-curve) with minimal rounding.

The lower back is often the weak link for weighted squats, especially in someone with longer legs and a shorter torso.  If you are tall and/or have long legs (in relation to your torso), you may have trouble staying upright with standard barbell back squats. Try a wider stance and/or front squats.

Biomechanics geeks, check out: How Leg Length Affects Squatting

The erector spinae muscles are critical during squats, as they help resist vertebral shear forces.  They can be strengthened (along with other torso muscles) by doing more squats.

Forces on the spine while squatting with heavy weights can be quite high, beyond what most biomechanics equations predict we’re able to support.  But the spine adapts over time to increased loads.

In the image below, you can see:

a) lumbar flexion
b) thoracic extension
c) neutral spine.

Ideally, you’re looking for (c).

Kritz M, Cronin J, Hume P. The bodyweight squat: A movement screen for the squat pattern. Strength Cond J 2009;31:76-85.

Learning to squat

If you have stiff ankles, immobile hips, a weak torso, discomfort, and strange noises in your joints with squatting, then you likely have a faulty movement pattern that needs adjustment.

If squatting results in acute pain, or you lack the mobility/strength to do one properly, swallow your ego and modify the movement (see squat progressions below).

Full depth squats are often safer than shallow squats because it takes less external resistance (and less stress on the joints) to create the same stress on the muscles (thanks to lever arms).  This makes full depth squats ideal for most people.

Exceptions include:

• knee rehab (which should progress to full squats, in most cases);
• extremely long legs in relation to torso; and
• folks who have specific partial-squat-related goals, such as athletes training jump squats.

Full squat	Partial squat

Squat progressions

However, most adults in Western cultures (where people sit instead of squat) don’t squat well when they start. They’ve often lost their natural childhood ability to drop down easily on their haunches.

Thus, many folks have to re-learn how to squat properly.

Here’s a basic overview of the movement.

Start standing, with good posture. Feet can be anywhere from close together, with toes pointed forwards, to wide, with toes pointed out. Experiment and find which foot placement works best for you.

1. Take a deep breath, lifting the ribcage.
2. Keeping this “proud chest”, push the butt back first and then sit down. (Imagine sitting down in a chair that’s not there, or sitting down on the toilet.)
3. Let the torso tip forward naturally from the hips as the butt shifts back.
4. Keep heels down.
5. Go down until your hamstrings touch your calves. (Or as far down as you can go, for starters.)
6. Drive through the heels, and keeping chest “proud” and head up, ascend.

Here is a helpful step-by-step progression for learning the squat: Lurn To Squat Good — E-Zy!

Squat variations

The squat isn’t a single exercise — it’s an exercise concept. By mixing up the loading (overhead, front, back, dumbbells held at the sides, etc.), form (1 or 2 legs), speed, foot placement, etc. you can have a hundred (or more) variations on the basic idea.

Plate squats

Plate squats encourage upright posture and appropriate load distribution.  Hold the plate parallel to the ground. If the plate tilts downwards, you’re probably rounding your back.

To be a real hardass, try balancing a ball on top of the plate, as shown in the photo below.

Use a light plate. You aren’t doing this movement to show off for gym peeps.

Source: Chiu LZ & Burkhardt E. A teaching progression for squatting exercises. Strength Cond J 2011;33:46-54.

Goblet squats

An option for those who have trouble with standard squats, as well as a great warmup or beginner squat variation.

Back squats

In the classic back squat, the barbell sits on the traps/upper back, not on the neck.

Jump squats

If you want a powerful leg contraction, jump.

Adding resistance to jumps can increase power output and jump height.  When it comes to optimal jump squat form, thighs usually don’t go below parallel.

To load the jump, weighted vests are ideal. You can also hold dumbbells, though it’s somewhat more awkward. Barbell and Smith machine jump squats tend to be the most dangerous, because of the loading on the spine.

Zercher squats

An option for those who have trouble with standard squats. Also handy as sport-specific training for wrestlers, especially if you use a sandbag instead of a bar.

Front squats

In the front squat, the weight sits at the top of the front of the shoulders, in the “groove” between deltoids and collarbone.

Because the torso stays more upright in front squats, this style of squatting minimizes compressive forces on the spine and knee joints.

If the barbell begins rolling forward from the shoulders, there is a lack of mobility and/or torso strength.  Many people think wrist range of motion is the limiting factor here, but it’s usually tight internal shoulder rotators (pec major, lats, teres major, subscapularis). Work on keeping elbows high throughout the movement.

See also the table below for front squat errors and corrections.

Source: Waller M & Townsend R. The front squat and its variations. Strength Cond J 2007;29:14-19.

Overhead squats

Great for developing full body mobility, balance, and strength. Plus it just looks cool.

1-leg squats

When you’ve mastered two legs, try one. Working one side at a time can increase demands from supporting hip muscles.

Shrimp squats

Pistol squats

Bulgarian split squat

Place one foot behind you on a bench or step. Use this nonworking leg for balance only — drive through the front leg.

With added range of motion:

Summary & recommendations

The squat is a basic human movement. Performing it makes you better at athletics, fitness, and life in general.

If you want to get better at the squat, practice.  Practice helps to coordinate movement, and builds the mobility you need to do the movement properly.

Start with a squat progression, such as squatting down to a step. Make it your goal to get as full a range of motion as possible — even though this may take time.

Every body type is different. Try a variety of squats, stances, and ranges of motion.

Focus on form and proper technique, not piling on weight to impress your gym buddies. Check your ego at the door.

Do your mobility drills.  A body with poor mobility is a body that will likely get injured with squats.

Full squats are often safer than shallow squats. The deeper you go when squatting, the more muscles recruited.

Control the descent and reverse the movement carefully. Don’t rely on your ligaments to bounce you out of a deep squat.

Think about how the squat helps your fitness and performance — don’t focus too much on how much you can lift. The squat technique that allows you to lift the most weight isn’t necessarily the best or most appropriate option.

Keep it simple. Even babies can squat. Don’t over-think it.

Troubleshooting the squat

When you’re working on learning the squat, try snapping photos or videotaping yourself. This can provide invaluable feedback.

Trouble getting a comfortable squat pattern?

• Try a wider stance, with toes pointed out a little (remember knees follow toes).
• Use natural foot positioning (similar to other athletic movements), with toes slightly out.
• Keep heels on the ground. If need be, put small plates under your heels until you develop better mobility in hip and ankle joints.
• Control squat speed, using a 2-3 second descent (unless your sport/activity demands another style).
• Maintain a neutral spine.
• Take breaks — fatigue can result in poor mechanics.
• Keep your hands close to your body.
• Look forward and keep your head up.
• Work on mobility drills for ankles, hips and the thoracic spine (All About Dynamic Joint Mobility).
• Use squatting progressions (see above).
• Get a coach who can help.

Trouble keeping the weight on your heels?

• Build hip mobility.
• Build core stability.
• Build ankle mobility.
• Build thoracic spine mobility (All About Spine Health).
• Take off your shoes or get a thin soled shoe.
• Keep your chest proud and core tight.

Trouble squatting deep?

• Get your body warmed up (All About Warming Up).
• Widen your stance and rotate your toes out.
• Think about squatting between your legs.
• Build ankle, thoracic spine, and hip mobility.
• Build core stability.
• Start the squat by sitting your hips back.
• Try box squat progressions (high to low box).
• Drop the amount of resistance you’re using.

Do your knees cave in during squats?

• Place a light band around knees as a guide (video).
• Strengthen the hip abductors/glutes.
• Focus on keeping the knees out and “spreading the floor”.
• Drop the amount of resistance you’re using.

Further resources

From Dork to Diva: The Squat (fellas, you can benefit from this article too):

Dan John squatting seminar

Hours of biomechanics fun

Other PN articles on squats and knees:

• Big Squat, Fast Sprint?
• All About The Knee
• Research Review: Front or Back Squats?

For extra credit

The squat has been shown to be effective during the rehab process of cruciate ligaments and/or patellofemoral injuries, with the most effective range of motion between 0 and 50 degrees of knee flexion (see image at right).  The vastus medialus oblique (VMO) tends to be activated more during partial squats.

The ultimate tensile strength of the patellar tendon is about 10,000 to 15,000 N.  The highest recorded compressive forces were obtained in a study of powerlifters lifting 2.5 times their bodyweight – about 8,000 N at full squat depth.

The greatest risk of injury with full depth squats is probably to the menisci and articular surfaces of the knee rather than the ACL/PCL.

Strong hamstrings can help to increase knee stability during the squat.

Stress on the knee ligaments can be decreased by keeping the heels on the ground

Peak quad involvement during squats is from the upright position down to 90 degrees knee flexion.  Beyond that, the hamstrings and glutes contribute most.

Foot placement (toes in, out, straight) doesn’t seem to influence muscle activation. Only a very wide stance incorporates more of the adductors.

References

Schuna JM & Christensen BK.  The jump squat: Free weight barbell, Smith machine, or dumbbells? Strength Cond J 2010;32:38-41.

Chiu LZ & Burkhardt E.  A teaching progression for squatting exercises.  Strength Cond J 2011;33:46-54.

Learning the Squat 1: Debunking the myths.  Krista Scott-Dixon.

Why squat? Krista Scott-Dixon

Goblet squats 101.  Dan John.  http://www.t-nation.com/free_online_article/most_recent/goblet_squats_101

Squat like you mean it: Tips for a deeper squat.  Tony Gentilcore.  http://www.t-nation.com/free_online_article/most_recent/squat_like_you_mean_it_tips_for_a_deeper_squat

Salem GJ & Powers CM.  Patellofemoral joint kinetics during squatting in collegiate women athletes.  Clin Biomech (Bristol, Avon) 2001;16:424-430.

Leg training myths exposed.  Alwyn Cosgrove.  http://www.t-nation.com/free_online_article/sports_body_training_performance/leg_training_myths_exposed

Kritz M, Cronin J, Hume P.  The bodyweight squat: A movement screen for the squat pattern.  Strength Cond J 2009;31:76-85.

McBride JM, et al. Relationship between maximal squat strength and five, ten, and forty yard sprint times. J Strength Cond Res 2009;23:1633-1636.

Gullett JC, et al. A biomechanical comparison of back and front squats in healthy trained individuals. J Strength Cond Res 2009;23:284-292.

Escamilla RF. Knee biomechanics of the dynamic squat exercise.  Med Sci Sports Exerc 2001;33:127-141.

Comfort P & Kasim P.  Optimizing squat technique.  Strength Cond J 2007;29:10-13.

Escamilla RF, et al.  Effects of technique variations on knee biomechanics during the squat and leg press.  Med Sci Sports Exerc 2001;33:1552-1566.

Five habits of defective squatters.  Mike Robertson.  http://www.t-nation.com/free_online_article/sports_body_training_performance/five_habits_of_defective_squatters

The squat: Good exercise gone bad?  Nate Green.  http://www.t-nation.com/free_online_article/sports_body_training_performance/the_squat_good_exercise_gone_bad

Fleming BC, et al.  Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction?  Exerc Sport Sci Rev 2005;33:134-140.

Schoenfeld BJ.  Squatting kinematics and kinetics and their application to exercise performance.  J Strength Cond Res 2010;24:3497-3506.

Waller M & Townsend R.  The front squat and its variations.  Strength Cond J 2007;29:14-19.

10 tips for flawless squattin’.  Mike Robertson.  http://www.t-nation.com/free_online_article/sports_body_training_performance/10_tips_for_flawless_squattin

Deep squatting – part 1. Anders Hansson.  http://www.athleticdesign.se/athletics/squat_article_1_english.html

What makes a starch “resistant”?

All starches are composed of two types of polysaccharides: amylose and amylopectin. (For more on polysaccharides, see All About Carbohydrates.)

Amylopectin is highly branched, leaving more surface area available for digestion. It’s broken down quickly, which means it produces a larger rise in blood sugar (glucose) and subsequently, a large rise in insulin.

Amylose is a straight chain, which limits the amount of surface area exposed for digestion. This predominates in RS. Foods high in amylose are digested more slowly. They’re less likely to spike blood glucose or insulin.

Thus, resistant starch is so named because it resists digestion.

While most starches are broken down by enzymes in our small intestine into sugar, which is then absorbed into the blood, we can’t fully absorb all kinds of starch.

Some starch — known as resistant starch (RS) — isn’t fully absorbed in the small intestine. Instead, RS makes its way to the large intestine (colon), where intestinal bacteria ferment it.

RS is similar to fibre (see All About Fibre), although nutrition labels rarely take RS into account.

SCFAs and RS

However, RS still plays an important role in our diets even though we don’t necessarily absorb it.

When RS is fermented in the large intestine, short chain fatty acids (SCFA) such as acetate, butyrate, and propionate, along with gases are produced. SCFAs can be absorbed into the body from the colon or stay put and be used by colonic bacteria for energy.

Evidence suggests that SCFAs may benefit us in many ways. For instance, they:

• stimulate blood flow to the colon
• increase nutrient circulation
• inhibit the growth of pathogenic bacteria
• help us absorb minerals
• help prevent us from absorbing toxic/carcinogenic compounds

The amount of SCFAs we have in our colon is related to the amount and type of carbohydrate we consume. And if we eat plenty of RS, we have plenty of SCFAs.

Rate of digestion changes absorption

RS can also help us stay lean and healthy.

As we cover in a Research Review on processed vs. whole foods, researchers found that less-processed foods offered less energy than refined foods. In other words, although whole and processed foods may contain the same amount of calories, we absorb fewer calories of energy from whole foods.

Since RS is incompletely digested, we only extract about 2 calories of energy per gram (versus about 4 calories per gram from other starches). That means 100 grams of resistant starch is actually only worth 200 calories, while 100 grams of other starch gives us 400 calories. High-RS foods fill you up, without filling you out.

The way we’ve modified/processed grains and starchy vegetables in the modern food supply diminishes the amount of RS we consume (think: cereal bars instead of oats, burgers instead of beans, potato chips instead of boiled potatoes). And fibre sources such as wheat bran, psyllium, and methyl-cellulose (Citrucel) don’t have the same benefits.

Thus, to get the most benefits from RS, we need to consume it in whole food format.

Most developed countries (including Europe, the United States, New Zealand, and Australia), which have a highly processed diet, consume about 3-9 grams of RS per day. In developing countries, diets are often based around whole plant foods and the intake of RS tends to be around 30-40 grams per day.

Potential benefits of RS

Improved blood fats

RS may help to lower blood cholesterol and fats, while also decreasing the production of new fat cells (the latter has only been shown in rats). Also, since SCFAs can inhibit the breakdown of carbohydrates in the liver, RS can increase the amount of fat we utilize for energy.

Better satiety

RS can help us feel full. SCFAs can trigger the release of hormones that reduce the drive to eat (leptin, peptide YY, glucagon like peptide). After someone starts eating more RS, it may take up to one year for gut hormones to adapt.

RS slows the amount of nutrients released into the bloodstream, which keeps appetite stable.

Better insulin sensitivity

RS doesn’t digest into blood sugar, which means our bodies don’t release much insulin in response.

RS might also improve insulin sensitivity via alterations in fatty acid flux between muscle and fat cells. Some data indicate that ghrelin might increase with RS consumption, improving insulin sensitivity (this is counterintuitive since ghrelin drives appetite). RS may also lower blood fats (see above), which also improves insulin sensitivity.

Improved digestion

RS may help alleviate irritable bowel syndrome, diverticulitis, constipation, and ulcerative colitis. RS can add bulk and water to the stool, aiding in regular bowel movements.

SCFAs can help to prevent the development of abnormal bacterial cells in the colon and enhance mineral absorption (especially calcium).

Better body composition

Since RS has less energy (calories) per gram than other starches, it can help us eat less. And consuming more RS may have a thermic effect in the body.

Keeping us hydrated

For those receiving treatment for cholera and/or diarrhea, RS can assist in the rehydration process (since it can normalize bowel function).

Improved immunity

Consuming RS can influence the production of immune cells and inflammatory compounds in the gut.

Where is RS found?

RS is found in starchy plant foods such as:

• beans/legumes
• starchy fruits and vegetables (such as bananas)
• whole grains
• some types of cooked then cooled foods (such as potatoes and rice)

The longer and hotter a starch is cooked, the less RS it tends to have — except for Type 3 RS.

How much RS should we consume?

Data indicates that RS is safe and well tolerated up to about 40-45 grams per day. Consuming more than this might result in diarrhea and bloating, since high amounts can overwhelm the fermenting ability of our colonic bacteria.

How we respond to RS varies by the type. One might notice more side effects when consuming RS3 (versus RS1, RS2, RS4). Our ability to ferment RS can increase over time, making it possible to adapt to a higher RS intake.

RS seems to be tolerated best when:

• It’s in solid food form (rather than liquid)
• It’s consumed as part of a mixed meal (rather than alone)
• Consumption is increased gradually over time (rather than a lot at once)

Here’s an idea how much RS is found in food. Note: these are average values and will vary.

Grams of RS per 100 g of food

Summary and recommendations

We absorb more energy (calories) from cooked and highly refined and processed carbohydrate dense foods. If we let machines and ovens do the digestion for us, we are left with highly digestible starches. Not good for glucose control, staying lean, or intestinal health.

Various cultures thrive and stay lean when eating whole unprocessed legumes, intact grains and starchy vegetables. RS may be one factor that enables this.

We might see some benefits from as little as 6-12 grams/day of RS, but closer to 20 grams/day might be ideal. This is easy to get if you eat plenty of whole plant foods.

More than 40 grams/day might cause digestive problems — especially if this RS comes from industrially produced RS products. In any case, we probably don’t get the same benefits of RS if it’s processed (i.e. an industrially created RS product) as we do from whole foods.

References

Anderson GH, et al. Relation between estimates of cornstarch digestibility by the Englyst in vitro method and glycemic response, subjective appetite, and short-term food intake in young men. Am J Clin Nutr 2010;91:932-939.

Nilsson AC, et al. Including indigestible carbohydrates in the evening meal of healthy subjects improves glucose tolerance, lowers inflammatory markers, and increases satiety after a subsequent standardized breakfast. J Nutr 2008;138:732-739.

Johnston KL, et al. Resistant starch improves insulin sensitivity in metabolic syndrome. Diabet Med 2010;27:391-397.

Bodinham CL, et al. Acute ingestion of resistant starch reduces food intake in healthy adults. Br J Nutr 2010;103:917-922.

Grabitske HA & Slavin JL. Gastrointestinal effects of low-digestible carbohydrates. Crit Rev Food Sci Nutr 2009;49:327-360.

Robertson MD, et al. Insulin-sensitizing effects of dietary resistant starch and effects on skeletal muscle and adipose tissue metabolism. Am J Clin Nutr 2005;82:559-567.

Higgins JA, et al. Resistant starch consumption promotes lipid oxidation. Nutr Metab (Lond) 2004;1:8-19.

Wolever TM, Spadafora P, Eshuis H. Interaction between colonic acetate and propionate in humans. Am J Clin Nutr 1991;53:681-687.

Higgins JA. Resistant starch: metabolic effects and potential health benefits. J AOAC Int 2004;87:761-768.

Landin K, et al. Guar gum improves insulin sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men. Am J Clin Nutr 1992;56:1061-1065.

Weickert MO, et al. Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Diabetes Care 2006;29:775-780.

Maki KC & Raines TM. Dietary fibers, insulin sensitivity, and risk of type 2 diabetes. Scan’s Pulse 2011;30:6-9.

Nugent AP. Health properties of resistant starch. British Nutrition Foundation Nutrition Bulletin 2005;30:27-54.

Position of the American Dietetic Association: Health implications of dietary fiber. J Am Diet Assoc 2008;108:1716-1731.

Elmstahl HL. Resistant starch content in a selection of starchy foods on the Swedish market. Eur J Clin Nutr 2002;56:500-505.

Murphy MM, et al. Resistant starch intakes in the United States. J Am Diet Assoc 2008;108:67-78.

Feder D. The Skinny Carbs Diet. Rodale. 2010.

You’re tired, you didn’t plan for dinner, and your fridge isn’t stocked with any fresh vegetables.

You could open that bag of frozen broccoli…but isn’t that the nutritional equivalent of a cardboard box? Instead, you order a supreme pizza with extra cheese and a side of rationalization.

Was that really the best choice?

Canned/frozen vegetables and fruits in context

It might seem hard to believe, but canned/frozen vegetables/fruits are some of your best options from a “nutrients per food dollar” perspective.  Even the FDA and IFIC have reported that canned/frozen vegetables/fruits have nearly the same nutrient profiles as fresh.

Most people believe that canning or freezing vegetables/fruits depletes their nutrients.  But we also need to remember that only 12% of the standard American diet is comprised of whole plant foods.  Yikes.

Adding a bag of frozen cauliflower to the above diet isn’t going to make it worse, that’s for sure.

Low vegetable/fruit intake is #6 on the WHO‘s list of 20 risk factors for mortality worldwide.  Sufficient consumption of these foods could save up to 2.7 million lives each year.

So let’s get three things straight right off the bat.

1. Fruits and vegetables are good for you.
2. Canned or frozen fruits or vegetables are not much worse than fresh.
3. Considering the big picture of the Western diet, any fruits and vegetables — in any format — are probably an improvement.

Why preserve fruits and vegetables?

Seasons change.  So unless you have a home garden capable of supplying 10 servings of fresh vegetables/fruits year round, you may want to introduce yourself to canned/frozen options.

Fresh vegetables/fruits are susceptible to moisture loss and microbial spoilage.  Refrigeration can slow this process, but canning/freezing puts a halt on moisture loss, nutrient loss, and growth of micro-organisms.

Many folks already prefer to buy certain types fruits and vegetables in preserved format. Below is a comparison of consumer habits. As you can see, while people prefer some things fresh (such as asparagus), they’re more likely to buy other things preserved, such as pineapple or tomatoes.

Source: Rickman JC, et al. Nutritional comparison of fresh, frozen and canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds. Journal of the Science of Food and Agriculture. 2007;87:930-944.

Preserving nutrients

Harvesting a vegetable/fruit separates it from the source of nutrients.

The longer a food is separated from the soil, the more nutrients are lost.  Leaving fresh foods sitting around leads to nutrient losses.  Food washing, peeling and cooking can also lead to further nutrient losses.

By the time you pick up a fresh vegetable/fruit at the grocery store, it might have already lost between 15-60% of some vitamins (unless purchased and consumed within 72 hours of harvest).  Canned/frozen varieties of the same vegetable/fruit usually have lost no more than 20% of these vitamins.

Check out this table comparing the vitamin C content of fresh and frozen peas, spinach, and French beans.

The nutrient content of preserved plant foods depends on four factors:

1. Time of harvest
2. Location
3. Growing conditions
4. Cooking method

Freezing is one of the best methods for preserving as many nutrients as possible. When plant foods are frozen, they are often blanched (briefly immersed in boiling water) to suppress the growth of microbes and retain color.  Then they’re flash frozen (immediately taken in small batches to freezing).

VIDEO: Frozen foods – behind the scenes

Blanching can make some nutrients (including phytochemicals) more bioavailable.  Some data indicate that certain nutrients are actually higher in frozen vegetables than in fresh or canned.  Even in delicate blueberries, the antioxidants aren’t much different between canned, frozen, fresh, and dried.

Vitamins

Regardless of whether a food is canned, frozen or fresh, cooking can leach out nutrients, especially vitamins B1 and C, with vitamin C being the least stable.  Don’t overcook foods if you want to maximize nutrient intake.  Microwaving and steaming seem to help retain the most nutrients.

Vitamins A, D, and E, along with most carotenoids, are fat-soluble, making them resistant to degradation from blanching and washing.  However, they’re still prone to oxidation with the presence of light, heat and oxygen.  This can be minimized with canning/freezing (compared to purchasing fresh, storing at home, and then preparing).

Further, we tend to absorb carotenoids better after eating cooked foods rather than raw.  So, canned/frozen foods might offer a better source for these nutrients.

Minerals

Minerals are resilient. They’re not destroyed by light, heat, or oxygen. Thus, noticeable mineral losses from canned/frozen foods are rare.

Minerals are removed from foods by leaching into the cooking water (tends to be negligible) and mechanical processing (e.g., the stems of mushrooms are often removed before canning them).

Canned vegetables may have higher levels of calcium and other minerals due to the uptake from hard water during processing.  Iron levels can increase and copper levels can decrease when foods are canned in tin-plated steel.

Fibre

Fibre losses occur only when there is mechanical separation of the food (e.g., removal of peels, skins, stems, etc.), such as with canned asparagus and tomatoes.  The fibre content in canned beans/legumes is the same as fresh.

Concerns about preserved foods

What about the environment?

Freezing/canning foods takes energy, resources, and fuel.  The act of keeping a freezer the proper temperature takes energy, and the coolant for freezers can harm the environment.

Most of the aluminum or tin-plate steel that cans are made from can be recycled.  This is superior to most frozen foods in plastic bags (some frozen foods are in biodegradable bags – like Stahlbush Island).

What about BPA in canned food?

Some companies are committed to BPA free can linings (like Eden Organics).  Check with the company whose products you buy.  More information on BPA in canned foods can be found here.

What about nitrates/nitrites?

Sodium nitrates/nitrites are sometimes added to canned meats/fish to prevent spoilage.  When combined with amino acids in an acidic environment (i.e., your stomach), they can form into nitrosamines, which have been linked to the development of cancer. For more, see All about Cooking and Carcinogens.  Many companies are now using alternative methods of preservation – so check ingredients.

What about sugar, salt and preservatives?

This is an important consideration, especially for canned foods. For instance, many fruits are canned in sugar solutions (look for “syrup”, “juice”, or “sweetened” on the label), while many vegetables (such as tomatoes) are high in sodium. Some canned vegetables are also packed in oil. As always, read labels carefully!

One option is to drain and rinse canned items before eating them. Draining/rinsing canned beans is very effective at reducing salt.  One experiment resulted in a 41% reduction in sodium per serving, from 503 mg to 295 mg.

Source: Enjoying nutrient rich canned beans with less sodium. VegetableWithMore.com

And I know this is shocking, but you can also buy low sodium, no-salt added, preservative free, no-sugar-added options.

What about food waste?

You know that moldy asparagus in the back of your fridge?  That’s food waste.

We waste about 25% of all the food we purchase for home (for more see All About Food Waste).  With frozen/canned foods, you don’t have to worry about food waste since the stems, stalks, peels and rinds have already been removed.  Plus, you just use what you need at the time you need it.

Summary and recommendations

Who likely has a leaner and healthier body?

• The person who eats 2 bowls of frozen cauliflower each day?
• The person who eats 2 bags of chips/pretzels instead of vegetables because they feel like frozen/canned options suck?

No matter whether they’re fresh, frozen, or canned – just eat more vegetables and fruits. Frozen cauliflower will likely benefit your body more than a moon pie.

Fresh veggies/fruits may taste better than frozen/canned, but only when they are local and straight from the soil do they contain substantially more nutrients. Fresh foods lose nutrients over time, while the nutrient content of frozen foods in particular is better than we might expect.

When heating foods, try to steam, stew, or microwave for nutrient retention. Don’t overcook.

Read labels for any ingredients you don’t want, such as sugar, salt, preservatives, and/or oils. Drain and rinse canned foods if necessary.

To make sure the planet doesn’t explode in the next few months, try this:

• Stock your home freezer well (this will save energy).
• Keep your freezer at -18 C (0 F).
• Recycle cans from canned foods.
• Try to find frozen foods in biodegradable bags.
• Try to find BPA free canned foods.

Extra credit

Do you tend to get the same three produce items?  Canned and frozen options can increase your variety.

Simply allowing frozen foods to thaw at room temperature won’t destroy any potential bacteria that are on the food.

The liquids from defrosted frozen food can contain nutrients.

Most people didn’t have freezers to store frozen food until the late 1940s.

Nutrient labels on packages aren’t always reliable since nutrients are influenced by washing, peeling, heating, oxygen, water losses, and further preparation at home.

Fruits usually aren’t blanched due to their delicate structure.

Frozen legumes can contain slightly more nutrients than their canned counterparts.

If your freezer is near a heat source (like your oven), operating costs can increase by nearly 50%.

Further resources

Frozen food FAQ

Nearly every part of the food preparation process can result in nutrient losses. See here for more.

References

Galgano F, et al.  The influence of processing and preservation on the retention of health-promoting compounds in broccoli.  J Food Sci 2007;72:S130-S135.

Food labeling: nutrient content claims, definition of term: healthy. Food & Drug Administration (FDA) website. Available at: http://www.fda.gov/ohrms/dockets/98fr/032598c.pdf Published March 1998. Accessed January 25, 2011.

The cold shoulder: why food snobs shouldn’t snub the freezer. Slate Magazine website. Available at http://www.slate.com/id/2102884/ Published June 2004. Accessed January 25, 2011.

IFIC.  September 2010.  What is a processed food?  You might be surprised. http://www.foodinsight.org/LinkClick.aspx?fileticket=wtg018sd8qk%3D&tabid=1398

Environmental aspects of frozen.  April 2010.  Last accessed 1/20/11. http://www.thenewiceage.com/top-environmental-aspects-frozen-foods

Darmon N, et al.  A nutrient density standard for vegetables and fruits: Nutrients per calorie and nutrients per unit cost.  J Am Diet Assoc 2005;105:1881-1887.

Wehrmeister AA, et al.  Antioxidant content of fresh, frozen, canned, and dehydrated blueberries.  J Am Diet Assoc 2005;105;38S.

Storing, defrosting and cooking frozen foods safely.  June 2010.  Last accessed 1/20/11.  http://www.thenewiceage.com/the-cold-facts/storing-defrosting-and-cooking-frozen-foods-safely

Fellows PJ. Food Processing Technology – Principles and Practice. 2nd Ed. London, 2000.

Mangels AR, et al.  Carotenoid content of fruits and vegetables: An evaluation of analytic data.  J Am Diet Assoc 1993;93:284-296.

Enjoying nutrient rich canned beans with less sodium.  Last accessed 1/20/11. http://www.vegetablewithmore.com/PDF/04/DrainRinse.pdf

Fresh, canned, or frozen – Get the most from your fruits and vegetables.  March 2010.  Last accessed 1/20/11.  http://www.eatright.org/Public/content.aspx?id=6442451032

Storing, defrosting and cooking frozen foods safely.  June 2010.  Last accessed 1/20/11.  http://www.thenewiceage.com/the-cold-facts/storing-defrosting-and-cooking-frozen-foods-safely

Wu Y, et al.  Vitamin C and B-Carotene in fresh and frozen green beans and broccoli in a simulated system.  J Food Quality 1992;15:87-96.

Nursal B & Yucecan S.  Vitamin C losses in some frozen vegetables due to various cooking methods.  Nahrung 2000;44:451-453.

A study of canned food nutrition. Department of Food Science and Nutrition, University of Illinois at Urbana-Champaign website. Available at: http://nutrican.fshn.uiuc.edu/ Accessed January 25, 2011.

Spada PD, et al.  Antioxidant, mutagenic, and antimutagenic activity of frozen fruits.  J Med Food 2008;11:144-151.

Spada PD, et al.  Macro and micro minerals: are frozen fruits a good source?  An Acad Bras Cienc 2010;82:861-867.

Bernhardt S & Schlich E.  Impact of different cooking methods on food quality: Retention of lipophilic vitamins in fresh and frozen vegetables.  J Food Engin 2006;77:327-333.

Chalom S, et al.  Composition of sulfited potatoes: comparison with fresh and frozen potatoes. Plant Foods Hum Nutr 1995;47:133-138.

Favell DJ.  A comparison of the vitamin C content of fresh and frozen vegetables.  Food Chemistry.  1998;62:59-64.

Rickman JC, et al.  Nutritional comparison of fresh, frozen, and canned fruits and vegetables II.  Vitamin A and carotenoids, vitamin E, minerals and fiber.  Journal of the Science of Food and Agriculture.  2007;87:1185-1196.

Rickman JC, et al.  Nutritional comparison of fresh, frozen and canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds.  Journal of the Science of Food and Agriculture.  2007;87:930-944.

Pellegrini N, et al.  Effect of different cooking methods on color, phytochemical concentration, and antioxidant capacity of raw and frozen brassica vegetables.  J Agric Food Chem 2010;58:4310-4321.

The history of canned food: http://www.tinplategroup.com/pooled/articles/BF_DOCART/view.asp?Q=BF_DOCART_197927

Siegle L.  Is it better to buy canned or frozen food?  The Observer. Sept 14, 2008.  http://www.guardian.co.uk/environment/2008/sep/14/1

Canned food and the environment.  Green Living Tips. May 14, 2008.  http://www.greenlivingtips.com/articles/225/1/Canned-food-and-the-environment.html

Research from the University of Tennessee (Institute of Food Technologists June 2009 Annual Conference) – draining and rinsing.

Most of us have had the experience of having a paper cut feel like it’s a “centre of our universe” pain, while we may have broken a limb or cut ourselves severely in another circumstance and not noticed until later on.

How can something as trivial as a paper cut be so huge, when something as damaging as a break could happen without our awareness?

What these simple differences tell us is that pain is a rich, complex experience. Pain involves not just the physical experience of some injury (or threat of some injury), but, according to research over the past 30+ years, pain involves processing stimuli from various inputs, including social, psychological and physiological experiences.

Pain is interpretation

Research in pain indicates that the electro-chemical signals from an injury do not of themselves always say “pain” to the brain. The same signals triggered in the body that say “pain” today may just be translated as “frustration” tomorrow.

In other words, pain is cognitive: it’s an interpreted event in which the brain takes in multiple signals – including physical, social, psychological input – and then decides whether the combined output says “pain.”

At its most fundamental level, we can say that:

1. Pain is not the same thing as injury.

2. Pain takes place not at the site of injury but in the brain.

Research also tells us that the brain interprets a particular input as pain when it perceives something jeopardizing the body’s balance (homeostasis).

Likewise, the role of pain seems to be an action signal: a signal that, if perceived, means something needs to be changed to restore the body’s homeostasis. This gives us a third point:

3. Pain is a signal to change.

One of the challenges for physical culture and rehab is that the site of pain is not always the source of pain. While pain is a brain signal, it does not necessarily tell us what is wrong. All we know is that our brain thinks something threatens our homeostasis.

Acute & chronic pain

Generally speaking, pain breaks down into two categories (though the International Association on Pain Studies has about 30 categories of pain).

Acute pain

According to the International Association for the Study of Pain (IASP), acute pain would be a sudden back twinge during deadlifts, or banging your shin into the barbell.

Acute pain is generally associated with an injury (or anticipated injury) and is site specific. With acute pain, the sufferer can usually show exactly where the pain is, and what triggers it. The pain is sharp and clearly defined. If there has been tissue damage, there can be swelling or later scarring.

Chronic pain

Chronic pain is more like the nonspecific shoulder or backache that’s been around for a year. Chronic pain is ongoing and tends to be more diffuse.

Chronic pain can be particularly challenging, because its intensity can come and go. It can often be unpredictable, and not always associated with specific events. For instance, sufferers might just wake up sore some days.

Sufferers of chronic pain often reduce their movement (to reduce pain), and fear the types of movements that seem to stimulate the pain, although it may not be a specific movement that induces the pain. Although chronic pain may be accompanied by inflammation, there may be no physical signs that there is any particular tissue repair work going on.

In both acute and chronic pain cases, however, pain-free movement can be a way to accelerate healing and break chronic pain cycles.

Managing pain with movement

Thus:

• Pain is an action signal.
• Pain a signal to change, but not a prescription for rehab.
• Pain is indicative rather than diagnostic.
• Pain is the brain telling us that something is threatening our homeostasis; it doesn’t tell us specifically what is wrong or what to do about it.

Pain is often described as acute or chronic. And for those of us who work out or play physically, acute or chronic pain seems to be par for the course.

Unfortunately, the two most common sports responses to pain – work through it or stop moving until it goes away – are both largely wrong. Turns out, we need to keep moving, but, unless it’s life and death, never move into pain.

Movement we know is a key part of health. Because of how we’re wired, movement — though again, not into pain — actually plays an important role in pain management.

Silencing pain signals

In the gym or on the field, if we experience a twinge, we often ignore it until it becomes a scream. The best response to an immediate pain, however, as soon as it happens is:

1. Stop what we’re doing – whether it’s a muscle cramp or just a twinge.
2. Reduce speed – recheck.
3. If there’s still pain, reduce load – recheck.
4. If there’s still pain, reduce range of motion.
5. If there’s still pain, do some other movement that incurs no pain.

In each of these tests, the advice is not to stop moving our body but where possible to keep moving the affected body part without pain.  Find a pain-free way to move.

The importance of movement

Movement is a key signal to our bodies about how well we’re doing. We are designed as “use it or lose it” systems, constantly adapting to what we do (see discussions of Woolf’s Law for bone formation and Davis’ Law for tissue; also see Lederman reference below for reducing scar tissue formation).

Our bodies adapt to the demands — or lack of them — they experience. If we don’t move something for a while, our bodies begin to adapt to support that lack of movement. Unused bone disappears. Unused muscles atrophy.

Our bodies compensate in other ways too, to make up for the lack of mobility. We often get new pain as a result of those compensations. For instance, our joints may swell, or muscles may complain when asked to do work for which they were not designed.

For instance, let’s say you have pain in your right hip. You start favouring your left leg to compensate. While this makes your right hip feel better (sort of), you eventually get pain in your left leg and hip, because you’re suddenly doing much more unbalanced work on the left hand side. Then, maybe your right shoulder starts to hurt, or your neck, because you’re walking around lopsided like a boat with one oar, and it’s pulling on your spine.

Here’s another common example. Your back hurts. So you go to bed. After a few days of lying around, you feel worse. Now your shoulders and neck hurt too. Your hips hurt from the pressure of lying down. Not a great solution!

Thus, immobilizing oneself can create a vicious cycle. Compensating for one painful movement induces other restricted movements.

By staying as mobile as possible, at every joint, without pain, we signal two things.

First, movement says we are still using this part of our body and thus this body part needs resources for healing and growth.

Second, the movement signals themselves can overwhelm a pain signal to say there’s more right than wrong going on in the area: there are more nerves that tell the body how we’re moving than nerves that say there’s something wrong.

Movement nerves (mechanoreceptors) are also easier to turn on than nerves that trip in the presence of noxious stimuli. This receptor ratio is used to great effect when we drop a weight on our thumb and then shake and rub the area and find the pain is reduced, as per the Oh Canada section in All About Dynamic Joint Mobility.

Managing pain: a complex system response

Beyond reducing the intensity of an immediate pain experience by reducing load, speed and range of motion, we can help protect ourselves from pain by considering our somatosensory system in our skills practice.

Prevention: movement, balance and vision practice

The somatosensory system includes a hierarchy of three interdependent systems:

1. the visual system (what we see);
2. the vestibular (our sense of balance and orientation relative to gravity); and
3. the proprioceptive system (our sense of movement and position in space).

If our nervous system perceives a threat to any of these systems, it can trigger compensations and eventual pain responses.

For instance, if someone has an esophoria – a condition where an eye may tend to pull in (example here) — that condition makes objects appear closer than they are. Imagine always reaching for something thinking it’s closer than it is, and having to readjust constantly.

This micro miscue and constant readjustment results in a low-grade ongoing stress that may affect muscular posture and eventually contribute to what becomes a chronic strain. Just rehabbing muscles of the body won’t eliminate the problem – we need to address the eye muscles too.

We can address this in the same way that we train: using movement work.  Here, sports vision training can help address the phoria and enhance visual performance, often improving proprioceptive and vestibular performance too, also often ultimately addressing the pain signal’s request for change.

Remember, the site of pain is not always the source of pain. In this case, the source of pain is the eyes’ muscular coordination. The site of pain may, in fact, be posture — or any number of other underlying problems.

It’s important to note that there are a variety of ways to address pain via better movement, balance and vision skills. This is not to say that glasses or orthotics or drugs are wrong; just that work with the somatosensory system is a powerful, if often overlooked, way to work with the body to improve performance and reduce pain.

A movement program can be used as a cornerstone of such a mixed practice to reduce the incidence of injury in physical practice and to help manage or even eliminate chronic pain. See All About Dynamic Joint Mobility for program suggestions.

Response: movement assessment

If we’ve experienced fresh or ongoing pain, it may help to seek out a movement assessment. This means being assessed in motion.

This guidance may seem obvious, but it’s not in practice. Many of us have seen specialists that will look at how a painful limb moves, or test our range of motion while lying on a table or standing still, but may not consider how we carry ourselves as we walk down a hallway.

Likewise, some approaches may deal only with musculo-skeletal issues. If that works, great, but if it does not, that may be a sign that some other part of the somatosensory system – like the phoria example above – is at play, affecting performance.

Pain is a signal to change. Until the underlying issue is identified and addressed, the signal to change may keep coming.

Moving forward, pain free

• Pain takes place in the brain. It is an outcome of the cognitive interpretation of multiple signals, from social to physical to neural.
• Pain is a response to actual or perceived threat to the body’s homeostasis. The same action may be interpreted differently under different circumstances, depending on whether the body thinks it’s a threat.
• The site of pain does not equal the source of pain.
• Pain is individual. Our experience of pain can change, depending on who we are, what we’re doing, and the context in which we experience it.
• Pain is a signal to change; it is not a prescription of what to do or where to go.
• Pain often directly affects quality of movement. However, one of the worst things we can do in response to pain is either ignore it and keep going (the tough it out, “no pain no gain” response) or respond to it by shutting down movement (the chronic pain vicious circle).
• Movement that does not cause pain is often an effective path to better function. It both reduces the duration of acute pain and helps to address the intensity or frequency of chronic pain.
• A movement assessment – especially one that considers somatosensory responses from the integrated visual, vestibular, and proprioceptive systems — can provide insight about movement strategies to help address a particular pain and improve performance.

References & related resources

Butler, D, Moseley, L, Sunyata. Explain Pain. Aus. Orthopedic Physical Therapy Products, 2003.

Cobb, E, Mauck, K, Mauck, S. The Essentials of Elite Performance (DVD Mini-Course) Z-Heath Performance Solutions, Arizona USA, 2010.

DeLeo, Joyce A (2006). Basic science of pain. The Journal of bone and joint surgery. American volume 88 Suppl 2 p. 58-62. PMID 16595445.

Iannetti, G D, and A Mouraux, “From the neuromatrix to the pain matrix (and back).” Experimental brain research. Experimentelle Hirnforschung. Experimentation cerebrale 205, no. 1 (July 2010): 1-12-12 http://www.springerlink.com/content/x6p070657v2tt6k6/ (accessed July 11, 2010).

Lederman, E. The Science & Practice of Manual Therapy. London: Elsevier, 2005

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(699):971–9. PMID 5320816.

Melzack, Ronald, “Evolution of the neuromatrix theory of pain. The Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004.” Pain practice : the official journal of World Institute of Pain 5, no. 2 (June 2005): 85-94 PMID 17177754.

Sonnon, Scott. Body Flow. Atlanta, USA: RMax.tv Productions, 2003.

Squire, L. and Colleagues. “Somatosensory Systems (Chp 25).” Fundamental Neuroscience, 3rd Edition. New York: Elsevier Academic Press, 2008.

Wilson, T.A., Falkel, J. Sports Vision: Training for Better Performance. Champagne, Il., USA: Human Kinetics, 2004.

What is ginger?

Ginger, aka Zingiber officinale, is a rhizome, a thick underground stem that sprouts roots and shoots.

Each ginger plant can grow up to three feet high and produce 2-5 sections of ginger, which can be harvested year-round. After a ginger root is broken off from the main plant it is washed and dried in the sun.

Once dried, it can be used for cooking or medicinal purposes.

Ginger as medicine

Ginger is one of the oldest medicinal foods.

Since the herb originated in Southeast Asia, it’s not surprising that ancient Chinese and Indian healers have made ginger a part of their toolkit for thousands of years.

Ayurvedic texts credit ginger as a “universal great medicine”. An old Indian proverb says that “everything good is found in ginger.” Traditional Chinese medicine holds that ginger “restores devastated yang” and “expels cold”.

Currently, since ginger grows best in warm, damp areas, it’s currently cultivated in China, India, Australia, and Jamaica. China and India produce most of the world’s ginger, with half being produced on India’s Malabar Coast.

Today, ginger is still used as food and medicine. Modern Western science has confirmed its usefulness for treating a variety of conditions.

Zingerone, shogaols, gingerols, and volatile oils give ginger its distinct aroma and flavour, as well as its medical properties. The amount of these therapeutic compounds in ginger is determined by geography, time of harvest, and processing methods.

Active compounds in ginger

Anti-inflammatory & anti-oxidant

Consuming ginger may help to decrease muscle soreness, inflammation, and relieve osteoarthritis pain.

It’s far from a sure thing (data is mixed), but one theory is that ginger may inhibit COX (cyclooxygenase) and LOX (lipooxygenase), making it anti-inflammatory. NSAIDs work in a similar fashion, but only inhibit COX (leading to upregulation of LOX).

Since ginger appears to inhibit both COX and LOX, it can lead to a lower production of chemical messengers like LTs (leukotrienes), TNF (tumor necrosis factor), and PGs (prostaglandins). This occurs systemically and at the site of inflammation, helping with pain relief.

Ginger may inhibit both COX and LOX

Unlike NSAIDs, ginger doesn’t appear to harm  the stomach or kidneys (in normal amounts), and may even have anti-ulcer properties.

Nausea

Ginger might help decrease nausea from chemotherapy, motion, pregnancy, and surgery. But data is mixed. It seems most effective for nausea related to pregnancy and surgery.

Ginger works by inhibiting serotonin receptors, exerting anti-nausea effects at both the brain and gut level. It may also decrease the release of vasopressin, diminishing nausea related to motion.

Digestion

Ginger has been valued as a digestive aid since the Middle Ages. Ginger can calm over-active stomach contractions, allowing stomach contents to enter the intestines (this may also help to decrease heartburn). It also contains an enzyme called zingibain that may assist in protein digestion.

Blood pressure & asthma

Animal studies have shown that ginger might help to control high blood pressure.

It’s thought that ginger may act (in a much weaker way) similarly to calcium channel blockers. Over several months, ginger may promote smooth muscle relaxation and more elastic blood vessels. Smooth muscle relaxation might also be a benefit to asthmatics. Note: these effects are based on theory and rat studies so far.

Cholesterol

In rodents, ginger can help to lower LDL cholesterol and triglycerides while raising HDL – at levels similar to conventional lipid lowering drugs. It may also decrease the liver’s production of cholesterol and increase cholesterol excretion (via bile/fecal excretion). Human trials have yet to show benefits.

Cancer

Population based studies show that those living in Southeast Asian countries have a lower incidence of cancers than folks in the Western world. It’s thought that some of the plants they consume have anti-cancer properties; ginger might be one of them.

Tumor promotion is linked with inflammation and oxidative stress. Thus, the anti-inflammatory and anti-oxidative properties of ginger could play a role in cancer prevention. Further, ginger might activate a tumor suppressor gene and downregulate a gene that plays a role in metastasis.

However, anti-cancer data on ginger has only been demonstrated in test tubes and animals so far.

Anti-bacterial

Ginger might help destroy oral pathogens and H. pylori (the bacteria that causes stomach ulcers), making it anti-bacterial.

Migraines

Ginger may help to reduce migraine headaches (pain and frequency), similar to some prescription medications.

Miscellaneous

You can even add ginger to baths and foot soaks.

Because of ginger’s anti-inflammatory and anti-bacterial action, it may help keep skin clear and free of blemishes. It may also help fight skin discolouration and aging, both when consumed and topically applied.

Ginger may help your sex life. The famous Arab physician Avicenna wrote that ginger “increases lustful yearnings”, and ginger appears in the Kama Sutra. Rat studies confirm that ginger may help increase testosterone.

Drug interactions

It’s possible that ginger could interact with calcium channel blockers and drugs that lower blood sugar. There have been reports showing interactions with blood thinning drugs. Five grams (or more) of ginger has anti-platelet action.

If you’re taking ginger medicinally, consider using standardized capsules or tablets, so that you can be sure of the dose you’re getting.

Consuming a lot of ginger at once (like, eating an entire knob of it) might result in heartburn, diarrhea, and mouth irritation. Besides that – ginger seems to be safe. After all, you could easily consume a fair bit of ginger normally in foods (such as pickled ginger with sushi).

Ginger as food

Choose firm, shiny-skinned and smooth knobs. Don’t buy roots with sprouts.

Peeled and sealed, ginger will keep in the fridge for about 2 weeks. It will keep unpeeled in a dark, cool place for weeks. Freeze if storing for long periods.

Peel ginger before using it; don’t consume the skin.

You can use ginger fresh, dried, crystallized, preserved, or pickled. If you aren’t willing to buy fresh, check out preserved versions.

Use ginger anywhere you need some zing. This includes dipping sauces, dressings, rubs, pesto, teas, and even Super Shakes. To convert a recipe from dried ginger, substitute in 6 parts fresh grated ginger for 1 part of ground.

Peeling ginger

How to prepare fresh ginger

Making ginger tea

Gourmet Nutrition includes many ginger recipes, such as:

• Fruity chicken skewers (pg. 116)
• Carrot, orange and ginger soup (pg. 134)
• Butternut squash and turkey soup (pg. 138)
• Miso corn chowder with salmon (pg. 170)
• Spinach and black bean soup with prawns (pg. 174)
• Miso vegetable brown rice (pg. 198)
• Curry coconut chickpeas (pg. 200)
• Soy ginger lentils with baby bok choy (pg. 204)
• Chickpea cakes (pg. 212)
• Asian dressing (pg. 242)

Summary and recommendations

Consuming 1-2 grams of ginger might help with nausea, muscle soreness, and digestion. Beyond that, ginger has the potential to promote overall health, but the data is limited. Ginger doesn’t appear to cause any health problems.

Don’t exceed 4 grams of ginger per day from food, drink and supplements.

Check with your doctor if pregnant, as ginger supplementation is controversial.

Extra credit

Ginger is in the same family as cardamom and turmeric.

Beta-elemene is an anti-cancer pharmaceutical derived from ginger.

In India, basil leaves combined with ginger is a popular remedy for children’s stomachaches.

The use of ginger in Asia is common because it’s believed to cleanse the body of toxins from meat dishes.

At one time in England, three pounds of ginger was the going rate for one head of cattle.

Chewing on a piece of fresh ginger might relieve a sore throat and hoarseness.

Eating slices of ginger sprinkled with salt before meals can aid digestion.

Some say that ginger is a “warming” food for the body.

Ginger is a main ingredient in kimchi.

When ginger is used in large quantities it can mask the odor of fish.

Ginger was so popular in Europe that it was used like salt and pepper. Folks even sprinkled it on beer (the origin of ginger ale).

Further resources

In 3-6 months you could have your own ginger if you grow it yourself.

References

Hughes MS. Flavor foods – spices and herbs. Lerner Publications Company. 2000.

Andoh E. Kansha. Ten Speed Press. 2010.

Simonds N. A spoonful of ginger. Borzoi Book. Random House. 1999.

Simonds N. Spices of life. Borzoi Book. Random House. 2005.

Hill T. The contemporary encyclopedia of herbs & spices. John Wiley & Sons, Inc. 2004.

McBride K. The herbal kitchen. Conari Press. 2010.

Pillai AK, et al. Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatr Blood Cancer 2011;56:234-238.

Zick SM, et al. Phase II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and vomiting. Support Care Cancer 2009;17:563-572.

Kim MK, et al. Modulation of age-related NF-kappaB activation by dietary zingerone via MAPK pathway. Exp Gerontol 2010;45:419-426.

Chung SW, et al. Peroxisome proliferator-activated receptor activation by a short-term feeding of zingerone in aged rates. J Med Food 2009;12:345-350.

Ojewole JA. Analgesic, anti-inflammatory and hypoglycaemic effects of ethanol extract of Zingiber officinale (Roscoe) rhizomes (Zingiberaceae) in mice and rats. Phytother Res 2006;20:764-772.

Willetts KE, et al. Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled trial. Aust N Z J Obstet Gynaecol 2003;43:139-144.

Vutyavanich T, et al. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-582.

Ernst E & Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. B J Anaesth 2000;84:367-371.

Altman RD & Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001;44:2531-2538.

National Center for Complementary and Alternative Medicine. NIH. Updated July 2010. http://nccam.nih.gov/health/ginger/

Medline Plus. NIH. Updated November 2010. http://www.nlm.nih.gov/medlineplus/druginfo/natural/961.html

Chrubasik JE, et al. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res 2007;21:675-683.

Morelli V, et al. Alternative therapies for traditional disease states: osteoarthritis. Am Fam Physician 2003;67:339-344.

Black CD, et al. Ginger (Zingiber officinale) reduces muscle pain caused by eccentric exercise. J Pain 2010;11:894-903.

Black CD & O’Connor PJ. Acute effects of dietary ginger on muscle pain induced be eccentric exercise. Phytother Res 2010;24:1620-1626.

Black CD & O’Connor PJ. Acute effects of dietary ginger on quadriceps muscle pain during moderate intensity cycling exercise. Int J Sport Nutr Exerc Metab 2008;18:653-664.

Chen Z, et al. Anti-hypertensive Nutraceuticals and Functional Foods. J Agric Food Chem 2009;57:4485-4499.

Gregory PJ, Sperry M, Friedman A. Dietary supplements for osteoarthritis. Am Fam Physician 2008;77:177-184.

White B. Ginger: An overview. Am Fam Physician 2007;75:1689-1691.

Grzanna R, et al. Ginger-An herbal medicinal product with broad anti-inflammatory actions. J Med Food 2005;8:125-132.

Nicoll R & Henein MY. Ginger (Zingiber officinale Roscoe): a hot remedy for cardiovascular disease? Int J Cardiol 2009;131:408-409.

Ali BH, et al. Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscose): a review of recent research. Food Chem Toxicol 2008;46:409-420.

Shukla Y & Singh M. Cancer preventive properties of ginger: A brief review. Food Chem Toxicol 2007;45:683-690.

Park M, et al. Antibacterial activity of [10]-gingerol and [12]-gingerol isolated from ginger rhizome against periodontal bacteria. Phytother Res 2008;22:1446-1449.

Mahady GB, et al. Ginger (Zingiber officinale Roscoe) and the gingerols inhibit the growth of Cag A+ strains of Helicobacter pylori. Anticancer Res 2003;23:3699-3702.

Aggarwal BB & Yost D. Healing Spices. Sterling. 2011.

National Center for Complementary and Alternative Medicine. Ginger. http://nccam.nih.gov/health/ginger/ Last updated July 2010. Accessed January 2011.

Stonesoup Blog: 9 things you should know about ginger. http://thestonesoup.com/blog/2010/06/9-things-you-should-know-about-ginger-with-self-saucing-ginger-puddings-5-ingredients-simple-baking/

What’s the #1 reason people visit the family doc? The common cold.

What’s the #2 reason? Lower back pain.

80% of adults report lower back pain at some point in their lives and 10-15% of all sports-related injuries involve the spine. Low back pain accounts for more lost person hours than any other type of occupational injury and is the most frequent cause of activity limitation in those under age 45.

Thus, it’s important to understand what the spine is, what it does, and — most importantly — how we can keep it healthy.

What is the spine?

Along with opposable thumbs that we can use to work the TV remotes we invented, one of the things that distinguishes us from many other animals is our spine. The spine provides structural support for our bodies, protection for our central nerves, and facilitates locomotion (aka movement).

The spine is made up of 24 semi-rigid presacral vertebrae (seven cervical, twelve thoracic, five lumbar) separated by discs. Five sacral vertebrae fuse to make up the sacrum, which helps transfer upper body weight to the pelvis through the sacroiliac joint. The coccyx (tailbone) makes up the bottom of the vertebral column.

The natural curves of the spine

Intervertebral discs hold vertebrae together, act as shock absorbers, and allow dynamic spinal movement. These discs measure around one centimetre in height and consist of a gooey center (nucleus pulposus) surrounded by connective tissue (annulus fibrosis). (Think of an Oreo with the disc as the filling and the vertebrae as the hard cookies.)

Bony projections come together along your mid-back to form the spinous process, which you can feel and see.

The cervical spinous process

Ligaments run along the spine and provide stability, helping the spine protect nerves extending from brain to body.

Spinal muscles and their roles

Several muscle groups attach to the spine or play a critical role in spinal health. Problems with these muscles can cause back pain. (For more on how this works, see the next section.)

1. Iliopsoas (psoas + iliacus) complex

These lie deep within the abdomen and hip, connecting the lumbar vertebrae and the iliac crest to the top of the femur. They’re major movers during bent knee leg raises and sit ups.

Aggravated with: Lots of sitting/driving, lots of kicking (martial arts or soccer), long bike rides in bent position, and sleeping in the fetal position.

2. Paraspinals

These are like the spine’s “suspenders” and help to control rotation, extension and bending. This group includes the erector spinae and multifidus along the spine.

Aggravated with: Sudden spinal overload, repetitive movement with poor technique, hunched posture, tight abdominal muscles, and lots of sitting.

3. Rectus abdominis

This sheet of muscle is your “washboard abs”. It runs between the lowest ribs and top of the pubic bone, and helps stabilize the torso. Excessive training of the rectus abdominis (at the expense of posterior chain muscles) can diminish the ability to carry weight overhead (think jerks, snatches, overhead presses) and lead to lower back injury. So: fewer crunches, more swings.

Aggravated with: Too many crunches (especially without posterior chain training), over-exercising, excess abdominal fat, reliance on weight training belts.

4. Gluteus group: maximus/medius/minimus

Aka the booty, these are the muscles that help bring your thigh behind you (think: donkey kicks), rotate it, and bring it to the side.

Aggravated with: Prolonged sitting, sleeping in fetal position with knees pulled up, sitting on your wallet, standing for long periods on one leg, sleeping on your back with feet splayed under the weight of a heavy blanket.

5. Piriformis

This small muscle lies deep within the glutes and connects the thigh to the pelvis near the sacrum. It rotates the thigh outward and swings the leg to the side when the thigh is flexed.

Aggravated with: Distance running (repetitive overuse in general), prolonged contraction (such as driving a car), sitting with one foot underneath you, walking with duck feet (toes out), sitting too much.

6. Quadratus lumborum

The “QL” lies deep in the side of the torso around the kidneys. It helps to bend, rotate, and straighten the torso from bent position. It also helps with exhalation (coughing, etc.), which many folks discover when they strain the QL and then live in fear of sneezing.

Aggravated with: Structural imbalances (one leg longer, uneven pelvis, etc.), habitual leaning to one side, slouching, always sleeping on one side.

7. Hamstrings

These big leg muscles run along the back of the thighs, attaching at the hip and the knee. They bend and stabilize the knee.

Aggravated with: Pressure from chairs, prolonged sitting, bed rest, overload (e.g. lots of sprints when a trainee isn’t used to sprinting).

8. Soleus

This deep calf muscle assists with walking, jumping, and pointing the toes. When irritated, pain can radiate to the sacrum.

Aggravated with: High heeled shoes, rigid/tight shoes, bedding that weighs down toes, standing still for extended periods, prolonged driving, sitting on chair that is too high (so the feet don’t touch the floor).

What can lead to spinal problems?

Usually, spinal problems are multifactorial. Predisposing factors include:

• Poor mobility in surrounding muscles
• Bad biomchanics
• Poor posture
• Weakness of supporting musculature
• Muscle imbalances
• Sedentary lifestyle, sitting, and immobility

Poor mobility in surrounding muscles

The pelvis is the foundation for the spine. Decreased mobility in the hips, hamstrings, ankles, and thoracic spine can lead to overcompensation at the lumbar spine and excessive pelvic tilt. This problem is particularly common in women — in part because of higher heels, but also because the connective tissues of an average woman’s spine are usually looser than the average man’s.

Bad biomechanics

Back pain only gets worse with poor biomechanics.

Most spine injuries that occur during training are muscle strains or ligament sprains, usually due to improper loading and technique. A common error is lumbar flexion during movements like good mornings, situps, deadlifts, and rows. Excessive lumbar extension is also dangerous and can lead to vertebral fracture (e.g., finishing a heavy deadlift).

The safest position for the lumbar spine is a neutral position — a natural but not exaggerated S-curve (double check the spine image at the top of this article for reference). You can find a neutral spine by flexing your lumbar spine, then extending it and trying to find the midpoint between the two, or by standing tall and taking a deep breath. Use a mirror to check.

Nice neutral spine

My disc just herniated looking at this picture (too much spinal flexion)

It’s important to get good at the movements you regularly do. If you’re always lunging and twisting for martial arts or your plumbing job, get good at lunging and twisting. Don’t just go home at night and do situps hoping to preserve your back.

Poor posture

If your posture sucks, your back sucks.

Poor posture means higher levels of shear stress on the spine. When posture is appropriate (proud chest, natural lumbar curve, tight core, retracted shoulder blades, etc.) – then we’re able to handle higher amounts of compressive force. Oh, a big gut and high heeled shoes can negatively influence posture. Try to avoid one or both as much as possible.

Weakness

Many people assume that strong abs help them bend and twist. This is true, in part, but most often the core’s role is stability rather than movement — in other words, preventing motion rather than initiating it. Too much flexion or extension at the lumbar spine, usually caused by weak core muscles, can lead to injury. It’s also biomechanically weaker. You can throw a lot farther or punch a lot harder when your hips and shoulders are involved than when you’re just twisting at the waist.

Reliance on weight lifting belts can lead to torso stiffness and weakness.

Imbalances

Folks with chronic back pain often neglect the posterior chain (i.e. the muscles that run along the rear of the body from neck to ankles). This is especially true for gym rats who do too much bench pressing and not enough pulling or hip extension. This keeps back problems in full force (plus said gym rats end up looking like light bulbs).

Single leg exercises help develop the lower body and immediately challenge the lower back and hips, building stability and function. We tend to be weak and imbalanced on extension movements because we do them less.

Not moving

Doctors used to recommend bed rest for back pain. Now they usually recommend movement. And, as you can see from the list of muscle problems above, “too much sitting” factors into a host of back problems.

When we sit or lie around all day, intervertebral discs absorb fluid and become tighter, allowing less range of motion and promoting injury. Introduce yourself to regular movement (warm ups, yoga, and dynamic joint mobility, along with walking and swimming). These all help to preserve spinal health. See here:

All About Warming Up

All About Yoga

All About Dynamic Joint Mobility

Other common problems

“Spondylo”s

A collection of spinal dysfunctions known as the “spondys” can result from spinal fracture, overtraining, and/or over-extension/twisting of the spine. They’re common, for instance, in gymnasts and yogis who repeatedly bend backwards. They can also occur acutely in high-impact sports such as rugby.

• Spondylitis is an inflammation of the vertebrae.
• Spondylosis is osteoarthritic narrowing of the vertebral space.
• Spondylolysis is a fracture, usually a stress fracture, of the pars interarticularis. It can lead to a spondylolisthesis.
• Spondylolisthesis, which can occur after a spondylolysis, is the forward slippage of one vertebrae on another. Think of a stack of books in which one book is pushed forward.

Excessive flexion, extension and rotation are bad news for anyone with spondylo-situations. Work on building mobility of the hip flexors, hamstrings and ITB.

Prolapsed disc

This occurs when intervertebral disc material bulges from its normal confines. Minor tears to the outside of discs can lead to inner disc leakage.

The key is to never let the problem start. Translation: build core stability.

Treating and preventing spinal dysfunction

Get moving

As mentioned above, movement is good, and inactivity can cause/exacerbate back pain.

• Resistance training helps build strength and endurance in the supporting musculature, and help activate weaker or inhibited areas.
• Mobility training helps improve active flexibility in tight areas.
• The intervertebral discs lack blood vessels. The only way they can absorb nutrients is through spinal movement. If you want to deprive your discs of nourishment, lie down and sit around a lot.

But before you randomly start lifting, running, twisting and jumping, think WWDMD (What Would Dr. McGill Do)? Spine biomechanicist Dr. Stuart McGill encourages the following approach when it comes to exercise design:

1. Do necessary corrective exercises
2. Groove appropriate movement patterns
3. Build full body joint mobility/stability
4. Increase core endurance (rather than maximal strength)
5. Build full body strength
6. Develop speed, power, and agility

How many people do you know that start at #1?

Spines & squatting

Squatting with poor mechanics will result in injury.

Squatting with added weight puts compressive forces on the spine. Why don’t we see more spinal blowouts at the gym? Luckily, our spine can adapt to compressive tolerance. But our spines need time to adapt. Take your time and allow this adaptation. To assist the process, build up your paraspinal muscles with exercises involving spinal extension and stabilization.

Double check squat form:

• Take a wider stance (at least shoulder width – if not wider)
• Use natural foot positioning (similar to other athletic movements)
• Keep heels in contact with the floor
• Gaze forward or slightly up
• Maintain lordotic curve in lower back — don’t round
• If back squats don’t work, try front, zercher and goblet squats
• Focus on hip extension — drive from the glutes and hips.

Intra-abdominal pressure (IAP) can help to stabilize the spine during squats. Momentarily stopping the breath and stiffening the abs to make the spine go rigid (think of what you do when you sneeze, or when you know someone is about to punch you in the gut — if you make a little “ungh” sound, you’re probably doing it right) will generate IAP.

Stabilizing the cervical spine

Neck muscles work isometrically to stabilize the cervical spine. A stable cervical spine is critical for contact sports. Thus, folks with greater musculature in the neck and shoulders have a better chance of withstanding cervical impact.

Forcing the cervical spine into excessive flexion or extension with resistance can lead to breakdown of joints and discs.

To build the cervical spine, try incorporating the following exercises. Hold for 10 seconds each, and do 1-5 sets:

1. Isometric neck flexion (forwards)
2. Isometric neck extension (backwards)
3. Isometric lateral neck flexion (right and left)
4. Isometric neck rotation (right and left)

Mobility warmup

Here are some sample mobility drills that can keep the spine mobile yet stable in all the right places.

Cat/cow spinal warm up

Foam roll the thoracic region (from 1:30 to 2:10 in video)

Thoracic mobilization

T push up

Stretch hip flexors

Reverse bridge with back on Swiss ball (for intermediate and advanced folks, begin alternating legs “marching”)

Squat to stand with reach

Finishing with spinal health movements

To promote spinal health, add some of the following to the end of your workout

McGill curl-up

Stir the pot

Side bridge

Bird dog (move the leg and arm laterally to make it harder)

Pallof presses

TRX back saver (from 0:58 to 1:40 in video)

To promote spinal health, try the following between workouts.

Instead of bending at the lumbar spine to pick something up from the ground, try the golfers pick up (unilateral deadlift):

Instead of squatting to get down on the floor, try going into a lunge and keeping your spine neutral.

Mix in some yoga

Yoga may help improve posture through development of extensor muscles and thoracic mobility. Vinyasa yoga is likely the best option for back health due to its dynamic nature. Try to focus on a neutral spine when statically stretching.

Balance

Standing on an unstable surface (like a balance board) recruits stabilization musculature.

While on this surface, assume a position of slight knee and hip bend while contracting the lower torso muscles. Then flex your arms in an alternating fashion while maintaining position. Try this for 1 minute, 2-5 times through. If this doesn’t help your spine, at least you’ll now be known as the balancing flailing loser in your neighbourhood.

Source: Kolber MJ & Beekhuizen K. Lumbar stabilization: An evidence-based approach for the athlete with low back pain. Strength Cond J 2007;29:26-37.

Summary and recommendations

Spinal health comes from a complex interplay of mobility in some areas and stability-strength-endurance in others. Many muscle groups are related to spinal health — ensure that you aren’t prioritizing the “beach muscles” (aka chest and abs) over the more important structural supporters like spinal extensors and glutes/hips/hamstrings.

Sitting is bad news for your spine. Get up and move. If you’re always sitting around, take time to get up, walk, bike, and stretch. Do what feels good and listen to your body.

Extra credit

Between ages 7 and 17 years, the spine can increase in length by about 26%.

Only performing “aerobic” workouts doesn’t seem to build spinal stabilization.

Tightness in the ITB and piriformis can limit pelvic movement.

Spinal compression is high during situps.

Lumbar flexibility tends to increase throughout the day.

Lateral deviation of the spine is known as scoliosis (when viewed from the front/back).

Using a Bodyblade correctly can actually enhance core stability

Further resources

Dr. Stuart McGill and BackFitPro

Exercises for low back pain

Core values – Preventing back pain

References

Schoenfeld BJ. Squatting kinematics and kinetics and their application to exercise performance. J Strength Cond Res 2010;24:3497-3506.

Lee J, Brook S, Daniel C. Back Pain – the facts. 2009. Oxford University Press.

Manire JT, et al. Diurnal variation of hamstring and lumbar flexibility. J Strength Cond Res 2010;24:1464-1471.

Kell RT & Asmundson GJG. A comparison of two forms of periodized exercise rehabilitation programs in the management of chronic nonspecific low-back pain. J Strength Cond Res 2009;23:513-523.

Sauer S & Biancalana M. Trigger point therapy for low back pain. 2010. New Harbinger Publications.

Kolber MJ & Fiebert IM. Addressing flexibility of the rectus femoris in the athlete with low back pain. Strength Cond J 2005;27:66-73.

Howley ET & Franks BD. Health Fitness Instructor’s Handbook. 4^th Ed. 2003. Human Kinetics.

Lower Back Savers Part 1:

http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/lower_back_savers

Lower Back Savers Part 2:

http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/more_lower_back_savers

Lower Back Savers Part 3:

http://www.tmuscle.com/free_online_article/sports_body_training_performance_repair/bulletproof_that_back

Kollias H. Core Values: Preventing back pain. Precision Nutrition. http://www.precisionnutrition.com/core-and-back-pain

Durstine JL & Moore GE. ACSM’s exercise management for persons with chronic diseases and disabilities. 2^nd Ed. 2003. Human Kinetics.

Durall CJ & Manske RC. Avoiding lumbar spine injury during resistance training. Strength Cond J 2005;27:64-72.

Ashton-Miller JA & Schultz AB. Biomechanics of the human spine and trunk. Exerc Sport Sci Rev 1988;16:169-204.

McGill SM, et al. Exercises for the torso performed in a standing posture: spine and hip motion and motor patterns and spine load. J Strength Cond Res 2009;23:455-464.

McGill S. Core training: Evidence translating to better performance and injury prevention. Strength Cond J 2010;32:33-47.

McGill SM. Low back stability: From formal description to issues for performance and rehabilitation. Exerc Sport Sci Rev 2001;29:26-31.

Kolber MJ & Beekhuizen K. Lumbar stabilization: An evidence-based approach for the athlete with low back pain. Strength Cond J 2007;29:26-37.

Ross MD. Preventing low back pain with athlete education and the prone press-up exercise. Strength Cond J 2007;29:78-80.

Harper TD. Protecting the spine during static stretching. Strength Cond J 1997;19:52-53.

Robinson EM. Overtraining the rectus abdominis can make you less efficient in weightlifting. Strength Cond J 2010:32:59-65.

Dreisinger TE. Strength training and low back pain. Strength Cond J 2003;25:56-59.

Frounfelter G. Selected exercises for strengthening the cervical spine in adolescent rugby participants. Strength Cond J 2008;30:23-28.

Nau E, Hanney WJ & Kolber MJ. Spinal conditioning for athletes with lumbar spondylolysis and spondylolisthesis. Strength Cond J 2008;30:43-52.

Greendale GA, et al. Yoga for women with hyperkyphosis: results of a pilot study. Am J Public Health 2002;92:1611-1614.

Greendale GA, et al. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc 2009;57:1569-1579.

Jeng CM, et al. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study. Eur Spine J 2010 Aug 15 (epub)

Williams K, et al. Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 2009;34:2066-2076.

Tekur P, et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med 2008;14:637-644.

Imagine this:

You are a 35 year old man and your blood pressure is 120/80.

Congrats – your life expectancy is 76 years (assuming you are healthy otherwise).

Now imagine this:

You are a 35 year old man and your blood pressure is 150/91.

Bummer – your life expectancy is 55 years.

Might want to let your kids know about this.

What is high blood pressure?

Think of the water pipes in your house. The pressure in them allows water to flow to sinks, tubs, and washers. Similarly, we need pressure in our blood vessels so that blood can make its way to organs and tissues.

When you’re bumming around Walgreen’s late on a Saturday night and you decide to test your blood pressure, the result comes back as two numbers. The top number is the pressure in your arteries during a heartbeat. The bottom number is the pressure in your arteries while your heart is resting between beats.

How to interpret your blood pressure results

Our bodies can regulate blood pressure in various ways.

• Pressure receptors in organs adjust the force and speed of the heart’s contractions. For instance, when you go from lying down to standing, pressure receptors sense this and trigger a brief increase in heart rate to keep everything from sloshing into your feet.
• The kidneys and adrenal glands adjust components in blood that influence blood volume and fluid balance. Anti-diuretic hormone (ADH) decreases urine production. Aldosterone increases reabsorption of sodium (in exchange for potassium) from the urine, sweat, saliva, and intestinal secretions. This draws fluid back into your body and increases blood volume and blood pressure.
• Receptors in blood vessels adjust their size and elasticity.

Why is high blood pressure a problem?

Just like water pipes, if the pressure is too high or too low, you have problems. Imagine trying to use a garden hose to handle the pressure of a fire hose. That gives you an idea of what happens to your blood vessels.

If the pressure in your vessels is too high each time your heart contracts, damage can result.

• If this damage occurs to vessels of the eye, you could end up blind.
• If this damage occurs to vessels of the kidneys, you could end up on dialysis.
• If this damage occurs to vessels of the heart, you could end up with a heart attack.
• If this damage occurs to vessels of the brain, you could end up having a stroke or developing Alzheimer’s.
• If this damage occurs to vessels in the legs/arms, you could end up with peripheral vascular disease.

For each increment of 20 mm Hg (a measurement of blood pressure), cardiovascular disease risk doubles.

High blood pressure and preventable deaths

In 2005, 395,000 Americans died due to high blood pressure. In terms of individual risk factors for preventable health conditions, only smoking causes more deaths.

Preventable causes of death in the U.S. (Image source: Danaei G, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6:e10000058.)

High blood pressure doesn’t affect everyone equally. Your risk can also depend on your sex, age, and racial-ethnic background. For instance, women are more likely than men to suffer from high blood pressure if they are older.

Rates (% of each group) of high blood pressure, by sex and age (Source: Centers for Disease Control)

In the US, African Americans have far higher rates of high blood pressure than Mexican Americans or whites. Here again, women are slightly more likely to have high blood pressure… unless they are white.

Rates (%) of high blood pressure, by sex and racial-ethnic background (Source: Centers for Disease Control)

How to get high blood pressure under control

It’s pretty clear that high blood pressure is not only a health risk in and of itself, but it also signals the presence of other underlying health problems.

If you’re American, about 1 in 3 of you has high blood pressure. But you feel fine? That’s because high blood pressure doesn’t have any symptoms. You could be at risk without knowing it.

So let’s talk about controlling it. Luckily, the things that control blood pressure also keep you lean and fit. It’s win-win!

Lose body fat (or stay lean)

Rule #1 for controlling blood pressure is stay lean. Extra fat on the body needs extra blood vessels. And fat cells produce substances that promote inflammation throughout the vessels and heart. Use the eyeball test here. If you look fat, you are fat.

Move your body

Bad news – if you don’t regularly move your body, your risk of high blood pressure can go up by 60%. Any type of regular physical movement is helpful here (except moving your hand from the bag of chips to your mouth). Exercise seems to be even more important for men.

Doing structured workouts can be especially effective in helping to lower existing high blood pressure. We’re talking at least 5 hours of exercise per week. And (up to a point) more is likely better. Just because you clean up the bats for the company softball team doesn’t mean you are moving your body enough to control blood pressure — check yourself.

All forms of exercise are useful here (including short bouts, long bouts, and resistance training).

Intense exercise could be one of the best "preventive blood pressure medications" you can take

However, if you already suffer from high blood pressure, use caution: Maximal resistance training and using the Valsalva maneuver can bump up blood pressure during lifting. If blood pressure is a concern for you, opt for shorter sets with longer rests, and watch your heart rate between sets. (Maybe squat only six plates instead of eight.)

Exercise helps to control insulin levels. Less insulin means less sympathetic nervous system activation, less sodium reabsorption in the kidneys, and more elasticity in blood vessels. Exercise also makes your heart more efficient.

Exercise alone can lower blood pressure by nearly 4 mm Hg (even without any concurrent weight loss). A 5 mm Hg reduction in systolic BP can mean a 7% reduction in all-cause mortality. That’s a good first step.

Dump the boozing and smoking

Alcohol has a somewhat contradictory relationship with blood pressure. A little of the right type, enjoyed slowly and socially with a good meal, seems to help. About one alcoholic beverage per day — especially red wine — can lower blood pressure slightly (especially in women).

However, more is not better. Lots of booze leads to lots of blood pressure.

And if you guessed that binge drinking on an empty stomach might not help control blood pressure, you are correct. High alcohol intake can:

• activate the sympathetic nervous system
• activate the renin-angiotensin-aldosterone system (which controls fluid levels in the body)
• increase levels of stress hormones such as cortisol
• decrease production of nitric oxide (which normally helps relax blood vessels, so if you have less nitric oxide, your blood vessels are going to be as pliable as frozen rubber)

These are all bad things for controlling blood pressure.

We all know smoking is bad. Smoking increases blood pressure, so you might want to find a new hobby.

Improve your nutrition

Diets built around whole, unprocessed plant foods can help control blood pressure. People with existing high blood pressure who add more plants to their diets can lower blood pressure into a healthy range — even if they don’t lose weight.

Eating more plants improves your intake of arginine, lycopene, folate, fibre, magnesium, potassium, sulfur, and vitamins C and E. All of these nutrients play a role in controlling blood pressure.

But wait a second, what if someone just consumed a Western diet while supplementing the aforementioned nutrients? Well, this might help a smidge, but not enough to impress your blood vessels.

Here are 8 important dietary changes you can make to lower your blood pressure.

1. Consume 1-2 servings of lower fat dairy each day.

Higher fat dairy doesn’t seem to have the same effect. Some studies suggest that dairy might help to moderate insulin levels, although the evidence is mixed — other studies have shown that dairy can be insulin-stimulating. Additionally, research suggests that peptides released with cow’s milk can inhibit angiotensin converting (ACE) enzyme, while a clinical trial showed that hydrolysate of casein lowered arterial blood pressure.

2. Get plenty of lean protein.

Protein dense foods help control insulin release. Plant proteins like beans/legumes are also good substitutes for more refined carbohydrates.

3. Consume at least 3 servings of intact whole grains each day.

This means whole grains such as brown rice, whole oat groats, sprouted grain bread, quinoa, etc. Whole grains can improve blood vessel elasticity.

4. Consume 10-30 grams/day of dark chocolate.

Compounds in cocoa may help blood vessel elasticity. Plus, it makes you feel groovy, and reducing stress is a great way to lower blood pressure!

5. Get enough vitamin D.

Vitamin D deficiency is associated with high blood pressure. Get blood levels tested and supplement if necessary. And get outside for some sunlight, cubicle moles! See All About Vitamin D for more.

6. Balance your fat intake.

Get plenty of omega-3s from oily fish (and other marine life), wild-caught game meats, and flax (ALA, EPA and DHA all seem to help – see here for more: All About Healthy Fats). High omega-3 intake is linked to lower blood pressure, likely because of omega-3s influence on eicosanoid production, which helps control vessel dilation and platelet aggregation.

7. Cut the sugar.

Americans eat about 22 teaspoons of added sugar per day, which might be contributing to our rampant high blood pressure. Excess sugar can make us fat, which can lead to high blood pressure.

And eating lots of added sugars may also activate the sympathetic nervous system, decrease urinary sodium excretion, increase sodium absorption in the GI tract, and decrease blood vessel nitric oxide. Not good.

8. Supplement wisely — once your diet is excellent.

Once you have everything else under control, you can look into supplementing things like Coenzyme Q10 and/or garlic.

Cut sodium intake…

It’s well established that dietary salt plays a role in regulating blood pressure. More sodium means higher blood pressure; conversely, lowering sodium lowers blood pressure too.

But don’t fear sprinkling a little salt into your homemade lentil soup. When we talk about over-salted Americans, we’re talking about processed foods and restaurants. About 80% of the sodium we consume comes from processed foods.

Going from standard salt-laden American eating (about 6,000 mg of sodium per day) to consuming under 2300 mg of sodium per day can lower blood pressure 10 points in hypertensive folks, without any other changes.

…but not too much

We need some sodium, especially if we’re active. We need at least half a teaspoon of salt each day for normal functioning. If you are really fit and lean, you can get by with about 1 teaspoon of daily added salt.

Cutting salt too much when you don’t need to isn’t a good idea. If you exercise and sweat a lot, you need more. And folks getting restrictive with salt intake are at risk for iodine deficiency. For more on sodium, see All About Sodium.

Many folks get hyper-focused on salt when it comes to blood pressure. But we all respond to it differently. A high salt intake is usually just a symptom of a crappy overall diet – too many processed foods, sugar, dairy, meat – and not enough vegetables, fruits, beans, whole grains and nuts/seeds (potassium from plant foods helps to balance the effects of sodium and keep blood pressure in check).

Yoga, meditation and stress

If you’re always stressed, your blood pressure is probably elevated.

Deep breathing, yoga, and meditation can immediately lower blood pressure by several points. But it’s not enough to be stressed out all week and hit a Sunday yoga class. You need to relax more overall. Five minutes of deep breathing can only do so much when the other 10,075 minutes in your week are hectic.

So make it a priority to chill out. Pet a dog, see a therapist, take a nature walk, meditate, listen to music, do yoga, see a comedian, or anything else that helps you get mellow. Your health may depend on it.

Summary and recommendations

Blood pressure can almost always be controlled with lifestyle changes. Just remember, small changes = small results. Big changes = big results.

• Stay lean. If you look fat, you are fat.
• Get 5 hours/week of exercise. At least some of it should be vigorous.
• Move around during the day. Use your body to get places.
• If you drink alcohol, keep it around one drink per day. Wine is best, and try to consume it with meals.
• Don’t smoke.
• When you sit down to eat, make sure that most of your plate/bowl is filled with vegetables, fruits, beans/peas, intact whole grains, and nuts/seeds. Including small amounts of lower fat dairy and dark chocolate each day might help.
• If you regularly eat added sugars and salt, your diet probably sucks. Cut them where you can and replace with veggies or fruits.
• Consume oily fish and other marine life. Mix in some flax seeds, hemp seeds, chia seeds or walnuts to get your dietary omega-3’s.
• If you are vitamin D deficient, use a supplement. Get outside in the sun.
• Bust stress. Do yoga, breathe deeply, connect with loved ones, laugh.

Extra credit

Lots of caffeine can bump up blood pressure. Though tea and coffee have mixed results on blood pressure (probably due to genetic differences in caffeine metabolism), you don’t need to chug them anyway.

Different types of religious fasts seem to have variable effects on blood pressure. No style of fasting appears to have a clear benefit.

Binge drinking increases both systolic and diastolic blood pressure by about 5 mm Hg during the time of intoxication.

Systolic blood pressure readings in excess of 300 mm Hg have been recorded during the leg press. In the 1-3 hours after exercise, systolic blood pressure tends to decrease by 10-20 mm Hg. This can last up to 9 hours. So if you’ve ever stood up too fast after a set of heavy squats or while cooling down from a workout and felt dizzy/saw floaters, then you’ve experienced this.

Early AM hours and cold weather can result in a higher blood pressure.

Certain medications can raise blood pressure – check with your doc.

The blood pressure levels of purely vegetarian Trappist monks were found to be lower than those of Benedictine monks, who consume a Western diet.

Adding more meat to a plant-based diet increases blood pressure, possibly from the “substitution effect” (swapping out blood pressure lowering plant foods).

References

Elmer PJ, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006;144:485-495.

He FJ & MacGregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2004(3):CD004937.

He FJ, Markandu ND, MacGregor GA. Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension. Hypertension 2005;46:66-70.

Dumler F. Dietary sodium intake and arterial blood pressure. J Ren Nutr 2009;19:57-60.

Craig WJ, Mangels AR: American Dietetic Association. Position of the American Dietetic association: vegetarian diets. J Am Diet Assoc 2009;109:1266-1282.

Al-Solaiman Y, et al. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Hum Hypertens 2010;4:237-246.

Berkow SE & Barnard ND. Blood pressure regulation and vegetarian diets. Nutr Rev 2005;63:1-8.

Suter PM, et al. Nutritional factors in the control of blood pressure and hypertension. Nutr Clin Care 2002;5:9-19.

Miura K, et al. Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004;159:572-580.

Steffen LM, et al. Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005;82:1169-1177.

Djousse L, et al. Dietary linolenic acid is associated with a lower prevalence of hypertension in the NHLBI Family Heart Study. Hypertension 2005;45:368-373.

Djousse L, et al. Influence of saturated fat and linolenic acid on the association between intake of dairy products and blood pressure. Hypertension 2006;48:335-341.

Malinski MK, et al. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Arch Intern Med 2004;164:623–628.

Taylor B, et al. Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction 2009;104:1981-1990.

Alkerwi A, et al. Alcohol consumption and the prevalence of metabolic syndrome: a meta-analysis of observational studies. Atherosclerosis 2009;204:624-635.

Sesso HD, et al. Alcohol consumption and the risk of hypertension in women and men. Hypertension 2008;51:1080-1087.

Field AE, et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001;161:1581-1586.

Hernelahti M et al. Stability and change of volume and intensity of physical activity as predictors of hypertension. Scand J Public Health 2004;32:303-309.

Barengo NC, et al. Low physical activity as a predictor for antihypertensive drug treatment in 24-64-year-old populations in eastern and south-western Finland. J Hypertens 2005;23:293-299.

Nakanishi N & Suzuki K. Daily life activity and the risk of developing hypertension in middle-aged Japanese men. Arch Intern Med 2005;165:214-220.

Madero M, et al. Dietary fructose and hypertension. Curr Hypertens Rep 2010 Oct 19 (epub ahead of print)

Trepanowski JF & Bloomer RJ. The impact of religious fasting on human health. Nutr J 2010;9:57.

Nguyen S & Lustig RH. Just a spoonful of sugar helps the blood pressure go up. Expert Rev Cardiovasc Ther 2010;11:1497-1499.

Kowalski RE. The Blood Pressure Cure. 2007. John Wiley & Sons, Inc. New Jersey.

Appel LJ, et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 2005;294:2455-2464.

Tayie FA & Jourdan K. Hypertension, dietary salt restriction, and iodine deficiency among adults. Am J Hypertens 2010;23:1095-1102.

Danaei G, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6:e10000058.

Tighe P, et al. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr 2010;92:733-740.

Gorden-Larsen P, et al. Active commuting and cardiovascular disease risk: the CARDIA study. Arch Intern Med 2009;169:1216-1223.

von Huth Smith L, et al. Commuting physical activity is favourably associated with biological risk factors for cardiovascular disease. Eur J Epidemiol 2007;22:771-779.

Houston M, Fox B, Taylor N. What your doctor may not tell you about hypertension. 2003. Warner Books. New York.

Brewer S. Overcoming high blood pressure. 2008. Duncan Baird Publishers. London.

Saptharishi L, et al. Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults. Indian J Community Med 2009;34:329-334.

Singh S, et al. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India 2004;48:461–465.

Schwickert M, et al. Stress management in the treatment of arterial hypertension. MMW Fortschr Med 2006;148:40–42.

Aivazyan TA, et al. Efficacy of relaxation techniques in hypertensive patients. Health Psychol 1988;7:193–200.

Damodaran A, et al. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. J Assoc Physicians India 2002;50:633-640.

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Rainforth MV, et al. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep 2007;9:520-528.

Nidich SI, et al. a randomized controlled trial on effects of the Transcendental Meditation program on blood pressure, psychological distress, and coping in young adults. Am J Hypertens 2009;22:1326-1331.

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Taubert D, et al. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 2007;167:626-634.

Geleijnse JM. Habitual coffee consumption and blood pressure: an epidemiological perspective. Vasc Health Risk Manag 2008;4:963-970.

Higdon JV & Frei B. Coffee and health: a review of recent human research. Crit Rev Food Sci Nutr 2006;46:101-123.

Disclaimer: This article deals with an alternative health therapy that developed from Eastern medicine philosophies. I’ll do my best to explain the original Eastern understanding of acupuncture while also reviewing the latest science.

What is acupuncture?

Acupuncture originated in China nearly 2500 years ago as a holistic therapy meant to treat the whole patient rather than a specific condition. The earliest acupuncture tools were sharp pieces of stone, flint, bones or bamboo.

While it’s become one of the most popular complementary therapies worldwide, it didn’t gain popularity in the West until the 1970s.

How is acupuncture performed?

Acupuncture involves puncturing the skin with a needle, but can include other types of stimulation to the epidermis. Modern acupuncture can also include electrostimulation through the inserted needles. The purpose of needle insertion is to alter the flow of Chi (or Qi) through body meridians. (More on Chi below.)

When needles are used as a method of treatment, they vary in size and length. Most are about one inch long. Needles up to three inches long can be used in fleshy areas like the glutes. To lower disease transmission, one-time disposable needles should be used.

Needle insertion can be just under the skin or into the muscle and can produce a mild ache or sense of heaviness, but is rarely sharply painful. Needles are usually left in place for 15 to 30 minutes. Between six and eight treatments might be required to detect any results, although patients may notice some immediate effects.

Balancing Chi

In traditional Chinese medicine (TCM), the normal flow of body energies or life force is called Chi (or Qi), and it’s in a constant state of flux. It’s thought that Chi circulates through meridians (energy pathways), just as blood circulates through vessels.

Unlike modern Western medicine, which focuses on “curing” disease symptoms, traditional Chinese medicine focuses on achieving a dynamic balance between the various elements that make up each person. Traditional practitioners claim that when Chi is out of balance, illness results. It’s been said that humans are born with a certain allotment of Chi, which we replenish with food and air.

TCM practitioners also look at the opposing but complementary forces of yin and yang. Yin pertains to cold, slow, dark, and quiet; it’s sometimes viewed as a “feminine” energy. Yang is hot, fast, bright, and loud; it’s sometimes viewed as a “masculine” energy.

According to TCM, yin and yang must be balanced to maintain optimal health. Chi can be bi-directional according to the yin or yang energy — for instance, raising or lowering blood pressure; increasing or decreasing gastric secretions, etc. It’s thought that acupuncture promotes this balance by using the body meridians through which Chi flows. There are 12 pairs of meridians associated with organs, joints and extremities. There is no known evidence for physical existence of these meridians.

Image source: Berman B, et al. Acupuncture for chronic low back pain. NEJM 2010;363:454-461.

Each meridian has five acupuncture points related to the five Chinese elements – earth, wood, water, metal and fire (not related to the periodic table of elements).

It’s thought that needling the meridian can improve the condition of the associated organ. Some of the meridian relationships are apparent, like the bladder relating to water. But some aren’t, like wood relating to the liver.

Harmful Chi is thought to contribute to illness and can arise from internal and external sources. Examples include wind, cold, heat, wetness, dryness, joy, anger, melancholy, obsessions, grief, fear, fright, irregular eating, excessive stress, lack of exercise, and trauma.

The flow of Chi is controlled by a biological clock allowing practitioners to assess the timing of symptoms (along with the actual symptoms) to get an idea of the organ affected. For example, if someone had a cough, asthma or tightness in the chest, it may be due to an excess or deficiency of lung meridian Chi, especially if the symptoms are noticed early in the morning when the lung meridian has a surge of energy.

Also, the pulse and tongue are checked by the acupuncturist to diagnose the flow of Chi and organ status.

Modern Western medicine’s interpretation

Modern medicine has proposed 5 interacting explanations for how acupuncture works.

1 – Local

Acupuncture may stimulate nerve fibers in the skin and muscles, triggering action potentials and the release of substances that can dilate vessels (increasing local blood flow). This may help to encourage tissue healing.

Source: Wang GJ, et al. Meridian studies in China: A Systematic Review. J Acupunc Meridian Stud 2010;3:1-9.

2 – Segmental

The action potentials that are triggered by the needle insertion can travel along the nerve and depress responses to painful stimulus, in part due to enkephalin release. This is likely the reason for pain relief. And when it comes to pain relief, some data indicate acupuncture can be as effective as morphine!

3 – Extrasegmental

Action potentials can go a long way. They can make their way up to the brain and stimulate the body’s pain-suppressing operations, in part due to endorphin release. This result doesn’t depend so much on needling specific areas of the body, rather, just getting enough nerve stimulation.

4 – Central regulatory

The hypothalamus and limbic system can be stimulated by acupuncture, which may have an overall calming effect and regulate the autonomic nervous system.

5 – Myofascial trigger points

We hear about myofascial release using foam rollers and tennis balls, but acupuncture can influence the fascia too. Small knots can form in tight muscles with repetitive use or injury. These knots might act as protective mechanisms ensuring the muscle rests/recovers, or it might just be a healing malfunction in the body. Either way, fascial knots are sensitive and acupuncture can help in their release. Moving the muscle through a full range of motion after treatment may assist in recovery.

The clinical data

Acupuncture sounds great – but isn’t it all just anecdotes? Is any of this legit science?

Evidence from clinical trials indicates that acupuncture isn’t just a placebo effect. Still, rigorous trials are difficult since it’s hard to mimic a needle or perform a “sham” puncture in blind studies, especially in cultures familiar with the practice.

Clinical research suggests that acupuncture is helpful for:

• Relief of nausea and vomiting
• Relief of back pain
• Relief of chronic knee pain
• Relief of post-operative dental pain

Beyond these areas, research hasn’t been accomplished, isn’t conclusive, or has shown no effect.

Data indicates that acupuncture is safe when a skilled practitioner is performing the treatment. Mild adverse events might include bleeding and drowsiness. Significant events are uncommon but might include infections, nerve/vessel injury, exacerbations of asthma, and seizure. All treatments should be performed lying down, due to the potential of fainting. Always avoid the use of embedded needles and self-acupuncture.

My acupuncture experience

While researching this article, I figured I should experience the world of acupuncture. Since I currently don’t have any illnesses or complaints, I requested a “general health” session, focusing on tendonitis (medial elbow) and cold hands (since I maintain a lean body year round, I’ve noticed colder extremities).

The practitioner showed me the needles (36 gauge, single-use disposable), explained her procedure, examined my pulse and tongue, and then moved forward with needle insertion.

She inserted one needle in each foot, two needles in each calf, two needles in my upper abdomen, one needle by each thumb, and one needle inside each elbow. Oh – and one needle in my forehead for relaxation.

I definitely felt all the punctures, and the needles on the right side of my abdomen, thumb, and calf resulted in some sharp and lingering pains. The practitioner told me this was Chi. I think it was my nerve endings.

After all the needles were inserted the practitioner told me to relax and take myself to a calm place. She turned off the lights and then left for about 12 minutes.

I wasn’t very relaxed because I didn’t want to move my body and bump a needle insertion. Also, my scalp started itching and I couldn’t itch it because I didn’t want to jam a needle into my head.

Let me be straight — I’m fine with needles. I donate blood, I’ve been certified in venipuncture, and I’ve even injected myself with veterinary vitamins when I was bodybuilding (don’t ask about it and don’t try it). But something about multiple small needles in my body at one time didn’t go very well. If you don’t like needles, you probably won’t like acupuncture.

When the practitioner returned, she explained that it can take up to 12 treatments to notice relief, depending on the ailment being addressed. She said my flow of Chi, pulse, and tongue were excellent. That’s always nice to hear.

I had very minimal bleeding at two of the insertion sites and there was some lingering dull pain in my calf, thumb and abdomen after leaving.

Keep in mind that I completed the acupuncture treatment for “general health,” and I don’t think the potential benefits outweighed the discomfort and cost ($75 for 90 minutes). I probably wouldn’t pursue acupuncture again unless I had a specific health concern.

Summary and recommendations

It’s difficult to draw strong conclusions since the acupuncture experience tends to be governed by social and psychological factors.

Acupuncture might be useful for the relief of nausea and vomiting, and some forms of pain relief. The effects seem to take place locally, along nerve segments, centrally, and at fascial trigger points.

Acupuncture does appear to be safe when working with an experienced practitioner. If you seek treatment, make sure to find a legit professional, see here for more: nccaom.org

Extra credit

Tattoo marks found on prehistoric human remains may have had a medical purpose similar to acupuncture. This was discovered around 3300 BC.

An unhealthy tongue can indicate buildup of harmful Chi.

One of the most respected medical universities in Canada, McMaster University, also offers a medical acupuncture program.

Semi-permanent acupuncture needles placed into the rim of the ear (see image below) have been used in the military to decrease pain.

Image source: Ambron T. The ancient art of acupuncture is new again. JAAPA 2010;23:51-52.

Further resources

More on the Chinese elements

References

World Health Organization. Acupuncture: review and analysis of reports on controlled clinical trials. Geneva. 2002.

Kidson RL. Is acupuncture right for you? Healing Arts Press. 2008.

White A, Cummings M, Filshie J. An introduction to western medical acupuncture. Churchill Livingstone Elsevier. 2008.

Miyamoto S, et al. Risks and causes of cervical cord and medulla oblongata injuries due to acupuncture. World Neurosur 2010;73:735-741.

Wang T, et al. A systematic review of acupuncture and moxibustion treatment for chronic fatigue syndrome in China. Am J Chin Med 2008;36:1-24.

Cheuk DK, et al. Acupuncture for insomnia. Cochrane Database Syst Rev 2007;3:CD005472.

Green S, et al. Acupuncture for lateral elbow pain. Cochrane Database Syst Rev 2002;1:CD003527.

Green S, et al. Acupuncture for shoulder pain. Cochrane Database Syst Rev 2005;2:CD005319.

Cheuk DK & Wong V. Acupuncture for epilepsy. Cochrane Database Syst Rev 2006;2:CD005062.

La Touche R, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain 2010;26:541-550.

Cho SH, et al. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond) 2009;33:183-196.

Trigkilidas D. Acupuncture therapy for chronic lower back pain: a systematic review. Ann R Coll Surg Engl 2010;92:595-598.

Cho SH, et al. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117:907-920.

Cho SH & Kim J. Efficacy of acupuncture in management of premenstrual syndrome: a systematic review. Complement Ther Med 2010;18:104-111.

Ambron T. The ancient art of acupuncture is new again. JAAPA 2010;23:51-52.

Berman B, et al. Acupuncture for chronic low back pain. NEJM 2010;363:454-461.

Wang GJ, et al. Meridian studies in China: A Systematic Review. J Acupunc Meridian Stud 2010;3:1-9.

I don’t know about you, but ever since I swallowed my first Flintstones’ chewable, I envisioned vitamin supplements coming from a magical fairyland where wizards would squeeze all the nutrients from whole vegetables and fruits. Do you have these visions too?

How vitamins are made (by Ryan, age 8)

People that use vitamin supplements likely start with good intentions. But where do these products actually come from? Are vitamin supplements any more natural than white flour or pharmaceuticals?

Where do vitamin supplements come from?

When people think of drugs, most think “artificial.” When people think of vitamin supplements, most think “natural.”

But both drugs and vitamin supplements can be artificial or natural. Many vitamin supplements produced today are artificial. Meanwhile, the world of “natural” isn’t all hopscotch tournaments and fairy dances. Poison hemlock, hallucinogenic mushrooms, rhubarb leaves and sprouted kidney beans are all natural – and potentially deadly.

There are six categories of nutrients used in the manufacturing of vitamin supplements.

1. Natural source

These include nutrients from vegetable, animal or mineral sources. But before making it into the supplement bottle, they undergo significant processing and refining. Examples include vitamin D from fish liver oils, vitamin E from vegetable oils, and natural beta-carotene.

When a vitamin is marked “natural”, it only has to include 10% of actual natural plant-derived ingredients. The other 90% could be synthetic.

Consider vitamin E tocopherols, which can be extracted from vegetable oils (often soybean, due to low costs).

1. First, the soybeans are crushed and the protein is removed by precipitation.
2. Second, the resultant oil is distilled off to become bottled vegetable oil.
3. Third, the remaining materials are solubilized to remove any carbohydrates.
4. Fourth, the vitamin E is solvent extracted away from the remaining waxes and lecithin.

Synthetic alpha-tocopherol is a combination of eight isomers, natural alpha-tocopherol is just one isomer, and consuming various isomers can decrease bioavailability.

Natural vitamin E - notice the D-alpha tocopherol

Synthetic vitamin E (notice the dl-alpha)

Another example is vitamin D3. The manufacturing starts with 7-dehydrocholesterol (usually from wool oil), which turns into cholecalciferol (vitamin D3) when exposed to ultraviolet light.

2. Nature-identical synthetic

This includes nutrients completely manufactured in a lab with the molecular structure identical to the same nutrients occurring in nature. Manufacturers often prefer this process because of the cost and scarcity of natural resources. Most standard vitamin supplements on the market today are this type.

An example here would be vitamin C. Most vitamin C currently manufactured is synthetic, coming from China. Vitamin C is a weak acid. Many supplements use salt forms (sodium ascorbate, calcium ascorbate, magnesium ascorbate) to decrease acidity.

The most popular form of synthetic vitamin C is ascorbic acid. Naturally occurring vitamin C is the same molecule as synthetic ascorbic acid. But in food, ascorbic acid is found within the vitamin C complex among other compounds. The ascorbic acid in supplements is often derived from corn starch, corn sugar, or rice starch, and is chemically dependent upon volatile acids.

The method for vitamin C synthesis using two-step fermentation was developed by China in the 1960s:

Ascorbic acid production. From: Vandamme EJ. Production of vitamins, coenzymes and related biochemicals by biotechnological processes. J Chem Tech Biotechnol 1992;53:313-327.

3. Strictly synthetic

Centrum is strictly synthetic

These nutrients are manufactured in a lab and are different than the same nutrients found in nature. Synthetic vitamins can have the same chemical constituents, but still have a different shape (optical activity).

This is important because some of the enzymes in the human body only work properly with a vitamin of the correct shape. When we give the body concentrated forms of synthetic nutrients, it doesn’t always appear to have an appropriate delivery system.

Starting materials for strictly synthetic supplements can be anything from coal tar to petroleum to acetylene gas. These supplements are made in facilities via chemical manipulations with the goal of duplicating the structure of the isolated vitamin. Specific formulas for the process aren’t made available to the public (sorry, I tried).

An example is vitamin B1. Coal tar is a widely used foundational substance for this vitamin — typically a crystalline yellow coal tar (yes, this means it’s from coal, a fossil fuel). Hydrochloric acid is often added to allow precipitation. Then fermentation, heating, cooling, and other steps are completed until a final synthetic vitamin is created. It’s then dried and tested for purity before being shipped to distributors.

Now, to get a natural vitamin B1 supplement the process is quite different.

The food or botanical containing the desired vitamin is harvested and cleaned (let’s say wheat germ). It’s then placed in a vat to be mixed with water and filtered to create an extract and remove fibre (unlike in whole foods, where you want fibre). The post-filtration extract of the sourced food contains the nutrients found in the original whole food. It’s then dried and ready for packaging.

4. Food cultured

Example of a “whole food” labeled supplement

This involves the same process behind cultured foods like yogurt, kefir, miso, and sauerkraut. Nutrient supplements are often grown in yeast or algae. Culturing in and of itself creates nutrients and can make them more bioavailable.

Raw materials (minerals and some synthetic nutrients) are added to yeast/algae suspensions where they concentrate within cells. The yeast/algae are then harvested, ruptured, and made into a vitamin supplement. The theory here is that yeast/algae contain the nutrients they’re fed in a whole food complex.

Sometimes food cultured vitamins are combined with synthetic vitamins to increase potency (i.e., to bump up the milligram/microgram count on the label), since most have a low potency on their own. Remember, counting the milligrams of a synthetic vitamin might not be comparable to what’s found in whole foods.

5. Food based

One kind of food based supplement is made by enzymatically reacting synthetic and natural vitamins with extracts containing vegetable proteins and then making this into a supplement. This is not food cultured, because the nutrients are not grown into a whole food, as in the yeast/algae suspensions.

Manufacturers don’t often use concentrates or extracts derived from whole food sources because of low nutrient potency, fluctuating nutrient levels, limited shelf life. Nutrients are easily degraded by heat, pH changes, light, and oxygen.

Food based form of vitamin C

6. Bacterial fermentation

This includes nutrients produced by genetically altering bacteria. Genetically altered bacteria can produce nutrient by-products.

Examples include CoQ10, amino acids, ergocalciferol (vitamin D2), menaquinone (vitamin K2), riboflavin (fermentation of ribose), cyancobalamin (vitamin B12; this is exclusively obtained via fermentation processes, as the naturally occurring source of B12 is bacterial metabolic activity, think animal tissues/meat carrying bacteria), and melatonin.

For instance, vitamin D2 is made by artificially irradiating fungus. It’s not a naturally occurring form of vitamin D. The starting material is ergosterol, a type of plant sterol derived from fungal cell membranes. Ergosterol is turned into viosterol by ultraviolet light, and then converted into ergocalciferol (vitamin D2).

What you should know about vitamin supplements

Full scale vitamin production started during the 1930s with widespread distribution after World War II. Now, about 1/3 of Americans use vitamin supplements.

Nutrients from food?

Most people are interested in vitamin supplements because they fear they don’t enough nutrients from food.

This is a worthwhile concern: nutrients can be lost from soil due to fertilizers, pesticides, herbicides, irrigation, farming practices, and other causes. The USDA has reported that the nutrient content of vegetables has fallen since 1973. Of the vitamins we do ingest from whole food, absorption can range from 20 to 98%.

Do vitamin supplements prevent disease?

A 2002 study in JAMA concluded that adults would be better off taking a multivitamin supplement each day. The authors didn’t specify synthetic or natural. Other reviews have concluded that beyond treatment of deficiency, vitamin supplements don’t promote health or prevent cardiovascular disease and cancer.

Data indicates that vitamin supplements can actually lead to more cancer (specifically breast and prostate), cardiovascular disease, kidney damage (in those with diabetes), and fractures, while not helping prevent infections and sick days.

However, it’s important to remember that chances of certain chronic diseases can increase for those who are deficient in certain micronutrients.

The American Dietetic Association (ADA) recommends that the best nutritional strategy for optimal health and reducing the risk of chronic disease is to choose a wide variety of whole foods.

Other vitamin sources

Even if you aren’t popping vitamin supplements each day, if you consume fortified foods (think cereals, milks, breads, meal replacement shakes, etc.), it’s nearly impossible to avoid synthetic vitamins.

A report from the National Institutes of Health noted that individuals who consume high dose single nutrient supplements and fortified foods along with multivitamin/mineral supplements are at risk for undesirable effects.

Notice the synthetic vitamins added to Corn Flakes and Special K. Check out the ingredient listing.

Added vitamins and minerals in Special K and Corn Flakes.

What do supplement companies say?

Good question. I got busy with the phone and email to find out.

I called Centrum. They don’t have any information on where the nutrients in their products come from. They told me that their “vitamins are synthetic and the minerals are derived from natural sources.”

I called Bayer (the maker of Flintstone’s Vitamins) two times. They didn’t provide any response about where their vitamin supplements are derived.

I emailed CSPI. They said “most” vitamin supplements on the market are synthetic.

I emailed Vitamin Cottage. They believe that coal tar should not be a source for vitamin supplements since there are other non-petroleum materials that can be used. They also indicated that none of their vendors have C or B vitamins derived from coal.

I emailed Nature Made about vitamin B-1. They said: “We appreciate your questions concerning our supplements. Nature Made Vitamin B-1 is manufactured in a laboratory from chemicals. It is synthetically made in our manufacturing facilities in Southern California.”

I emailed GNC. They said: “GNC purchases vitamins, herbs, minerals, and other dietary ingredients from domestic suppliers as well as suppliers in many other countries from around the world. This will vary by ingredient.”

Summary and recommendations

With all of the data regarding nutrition and optimal health, the most convincing information tells us to focus on what we eat — not what we get from a pill bottle.

Synthetic vitamin supplements are isolated man-made chemical compounds, and appear to be in the same class as other synthetic pharmaceuticals.

Some supplements hold real benefit. For instance:

• folic acid for pregnant women
• iron for those who are anemic
• B-vitamins for those dealing with alcoholism
• vitamin D for those who’ve undergone bariatric surgery
• vitamin C for someone with scurvy

But in a situation where it’s possible to get nutrients from whole foods, choosing a supplement instead doesn’t seem to promote health, and taking supplements may actually cause harm.

The conclusion of an NIH State-of-the-Science conference in 2006:

“The present evidence is insufficient to recommend either for or against the use of MVMs [multivitamins/minerals] by the American public to prevent chronic disease.”

If you want to find a natural vitamin supplement, look for one with a label that indicates “naturally occurring food sources.” If the potency of the vitamin is higher than anything you would find in nature (e.g., 1000% vitamin B-3 per serving), the product likely contains synthetic ingredients.

To find out where your vitamin supplements come from, contact the company directly. A non-response or a generic response can go a long way in telling you what you’re getting.

Extra credit

Fortification of foods with vitamin B-3 has lead to intakes greater than twice what’s recommended, most notably in kids, who eat processed fortified foods. This higher intake of vitamin B-3 might lead to increased appetite and impaired glucose tolerance.

Capsules that enclose vitamin supplements can be derived from plant sources, like seaweeds, or animal sources like gelatin. Animal gelatin is from tallow, animal bone, marrow, or tissue scraps, and may include diseased tissues.

The tablet coating methylene chloride is a carcinogen.

Food color additives are often used in children’s vitamins. See All About Food Colour Additives for more.

The Dietary Reference Intakes (DRIs) are based on synthetic vitamins. We don’t fully understand how they translate to whole food alternatives.

Some manufacturers are currently trying to make an ergosterol precursor (cholestatetraenol) produced by yeast fermentation.

If you are interested in avoiding supplement contaminants, look for the NSF logo.

In North America, a majority of the raw materials for synthetic vitamin supplements are from the following companies:

• Arnet Pharmaceuticals Corporation – Davie, FL
• Botanical Laboratories, Incorporated – Ferndale, WA
• Contract Pharmacal Corporation – Hauppauge, NY
• Leiner Health Products Incorporated – Carson, CA
• Perrigo Company – Allegan, MI

I contacted all of these companies and got no response.

Further resources

New Chapter Organics, makers of food based vitamin supplements

All about Nutrient Deficiencies

All about Vitamins and Minerals

Infographic – scientific evidence for popular health supplements

Deciphering synthetic vs. natural supplement labels

References

United States National Library of Medicine. TOXNET.

Roan S. The dirt on dietary supplements. 2009.

Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev 2008;3:CD004183.

Bjelakovic G, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2008;2:CD007176.

Bjelakovic G, et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842-857.

Sesso HD, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2008;300:2123-2133.

Bolland MJ, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691.

Epstein D & Dohrmann G. What you don’t know might kill you. Sports Illustrated. May 18, 2009.

Cook NR, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women’s Antioxidant Cardiovascular Study. Arch Intern Med 2007;167:1610-1618.

Vivekananthan DP, et al. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomized trials. Lancet 2003;361:2017-2023.

Vinson JA & Bose P. Comparative bioavailability to humans of ascorbic acid alone or in a citrus extract. Am J Clin Nutr 1988;48:601-604.

Hickey S & Saul AW. Vitamin C: The real story. Basic Health Publications. 2008.

Cooperman T, Obermeyer W, Webb D. Consumerlab.com’s guide to buying vitamins and supplements. Consumerlab.com. 2003.

McDougall J. http://www.drmcdougall.com/misc/2010nl/may/vitamins.htm

Ji Sayer. Research: Vitamins may increase the risk of death.

Ji Sayer. Is your multivitamin toxic?

Fletcher RH & Fairfield KM. Vitamins for chronic disease prevention in adults. JAMA 2002;287:3116-3129.

Orr KK & Hume AL. An evidence-based update on vitamins. Med Health RI 2010;93:122-124.

Huang HY, et al. Multivitamin/mineral supplements and prevention of chronic disease. Evid Rep Technol Assess (Full Rep) 2006;139:1-117.

Nutrition Business Journal.

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Cohn W, et al. Comparative multiple dose plasma kinetics of lycopene administered in tomato juice, tomato soup or lycopene tablets. Eur J Nutr 2004;43:304-312.

Lodge JK. Vitamin E bioavailability in humans. J Plant Physiol 2005;162:790-796.

Clement BR. Supplements Exposed. Career Press and New Page Books. 2010.

USDA Nutrient Content of the U.S. Food Supply

Linus Pauling Institute

Halwell B. Still no free lunch. (PDF)

Baker H, et al. Inability of chronic alcoholics with liver disease to use food as a source of folates, thiamin and vitamin B6. Am J Clin Nutr 1975;28:1377-1380.

Li D, et al. Chronic niacin overload may be involved in the increased prevalence of obesity in US children. World J Gastroenterol 2010;16:2378-2387.

Bates CJ & Heseker H. Human bioavailability of vitamins. Nutrition Research Reviews. 1994;7:93-127.

Neuhouser ML, et al. Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med 2009;169:294-304.

Hill AM, et al. The role of diet and nutritional supplements in preventing and treating cardiovascular disease. Curr Opin Cardiol 2009;24:433-441.

Sesso HD, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2008;300:2123-2133.

Gaziano JM, et al. Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians’ Health Study II randomized controlled trial. JAMA 2009;301:52-62.

Cook NR, et al. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women’s Antioxidant Cardiovascular Study. Arch Intern Med 2007;167:1610-1618.

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Padmini J. New technology for vitamin C production may end Chinese monopoly. Dec 23, 2004.

In Part 1 of our plant-based eating roundtable, we discussed the following questions:

• What should plant-based eaters be eating?
• Do plants provide enough amino acids?
• Where do most people go wrong?
• Will carbs from whole plant foods lead to excess body fat?
• Is it actually possible to gain muscle and fuel performance when eating plant-based?
• What’s the deal with soy?

The plant-based eating gurus are back for another round! For the first installment and more about our panelists, check out Part 1.

Before we get in to the details, let’s step back and ask the big philosophical question:

Q. Why a plant-based diet?

John Pierre: I feel that life should be about “we” not “me”. Most people eat only to benefit themselves, not considering the suffering and death of animals, the devastation to the environment, and the lack of resources that will be left for future generations. And of course, a properly followed plant-based diet gives you vitality, so it’s an easy choice for me.

Jon Hinds: Three big reasons:

1. I love animals, so I don’t want to harm them.
2. I want to help global cooling, so I don’t support the meat/milk industry.
3. It’s healthier for me, other people, and the planet.

Nathane Jackson: My mom passed away from cancer in the fall of 2009. During this time in my life, my research led me to the power of raw plant foods and the effect they have on our body.

Jack Norris: I want to contribute as little as possible to the death and suffering of animals.

Mike Mahler: I adopted a plant-based diet for moral reasons when I was 15 years old.

Jeff Novick: Philosophical reasons, health reasons, and because of the overall impact on personal and planetary health. Oh, and because it’s easier to sneak up on a carrot than a rabbit.

Take-home: Whether you’re concerned about the planet, animals, your community, or your own health, there are many reasons to move towards a plant-based diet.

Q. What supplements should plant-based eaters consider?

Novick: Focus on food first and centre your diet around the most nutrient dense foods.

Pierre: Each person is unique, so everyone needs different levels of nutrients according to their lifestyle.

Hinds: In fact, plant-based eaters’ supplement needs are largely the same as omnivores.

PROTEIN

Hinds: Protein supplements can be useful. The best options are combinations of hemp, brown rice and pea protein. Vega is a good source for all of these and Sunwarrior makes a quality brown rice protein powder. I take a plant-based nutrient powder called Source of Life Energy Shake.

Mahler: A quality protein powder isn’t mandatory, but can be useful to ensure optimal protein intake. I like to start each day with a shake — loaded with fruits, coconut oil or coconut milk, greens, and protein powder.

FAT

Mahler: Essential fats are important. Flax seed oil takes care of ALA, and ALA can convert to EPA/DHA (to a degree), but it’s still a good idea to take an algae- based DHA/EPA product (such as V-pure) to ensure adequate levels are met.

VITAMINS & MINERALS

Jackson: Everyone needs Vitamin D. Unless you live in the southern hemisphere and spend a half hour outside each day, you should take a supplement. I also recommend a quality organic vitamin B-12 product.

Pierre: Vitamin B12, sunshine or Vitamin D, and iodine or sea vegetables.  If you don’t get enough of these nutrients you can have problems with red blood cells (anemia), permanent neurological problems, symptoms that mimic dementia, elevated homocysteine levels (which may contribute to heart disease), depressed immunity, and a dysfunctional metabolism.

A 100% plant-based eater who consumes no fortified foods should consider Vitamin B-12.

Mahler: B vitamins are definitely important for energy, hormone optimization, and overall health. They get depleted when we are under stress.

Zinc and magnesium supplements are worth investigating since they are important for testosterone and insulin. I prefer Zinc citrate and transdermal magnesium oil.

Norris: Supplements are discussed here: http://www.veganhealth.org/

Take-home: Get most of your nutrition from a variety of whole foods. Beyond that, focus on getting adequate protein, B vitamins (especially B12), vitamin D, essential fatty acids, and minerals such as magnesium, iodine, zinc.

Q. What animal food do you feel causes the most health, body composition, and performance problems?

The experts are pretty much agreed: Milk does not do a body good.

DAIRY

Sorry, Bessie.

Hinds: Today, most every animal product is unhealthy, as they often contain toxins (antibiotics, steroids, pesticides and hormones) that lead to major diseases (heart disease, cancer, stroke, diabetes, arthritis).

And milk does a body bad. The intake of milk products doesn’t seem to improve bone health and can blunt the absorption of nutrients. Many people cannot tolerate dairy, but are encouraged to consume it by nutrition experts/coaches.

Jackson: Yes, dairy products have been put on a pedestal but are a leading contributor to many bodily dysfunctions. Not only are more people lactose intolerant than ever, but cases of cancer, diabetes, fibromyalgia, acne, arthritis, and irritable bowel have been cured by eliminating dairy products.

Pierre: I agree; dairy products are the worst. You are ingesting a hormonal secretion of a bovine. I don’t feel that the body is equipped to digest these secretions. Dairy can lead to inflammation, asthma, joint pain, congestion, and of course weight gain.

MODERN FARMING

Mahler: It’s not necessarily the “animal foods” per se that cause problems, but the way animal foods are being raised/processed.

Meat, dairy, and eggs from factory farms are the most problematic. These animals live in miserable conditions, are given antibiotics, and provided low quality feed.

If the animals aren’t healthy, do you think that you’ll be healthy eating them? Of course not!

Moreover, imagine the stress that these animals experience on a daily basis. The adrenaline and cortisol they produce goes into their tissues, and this is what people are eating.

If you support the level of suffering that these animals experience you shouldn’t be surprised when it comes full circle and causes human health problems. Even if you don’t care about animal welfare, consider having more respect for yourself and consuming meat, dairy, and eggs from animals that are treated humanely and fed optimal diets.

Take-home: Avoid dairy. If you eat animal products, make sure they’re organic and humanely raised.

Q. What do you eat in a typical day — and a non-typical day (travel days, busy days, the kids are sick, your juicer broke, etc.)?

Hinds: I start the day with water and some greens powder to alkalize my body. When at home:

• soaked oats, berries, nuts, Source of Life Energy Shake
• banana, mango, plant protein, nuts
• kale, butternut squash, pine nuts
• greens powder and water
• sprouted tortillas (Ezekiel brand), red pepper hummus, homemade veggie nut burgers, broccoli and peas
• greens powder and water

When traveling:

• greens smoothie at a health food store: spinach, mango, spirulina, raw nuts
• two pieces of fruit and/or some trail mix
• salad bar (usually at Whole Foods Market): kale, beets, corn, beans, pumpkin seeds
• greens powder and water (I travel with this stuff)
• if we’re eating at a typical restaurant like P.F. Chang’s, we’ll get sautéed spinach, green beans, and brown rice. Side orders are the way to go when traveling. At Mexican restaurants I’ll get sides of fajita filling (onions, bell peppers), black beans and red rice. This is a great meal; just make sure to say “no cheese!”
• greens powder and water

Jackson: The majority of the time I follow the schedule below. When I travel or go out to eat, I just rely on raw fruits and vegetables.

• water with lemon and cayenne pepper
• large bowl of mixed fruit — banana, dates, mango, grapes, apple or pear, goji berries, hemp seed and soaked sunflower or pumpkin seeds
• post workout smoothie — bananas, dates, carob powder, plant protein powder, goji berries, maca and coconut water
• large leafy green salad with raw vegetables and soaked nuts or raw hummus on dehydrated veggie wraps.
• green juice — cucumber, celery, kale, apples (sometimes beets, carrots, lemons, ginger, etc.)
• whatever I feel like (I tend to favor more protein and fat at this point in the day), e.g., raw zucchini pasta and raw pasta sauce, or raw mushroom & nut burgers, or large salad, or a juice/green smoothie
• plant protein powder, almond milk and peppermint oil

Novick: My diet is very simple and ordinary. It doesn’t change much, regardless of where I am. It’s almost entirely composed of foods in their natural form. While I’m not a breakfast eater, if I did, it would be oatmeal and fruit. Most of my lunches and dinners are centred around vegetables, intact whole grains, and legumes. I have a new DVD out called Jeff Novick’s Fast Food, which explains my theory and system based on 10-minute meals with no more than 5 ingredients, and can be done with no more than scissors and a can-opener for $3/day.

Mahler: I have some ideas here and here.

Take-home: Wherever you are and whatever you’re doing, it’s easy to get more plants into your diet with a bit of planning.

Q. Where do you get food and recipe ideas?

Hinds: I’m always reading plant-based eating books. My favourites are:

• The Thrive Diet by Brendan Brazier
• Superfoods by David Wolfe
• The Engine 2 Diet by Rip Esselstyn
• Skinny Bitch by Rory Freedman & Kim Barnouin

I usually keep it simple and just eat the foods I like. All my meals can be made in a few minutes.

Jackson: Most of raw foodies have blogs. If you type in “raw” or “vegan” before a recipe name you’re looking for, I can almost guarantee that you will find someone with a blog post/website recipe. I have a section on my blog titled RAWsome Vegan RAWcipes. I also like Dr. Gabriel Cousens and his Tree of Life café books as well as The Thrive Diet by Brendan Brazier.

Novick: I graduated from culinary school and was a former chef, so I make up recipes myself. Most of them come from playing in the kitchen with basic foods under the heading of “making things simple, easy and tasty.”

Mahler: I am half Indian and fortunate to have a mother who is a lifelong vegetarian. I learned the basics of plant-based eating from her and went on to personalize it for my training goals. I like Indian food, rich in beans and vegetables. The website vegsource.com has great recipes. Brendan Brazier and Robert Cheeke have great books on the vegan diet loaded with recipes.

Take-home: When it comes to plant-based eating recipes and inspiration, you’re only limited by your imagination and Google skills.

Q. For someone who eats a more animal-based and/or processed diet (read: most of North America), what’s one simple step they can take starting right now to eat more nutritious plants?

Hinds: I’ll give you three tips:

• Substitute rice milk or almond milk for cow’s milk
• Substitute veggie patties for meats
• Instead of snacking chips or pretzels, have an orange or an apple

Jackson: Green smoothies are a great way for adults (and kids) to incorporate leafy greens into their diet. Adding a handful of spinach into a fruit smoothie is a solid start.

Pierre: Eat fruits and/or vegetables with every meal. Make smoothies with fruits/vegetables. Enjoy vegetables with dips and herbal seasonings.

Mahler: Add a baby spinach salad to your daily meal rotation. Each time you eat, make sure 2/3 of your plate is comprised of vegetables.

Novick: As Nike always says, just do it!

Take-home: It’s easy to start incorporating more nutrient-rich plants to your diet with some simple substitutions or additions.

More resources

For more on plant-based eating, check out Precision Nutrition V3.0.

There are also resources in the PN Member Zone.

• For plant-based omega-3 supplement options, see here.
• For plant-based protein supplement options, see here.

Our panel

	Jon Hinds runs Monkey Bar Gym in Madison, WI.
	Nathane Jackson is an NSCA certified strength & conditioning coach and kettlebell trainer specialist in Toronto, Canada. Nathane is a pro fitness model, physique competitor, and fitness personality.
	Mike Mahler is a writer, strength trainer, and kettlebell instructor in Las Vegas, NV.
	Jack Norris is a Registered Dietitian and the President and co-founder of Vegan Outreach.
	Jeff Novick holds an MS and RD, is Vice President for Executive Health Exams International, lectures at the McDougall Program in Santa Rosa, California, and serves as an Adjunct Professor in the School of Health Sciences for Kaplan University.
	John Pierre is a nutrition and fitness consultant specializing in geriatrics, nutrition, fitness, women’s empowerment, green living, and cognitive retainment and improvement.

Plant-based eating is undiscovered territory for most North Americans.

We’re used to tall glasses of moo juice, grilled chicken salads at restaurants, big omelets, and whey protein shakes. (And that’s the most nutritionally-conscious of us. Many folks still think vegetables mean French fries, or perhaps the anemic wisp of iceberg lettuce on a bacon cheeseburger.)

When folks decide to add more plants to be “healthier” or “more environmentally friendly”, that addition might include refined grains, processed soy, Twizzlers, and beer. While this kind of food swapping is usually better for animals, and — depending on how these pseudo-foods were produced — better for the planet, it might not be so good for our health and body composition.

This can lead to plant-based eating confusion. What’s “good”? What’s “healthy”? What really benefits animals, the planet, and your wellbeing?

Luckily, more and more coaches and experts understand plant-based eating. I gathered some of the best and brightest to discuss the topic.

Our panel

	Jon Hinds runs Monkey Bar Gym in Madison, WI.
	Nathane Jackson is an NSCA certified strength & conditioning coach and kettlebell trainer specialist in Toronto, Canada. Nathane is a pro fitness model, physique competitor, and fitness personality.
	Mike Mahler is a writer, strength trainer, and kettlebell instructor in Las Vegas, NV.
	Jack Norris is a Registered Dietitian and the President and co-founder of Vegan Outreach.
	Jeff Novick holds an MS and RD, is Vice President for Executive Health Exams International, lectures at the McDougall Program in Santa Rosa, California, and serves as an Adjunct Professor in the School of Health Sciences for Kaplan University.
	John Pierre is a nutrition and fitness consultant specializing in geriatrics, nutrition, fitness, women’s empowerment, green living, and cognitive retainment and improvement.

What’s in Part 1

In part 1, we’ll cover the following:

• What should plant-based eaters be eating?
• Do plants provide enough amino acids?
• Where do most people go wrong?
• Will carbs from whole plant foods lead to excess body fat?
• Is it actually possible to gain muscle and fuel performance when eating plant-based?
• What’s the deal with soy?

Before you throw your hands up in frustration and order another chicken salad, read this Q&A.

Q. Why do some folks feel plant-based eating doesn’t provide enough protein?

Jon Hinds: Because we learn that meat, milk, etc. are the “protein” foods. Don’t worry, plants have protein!

Jack Norris: Indeed, many people do not even know that plants contain any protein at all. How they think vegetarians survive is an interesting question!

Nathane Jackson: The bodybuilding influence has dominated most mainstream fitness magazines for decades. This approach tells us to consume large quantities of animal protein in order to build muscle. But we need to consider other issue in these extra-large physiques: performance enhancing drugs; mucus build-up from excessive animal protein consumption; and for the most part non-functional movement. The general public reads these magazines and get brainwashed into feeling like they require high levels of animal protein (and isolation exercises, but that’s a topic for another time).

John Pierre: Most people aren’t familiar with plant-based diets and the research supporting them. Look no further than athletes who eat plant-based. Eat properly, and you’ll get all the protein you need.

Mike Mahler: Fitness magazines often recommend 1-2 grams of protein per pound of bodyweight. As a result, people think they require a lot of protein.

However, I don’t think people need this much. Instead, 1 gram of protein per kilogram of bodyweight is a good starting point. Beyond this, you could add 30-40 grams each day if you are in a phase of intense training.

Using this approach, a 200 pound athlete would take in around 90 – 130 grams of protein each day, which can easily be achieved on a 100% plant-based diet. Building muscle and losing bodyfat comes from creating an optimal hormonal environment, not from over-consuming protein.

Take-home: Plants have protein, and with a well-chosen diet you can get everything you need, even if you’re an athlete.

Q. Joe/Jane Meat Eater decides to start eating more plant-based. Where will Joe/Jane likely go wrong?

Hinds: Joe/Jane won’t eat enough nutritious foods, and then they’ll get tired, weak, and think plant-based eating isn’t for them.

Jackson: They’ll consume excessive amount of nuts, beans, and plant protein powders (neglecting fresh vegetables and fruits – the foundation of a nutrient rich eating plan). As an athlete I do consume plant protein powders such as Vega and Sunwarrior, but I’ve seen folks use such products at every meal to adhere to the “meat-eating bodybuilding influence” of 30 grams of protein per meal.

Novick: Eating too many refined and processed “vegetarian” foods. The real benefit from “plant-based” comes when the diet is centered on whole unrefined/unprocessed fruits, vegetables, intact whole grains, and legumes with the addition of a few nuts/seeds.

Norris: When some people eat 100% plant-based, they also give up added fats (among other things). They end up with a very low fat diet and sometimes not feeling so great. They then go back to eating meat for the “protein,” not realizing that many types of meat are 50% or more fat. They feel better with the meat and chalk it up to the protein. Often it was really the added fat that made them feel better, not the protein; they could have gotten a similar effect by adding more fat to their plant-based diet.

Mahler: Yes, fat consumption is generally too low or from poor sources. Or people eat excessive amounts of grains, like pasta, bread, cereal, etc. People need a balance of protein, healthy fats, and low glycemic carbohydrates at each meal from whole food sources.

And avoid “fake meat” products. These products are often loaded with garbage ingredients such as wheat gluten, soy protein isolate, tons of sodium, and other chemical derivatives.

Norris: On the other hand, plant-based diets can fall short on the amino acid lysine if someone is avoiding all legume-based foods. Legume-based foods include:

• tofu;
• tempeh;
• soymilk; and
• other soy products; peanuts; beans, lentils, and peas.

These foods are the highest in lysine. If you don’t eat any of these foods regularly (at least 2 servings per day – 1 serving typically being 1/2 cup cooked or 1 cup of soymilk), then you should make sure you’re getting plenty of servings of the few other high-lysine foods in the plant kingdom – quinoa, pistachios, and cashews.

Take-home: Many folks simply eliminate meat from their diet, but don’t add in more healthy options. Or they go overboard with what they think are “healthy options”: processed foods, refined grains, and protein powders. Fruits, veggies, nuts, seeds, and legumes should provide the foundation of a plant-based diet.

Q. Some folks are concerned with controlling carb intake and often get scared away from plant-based eating. What do you tell them?

CARB TYPE

Hinds: We’re told carbs are “bad,” so many folks resort to eating only meat and vegetables to lose body fat. “Carbs” in general aren’t the problem; it’s the source of the carbs that matters. Some plant-based eaters consume high amounts of processed carbs and end up looking/feeling like trash. This gives the plant-based eating population a bad rep.

Novick: Over 90% of the carbs consumed in America are highly refined, highly processed, and mostly in the form of refined flour and sugar. This is the problem. Avoid these.

However, carbs in the form of fresh fruits, vegetables, starchy vegetables, intact whole grains and legumes are the healthiest foods for us, and should be the center of any healthy diet. This is a very important distinction.

Hinds: Eat strong plant foods like wild rice, sweet potatoes, millet, quinoa, amaranth, etc. These kinds of carb-dense foods aren’t causing body fat problems and disease.

CARB TIMING

Jackson: Consume the majority of your carbohydrate-dense foods (root vegetables and grains) earlier in the day and/or around workout times. If you work out in the evening, surround your workout with a combination of simple and complex carbohydrates to maximize workout potential and recovery.

Pierre: Yes, complex carb sources found in whole foods will help control insulin response; save simple carbs for after intense workouts.

Take-home: Avoid processed carbs; look for better sources such as whole grains and tubers. Stay active, and consume most of your carbs around your workouts.

Q. Some folks want to gain muscle/strength and fuel high levels of performance. What do you suggest they do to get enough nutrient dense food each day?

Hinds: We have a guideline called the MBG Hand Plan: Eat only when hungry, eat only until satisfied, and drink lots of water.

• To lose fat, eat 2 meals and 3 snacks per day.
• To maintain body composition, consume 3 meals and 2 snacks per day.
• To gain muscle, eat 5 meals per day.

Make up these meals from nutrient dense foods like veggies, fruits, raw nuts and seeds, legumes and then grains (in that order). Eating like this consistently will lead to amazing results.

SMOOTHIES

Jackson: Try some meals in the form of smoothies and juices for easier digestion and assimilation.

Pierre:  Add healthy fats like flax or walnuts. Add veggies to each meal, including your smoothie. And if you have protein anxiety, use a pea or brown rice protein (or a blend like Vega).

Mahler: I like Sun Warrior Rice Protein, Olympian Labs Pea Protein, and Manitoba Harvest Hemp Protein.

I would also suggest adding coconut oil or coconut milk. Coconut is a great source of medium chain fats, which the body uses well. Coconut oil in a protein shake two hours before a workout will help to ensure that you have enough energy to crush it. Having a balance of protein, fat, and carbohydrates at each meal will balance energy levels throughout the day.

Norris: And possibly 3-5 grams of creatine if you’re doing explosive sports like power lifting or sprinting.

Take-home: Eat a variety of nourishing foods. Eat in accordance with your appetite and goals. And make friends with your blender.

Q. Soy – any thoughts?

Pierre: Soy is a legume, it’s not mystical or magical. Don’t hide from it nor hold it above any other legume.

HOW MUCH?

Hinds: Soy’s received a lot of bad press. But really, in order to notice any negative effect, your intake of soy has to be huge! Occasional soy from whole food sources (tempeh, edamame, etc.) is no problem.

Novick: Soy is highly over-blown, over-hyped and over-promoted in the USA. In Southeast Asia, the average intake is about 2 oz a day, or the equivalent of about 7-9 grams of soy protein. Limit overall soy consumption. You can get all the benefits of soy from other beans without the potential health concerns.

WHAT ABOUT “FAKE-ON” OR “SOYLONEY”?

Hinds: When people first start transitioning to plant-based eating, using “fake soy meat” products is fine. Beyond that initial transition period I encourage folks to eat whole foods as much as possible, and not rely on these fake substitutes.

Jackson: Personally, I am not a fan of soy. However, people can get away with including non-GMO (genetically modified) soy products on occasion. But I do warn them about the potential health problems from eating fake products such as soy burgers, soy milk, and soy cheese.

Novick: Avoid all the highly processed forms of soy. Edamame = good; isolated soy protein = bad. Tempeh = good; soy energy bars = bad.

Mahler: Not all soy products are created equal. Fermented products, such as natto and tempeh, are absorbed more efficiently and don’t seem to block mineral absorption like other soy products.

Still not really the healthiest choice.

WHAT TO WATCH FOR

Mahler: After the soy scare many years ago, a lot of research was done to see if soy does in fact lower testosterone and raise estrogen levels. The results are still inconclusive. The theory that phytoestrogens in soy lower testosterone has not been confirmed.

This doesn’t mean that one should go crazy on soy as many people have soy sensitivities without realizing it, and you could develop sensitivities if high levels of soy are consumed each day. Soy can have negative effects on the thyroid, so anyone with thyroid issues should question their soy use.

Take-home: Choose soy foods carefully and in moderation, if at all.

What’s coming up

Part 2 of our plant-based eating roundtable will get into the following questions:

• What supplements should plant-based eaters consider?
• When concerned with health and body composition, what animal food should someone think about nixing first?
• Why would someone want to eat plant-based?
• Where can people find food/recipe ideas?
• What steps can someone take today to eat more plants?

There are three things related to nutrition and lifestyle that I never want to experience:

1. A cardiac catheterization
2. A Cinnamon Toast Crunch-induced coma
3. A kidney stone

Needless to say, I was excited to write this article.

What are kidney stones?

Kidneys make clean blood by eliminating wastes.

For instance, if you eat a can of soup with lots of salt, the kidney will excrete more salt to balance out levels in the body. If you eat a big steak, more urea will be excreted in the urine.

If the body is unable to eliminate these wastes, you get sick. (Here’s a primer on the urinary system.)

Our kidneys eliminate waste products through urine, and when there is excessive waste or not enough fluid volume, urine becomes supersaturated and a stone can form. Stones can be tiny like a grain of sand or big like a golf ball.

Three things you never want in your kidneys: a dime, a kidney stone, and a safety pin

Stones can hang out in the kidneys for years without obstructing any tubing. But when a stone obstructs the ureter, serious pain follows (it’s been said that kidney stones are the worst pain imaginable). The pain can stop/start as the stone heads to the bladder. The bladder tunnel is where most stones get hung up. Since stones may have sharp edges, they can draw blood into the urine.

Kidney stone types

There are four main types of kidney stones:

1. Calcium-containing stones – these make up a majority, nearly 75% of stones
2. Uric acid stones – these make up about 10% of stones
3. Struvite (infected) stones – these make up about 10% of stones and form after an infection in the urinary tract
4. Cystine stones – these are stones that form from the amino acid cystine, the most uncommon

The table below shows the composition, frequency, and causes of kidney stones, aka nephrolithiasis (nephro = kidney; lith = stone).

Source: Hall PM, Nephrolithiasis: Treatment, causes, and prevention. Clev Clin J Med 2009;76:583-592.

Why are kidney stones important?

Kidney stones are increasingly common, especially in industrialized and more affluent countries.

By 70 years of age, about 11% of American men and 6% of American women will have had a symptomatic kidney stone. The incidence of kidney stones in the U.S. jumped by nearly 35% between 1980 and 1994 (side note: this increase parallels the rise in obesity).

Lifetime expectancy for kidney stones, men aged 60-70, by country. (KSA: Kingdom of Saudi Arabia; UAE: United Arab Emirates)

Kidney stones and chronic diseases

Several factors seem to affect people’s risk of kidney stones.

For one thing, kidney stones can be a sign of other diseases. Most stone formers also have things like:

• lipid abnormalities
• cardiovascular disease
• type 2 diabetes
• high blood pressure
• excess body fat
• gout

High blood pressure in particular doubles the risk of stones, since it changes how calcium is absorbed in the kidneys.

Diet and kidney stones

Doctors think that people who form stones lack specific chemicals in the urine to prevent them. That’s the bad news. The good news is that these folks can modify what they eat/drink to control stone formation. About two-thirds of people can limit stone formation with basic dietary modifications.

The six major dietary factors in kidney stone formation are:

1. Hydration
2. Animal protein intake
3. Calcium
4. Oxalate
5. Sodium
6. Extreme diets

Factor 1: Hydration

Hydration is probably the most studied area relating to kidney stones. It makes sense: getting enough fluid consistently is vital for stone prevention.

Urine is composed of water, salt, urea, oxalate, uric acid, potassium, magnesium, calcium, oxalate, creatinine, and other acids/waste products of metabolism. The composition of urine changes based on what we ingest. If we don’t drink enough water, or eat excessive amounts of rich foods, the urine becomes more concentrated, which can increase the odds of stone formation.

Concentrated urine can result from someone not drinking enough water, sweating a lot, or eating a rich diet (or a combination of all these factors). When you sweat a lot, you are losing fluid by another means, so you’ll urinate less.

In theory, even if your diet was extremely concentrated in rich foods, if your urine was always dilute, you probably wouldn’t form stones (but you may suffer from hyponatremia).

What you drink can also be a factor.

This is because citrate inhibits calcium stones. We make citrate in the kidney when urinary pH is alkaline.

Potassium citrate found in lemons (and other fruits and vegetables) can increase urinary citrate, which can protect against kidney stones. But citric acid, which is added to many soft drinks, doesn’t appear to be protective. Apple juice, grapefruit juice, cranberry juice, and cola drinks seem to increase the risk of forming stones. Fruit-flavoured soft drinks don’t seem to have this negative effect (including drinks like Gatorade). Naturally carbonated mineral water acquires carbonation from dissolved limestone and can contribute to kidney stone formation.

Thus, water and liquid from whole foods (such as lemons) is ideal.

You should get a minimum of 2 litres of liquid per day (either from water or in foods) to produce adequate urine volume (you want about 2 litres of urine volume). Hydration needs fluctuate with body size, climate, physical activity, etc. — if you’re bigger, warmer, and/or working harder, you’ll want more fluid.

Factor 2: Animal protein

Beyond hydration, a high animal protein intake is probably the most important factor influencing kidney stone development. Why? A few reasons:

1. Animal protein contains purines (well, some plant foods do too, but it appears that purines from plants don’t seem to have the same effects in the body). We break down purines into uric acid. Some of this in the body is fine, but too much can supersaturate the urine and lead to stones (both uric acid and calcium-containing types).
2. Animal protein makes the urine more acidic, leading to less solubility for uric acid, and suppression of citrate formation. If you don’t consume enough alkaline-forming fruits and veggies, this means trouble.
3. Animal protein contains high amounts of glycine and methionine. Glycine is metabolized into oxalate, and methionine can increase urinary calcium.

Data has indicated that those who eat a plant-based diet tend to have a lower incidence of kidney stones, even when including more oxalate-rich plants. Plant-based eaters form stones at about 1/3 the rate of those eating an omnivorous diet. This may be due to the higher intake of citrate-rich foods on a plant-based diet, which can make the urine more alkaline (and help prevent stone formation).

One study demonstrated a 33% increased risk of kidney stones with a 77 gram versus a 50 gram animal protein diet (some people eat this much animal protein per meal). Another trial showed that a diet low in animal protein (52 g/day), sodium (50 mmol/day), and oxalate (200 mg/day), with normal calcium intake (1200 mg/day) was associated with a reduction in stone formation of almost 50% over a five year period.

It’s important not to restrict protein below 0.8 g/kg body weight per day (so, for someone who weighs 180 pounds, this would be about 65 grams of protein per day), as this can increase parathyroid hormone and calcium in the urine.

For more on acid-base balance, see All About Dietary Acids and Bases.

Factor 3: Calcium

When we consume and absorb high levels of calcium, we must excrete the excess. One way to excrete calcium is via urine. Higher levels of calcium in the urine can increase the chances of kidney stones for certain individuals (calcium is the most abundant mineral in kidney stones).

While excessive calcium intake isn’t a good idea, a low calcium diet might be even worse.

First, not getting enough calcium can harm bone health.

Second, eating calcium rich foods can help bind oxalates in the gut (see below for more on oxalates) and get rid of them in the stool (before they’re absorbed and travel to the kidneys).

Finally, a low calcium intake leads to bone breakdown and higher levels of calcium in the urine.

What about calcium supplements?

Well, when calcium isn’t bound to natural co-factors in food, the delivery system is altered, and the calcium may end up in places we don’t want (e.g., calcification in vessels and kidneys). Further, the body might attempt to relieve itself of the elemental calcium by pushing it through the kidneys (resulting in stones).

If you supplement with calcium, balance your intake with foods, only use calcium citrate, make sure vitamin D status is controlled (not too high or too low), and consume supplements with meals.

About 800 – 1000 mg per day of calcium should be plenty (total – from food and supplements).

Factor 4: Oxalates

Oxalic acid is a naturally occurring substance that can bind with minerals. Oxalates are kind of boring, well, until they crystallize with calcium to form kidney stones.

When someone has lots of oxalates in their urine, where the heck did they come from? Well, there are five potential sources of oxalates:

1. Oxalate-rich plant foods
2. Waste products of general metabolism
3. Vitamin C supplements
4. Animal protein
5. Beverages

Source #1: Oxalate-rich plant foods

Oxalate content in plants can vary because of differences in climate, soil, ripeness, or section of the plant analyzed. Younger plants have more oxalic acid, which we absorb more of. Older plants have formed calcium oxalate salts, which we absorb less of.

Foods higher in oxalates include:

• spinach
• rhubarb (the leaves are so high in oxalates they are poisonous)
• beets
• amaranth
• Swiss chard
• chives
• parsley
• cocoa
• berries
• bran
• nuts

Panicked yet? Don’t worry — dietary variety is your friend.

Swap out kale for spinach. Don’t eat rhubarb leaves. Only eat beets during the peak season. Lots of cocoa means lots of chocolate, and if you are consuming it regularly, you’ll have problems beyond kidney stones. Incorporate pumpkin seeds, sunflower seeds, flax seeds, and macadamia nuts in place of higher oxalate nuts/nut butters.

Seasonal eating can help control oxalate intake. Some people eat spinach and berries year round. Holy oxalates. Instead, each spinach and berries only during peak seasons. During the other months, switch to lower-oxalate foods like cauliflower and apples.

A “normal” day of eating might include 80-100 mg of oxalate/day, and we only absorb about 10-20% of that.

After oxalates are absorbed, the only way to get rid of them is in the urine.

Excreting excessive amounts of oxalates in the urine is called hyperoxaluria, and it’s unlikely that you’ll end up with that from dietary intake alone. Rather, it’s from overabsorption in the gut (more oxalates are absorbed in the gut when someone is suffering from inflammatory bowel disease), low dietary calcium intake (remember, calcium binds oxalates in the gut), low fibre intake, and endogenous production.

Oxalates from food are tricky. Some data even indicates no added risk for stone development from oxalate-rich food.

Source #2: Waste products of general metabolism

Normal metabolic processes in the body contribute to oxalate formation.

Vitamin B6 (pyridoxine) is a cofactor in the conversion of glyoxylate to glycine, and its deficiency could increase oxalate production in the body. So get enough vitamin B6 from sources like whole wheat, brown rice, green leafy vegetables, sunflower seeds, potato, garbanzo beans, banana, spinach, tomatoes, avocado, walnuts, peanut butter, lima beans, and bell peppers.

Source #3: Vitamin C supplements

Vitamin C supplements (ascorbic acid) can be metabolized to oxalic acid once ingested.

Source #4: Animal protein

When we use amino acids as an energy source, oxalate synthesis can result. Also, data indicates that a precursor to oxalate, called glycolate, might increase as we consume more animal protein. Still, these results are variable based on what type of stones the person tends to form.

Metabolic pathways from meat proteins to oxalates

Source: Nguyen QV, et al. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int 2001;59:2273-2281.

Source #5: Beverages

Cola soft drinks may lead to higher levels of oxalates in urine, while decreasing magnesium and citrate. Bad news if you like your kidneys. Still, some data indicates that caffeine and sugar-free colas don’t have any negative influence on stone formation.

Those who drink small amounts of coffee, alcohol, and tea may have a lower risk of kidney stones, even though these beverages can contain oxalates. Drinking coffee/tea with milk can further bind oxalates and prevent absorption (this is due to calcium, so any non-dairy milk fortified with calcium would work). Green teas, rooibos teas, and herbal teas tend to contain less oxalate than black teas.

Excessive sugar consumption (from food or drink) may lead to increased oxalate, calcium, and uric acid in the urine.

Factor 5: Sodium

As we increase sodium in the diet, urinary calcium excretion increases, and this can influence stone formation.

By now, most everyone knows (I hope) that we get most of our sodium from processed foods. Limiting sodium to less than 2300 mg per day — simply by switching to unprocessed, whole foods — can greatly decrease the amount of oxalate and calcium in the urine, both extremely helpful in preventing stones.

A note on sodium: if small amounts of sodium in a beverage help someone keep fluid intake at 2 litres per day, the benefits of more fluid outweigh the risks of more sodium.

Factor 6: Extreme diets

We know that yo-yo diets are a great way to form gallstones, but risk for kidney stones also goes up.

Large meals and binge eating, especially at night before sleep, can lead to very concentrated urine. Further, with yo-yo dieting we repeatedly break down stored body fat for energy, leading to metabolic by-products (including ketones) that must filter through the kidneys. These by-products tend to make the urine more acidic, which can lead to stones.

Lower-carb, higher-fat/protein diets can increase urinary acidity, lower urinary citrate, and raise urinary calcium – increasing the chances of kidney stone formation.

Factors beyond our control

Genetics

Kidney stones tend to run in families. If you have a relative with kidney stones, your risk is 2-3 times higher of getting one. Specific factors have been associated with this.

Alanine:glyoxylate aminotransferase (AGT) is a vitamin B6 (pyridoxine) dependent enzyme found in the liver that converts glyoxylate to glycine, reducing the formation of oxalate from glyoxylate.

A genetic variation can result in more AGT in the mitochondria rather than perioxisomes. Peroxisomes deal more effectively with plant-derived glycolate, whereas mitochondria handle meat-derived hydroxyproline – both sources of glyoxylate production.

Thus, certain AGT genetic variations may affect a person’s response to their diet — and affect whether a plant- or meat-based diet works better. (This may also explain why researchers are still figuring out which dietary factors are most relevant: people may differ in their genetic risk and dietary response.)

Other genetic variations may directly influence oxalate absorption in the gut and sodium-phosphate transporters in the kidney.

Chronic diseases and health problems

There are various medical conditions that can lead to kidney stone formation. These conditions include:

• Bowel disease
• Medullary sponge kidney
• Hyperparathyroidism
• Milk-Alkali syndrome and ulcers – this increased in the early 1900s when folks tried to control ulcers with milk and antacids, leading to dangerous levels of calcium in the blood. This condition is on the rise again due to increased use of calcium and vitamin D supplements.
• Anatomic abnormalities with the kidney
• Paralysis
• Renal tubular acidosis
• Cystinuria
• Oxalosis

Medications used to treat kidney stones include:

• Alkaline potassium salts – used to raise urinary pH. You may need to dilute them with water if they cause stomach upset.
• Alkaline sodium salts – an alternative to potassium salts.
• Thiazides – diuretics used to decrease urinary calcium. You must control sodium intake when using them. They can deplete potassium levels in the body.
• Allopurinol – reduces production of uric acid in the body. Extremely serious side effects.

Summary and recommendations

We’ve made a lot of advances in our medical treatment of kidney stones. But ideally, you don’t ever want to have a kidney stone — or worse, have more than one.

Here are some ways to lower your risk.

Keep urine dilute

Drink at least 2 litres of water per day. Small amounts of coffee, tea, lemon water, and alcohol may also be helpful.

Get rid of the excess

If it doesn’t use stuff, our body has to excrete anything that we ingest. Overeating, overdrinking, and overmedicating can lead to more work for the kidneys. Big meals, yo-yo dieting, and binging put big demands on the kidneys and can promote stone formation. Avoid big meals before bed. (You’ll sleep better that way anyway.)

Vary fruit, vegetable, and nut/seed intake

If you rely on oxalate-rich foods year round, your kidneys might get overwhelmed. Eat a variety of foods, and eat with the seasons to give your kidneys a break. The food will be fresher, too. Bonus!

Limit animal protein

If you’re at risk, consider lowering your animal protein intake to no more than about 50 grams per day. Make up the rest from plant sources as much as possible.

Limit sodium intake

Less than 100 mmol/day (2300 mg/day). This is easy if you don’t eat processed foods.

Stay lean

Less body fat turnover means fewer waste products for the kidney to deal with.

Control calcium

No more than 800-1000 mg/day of calcium (food and supplements combined). With calcium, you don’t want to go too high or too low.

Use vitamin supplements with caution

Vitamins A and D can lead to increased calcium in the urine and stone formation. Only supplement with vitamin D if you require it (based on blood testing), watch out for fortified foods.

Vitamin C supplements can be excreted in the urine as oxalate. Avoid using them unless you’re deficient.

This includes fortified foods/drinks.

If you have stones, find a specialist

Watch out for internet scams.

Avoid antacids with calcium base

These can cause phosphate depletion and increase calcium in the urine.

Further resources

What I need to know about kidney stones

National Kidney Foundation

Extra credit

Ben Franklin suffered from kidney stones.

Adequate magnesium intake may help to prevent oxalate stone formation in the kidneys. Sources of magnesium apples, apricots, avocadoes, bananas, whole grains, nuts, and green leafy vegetables.

If you don’t care about kidney stones, you will after seeing a picture of a ureteroscopy!

Although kidney stones are generally higher in affluent regions, the highest incidence for kidney stones throughout the world is among uranium workers in eastern Tennessee and adults in northeast Thailand.

The protease inhibitor indinavir, used in HIV/AIDS, can increase risk for stones.

A high fat intake can increase oxalate absorption.

The ratio of calcium to oxalate in urine is usually 10:1.

Stones risk increases with a protein rich diet, but also from malnutrition.

There is currently no analysis or research that shows whether oxalic acid is present in hemp. Living Harvest is hoping to perform analysis by 2011.

NSAIDS and acetaminophen, used chronically, can damage the kidney, and increase odds of stone development.

With pregnancy comes changes in urinary pH, which can increase chances of stone development.

South Africans are virtually resistant to kidney stones, but standard urinary measurements haven’t been able to isolate why.

The drug Flomax might help to increase the likelihood of spontaneous stone passage (in someone with a passable stone).

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Nguyen QV, et al. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int 2001;59:2273-2281.

Knight J, et al. Increased protein intake on controlled oxalate diets does not increase urinary oxalate excretion. Urol Res 2009;37:63-68.

Giannini S, et al. Acute effects of moderate dietary protein restriction in patients with idiopathic hypercalciuria and calcium nephrolithiasis. Am J Clin Nutr 1999;69:267-271.

To keep healthy knees, you need:

1. Mobile joints above and below the knee
2. A strong knee joint
3. Proper mechanics during physical movement

That about sums it up.

What is the knee?

The femur, tibia, and patella come together to form the knee joint. The width of the knee joint allows the structure to handle greater loads.

The patella is your “kneecap” and sits within the quadriceps tendon, providing an enhanced mechanical advantage when the quads are contracted. The back side of the patella is a smooth surface made up of hyaline cartilage. This is important during knee movements: flexion, extension, and rotation.

The knee ligaments, capsule and menisci help to keep your knee joint together.

The value of exercise

Our bodies respond to the stresses that we place on them. If you exercise regularly, you inspire turnover and growth of knee structures (muscles and connective tissue). This is a good thing. To keep the knee joint healthy, you need to balance exercise loading, frequency, activity type, and rest/recovery.

For instance, if you keep pounding out the hard miles doing only distance running every day, you’ll probably end up with tendonitis. On the other hand, if you sit around all day, you’ll also risk knee injury from weakened knee structures and the pressure of the kneecap on the thighbone in the seated position (aka “movie theatre knee”).

For healthy knees, get regular daily activity, keep the joint moving through a full range of motion, and do different things.

Knee ligament anatomy

Knee Ligament Anatomy Animation

Four main ligaments provide stability and prevent excessive movement of the knee.

1. Anterior cruciate ligament (ACL) – prevents the tibia from moving forward
2. Posterior cruciate ligament (PCL) – prevents the tibia from moving backward
3. Medial collateral ligament (MCL) – prevents excessive inward movement of the knee joint. This is the most commonly injured knee ligament, but it can usually heal without surgical intervention.
4. Lateral collateral ligament (LCL) – prevents excessive outward movement of the knee joint

Knee ligaments are tiny. The ACL and PCL are only 6-14 millimeters wide.

Two crescent- shaped rings of cartilage comprise the menisci. The menisci provide knee stability, distribute weight from the femur to the tibia, act as shock absorbers, and spread synovial fluid. Just like other types of cartilage, they can be torn.

It’s not just ligaments that keep our knee intact. The quadriceps, hamstrings and calves enhance stability too. When these muscles are strong, we are able to rely less on the passive structures, like ligaments, to resist unwanted movement.

What you should know about the knee

Most knee problems develop over time, not just on a random day in your basement during a dance-a-thon. This is repetitive trauma (think: wear and tear), and any mechanical device (including the knee) will fail with excessive strain. One in three sports-related injuries occurs at the knee.

Warming up and dynamic joint mobility

Warming up and dynamic joint mobility seem to be important for knee health. These practices help to control inflammation, distribute joint fluid, develop structures around the joint, and enhance range of motion.

Resistance training

Resistance training through a full (and mechanically correct) range of motion is essential for healthy knees. Weight-bearing exercises can help to promote joint stability and strength.

However, poor technique (including going too heavy in a partial range of motion) and too-heavy or too-frequent resistance training without adequate recovery can damage the knee joint. Don’t keep hammering away at those squat one-rep-maxes too often — mix up the movements and the loading.

And remember that your legs move in more than one plane! Try asymmetrical and one-legged movements such as:

• “star” lunges or jumps (stepping/jumping out to the side or on a diagonal)
• stagger-stance squats, wrestling shoots
• side/diagonal step-ups on to platforms
• zig-zag jumps and runs, etc.

Common knee problems

Patellar tendonitis

Get ready for this knowledge bomb: Tendonitis is the inflammation of a tendon. Who knew? This often takes place with repeated stress and loading (translation: overuse). Ice, adequate recovery between workouts, and developing mobility can help. You can reduce discomfort by limiting the range of motion during exercises, but ideally you want to work your way back to a full,  healthy range. You can also use static holds and eccentric training.

Chondromalacia patella/kneecap pain

You’ll often notice this with climbing stairs, walking down hills, or sitting. This is the progressive destruction of hyaline cartilage on the backside of the kneecap. You might hear snapping, popping and cracking noises when you bend your knee. Perfect technique on lower body exercises and reducing the range of motion (with the eventual aim of increasing that ROM) can help. Women tend to suffer from this condition more than men.

Torn meniscus/removal of meniscus

Meniscus problems often manifest as a catching or grinding sensation in the knee. Since a meniscal injury can cause pain, catching and swelling, many people opt for surgery to remove torn bits. Menisci lack blood supply except at their outer rim, so they often heal poorly when torn. Heavy vertical compressive loads (e.g. heavy squatting, jumping) can interfere with healing. Use a limited, gradually increasing range of motion and minimal resistance while recovering.

Ligament problems

ACL injuries are common in sports with running and jumping, such as basketball and soccer, or with twisting/lateral forces on the knee, such as downhill skiing. Women suffer ACL injuries more than men because their knee joints tend to be looser; however, learning and practicing proper running and jumping form can greatly reduce the risk.

ACL repair is a biggie, since it cannot simply be sewn together after it tears (try attaching two mop ends). Rather, ACLs are reconstructed with borrowed tendons.

It may be months before progressive resistance training can be re-introduced after an ACL repair. Rehab for ligament injuries often involves partial range of motion exercises and hip/hamstring strengthening. While open chain exercises might serve a purpose in limited rehab settings, use is reserved until post-operative knee function is assessed.

Mild sprains can occur when a ligament is overstretched or partially torn and recovery consists of rest and ice. Workouts resume when tolerated once the knee feels better.

Arthritis

While breakdown and inflammation of knee joint cartilage can take place with advancing age, it doesn’t mean pain and disability soon follow.

The elephant in the room with most arthritis is body weight. A higher body weight is strongly associated with knee arthritis. If your BMI is above 30, chances of developing arthritis go up nearly 4 times. More body mass requires more plantar flexion and a shorter stride. This leads to hamstring dominant knee stability. Not good. An abnormal positioning of the feet during walking and running is also common in those who carry extra pounds. The toes can rotate out (duck walk) or in (knock-knee, aka valgus), both of which can cause knee injury and diminished mobility.

What to do for knee health

Check your shoes and how you walk

A non-bouncy and relatively flat shoe sole can assist in balance and integrity around the foot and ankle. There is emerging interest in barefoot/minimally shod walking — the theory is that the more sensory input comes through the soles of the feet, the more the body can perceive and correct deviations in position.

Messed up shoes, feet and ankles can lead to messed up knees. In fact, too much cushioning in a shoe could be a problem; it’s harder to stabilize feet in squishy shoes.

“Duck feet” or the opposite, “knock knees” and excessive heel strike when walking/running can cause knee problems.

Check your squat

Learn good squat technique and use it. Don’t sacrifice good technique for adding more weight, especially in a partial range of motion.

Keep your hips behind your heels — sit back into the squat. The farther forward the knees, the greater the force on the knee joint. The goal is to keep shins closer to vertical, although Olympic weightlifters tend to squat with a slightly greater shin angle.

Good squat form

Good squat form

Squatting with a serious forward shin lean (aka the “campfire squat”) can be safely done unweighted, but it puts a lot more stress on the knee joint — we don’t recommend you try it with heavy weight.

Free weight squatting seems to activate muscles around the knee more than machine squats.

The back squat results in higher compressive forces at the knee joint, compared to the front squat.

Squatting on a decline or with something under your heels maximizes load on the patellar tendon and minimizes glute recruitment.

Back squat	Front squat
Squat with heel elevation
Just plain awesome

A wide stance and greater range of motion when squatting can elicit more hip musculature. If you squat wide, you’ll probably find it most comfortable to turn the toes out slightly — be sure that your knees are following the direction of your toes, and don’t let the knees cave in.

Going down to where hamstrings contact the calves (rather than stopping and reversing direction at parallel) seems to be the safest position for knees during weighted squats. This will need to be adjusted based on length of femur, tibia, and torso. Once the lower back starts to lose its lordotic curve, you are likely going too deep.

Check your muscle balance

Many physios say that the knee is the “outlet valve” for the hip. Knee problems may actually be hip problems.

Most people have stronger quads than hams and glutes, making knee stability unbalanced. Counteract this with strong hips. Strengthening the hips two times per week for six weeks reduced patellofemoral pain for one group of athletes. The following exercises can strengthen the hips:

Hip Bridge

Dumbbell Step-Up, Alternating

Single-Leg Stiff-Leg Deadlift, Weighted

X-band walks

Band stomp

But don’t completely neglect the quads. Weak quads can lead to an unstable knee joint. And an unstable knee joint can lead to weak quads. It’s a vicious cycle. The vastus medialis obliquus (VMO) is a key knee stabilizer.

Activating the VMO can be tricky. Try terminal knee extensions (TKEs) and backwards walking (even better on an incline) to start.

After you master TKEs and backwards walking, full range of motion squats and single leg exercises can help develop the VMO (well, when proper form is used).

Activating the muscles surrounding the knee can be tough with a wider Q-angle. The Q-angle is the relative angle between the hip and knee, and problems can arise when it’s larger (i.e. the femur has more of a tilt). This is one of the reasons why female athletes — who have wider pelvises than male athletes — are more likely to suffer an ACL injury.

Check your flexibility/mobility

We need mobile joints and soft tissues around the knee to accommodate enough movement.

In your life you’ll have a personal standard for knee flexibility depending on what you do (professional chess player vs. collegiate pole vaulter). But if you can’t do a full squat, you probably have limited mobility.

Joint mobility can be good, but we don’t want excessive joint mobility at the knee joint itself. However, limited mobility can affect proper range of motion, which alters knee mechanics. Thus, we want a balance between mobility/movement and stabilization.

We can improve the knee’s range of motion with flexibility exercises and building mobility at surrounding joints. (See All About Dynamic Joint Mobility.) Conversely, we reduce the knee’s range of motion by being inactive — especially if we sit all day, which shortens the front of the hips and “turns off” the muscular contribution from hips. This alters hip mobility and the knees pick up the slack.

Improving hip mobility is one of the most crucial things you can do to improve knee health. Stretches for the hip flexors:

Lunge with knee on pad

Mermaid/one legged king pigeon (advanced)

Anterior/posterior leg swings

Warrior lunge with reach

Side to side leg swings

Bow pose

Back dome (starts at 2:00 in video – no resistance)

Don’t neglect ankle mobility either. Like the hips, the feet/ankles can affect the kinetic chain. Flexibility exercises for the ankle:

Wall knee taps

Elevated ankle stretch

Foam rolling for the tibialis anterior (about ¾ down the page)

Summary and recommendations

Healthy knees require…

…mobile joints above and below the knee.

• Work on hip and ankle mobility exercises.

…a strong knee joint.

• Do full range squatting movements.
• Train the quads, making sure to activate the VMO.

…a strong posterior chain.

• Train your hips, hamstrings, and glutes.
• Include single-leg work.

Don't forget that posterior chain!

…proper mechanics during physical movement.

• If it hurts your knee, avoid it (but work on your underlying biomechanics and solving the fundamental problems).
• Check your gait and shoes.
• Learn and practice proper running, jumping, and exercise form.

In general, if your knees are already in pain, the rules of exercise modification include decreasing the resistance, adjusting the range of motion, controlling the speed, reducing the volume of work, and/or changing exercises.

For healthy knees, get regular daily activity, keep the joint moving through a full range of motion, and do different things.

Extra credit

Closed chain exercises can reduce the anterior directed forces acting on the tibia in relation to the femur, increase compressive forces between the tibia and femur, increase co-contraction of the hamstrings and quads, mimic daily functional activities more closely, and reduce the incidence of patellofemoral complications. (Translation: training real-world movements like squatting and walking uphill puts the correct forces on the knee, recruit the right muscles, and keep your knees happy.)

Proprioception helps to protect the knee from injury and joint damage. Develop proprioception by doing single-leg lower body exercises, wearing a knee sleeve (for additional sensory input) or standing on one leg while you brush your teeth and floss.

Forces on the knee can range from about twice your body weight during normal walking, to more than four times your body weight during running and jumping activities.

Knee wraps and sleeves can help to promote warmth and blood flow at the joint, as well as provide proprioceptive cues. However, taping and loosely wrapping the knees will not provide much stability, so don’t rely on this.

Heat applied to the knees pre-workout can help make tissues more elastic.

Be careful with plyometrics if you’re overweight or your knee is injured.

Further resources

Nick Tumminello’s Joint Friendly Strength Training DVD

Big legs with bad knees

Mike Robertson’s Knee Basics Part 1 |  Part 2 |  Part 3

References

Schwanbeck S, Chilibeck PD, Binsted G. A comparison of free weight squat to Smith machine squat using electromyography. J Strength Cond Res. 2009;23:2588-2591.

Gullett JC, et al. A biomechanical comparison of back and front squats in healthy trained individuals. J Strength Cond Res. 2009;23:284-292.

Paoli A, Marcolin G, Petrone N. The effect of stance width on the electromyographical activity of eight superficial thigh muscles during back squat with different bar loads. J Strength Cond Res. 2009;23:246-250.

Caterisano A, et al. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res. 2002;16:428-432.

Escamilla RF. Knee biomechanics of the dynamic squat. Med Sci Spots Exerc. 2001;33:127-141.

Senter C, Hame SL. Biomechanical analysis of tibial torque and knee flexion angle: implications for understanding knee injury. Sports Med. 2006;36:635-641.

Robertson M. Bulletproof Knees. 2007.

Shankman G. Training guidelines for strengthening the injured knee: Basic concepts for the strength coach. NSCA Journal 1989:11:32-42.

Johnson J. Treat your own knees. Hunter House Publishers. 2003.

Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Rheum Dis Clin North Am 2008;34:713-729.

O’Neill DF. Knee Surgery: The essential guide to total knee recovery. St. Martin’s Press. 2008.

Garrett J & Reznik B. Knee pain: The self-help guide. New Harbinger Publications. 2000.

Fleming BC, Oksendahl H, Beynnon BD. Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction? Exerc Sport Sci Rev 2005;33:134-140.

Visnes H & Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. Br J Sports Med 2007;41:217-223.

Dierks T. Presentation – American College of Sports Medicine Annual Meeting, 2010.

Lange AK, Banvanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Rheum 2008;59:1488-1494.

What is menopause?

Menopause is when the ovaries stop releasing eggs and menstruation ends for good. A woman has officially entered menopause on the 365^th day from the date of her last menstrual period.

However, women’s transition to menopause is usually gradual and involves fluctuating hormone levels and a range of symptoms for several years.

Female hormone “operation shut down” actually begins during the late twenties, but isn’t really evident until between the ages of 35 to 45 years. This is when many women start to notice changes in their bodies, minds, and feelings. Periods become irregular, the libido tanks, and counting sheep no longer helps with sleep. And hey, did someone turn up the thermostat?

A shared yet diverse experience

While there are common symptoms that many women experience (see below), and an official definition (see above), it’s important to understand that each woman’s experience of menopause is unique.

Symptoms of menopause, perceptions of menopause, and age of onset vary widely from woman to woman, region to region and by ethnicity. This is probably due to differences in

• lifestyle
• diet
• genetic factors
• reproductive history and pregnancy (for instance, on average African women have more children and hit menopause earlier than their counterparts of African descent living in the U.S., which researchers think may be due to demographic patterns of earlier and more frequent pregnancies)
• cultural factors: each culture and social group views menopause differently, which affects how women think about their own symptoms and experiences
• social factors: women have other life challenges, changes, and demands during midlife

In the U.S., about 85% of women will have entered menopause by age 52. With the population of older folks increasing in developed countries, more women are menopausal and post-menopausal.

When is too soon?

Since there’s no specific age of onset, and women’s experiences are diverse, it’s hard to define exactly what “premature” menopause is. However, if women have low sex hormone levels and their periods check out before age 40, that’s officially considered “premature”.

We don’t yet know why premature menopause occurs; it could have an autoimmune component and has been linked to other autoimmune disorders such as thyroiditis and fibromyalgia. Chances of premature menopause also go up with smoking, ovary damage (e.g. from surgery), genetic predisposition, and exposure to xenoestrogens.

What you should know about menopause

Ovaries produce estrogen, progesterone and androgens. They are signaled to do so by FSH (follicle stimulating hormone) and LH (luteinizing hormone) from the brain. With menopause, these hormones gradually decrease.

Changes in estrogen and progesterone during the life cycle

With advancing age, muscle mass and bone mass can decrease, which can influence other hormones in the body, leading to a decrease in GH, IGF-1, and DHEA.

As hormone levels change, so does the body. A perimenopausal woman should be on the lookout for:

• Loss of the menstrual cycle
• Hot flashes and night sweats
• Cardiovascular disease
• Osteoporosis
• Emotional changes
• Vaginal dryness/infections
• Incontinence/urinary tract infections
• Decline in sex drive
• Insomnia

Hormone production

As ovarian hormone production declines, sex hormones secreted by body fat and other organs such as the adrenal glands become more prevalent. The balance tips.

It’s important to keep your body fat in a healthy range with good nutrition and regular activity as you age. Having a lot of excess body fat puts your hormone production out of whack and creates systemic inflammation. That just makes things worse.

See All About Estrogens for more.

Hormone replacement therapy: A controversial option

Hormone replacement therapy (HRT) can offset low hormone levels in the body. Large studies have been completed that provide useful information about perimenopausal HRT, including the HERS study, the ERA study, and the Women’s Health Initiative Clinical Trial.

The Women’s Health Initiative Clinical Trial indicated that for women who are within 10 years of menopause who have taken HRT for 5 or more years, there is a 30% reduction in all cause mortality.

There are natural and synthetic options for HRT.

Natural hormones are substances identical to those produced in the body. Synthetic hormones are chemically altered so that companies can patent them, but still similar enough to the natural kind so they enter the cell and perform most of the same functions.

Only natural progesterone seems to help prevent cancers, normalize blood fats, restore sex drive and regulate sleep. Synthetic progestins can contribute to mood swings, fatigue, insomnia, bloating, weight gain, and anxiety.

Most published data on HRT relates to synthetic hormones, and many women’s health advocates have pointed out significant problems with using synthetic hormones, which are typically derived from non-human sources such as pregnant mares and not identical to the hormones already present in women’s bodies.

Based on available data, here’s how HRT — again, mostly with synthetic hormones — stands.

The American Association of Clinical Endocrinologists announced in 2008 that the benefits of HRT in women under 60 years of age outweigh the risks, and the use of HRT is supported by the ACOG and North American Menopause Society.

Note: Many of the negative HRT effects seem to occur when using combination therapy (synthetic estrogen + synthetic progestin) vs. estrogen only.

(Haas J, et al. Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results. Ann Intern Med. 2004; 140:184-188.)

Why menopause is important

Most of the factors that accompany menopause are temporary, but some can be very harmful. Let’s highlight the biggies.

• Hot flashes/night sweats
• Cardiovascular disease
• Osteoporosis; decreased bone density
• Emotional changes
• Insomnia

“Power surge”: Hot flashes

Hot flashes aren’t really “harmful,” assuming they don’t harm your social life or light the bedsheets on fire. But they sure are a drag.

Some women never have hot flashes at all, probably because they are good at making estrogen from other sources like body fat and androgens.

Hot flashes usually last a few — seemingly interminable — minutes. During this time, skin temperature can actually increase by up to 8 degrees F. Core body temperature stays the same or decreases. Many women find that hot flashes are particularly bad at night.

Hot flashes often increase before menopause, peak 2-3 years after onset, and then taper off. Triggers include stress, coffee, spicy foods, alcohol, sugar, citrus fruits, high BMI, smoking, SSRIs, large meals, and intense exercise.

Soy and hot flashes

Just 25% of Japanese women experience hot flashes vs. 85% of North American women (although some researchers propose that these numbers might be skewed due to reporting bias).

Although there are probably many factors involved, such as genetics and other dietary factors such as fish/seafood consumption (which creates a higher level of omega-3 fatty acids), some think this variation is due to the consumption of soy.

Soy (and many other plant foods) contains isoflavones, a type of phytoestrogen, which are plant derived compounds that can exhibit hormonal activity. American women consume less than 3 mg of isoflavones per day, while women in Eastern Asia consume between 20 and 80 mg/day.

Consuming 50-100 mg/day of isoflavones from food seems to be a safe amount that helps to relieve hot flashes. This would be equivalent to consuming one of the following:

• 1 to 1½ cups soy milk
• 4-5 oz tempeh
• 4-5 oz tofu
• ½ cup edamame
• 3-4 tbsp miso
• ¼-1/2 cup soy nuts

However, flax meal may also be useful. One study showed that women suffering at least 14 hot flashes per week who added 4 tablespoons of flax meal per day to their diet for 6 weeks decreased daily hot flash frequency by 50%, and intensity dropped by 57%.

Some important notes:

Not all women efficiently convert phytoestrogens into a form the body can use to relieve menopausal symptoms.

Soy, like any food, can provoke hypersensitivity reactions. Some nutrition researchers note that soy can be allergenic or interfere with proper nutrient absorption and digestion.

If you are prone to thyroid and/or breast problems, as well as food intolerances, you might want to discuss eating more soy with a doc or dietitian first.

It’s best to get isoflavones from food rather than supplements. Isoflavone supplements might interfere with thyroid function and inhibit mineral absorption, so stick with whole food sources. Avoid consuming more than 150 mg of isoflavones per day.

Regular intake for 1-2 months is usually necessary to notice any effects from isoflavones.

Go with organic soy when possible.

The ACOG approves soy for relieving hot flashes.

Other options for hot flashes

Other options that might help to relieve hot flashes include:

• St. John’s wort (take caution as this herb interacts with various pharmaceuticals)
• yoga
• acupuncture
• massage
• meditation
• exercise

HRT is currently the only FDA approved treatment for hot flashes.

Options that don’t seem to help relieve hot flashes (and may cause additional problems) include:

• kava kava
• Dong quai
• evening primrose oil
• red clover
• ginseng
• black cohosh (Some cases of animal cancers have been reported, and there are 30 reports of serious liver damage with supplementation Mahady GB, et al. United States Pharmacopeia review of black cohosh case reports of hepatotoxicity. Menopause 2008;15(4 Pt. 1):628-638)
• wild yam cream (This contains progesterone precursors; yet humans lack the enzyme necessary to metabolize them. The only way to get true progesterone cream is with a prescription. OTC creams are fraudulent.)

Some menopause specialists simply recommend that rather than trying to eliminate hot flashes entirely, women integrate hot flashes into their daily lives: dress in layers, pop out for some fresh cool air if possible, etc.

Cardiovascular disease

Cardiovascular disease is the leading cause of death in postmenopausal women. Along with declining estradiol, as women age and put on body fat, they can develop insulin resistance/metabolic syndrome, which leads to Type 2 diabetes and further elevates their CVD risk.

While naturally occurring estradiol is cardioprotective, synthetic estrogen in HRT can lead to inflammation, blood clots, and be of no help to existing plaque on vessel walls.

To greatly decrease chances of developing heart disease as you enter menopause, do the following:

• Keep blood pressure below 120/80 mmHg
• Keep total cholesterol below 200 mg/dl
• Keep LDL below 70 mg/dl
• Keep HDL above 60 mg/dl
• Don’t smoke
• Manage stress and meditate
• Keep your body fat in a healthy range; don’t yo-yo diet
• Exercise at least 5 hours each week
• Consume plenty of whole, plant foods like vegetables, fruits, beans, whole grains, nuts and seeds
• Avoid processed foods and added sugar
• Include smaller amounts of alcohol, meat, fish, dairy, and eggs
• Drink tea and water

Osteoporosis

At menopause, calcium absorption is generally 50% below the adolescent peak rate. This is likely due to a lack of vitamin D (less time in sun, less consumed in diet, less uptake in gut).

Estrogen helps to slow bone breakdown and prevent factures by turning on vitamin D receptors in the gut (see more here: All About Vitamin D). HRT won’t help to build or replace bone, but it may help to prevent bone loss.

Ways to preserve bone mass upon menopause:

• Incorporate green leafy veggies, legumes and nuts/seeds – these seem to be the optimal sources of bone building calcium
• Get adequate sunlight to attain vitamin D (see more here: All About Vitamin D) — and hey, fresh air and exercise help relieve hot flashes too! Win-win!
• Avoid excessive alcohol, salt, carbonated drinks, and caffeine
• Check your calcium supplementation – it might contribute to the progression of cardiovascular disease. It’s best to only supplement when you can’t get enough calcium from food and vitamin D status is adequate. In addition, many women eating standard Western diets are actually deficient in magnesium and other trace minerals (such as phosphorus), not calcium.
• Eat soy – soy can increase intestinal calcium absorption and protect bone cells
• Do weight bearing exercise (resistance training, walking, etc.)
• Don’t smoke
• Include foods from the allium family – these can protect bones and inhibit cancer development
• Avoid refined sugars/grains – these don’t provide nutrients, can diminish bone health, increase inflammation, and result in mood swings and fatigue

Recent research suggests that osteoporosis is less a disease of “not enough calcium” and more about systemic inflammation and poor mineral absorption, particularly from a diet high in grains and dairy and low in veggies. (See All About Dietary Acids and Bases). There is evidence that estrogen may affect inflammatory cytokines (cell signaling molecules).

Emotional changes

Many women notice emotional highs and lows. This is a scientifically detached and polite way of saying that many women sometimes feel like they’re going nuts.

Emotional symptoms can include:

• crying spells; sadness
• irritability and anger
• panic and anxiety; sense of dread or impending doom
• depression and lethargy

To ensure a stable mood:

• Incorporate plenty of whole foods rich in vitamin C like bell peppers, citrus fruits, broccoli, teas, potatoes, and yams
• Eat foods with B vitamins for the nervous system like wild rice, brown rice, quinoa, buckwheat, polenta, and green leafy vegetables
• Get outdoors for recreation
• Eat whole grains to bump up serotonin
• Eat regular meals
• Limit processed foods, added sugars, alcohol and caffeine
• Incorporate omega-3 fats from algae, flax, hemp, chia, and walnuts
• Address underlying factors, e.g. stress, relationship difficulties, etc.

Many women find that counselling is helpful during this period. Midlife is also a period of life change, and mood changes can reflect “real” changes, shifts in priorities or life demands, and/or underlying issues (such as changes in family dynamics or caregiving).

Recognize that these symptoms are common, and (in part) related to hormonal changes — you’re not going crazy!

Insomnia

This is often due to night sweats and/or anxiety, but generalized hormone fluctuations can cause sleep disturbances too. Along with changes in sex hormones, women may notice changes in other hormones such as thyroid and/or adrenal hormones.

To promote restful sleep:

• Limit alcohol (see here for more on this: All About Alcohol) – remember that alcohol can compromise liver function, diminishing its ability to metabolize estrogens
• Limit caffeine
• Try a small serving of starchy carbohydrates in the evening, which can increase serotonin
• Avoid protein, sugar, fat, beans, and liquids before sleeping
• Melatonin or valerian might help with sleep, but side effects can occur
• Basic sleep hygiene is in order; see All About Sleep for more
• Other hormonal conditions can affect sleep, so discuss any symptoms with your doctor or endocrinologist

There are social factors too. Many midlife women are struggling with competing responsibilities: paid work, unpaid work (e.g. domestic work), caregiving for children and aging parents, etc. It’s no wonder that many of them can’t sleep!

Other physical and mental changes

Hey, where did that spare tire come from? Why are you feeling more like an apple than a pear these days? Why doesn’t food X agree with you any more? Why is it so hard to lose fat? Why are you suddenly attracted to elastic waistbands? And where did you leave your freaking car keys??!

There are many other physical and mental changes that can occur in midlife, which again reflect changes in both the physical environment (i.e. hormonal changes) and changes in your personal life (e.g. caregiving stress). This includes:

• changes in sex drive
• vaginal dryness; yeast infections; bladder infections and interstitial cystitis
• changes in breast size (as estrogen declines) and comfort (e.g. tenderness, lumpiness)
• forgetfulness; “brain fog”; difficulty concentrating
• digestive changes; new food intolerances
• water retention; bloating
• increased intensity of PMS symptoms
• difficulty losing fat
• changes in appetite and/or food cravings
• dizziness; lightheadedness
• heart palpitations
• “inner tremor” or jitteriness; some women talk about it feeling like an “inside earthquake”
• headaches; migraines
• joint pain
• tingling, “electric shock” type pain in extremities
• fatigue; lethargy
• hair loss; thinning hair
• brittle nails

Summary and recommendations

Physical, intellectual, and emotional changes in midlife are normal for men and women. Changes take a variety of forms.

Each woman’s experience of menopause is unique. You can significantly affect your menopause symptoms with good nutrition and regular activity.

Symptoms are complex and inter-related. For instance, changes in digestion or the hormonal environment can affect fat loss. Insomnia can add to your stress, worsen your mood, and make you want to reach for that caffeine.

Build a strong support network that includes health care providers, coaches, counsellors, other women, family and friends, etc. Ask for help. Don’t go it alone.

Do your homework and learn about your experiences, as well as those of other women. Chances are, you’re not “abnormal”.

If menopausal symptoms are manageable, exploring natural options is likely the best option. For those with significant and debilitating menopausal symptoms, and under the age of 60, HRT might be something to consider.

Living, exercising, and eating the PN-style way can help control symptoms and decrease chances of potential diseases associated with menopause. This includes:

• Keep your body fat in a healthy range; don’t yo-yo diet
• Exercise at least 5 hours each week, and include weight-bearing activities as well as stress-relieving activities such as outdoor walking
• Consume plenty of whole, plant foods like vegetables, fruits, beans, whole grains, nuts and seeds
• Include controlled amounts of alcohol, caffeine, meat, fish, dairy, and eggs
• Avoid processed foods, added salt, smoking, and added sugar
• Drink tea and water
• Consider eating small amounts of whole soy foods each day
• Manage stress and meditate

Extra credit

A hysterectomy will cause menstrual periods to stop, but it won’t induce menopause, because the ovaries continue to function.

Bloating with menopause/post-menopause can be due to changes in digestive abilities. Stomach acid tends to decrease. This can be alleviated with a digestive enzyme supplement, digestion tea with peppermint/ginger, limiting animal foods, using a probiotic rich food or supplement, and lightly cooking raw vegetables.

Taking a contraceptive pharmaceutical can mask perimenopuase by controlling typical symptoms. This doesn’t “change” the time of menopause for you.

Estradiol tends to suppress appetite.

The Japanese have no word for “hot flash.”

A plant-based diet is associated with fewer hot flashes.

Changes in estrogen might influence fat cell activity in the abdomen.

Men can experience hot flashes when testosterone suddenly drops, such as in prostate cancer treatment.

Current data provides assurance that isoflavone exposure at levels consistent with historical Asian soy intake doesn’t seem to result in adverse effects on breast tissue.

Cruciferous vegetables may guard against estrogen dependent cancers.

Seaweed has minerals for thyroid function and can inhibit cancer development.

Further resources

North American Menopause Society

The American Congress of Obstetricians and Gynecologists

References

Avis, Nancy, et al. Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups.
Social Science and Medicine (February 2001), 52 (3), pg. 345-356.

Pinkerton JV, Stovall DW, Kightlinger RS. Advances in the treatment of menopausal symptoms. Womens Health 2009;5:361-384.

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact 2009;9:186-197.

Taylor N. Natural Menopause Remedies. New American Library. New York, NY. 2009.

Herrington DM, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000;343:522-529.

Lakoski SG, et al. Hormone therapy, C-reactive protein, and progression of atherosclerosis: data from the Estrogen Replacement on Progression of Coronary Artery Atherosclerosis (ERA) trial. Am Heart J 2005;150:907-911.

Abdali K, et al. Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17:326-331.

Bolland MJ, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010;341:c3691.

Mundy, Gregory. Osteoporosis and inflammation. Nutrition Reviews 65 no.12 (December 2007): S147–S151.

Crawford AM. The Natural Menopause Handbook. Crossing Press. Berkeley, CA. 2009.

Glenville M. Healthy eating during menopause. National Book Network. Lanham, MD. 2004.

Cheung T. The all-natural menopause diet. Pegasus Books. New York, NY. 2008.

Thacker HL. The Cleveland Clinic Guide To Menopause. Kaplan Publishing. New York, NY. 2009.

Seaman B & Eldridge L. The no-nonsense guide to menopause. Simon & Schuster. New York, NY. 2008.

Messina MJ & Wood CE. Soy isoflavones, estrogen therapy, and breast cancer risk: analysis and commentary. Nutr J 2008;7:17-29.

Edelman JS. Menopause Matters. The Johns Hopkins University Press. Baltimore, MD. 2010.

Saxena T, et al. Menopausal Hormone Therapy and Subsequent Risk of Specific Invasive Breast Cancer Subtypes in the California Teachers Study. Cancer Epidemiol Biomarkers Prev. 2010;Online First.

Cassidy A. Diet and menopausal health. Nursing Standard. 2005;19:44-52.

Pines A & Berry EM. Exercise in the menopause – an update. Climacteric 2007;10(Suppl2):42-46.

Kronenberg, F. Menopausal hot flashes: A review of physiology and biosociocultural perspective on methods of assessment. J Nutr 2010;140:1380S-1385S.

Messina M. A brief historical overview of the past two decades of soy and isoflavone research. J Nutr 2010;140:1350S-1354S.

Hagey AR & Warren MP. Role of exercise and nutrition in menopause. Clin Obstet Gynecol 2008;51:627-641.

What is dynamic joint mobility?

Dynamic Joint Mobility (DJM) is when someone actively moves a joint through its range of motion (ROM), and where the goal is, with precise movement practice, to improve the joints’ mobility.

DJM is not:

• statically holding a joint in position
• moving a joint through partial ROM
• having the joint passively moved through its ROM by someone or something else

DJM: A brief history

DJM has a long history, mainly as an integral part of martial arts practices such as T’ai Chi, Qi Gong and Bagua zhang.

It’s even part of modern martial arts like Russian Systema, particularly the floor movements.

Beyond bodyweight movements, there has been a resurgence of interest in Indian clubs for upper body and shoulder rehab (see DVD in resource section below). Club practices move body joints in multiple planes and through a full ROM.

The late 19^th to early 20^th century physical culture of richer joint movement that included calisthenics, rope climbing and club swinging waned by the mid 20^th century. Exercising in gyms since then has largely become about training in limited planes and ROM.

In the 21^st century, specific joint mobility practice outside the martial arts context via programs such as Intu-flow, Super Joints, Spiralflow and Z-Health have been developed. These programs are designed to re-introduce joint mobility practice and overcome limitations of restricted gym movements and sedentary lifestyles.

Why is dynamic joint mobility important?

Our bodies are plastic: we constantly adapt to what we do. This adaptation shows up when we learn new physical skills and build new body tissues. The principle applies to our brains and nervous system, too. We are “use it or lose it” organisms.

Our design is so physically interconnected that what happens at one site cascades to others.

For instance, if the movement in our ankle joints is restricted from normal ROM, this can impact our gait. To make up for this restriction, our knees and/or hips may change movement to support the missed job of the ankles. We practice this compromised gait many times a day, causing our muscles and related tissues to adapt to support our “special” gait.

This adaptation may have painful consequences: our knees may hurt from a walk that moves those joints outside a normal ROM. Likewise, our hips may be pulled out of their normal pattern emerging as low back pain.

This cascade is often why movement specialists will say “the site of pain is not always the source of pain.” Compromised joint ROM is often seen with limited squat depth and poor running economy.

As use-it-or-lose-it organisms, we get the body we practice having.

On the plus side, this means that better practice = better body.

By practicing joint mobility with intent, we re-educate and rehabilitate our movement towards a healthier ROM.

Left: Demonstrating how to identify joint locations for a DJM movement (an outside toe pull here).	Right: Demonstrating one way to position the foot to hit the outside toe pull properly.

Source: From R-Phase DVD.

Benefits of DJM training

Proprioception/Sensory motor benefits

Beyond the physiological benefits of moving joints through their ROM, joint work helps us neurologically: joints are key triggers for sensory-motor perception. We experience the world in a sensory-motor hierarchy of visual (vision), vestibular (balance) and proprioceptive (where we are in space) systems. Joints have a very high number of proprioceptive nerves that tell the brain where we are in space and how fast each part of us is moving.

Reducing injury

Studies on ankle mobility have shown that athletes who practiced enhancing mobility/proprioception in their ankles reacted better to simulated stumbling than those who had not. Likewise, mobility work as part of balance and resistance training in elderly women at risk of hip fractures was found to have a profound effect on reducing the incidence of falls.

Micro DJM

To counterbalance high repetition typing/writing, someone can use “micro DJM”.

Typing is largely finger flexion without finger extension. Mobility drills designed for the wrists, hands and fingers help us get in repetitions that balance extension or flexion with up, down, side to side, and back and forth, movements that are all part of this joint’s capacity. These simple strategies can restore mobility around the joints and reduce the effects of associated conditions like repetitive strain injury.

Jammed joints and reduced strength

The nervous system is designed for survival first, not performance. If the nervous system detects a problem in its function – like a joint that is not able to move properly – it more or less cuts down power to the rest of the system (so the compromised component doesn’t put the system at risk).

This shutdown is global. A jammed joint in the foot can be seen in reduced quad muscle strength. Conversely, opening up the jammed joint can bring the power back on line. This phenomenon was first noted decades ago and labelled the “arthrokinetic reflex.”

Here, PN Moderator and Z-Health Master trainer Mike T Nelson demonstrates the effect of jammed and unjammed joints on any other muscle’s performance.

How does DJM compare to…

…stretching?

Stretching has emerged as a dominant form of warm-up and cool-down. If someone has restricted ROM when doing a lift, we hear about “tight muscles” needing to be “stretched out.” We know, however, that there are times (such as before a heavy lift) when elongating a muscle is not optimal. See more: All About Warming Up.

DJM can improve performance without the potential negatives of static stretching. A DJM movement such as the outside toe pull (described here, shown above) can have a direct effect on the hamstrings to increase ROM at the hip.

…foam rolling?

Foam rolling is an increasingly popular strategy to work what is presumed to be restricted fascia, trigger points and/or again “tight” muscles. These approaches often tend to focus on the site of the issue as the source of the issue, without necessarily exploring why this tightness has evolved in the first place.

By working on joint mobility across the body, areas previously seen to be persistently tight begin to open up and, importantly, stay open. Further, foam rolling, from the body’s perspective, is passive – it’s an act being done to part of the body by something else – thus, less of the nervous system is involved in the movement.

Active vs. passive body mechanics

DJM is an active model, rather than passive, meaning that the body is actively engaged in movement and therefore firing up more neurons to learn how to reproduce these movement patterns on its own. It’s the difference we experience between someone putting their hands on our wrists and guiding us through a tennis swing, for instance, and doing it ourselves.

Below: Eric Cobb demonstrates differences between active vs. passive therapy in Essentials of Elite Performance Mini Course

Proprioception & pain

Pain is part of neurological signalling triggered by another proprioceptive nerve, the nociceptor.

Typically, there are more mechanoreceptors (nerves that sense touch, movement, and position) around joints than nociceptors. Mechcanoreceptive nerves send their signals several hundred times faster than most nociceptors. This means that proper joint movement can send a far stronger signal, faster, to the body than a pain signal can.

Summary and recommendations

1. Dynamic joint mobility is important for overall wellness and function.

We have seen that one jammed joint anywhere reduces the strength of the body everywhere, but freeing this joint immediately improves performance. Our bodies are designed to move through a large ROM and various planes of movement.

Sedentary bodies rarely experience this full ROM in all joints. Since our bodies are designed to adapt to what we do, lack of movement can quickly develop into movement restrictions that have associated effects on well being, from tight muscles to arthritis.

2. This same plasticity, however, can quickly adapt to movement practice.

A deliberately designed DJM practice has tremendous and rapid benefits for well being, and re-educating our bodies about how our limbs are supposed to move. Such programs can be time efficient and move each body joint through its ROM in just 10 minutes.

A shoulder mobility sequence from Z-Health

3. Find a mobility coach.

Mobility practice, like any movement, requires skill development. While there are DJM programs available on DVD, for guidance and support, a coach can ensure quality of movement and accelerated progress (listings below).

Resources

Linked Listing for movement coaches (PN’s guidelines on how to pick a personal trainer apply here, too).

Cobb, E, Mauck, K, Mauck , Z-Health Neural Warm Up 1 and R-Phase Package (DVDs and manuals). Z-Heath Performance Solutions, Arizona USA, 2006.

Cobb, E, Mauck, K, Mauck, S. The Essentials of Elite Performance (DVD Mini-Course) Z-Heath Performance Solutions, Arizona USA, 2010.

Jones, Brett, Cook, Gray . Club Swinging Essentials (Featuring Ed Thomas) (DVD). Functional Movement, Virginia, USA, 2010

References

Anderson, Owen “Can proper proprioceptive training reduce your probability of injury?” Sports Injury Bulletin. (no date, but post 2001).

Blakeslee S & Blakeslee M. The Body Has a Mind of Its Own: How Body Maps in Your Brain Help You Do (Almost) Everything Better. Random House, NY, 2008.

Baszanowski, W., ed. 8 European Weightlifter Federations: a Brief History of Their Centenaries. Special Issue. European Weightlifter, EWF Secretariat. 2005 (pdf).

Butler D & Moseley LG. Explain Pain. Noigroup Publications, Australia, 2003.

Cobb, E, Pincus, R. The SPEAR System and Converting Flinch Response. Law and Order. 2003.

Colvin, What it takes to be great, Fortune Magazine, October 19 2006.

Doige, Norman. The Brain that Changes Itself. Penguin, Middlesex, UK, 2007.

Deliagina, T. Neural Bases of Postural Control. Physiology 2006;21(3):216-225.

Frost HM. From Wolff’s law to the Utah paradigm: insights about bone physiology and its clinical applications. Anat Rec 2001;262(4):398-419.

Karinkanta S, et al. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 2007;18(4):453-62.

Lederman, E. Neuromuscular Rehabilitation in Manual and Physical Therapies: Principles to Practice. Churchill Livingstone, London, 2010.

McIntosh, G., Hall, H. “Low Back Pain,” Clinical Evidence, BMJ Publishing Group Limited. Oct 2008.

Myers, T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2^nd Ed CHURCHILL LIVINGSTON London & New York, 2008.

Ostry DJ, et al. Somatosensory plasticity and motor learning. The Journal of neuroscience: the official journal of the Society for Neuroscience 2010;30(15): 5384-5393.

Riemann BL, & Lephart SM. (2002) The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability. Journal of Athletic Training 2002;37(1):80-84.

Remember when you’d get done with a bowl of Froot Loops and the milk would be blue? Those were the days.

But where did that colour come from? And are we all going to regret slurping up that milk?

What are food colour additives?

A food additive is defined as:

Any substance not normally consumed as a food in itself and not normally used as a characteristic ingredient of food, whether or not it has nutritive value.

Thanks for nothing, definition. So basically, a food additive is something that doesn’t normally occur in the food we eat — it has to be added… hence the name.

There are many types of food additives: preservatives, sweeteners, firming agents, anti-caking agents, etc. (For a full list of food additives see the FDA site or Health Canada, which has a handy Food Additive Pocket Dictionary — great for when you can’t remember the difference between isopropyl alcohol and isobutane.)

Colour additives are categorized as either dyes or lakes.

Dyes dissolve in water and are manufactured as powders, granules, liquids or other special-purpose forms. They can be used in beverages, dry mixes, baked goods, dairy products, jams, pudding, pie filling, yogurt, popsicles, pet foods and a variety of other products.

Lakes are the water-insoluble form of the dye. Lakes are more stable than dyes and are ideal for colouring products containing fats and oils, or items without enough moisture to dissolve dyes. Typical uses include coated tablets, cake and donut mixes, cheese, margarine, candy and chewing gums.

Where do food colours come from?

Humans have long known that certain plants, animals, and minerals will stain surfaces such as fabric, skin, wood, and food. Naturally occurring pigments in these plants and minerals — or the chemical reactions that can occur (e.g. when things go green with the oxidization of copper) — create the colours. This includes things like:

All of these, by the way, are legal “natural” food dyes.

With the advent of industrial processing, many food dyes were originally synthesized from coal tar, a carcinogen. Now they tend to be petroleum (oil) based.

Types of food color additives

In the United States, the Food and Drug Administration divides food colour additives into two groups: certified, and exempt from certification.

Certified colours are synthetically produced (or human made) and used widely because they impart an intense, uniform color, are less expensive, and blend more easily to create a variety of hues. Only 9 are permitted in the U.S. (More on this below.)

Colors that are exempt from certification include pigments derived from “natural” sources such as vegetables and animals as well as metals/minerals such as aluminum, silver, iron, and titanium dioxide. These are usually more expensive, and may add unwanted or unintended flavours to foods.

Why do manufacturers use food colour additives?

Manufacturers use colour additives to cover up an absence of natural colour (e.g. in margarine), offset colour loss due to light/air/temperature exposure, and give the product “added value.”

See the food colour additives on the ingredient panel of Froot Loops? What colour do you think Froot Loops were before all those chemicals were added? (Hint: See All About Breakfast Cereals.)

What you should know about food colour additives

The most widely used dyes areR ed 40, Yellow 5, and Yellow 6 – accounting for 90% of all dyes used. They contain carcinogens and may cause allergic reactions. Each year, about 15 million pounds of synthetic dyes go into the U.S. food supply (well, the “processed” U.S. food supply).

Since 1955 our consumption of food colour additives has increased by five times. Translation: the U.S. eats a lot of processed foods.

What are the problems with food colour additives?

There are some potential problems with food dyes, specifically:

• Carcinogenicity – leading to cancer development
• Genotoxicity – leading to mutations or damaging chromosomes
• Neurotoxicity – leading to the damage of nerve tissue

Banned food dyes include:

• Green 1, Red 1 – promote liver cancer
• Orange 1, Orange 2, Violet 1, Red 2, Red 32 – carcinogenic
• Sudan 1 – toxic
• Yellow 1 and 2 – lead to intestinal lesions
• Yellow 3 and 4 – promote heart damage

While some studies show that certain dyes aren’t themselves strong carcinogens, there may be a synergistic effect. Thus, various food dyes in a single processed food could lead to more potent carcinogenicity.

Ummm... should I eat that? Is that food?

There are still nine food dyes permitted by the FDA. According to the FDA, these nine dyes don’t have enough evidence to warrant a ban.

FD&C Blue Nos. 1 and 2 – I remember hearing stories from the nurses at the hospital where I worked, about using Blue no. 1 in feeding tube solutions. They did this with the intent to trace the flow of liquid into the gut and not the airway (because a feeding tube entering the lungs can lead to pneumonia).

Animal studies indicate that small amounts of Blue no. 1 are absorbed through the GI tract. That’s not good. And what’s really not good is that the animals in those studies were “healthy,” not confined to the ICU. People getting tube feeds in the ICU tend to have weak GI tracts. Beginning in 1999 a series of reports appeared that indicated Blue no. 1 could pass across the digestive tract and into the blood, often with catastrophic penalty. In 2003 the FDA advised against putting this dye in feeding tubes.

But it’s still in food.

To get this...

...manufacturers use this.

FD&C Green No. 3 – may promote cancer in animals and isn’t used very often in the North American food supply.

FD&C Red Nos. 3 and 40 – Red 40 is one of the most common food dyes (check out Orange Crush) and might promote tumours in animals. Red no. 3 has been around since 1907. You know those maraschino cherries in your Shirley Temple? Those have been coloured with red no. 3. Red no. 3 is an animal carcinogen and is genotoxic.

FD&C Yellow Nos. 5 (tartrazine) and 6 – these dyes have connections to hypersensitivity reactions. The chemical structure is very similar to benzoate and salicylate (the active ingredient in aspirin). Yellow no. 5 seems to be mutagenic (aka mutation-causing; DNA-damaging) in animals and might also have random contaminants. Yellow no. 6 might also include contaminants, but doesn’t appear to promote cancer.

Orange B – not much to say about this except I would like to have this name if I were a rapper. Actually, orange B is only permitted for use in sausage casings. Animal studies show potential problems with the spleen, lymphatic system and kidneys when exposed to orange B. The FDA wanted to ban this in 1978, but never followed through because most food companies stopped using it.

Citrus Red No. 2 – often added to orange peels. Enough of this stuff is produced each year to colour 2 billion oranges. It seems to promote cancer and tumors in animals.

Note: FD&C stands for Food, Drug and Cosmetic

So, “natural” is OK, right?

Well, that depends. Some “natural” food additives are likely just fine.

• In the case of dehydrated beets, for instance, it’s probably not a big deal.
• With beta-carotene, the worst that’ll probably happen is you turning orange from over-consumption.
• Turmeric comes from the ginger family of plants, and may have anti-inflammatory properties, although there’s probably not enough of it in your yellow mustard to make that mustard a health food.

Other “natural” food additives might be more problematic. For example:

• Annatto extract – a carotenoid extracted from a tropical tree seed (Bixa orellana), often added to cheese. Has been implicated in IgE mediated allergic reactions.
• Cochineal extract or carmine is a red dye made from crushed cochineal beetle. It’s now listed on the ingredient label as cochineal extract or carmine (before 2009 it didn’t need to be). 70,000 beetles may be killed to produce one pound of this red dye. Has been implicated in IgE mediated allergies.
• Caramel colour – this makes cola brown and beer gold. Caramel colour is the most commonly consumed food colouring ingredient in the world. It’s produced by heating carbohydrates (like fructose, dextrose, or invert sugar) with a food-grade acid (like sulfuric, phosphoric, or citric) to break the sugar bonds. Think of caramel colour as burnt sugar. Negative health consequences of caramel colour are unlikely as long as someone doesn’t consume loads of it. (For more on the problems with the Maillard reaction, see All About Cooking & Carcinogens.)  There is the potential of an allergic reaction.
• Titanium dioxide, which makes things white (such as your soymilk), has recently been classified by the International Agency for Research on Cancer (IARC) as an IARC Group 2B carcinogen — ”possibly carcinogenic to humans”.
• Aluminum, used as an additive in a variety of foods such as cake decorating materials, canned seafood (including caviar), and relish, might cause adverse effects related to reproduction, neurological behaviour and neurological development.

How are additives regulated?

In 1938, after people raised concerns about dyes in food and beauty products, the US passed the Food, Drug and Cosmetic Act. In 1960, the Color Additives Amendment was enacted, which ruled that the FDA had to approve any new food colour additive before any food colour additive could hit the market.

Relative to other industrialized regions, the U.S. tends to have weaker food regulations.

In the European Union (EU), the Community legislation on food additives is based on the principle that manufacturers can use only those additives that are explicitly permitted. Food additives in the EU may only be permitted if:

• there is a technological need for their use,
• they do not mislead the consumer,
• they present no hazard to the health of the consumer.

Most food additives may only be used in limited quantities in certain foodstuffs. If regulations don’t specify a particular upper limit for a particular additive, that additive must be used according to good manufacturing practice — only as much as necessary to achieve the desired technological effect.

In Canada, food colour additives are regulated by Health Canada, which is currently considering legislation that will require manufacturers to list which colours they use… instead of just saying “colour”.

Why are food colour additives important?

If you eat processed food, you likely eat food colour additives. Many experts have raised health concerns about food colour additives.

Food additives and children

The European Union (EU) requires that food colour additives must have a warning label when added to food, since they may cause adverse effects on activity and attention in children. You’ll currently find the following warning on the label:

“May have an adverse effect on activity and attention in children”

In the U.K., almost 30% of kids under 11 years old have experienced problems with consuming food additives. Still, food colour additives don’t seem to provoke as many complications as other additives (e.g., aspartame, monosodium glutamate, etc.).

Researchers have speculated on behavioural problems related to food colouring ingestion since the 1970s. A 2004 meta-analysis concluded that artificial dyes influence children’s behaviour, and two studies funded by the British government found that mixtures of dyes (along with the preservative sodium benzoate) unfavorably influence the behaviour of kids.

In the U.K. the same food products we have in the U.S. are coloured with different additives.

In the U.S.	In the U.K.
Fanta orange soda is dyed with Red 40 and Yellow 6	Fanta orange soda is dyed with pumpkin and carrot extract
In the U.S.	In the U.K.
Kellogg’s Strawberry Nutrigrain bars are coloured with Red 40, Yellow 6 and Blue 1	Kellogg’s Strawberry NutriGrain bars are coloured with beetroot, annatto and paprika extract
In the U.S.	In the U.K.
McDonald’s Strawberry Sundaes are coloured with Red dye 40	McDonald’s Strawberry Sundaes are coloured with strawberries

Side rant: Before you get ready to throw down at the FDA offices, consider what foods we are talking about here. Orange soda, cereal bars, and strawberry sundaes? I don’t care if those are coloured with rare flower petals from Fiji – if you consume them on a regular basis, your health is probably going to suffer.

Candy indicating “no artificial dyes or flavours” – could still give you cavities and diabetes

Most unfavourable responses to food colour additives do not involve the production of IgE antibodies, except if there is an allergy to a food colouring derived from a plant/animal source (e.g., annatto extract, cochineal extract, etc.).

PDF Summary of food dye studies (source: Center for Science in the Public Interest)

Summary and recommendations

While a few food colour additives may not show direct evidence of causing health problems, many do. Further, food colour additives are unlikely to promote health and longevity (but hey, you never know). So – why bother consuming them at all?

The easiest way to avoid food colour additives is to eat whole, unprocessed foods (except for that orange peel colouring, as well as substances like beta-carotene in chicken feed to make anemic yolks brighter yellow). If possible, buy from small farmers and ask about how they treat their foods and animals.

If you buy a processed food, check the ingredients. When you check the ingredients, if you see any of the following words, set it down and back away slowly:

• Artificial colour
• Green, orange, red, violet, blue, or yellow followed by a number
• Caramel colour

Extra credit

One study in rats indicated that blue food dye could actually prevent paralysis after spinal cord injury (see here: CBS News Story).

Further resources

Summary of colour additives for use in the U.S. in foods, drugs, cosmetics, and medical devices

References

Lucarelli MR, et al. Toxicity of food and drug cosmetic blue number 1 dye in critically ill patients. Chest 2004;125:793-795.

U.S. Food and Drug Administration. FD & C Blue no. 1 in enteral feeding solutions. Public Health Advisory. Sept 29 2003.

McCann D, et al. Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet. 2007;370:1560-1567.

European Commission. Food Safety: Food Additives (contains links to relevant legislation).

Curran L. EU places warning labels on foods containing dyes. July 21, 2010. http://www.foodsafetynews.com/2010/07/eu-places-warning-labels-on-foods-containing-dyes/

Kobylewski S & Jacobsen MF. Food dyes: a rainbow of risks. June 2010. Center for Science in the Public Interest. http://cspinet.org/new/pdf/food-dyes-rainbow-of-risks.pdf

Artificial food colouring and hyperactivity symptoms in children. Prescrire Int. 2009;18:215.

Schab DW & Trinh NH. Do artificial food colours promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr. 2004;25:423-434.

Fuhrman J. Dangers associated with food dyes. July 16, 2010. http://www.diseaseproof.com/archives/food-safety-dangers-associated-with-food-dyes.html

CBS News. Does blue food dye prevent paralysis? July 28, 2009. http://www.cbsnews.com/stories/2009/07/28/earlyshow/health/main5193187.shtml

FDA: Food ingredients and colours. Revised April 2010. http://www.fda.gov/food/foodingredientspackaging/ucm094211.htm

Bateman B, et al. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Child 2004;89:506-511.

McCann D, et al. Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial. Lancet 2007;370:1560-1567.

Randhawa S & Bahna SL. Hypersensitivity reactions to food additives. Curr Opin Allergy Clin Immunol 2009;9:278-283.

Skypala I. Other causes of food hypersensitivity. In: Food Hypersensitivity, eds: Isabel Skypala & Carina Venter. Wiley Blackwell. 2009.

What are kettlebells?

Kettlebells are iron or steel balls with flattened butts on one end and a curved handle on the other.

Kettlebells are used both for general athletic training and competitive sport. They facilitate whole body dynamic movement for strength, endurance, and power training. They are used by sports teams, those who train at home, world class athletes, and folks who want to burn fat and build muscle.

Kettlebells: a brief history

Humans probably devised a kettlebell-type object — a weight with a handle — not long after they figured out how to use their opposable thumbs.

Kettlebells, or things that seem to look like them, have been found in excavations of ancient Greece. It’s thought that implements like them were used in Russia initially as grain measures, with the approximately 16 kg, or one “pood“, being the standard measure.

Modern kettlebell manufacturers generally respect these weight conventions; thus kettlebell sizes range in 4 kg increments around the 16 kg “1 pood” standard (e.g., 12 kg, 16 kg, 24 kg and 32 kg). However, manufacturers are increasingly producing sizes in between the standards – like 14 kg and 28 kg, and masses as great as 60 kg kettlebells.

From obscurity to mainstream

Kettlebells have a long history in Europe and Russia from the 1700s onward, and were a feature of European gyms and strongman performances in the late 19th and early 20th century. Now, they are perhaps best known for their association with late 1940s Russian physical culture.

Their popular introduction to North America in the 21^st century is largely credited to Pavel Tsatsouline, a Russian émigré, Special Forces trainer and coach. Along with his book The Russian Kettlebell Challenge (see references below), Tsatsouline concurrently began offering classes and a kettlebell trainer certification known as the RKC, now the oldest and most established kettlebell certification in North America.

Since their introduction in the West, kettlebells have slowly begun to emerge as a mainstream training tool with numerous trainer certifications being offered. Likewise, what is known as Girevoy Sport (GS) kettlebell competitions as formalized in Russia around the mid 1980s have started being held in North America. Valery Fedorenko is credited with the sport’s presentation in North America and is now mainly promoted through what has become the World Kettlebell Club.

Why are kettlebells important?

Because of their design, kettlebells enable many familiar movements from pushes like the shoulder press to pulls like Renegade Rows. Yet, they also support whole-body, dynamic weighted movements, once the specialized preserve of Olympic barbell lifters.

The kettlebell swing

For instance, the foundational kettlebell movement — the swing — starts with a posture and hip drive similar to the deadlift or Olympic clean, but the cannonball-with-handle kettlebell design means that this weight can be swung up from between the legs, driven by the hip thrust forward to about chest height, and then accelerated down again by the shoulders pulling the weight down, back through the legs, then driven back up again with the hips, back and forth for reps.

Depending on the mass of the kettlebell used, sets of swings are either very low-rep (3-5) with adequate recovery breaks, or high-rep (anywhere from 10-100 or more for time), depending on the energy system/strength type being trained. This demonstrates the versatility of the kettlebell — the same movement can be used for everything from maximal strength, to strength-endurance, to “cardio” or metabolic conditioning.

Hanging onto the kettlebell during swings also works the grip and forearms. Kettlebell swings can also be performed with two hands on one bell, one hand/one bell, or one bell in each hand for two bells at a time (doubles).

The Beautiful Swing
More Beautiful Swings

Other dynamic kettlebell movements like the snatch and the clean and jerk also develop full body strength, power and endurance, and besides being used for general conditioning, are the core kettlebell competition moves.

Kettlebell advantages

The primary advantage of kettlebell training is its efficiency. While it’s helpful to have a few kettlebells of different weights, one bell alone can give you a darn good workout.

• They are a room efficient gym: if there is room to swing a cat, there’s room to swing a kettlebell.
• By varying weights used, you can use the same movement for cardio, strength-endurance, speed, or power.
• You can do presses, pulls, squatting-type movements, and dynamic work.
• Because dynamic kettlebell movements involve the whole body, you work upper and lower body strength concurrently and time effectively.
• Because these are compound moves, you must engage antagonist, agonist and support muscles.
• The hip drive focus is also particularly useful for working the core and “posterior chain” — the muscles of the spine, butt, and back of the legs.
• The focus on form for shoulder work helps strengthen and stabilize the shoulder joint.

Cautions

Some people immediately fear for a lifter’s back when they see any dynamic movement of a weight at high speeds. Kettlebells can evoke a similar response in those unfamiliar with proper form.

Yet Stuart McGill, a leading back expert, is a strong supporter of kettlebells (and deadlifts). Lifters maintain spinal stability and neutral spine throughout the movements (notice in the photos above that the lifter never rounds the back, but keeps a natural curve).

That said, as with any skill, doing it right can be safe; doing it wrong can lead to injury.

“Safety first” is such a mantra in the kettlebell community that the staple training manual since 2006, Enter the Kettlebell (review), includes a chapter on safety and back health, and concludes with the warning: “If you get hurt, it’s your fault.”

Applications for kettlebells

For fat burning

When combined with proper nutrition, training with kettlebells seems to offer the benefits of intense interval training on bikes but with the strength development of weights. There are increasing numbers of weight loss stories where kettlebells, along with good nutrition, contribute to success.

For field athletes

Strength and conditioning (S&C) coaches like Jeremy Layport and Chris Holder are using the kettlebell to improve overall endurance capacity of their athletes. Even Lance Armstrong has been seen swinging kettlebells (below).

A basic S&C template that many coaches use with infinite variety is to alternate between kettlebell swings and Turkish get ups. For example, one partner does a Turkish get up to the left and to the right, while the other swings non-stop.

Getting more from one kettlebell

The kettlebell design also means it can be used in a variety of ways to extend the life of a given kettlebell weight.

While the standard hold is with the handle across the palm with the bell resting against the forearm, a challenging alternative is to use the bottoms-up grip where the handle is squeezed, and the weight is held straight up, rather than resting against the wrist, as in the “bottoms up carry” as described by Stuart McGill (pdf).

Warning: Despite the great versatility of a single bell, kettlebells are also well-known to multiply. Partners of new kettlebell enthusiasts should be aware that claims of “I only need one, or maybe two — look, they take up no space” may still find kettlebells behaving like Tribbles.

Getting started: find a coach

The best start for any kettlebell user is to begin with a coach [see more at PN’s How to Find a Trainer].

A trained eye can evaluate key parts of foundational moves, such as:

• proper grip/wrist alignment with the bell
• foot to knee position
• shoulder action
• appropriate back alignment

Likewise, learning good technique will help preserve hands when doing high repetition kettlebell work.

Avoid this ouchy when doing high-rep kettlebell work by learning good form first

A few sessions with a coach is the best way to help learn and refine these elegant moves.

There are listings of RKC “Hard Style” coaches. The IKFF lists coaches who blend GS style with mainly bodyweight fitness training, or, one can go right to the Russian source with the IKSFA for a technique workshop.

A well-qualified coach will also be able to help anyone work up to a kettlebell swing and beyond, as some folks aren’t quite able to achieve that butt back swing position right away. So coaching is key: trying to swing kettlebells without proper form is about as safe as trying to deadlift with a rounded back.

Summary and recommendations

Kettlebells are a fabulous and often overlooked tool for strength and conditioning. The mileage one can get from a single kettlebell is hard to match with any other training tool.

• As the kettlebell’s signature movements are dynamic, they blend the benefits of compound strength lifts with power and endurance work.
• Kettlebell work also helps develop forearm, hand and finger strength because of numerous options for grip, and various loads dynamically challenging the grip repeatedly and at high speeds.
• A single kettlebell workout can include a great variety of pushes, pulls and ballistic movements. Because of the options of varying load and sets, kettlebells offer fat burning alternatives to bikes or treadmills.
• Kettlebells engage the whole body with a single tool that is small, portable, and affordable for home use.
• Kettlebells can help strengthen the spinal musculature, keeping your back happy; there is no significant lumbar flexion in kettlebell work.

Whether looking for conditioning, fat burning, raw strength or power, it’s worth any practitioner’s while to investigate kettlebell training.

For extra credit

Early research in support of kettlebells

Most of the formal research on kettlebell training for performance is in Russian. We know it mainly from Pavel Tsatsouline’s translations and summaries like these from Enter the Kettlebell.

In the 20th century, Soviet science validated what Russian hard men had known for centuries: kettlebell lifting is one of the best tools for all around physical development. Voropayev (1983) observed two groups of college students over a period of a few years. To gauge their performance, he used a standard battery of the armed forces physical training (PT) tests: pull-ups, a standing broad jump, a 100- meter sprint, and a 1K run. The control group followed the typical university PT program, which was military oriented and emphasized the above exercises. The experimental group just lifted kettlebells. In spite of the lack of practice on the tested drills, the kettlebell group showed better scores in every one of them! Vinogradov and Lukyanov (1986) found a very high correlation between the results posted in a kettlebell lifting competition and in a great range of dissimilar tests: strength, measured with the three powerlifts and grip strength; strength endurance, measured with pull-ups and parallel bar dips; general endurance, determined by a 1K run; and work capacity and balance, measured with special tests. Lopatin (2000) found a positive correlation between soldiers’ kettlebell sport ranking and their obstacle course performance. Kettlebells improve coordination and agility (Luchkin, 1947; Laputin, 1973). Kettlebells develop professional applied qualities and general physical preparedness (Zikov, 1986; Griban, 1990).

Current research

The English-speaking world still lags behind with kettlebell research.

• An MSc project study on VO2max training has been turned into a book called Viking Warrior Conditioning by Kenneth Jay (overview).
• The American Council of Exercise commissioned a non-controlled study (pdf) that repeated Jay’s work, sadly, without attribution or again without peer review.
• Finally, however, there has been one peer reviewed study, 2009, in the Journal of Strength and Conditioning showing that one rather tame version of a kettlebell protocol (men performing as many two handed swing for ten minutes with as many user-determined stops as desired) is tougher than circuit training.

It’s been hypothesized that the swing also provides the forces necessary to generate increased bone density.

Kettlebell juggling

Kettlebell work is most often in the sagittal (back and forth) plane, but some experienced kettlebell enthusiasts break out of this box with kettlebell juggling, either as a solo or partner activity.

Russian Navy members practicing kettlebell juggling:

Competition

For folks who fall in love with these weights, there are the Girevoy Sport competitions.

In a competition, athletes have a fixed time to achieve a minimum number of reps in particular lifts at specific weight-class loads to attain one of several possible rankings in the sport. Competitions include the Long Cycle which is non-stop clean and jerk, the jerk, and the snatch.

Women’s 24 kg snatch competition featuring Kseniya Dedyukhina

Tactical Strength Challenge

Another form of competition is known as the Tactical Strength Challenge. This includes the kettlebell snatch, a deadlift and a pull up competition. It’s also fun.

Size

As for what size to start with, generally women start with an 8 kg and 12 kg; men with a 16 kg and 24 kg.

Having a lighter and a heavier bell gives beginners the option to work on technique first, and heavier sets later.

Folks who have been sedentary for a long time may happily start lighter; more experienced strength athletes may prefer to go heavier. HardStyle magazine (pdf) has a section each month on how to pick a size appropriate for any level.

Quality

Almost more critical than the right starting weight is quality of the bell.

The shape, size and finish of the handle can make the difference between a good or horrible experience. Poor finishes can be filed down, but poor size or shape cannot be changed. A poorly designed/made bell may be cheap(er) but will be used once and abandoned. A good quality 16 kg kettlebell will cost about as much as a higher end pair of sneakers but will last for a lifetime.

Resources and references

Baszanowski, W., ed. 8 European Weightlifter Federations: a Brief History of Their Centenaries. Special Issue. European Weightlifter, EWF Secretariat. 2005 (pdf).

Farrar RE, Mayhew JL, & Koch AJ. Oxygen cost of kettlebell swings. Journal of strength and conditioning research, 24 (4), 1034-6, 2010. PMID: 20300022

Jay, Kenneth. Viking Warrior Conditioning. Dragon Door Publications, MN, 2009.

Sanchez, Thierry. Kettlebell Sport and Athletic Preparation, Aalborg Sportshøjskole & Trænerakademiet, 2009 (pdf)

Tsatsouline, Pavel. Enter the Kettlebell. Dragon Door Publications, MN, 2006.

Tsatsouline, Pavel, The Russian Kettlebell Challenge. Dragon Door Publications, MN, 2001.

Tsatsouline, Pavel McGill on Kettlebells Power By Pavel Newsletter, 155, (April 30, 2008).

What is blood work?

Blood is a transport system for the body. We carry all kinds of things in the approximately 5 litres of blood that circulates constantly through our system. Blood tests, aka blood work, can show us what’s in our blood — and by extension, what’s in our bodies. Blood can also show us changes in our bodies that we might not be able to see from the outside — such as our blood sugar levels or nutritional status.

Thus, we can use blood work to assess overall health, and it can give us a much more accurate and objective snapshot of wellness than “Gee, I think I had some veggies yesterday” or “I feel fat today”.

How is blood work done?

We get blood for testing from:

• Capillary skin puncture (finger stick)
• Dried blood samples
• Blood drawn from an artery
• Blood drawn from a vein (most common)
• Bone marrow aspiration

What happens to blood after it’s drawn?

Blood is analyzed in a lab. The blood is put into a centrifuge and spun until it separates.

Reference ranges

Then, technicians compare results to a “reference range.” The reference range is the range of expected values for each test listed.

Expected ranges used in lab analyses include 95% of the “healthy” population. So, 95% of healthy people would have lab values within these ranges. This range varies depending on the lab, region (e.g. US vs EU) and type of blood component.

A number above or below this reference range can give valuable diagnostic information about body systems. High and low values are especially useful when taken in context with other symptoms, lifestyle factors, and tests.

Variation in results and ranges

Lab values vary for each person and must be assessed relative to other factors. While reference ranges are established after testing a large number of healthy people, everyone is slightly different.

Blood analyses vary based on:

• Time of year
• Posture/positioning
• Food/fluid intake
• Stress
• Medication/supplement use
• Alcohol
• Smoking
• Exercise/physical activity
• General tests

Blood work: the tests

The basic test

A general lab ordered by a physician is typically called SMAC-20, SMA-20, or Chem-20.

This basic test looks at 20 different parts of the blood including levels of certain minerals, proteins, etc. This test is standard and should be done, although it’s not very telling of one’s overall health profile.

Beyond the basic SMAC-20, there are many different blood tests you can request. Highlighted below are some of the most useful tests.

Cardiovascular tests

Liver function tests

Kidney function tests

Thyroid tests

Reproductive function tests

Carbohydrate tolerance tests

Protein status tests

Vitamin, mineral, acid/base status tests

White blood cell tests

Red blood cell tests

Miscellaneous tests

Summary and recommendations

Getting annual blood work with a physician is a good idea for preventative health. You can observe trends and catch potential health problems before they spiral out of control. Make sure to request a copy of your lab results.

Extra credit

Most blood collection tubes contain EDTA as an anticoagulant. The same EDTA that’s in Fresca….

Mishaps with blood draws

• If blood is drawn from your arm after the tourniquet is on for several minutes, values can be skewed because cells will concentrate in the lower arm.
• If the needle used is too small, it can cause red blood cells to break, leading to a skewed analysis.
• If the puncture site isn’t sanitized – infection can result.
• If you tense up excessively during a blood draw, you can experience extensive bruising at the site.

Further resources

Amarillo Medical Specialists

Lab Tests Online

References

Medical Tests Sourcebook. Third Edition. Health Reference Series. 2008.

Fischbach F. A manual of laboratory and diagnostic tests. 7th Ed. Lippincott Williams and Wilkins. 2004.

Lab Tests Online.

Mahan & Escott-Stump. Krause’s Food, Nutrition, & Diet Therapy. 2004. Elsevier.

When Neolithic farmers figured out how to cultivate wheat, millet, oats and other wild grasses some 10,000 years ago – they created the first steady food supply we’d ever known. We could actually grow food and store it!

But a supply of barley for the winter is a bit different from the bulk pack of Cupcake Pebbles from Costco.

You may be shocked to learn this is not a historically accurate representation of early humans.

What is cereal?

For thousands of years, many traditional cultures have eaten cereals in the form of porridge. Traditionally, these were whole or ground grains (and sometimes legumes such as peas or starches such as tapioca) that were soaked in water and allowed to ferment. Historically, porridge was often seen as poor people’s food, or the kind of cuisine you’d get in prison.

Flintstones notwithstanding, the breakfast cereals of today don’t look much like their traditional ancestors.

Breakfast cereal: A brief history

Dr. James Caleb Jackson created the world’s first cold breakfast cereal in 1863. It was whole wheat flour and water.

He baked it, broke the pieces up, and then baked them again. Ta-da – he had “Granula”. Granula had to be soaked overnight in order to be chewed.

Later, food manufacturers began to add vitamins and minerals to cereals, and people began to view cereals as health-promoting rather than as prison or peasant cuisine.

During World War II, the government encouraged vitamin and mineral enrichment of foods to improve the nation’s health. This continues today, with mixed results. In 1988, Kellogg’s saturated about 30,000 packages of Rice Krispies with excessive amounts of iron. Later that year, 28,000 packages of Mini-Wheat’s had too much vitamin A added.

How cereal is made

In general, when cereals are made, grains are processed into flour, cooked, mixed with other ingredients, dried, and shaped. Cereal can also be puffed, flaked or shredded.

Making breakfast cereal involves:

• mixing grains with flavouring agents and water
• cooking to gelatinize the grains’ starch, which creates the desired final texture and makes the grains digestible
• drying
• cooling/tempering, then pressure-flattening or passing through an extruder that makes shapes (rather like a big toothpaste tube)
• toasting and flaking

Here’s a schematic diagram of some of the machinery involved. Yummy! Just like grandma used to make!

Cereal manufacturers use mechanical food texture analyzers to test the “crunchiness” of cereal. One of the reasons cereal is often sugar coated is to provide a layer between the liquid (usually cow’s milk) and the cereal to extend its crunch.

8 types of cereal processing

Beyond the basic cereal production process, there are eight distinct cereal processing categories:

1. Flaked cereals

A typical formula contains 100 pounds of grain, 6 to 12 pounds of sugar, 2 pounds of malt syrup, 2 pounds of salt, and enough water to achieve 28-32% moisture after cooking. Too much moisture reduces crunchiness. Too little moisture leads to breakage. Cooking time varies depending on the grain. Corn takes about 120 minutes, rice takes 60 minutes, and wheat takes 35 minutes.

Example: Corn Flakes.

2. Gun-puffed whole grains

Here, the grain must be cooked, followed by a rapid pressure drop in the atmosphere surrounding the grain. This releases steam from the grain as the pressure within the grain tries to equilibrate with the lower pressure surrounding it.

Rice and wheat are the only whole grains used for gun-puffing (corn can also undergo this process, but not in whole-grain form). Puffing can be done with single or multiple shot guns. Temperatures vary, staying above 400 degrees F. Puffed cereals rely on a coating (usually sugar) to maintain a crisp texture.

Example: Golden Crisp/Sugar Crisp

3. Extruded gun-puffed cereals

The starting material is flour. Cooking takes place in the extruder, and then dough is formed and cast. Using modified food starch (e.g., like tapioca or potato starch) helps to obtain a high expansion volume and form a film on the cereal while keeping the fat content low. When the dough is cast, the desired shape is created, similar to pasta. Extruded cereals tend to have less browning than other varieties.

Example: Cheerios

4. Shredded whole grains

The grain is cooked, cooled, and tempered for up to 24 hours. After this, the wheat is squeezed between one smooth and one grooved roll. A comb runs along the grooved roll to separate the shreds.

Example: Shredded Wheat

5. Extruded and other shredded cereals

A blend of the extruded and shredded processes mentioned above.

Example: Life

6. Oven-puffed cereals

These cereals are usually rice or corn (or a mixture), and require very high temperatures (550 to 650 degrees F). For more on high cooking temperatures and processed carb foods, see All About Cooking & Carcinogens.

Example: Rice Krispies

7. Extruded expanded cereals

Similar to the extrusion process above.

Example: Cap’n Crunch

8. Granola cereals

A mixture of grains, sweeteners, fruits, nuts and other additives baked at 300 to 425 degrees F to achieve a light-brown color and 3% moisture.

Example: Umm… granola.

Here’s a general overview of how cereal (and cereal bars) is made:

Why is cereal so important?

If you want to see America’s advertising expertise in action, walk down the cereal aisle.

Cereal was one of the first marketing panaceas, and we’ve taken the advertising bait. Cereal also kicked off our addiction to convenience. Forget about a 15 minute delay for rolled oats or a vegetable omelet. Cereal = open, pour, and hover. Ready in 30 seconds.

A few cereal consumption facts:

• We buy about 2.7 billion boxes of cereal each year, leading to annual sales of about $10 billion, making it one of the top three most popular supermarket products (behind beverages and bread). Per capita consumption of cold breakfast cereals rose from 4.4 pounds in 1939 to 14.3 pounds in 1997. By comparison, France consumes about 1.8 pounds and Canada eats about 9 pounds.
• The only countries that eat more cereal than the U.S. are England, Ireland and Australia.
• Kellogg’s, General Mills and Post make up 73% of the cereal market share. The top three most popular cereals are Cheerios, Special K, and Honey Bunches of Oats. About 20 new cereals are offered each year.

Yep, we love our breakfast cereals. In part, this is because we mistakenly think they’re good for us… and our kids.

But breakfast cereals marketed to children contain more sugar and salt than those for adults. Cereal manufacturers spend millions of dollars each year marketing to kids. During kids TV shows the top category of advertised food is cereal (beating out candy, snacks and fast food).

On average, 8 to 12 year olds see three cereal ads per day (about 1095 cereal ads per year). And you wonder why your 10 year old turns into a drugged up monkey while browsing the cereal aisle?

What you should know about cereal

Before cereal was invented, the U.S. was eating grease, flour (e.g., pancakes), pork, mutton, liver, kidney, pickled meats, and rich sauces for breakfast. As you might expect, many Americans were also battling indigestion, gout and constipation.

Religious folks were ready to intervene with a whole grain alternative to help with regularity and gut health. Oh, and they also wanted to get rid of meat at breakfast to “curb ungodly desires.”

Kellogg, cereal pioneer

John Harvey Kellogg helped lead the way. Kellogg was a Seventh Day Adventist who studied medicine, eventually writing books/articles. He recommended no drugs, no alcohol, and no tobacco, plenty of exercise, low calorie consumption, and low meat intake. This was revolutionary (in the 1890s).

He believed that optimal health started in the GI tract – so he also pushed bran consumption and daily enemas.

But before you become a Kellogg disciple – he also prescribed 12 pounds of grapes each day for people with high blood pressure and forced underweight patients to consume 26 milk feedings per day while lying motionless in bed with sandbags on their feet (seriously).

Kellogg began experimenting with cereal recipes based on Dr. James Caleb Jackson’s original mix. He combined wheat flour, cornmeal and oatmeal into various ready-to-eat cereal shapes and sizes.

In 1894, wheat flakes were developed by cooking ground wheat into dough and then flattening it between metal rollers. The flakes were then cooked and cooled. Kellogg called it “Granose.” Eventually, corn was also used. This began the cold cereal revolution.

In 1902, W.K. Kellogg (John Harvey’s brother) experimented with adding sugar to cereal. Between 1910 and 1925 sugar consumption doubled. Adding sugar to cereals increased sales and cereal companies began to focus on profit.

Not until the 1970s did parents question added sugars in cereal, and thus cereal names started changing.

• Sugar Crisp became Golden Crisp
• Sugar Pops became Corn Pops
• Sugar Smacks became Honey Smacks

Big Cereal and the business of breakfast

Cereal is big business. Each new cereal production technique was (and is) a marketing opportunity.

In the mid 1900s, food manufacturers wanted people to buy more cereal, so they did motivational research on flavours and textures. They modified the packaging to draw more attention to the cereal.

Eventually, the production of cereals became so secretive that factory tours were cancelled in the 1990s due to espionage.

It’s no surprise — cereal production takes a 12 cent bushel of grain and converts it to a product that sells for around four dollars… and most of the money is spent on marketing.

Kulp K & Ponte JG. Handbook of cereal science and technology. CRC Press. 2000.

Cereal and health

In North America, we don’t eat whole grains much. One of these potential occasions is a bowl of breakfast cereal (the other major sources are popcorn and bread). Of all foods consumed for breakfast, cereal is the most common, making its way into about one-third of all breakfast occasions.

Data show that consuming commercial breakfast cereals can increase overall nutrient intake and lead to a healthier weight – when compared to those who skip breakfast. It’s hard to conclude much from studies on eating cereal and body weight, due to the multitude of other factors.

In the last decade, we’ve seen the introduction of cereal bars and cereal cafes.

Manufacturers have successfully convinced many of us that cereals are good for us, especially when “fortified” with added vitamins, minerals, and fibre. But ask yourself… why is all that good stuff missing in the first place?

Let’s look at what Honey Nut Cheerios, for instance, contains. I’ve taken the liberty of putting sugar sources in bold.

Let’s see… five types of sugar, for starters. And the fibre has to be added in.

I wouldn’t exactly call that healthy. By the way, go and measure 3/4 cup of cereal. I bet you’ll be surprised at how tiny it looks. Most folks could easily eat three times that and not notice.

The “healthy” cereals

Oats

Oatmeal was proclaimed in the 1800s to be one of the best soothers for an irritable stomach. In the 1920s, Quaker Oats began utilizing radio advertising to promote sales. The first instant flavored oatmeal was introduced in 1970 – less than 50 years ago. In the 1980s, Wilford Brimley started pushing oatmeal, and sales increased by 25%.

Cream of Wheat

Cream of Wheat was discovered in 1893 by a guy in North Dakota who was looking to save some money by cooking up “wheat leftovers” (the bran) as porridge.

Ralston

Ralston (endorsed by Dr. Ralston) wheat cereal originated as livestock feed. To bump up profits, it was eventually marketed as a cereal for humans.

Wheaties

I don’t know about you, but during my 7^th grade basketball season, I made sure my mom bought Wheaties. Was this due to nutrition science? Nope. It’s because Michael Jordan was on the box.

The advertising push for Wheaties began in 1924. Interestingly, a survey in 1991 revealed that most American consumers didn’t realize Wheaties were made out of wheat.

Jim Fish, a former vice president of advertising for General Mills said, “Wheaties is no different from anybody else’s [cereal]; it’s just a product of unique and consistent advertising.”

Special K

This was invented in 1955. The 1950s was when TV advertising for cereals took off. The industry took advantage and Special K swept across the U.S. As you can see, TV ads for cereal in the 1950s and 1960s were riveting.

Kix commercial from the 1950s

Trix cereal commercial from the 1960s

Special K commercial from the 1970s

Cheerios commercial from the 1980s

Wheaties commercial from the 1990s

Froot Loops commercial from the 2000s

All Bran

In 1984, All Bran sales increased 41% when a TV commercial claimed that bran could decrease the risk of cancer.

Summary and recommendations

Most of us can acknowledge that a majority of cereals are edible entertainment. Cereal consumption usually has little to do with nutrition and a lot to do with advertising, characters, images, and convenience.

Cereal is one breakfast option that may contribute to optimal health/body composition… if the alternative is eating nothing. But always consider what your alternative option would be (for more on alternative breakfast options, see All About Breakfast).

Be aware that a majority of cereals have added sweeteners/preservatives, are highly processed, and are a concentrated source of energy (which can be helpful when trying in increase body weight).

If you eat cereal, use common sense when reading the ingredient label, and as always, don’t believe any of the information printed on the front of the box.

Extra credit

In 1898 C.W. Post tried developing a coffee substitute, but instead he sold it as breakfast cereal. It’s called Grape-Nuts — “grape” because it contained maltose, which at the time Post called “grape sugar.” And “nuts” because it tasted like nuts.

When cow’s milk pasteurization became standard in the early 1900s, cereal became more popular.

In the 1960s Post worked on freeze drying fruits for cereals. This allowed them to double the price of cereal. They started to actually deplete North American strawberry crops.

Lucky Charms were invented based on the inclusion of Circus Peanut marshmallow shavings in a basic extruded cereal.

Since cereals can break into bits and settle during transport – companies claim “Contents measured by weight, not volume,” on the front of the package.

In 1966, Quaker test marketed an entire Cap’n Crunch product line with cookies, snacks and shakes.

Food and beverage packaging is a major source of waste, accounting for 55% of global packaging waste.

In 2008, each percentage point of market share for cereals was worth approximately $62 million.

A cereal fortified with fluoride was tested in the 1950s by Post.

Cereal production lines can package 2 boxes per second.

In the 1990s cereal companies started printing and distributing coupons – this was done to increase sales.

Grains contain lectins. See All About Lectins for more.

Further resources

DVD – Cereal: History in a bowl

For more on the food industry structure see here.

Check out this cereal timeline.

References

USDA/Economic Research Service. Data last updated February 1, 2010.

Deshmukh-Taskar PR, et al. The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey 1999-2006. J Am Diet Assoc 2010;11:869-878.

History of Kellogg’s

Maras JE, et al. Whole grain intake: The Baltimore Longitudinal Study of Aging. J Food Compost Anal 2009;22:53-58.

Schwartz MB, et al. Examining the nutritional quality of breakfast cereals marketed to children. J Am Diet Assoc 2008;108:702-705.

2008 Source: A.C. Nielsen Financial Services for the 52-weeks ended June 8, 2008. http://www.lavasurfer.com/cereal-stats.html

Bruce S & B Crawford. Cerealizing America – The unsweetened story of American breakfast cereal. 1995. Faber and Faber. Winchester, MA.

Shapely D. Kellogg’s Cereal Recall Highlights a New Concern: Chemicals Leaching from Food Packaging. http://www.thedailygreen.com/healthy-eating/eat-safe/kellogg-cereal-recall-0628 Accessed 7/7/10

Eastman J, Orthoefer F, Solorio S. Using extrusion to create breakfast cereal products. American Association of Cereal Chemists. 2001;10:468-471. http://www.pacgrain.com/uploads/File/CFW.pdf

Burrington KJ. Keeping the crunch in breakfast cereals. Food product design. June 2001. http://www.foodproductdesign.com/articles/2001/06/keeping-the-crunch-in-breakfast——cereals.aspx

Emission Factor Documentation – Cereal Breakfast Food – Final Report. Environmental Protection Agency. August 1995. http://www.epa.gov/ttnchie1/ap42/ch09/bgdocs/b9s09-2.pdf (used for cereal production images)

Kulp K & Ponte JG. Handbook of cereal science and technology. CRC Press. 2000.

The Kaiser Family Foundation. Food For Thoughts. March 2007. http://www.kff.org/entmedia/upload/7618.pdf

Mass of U.S. breakfast cereal consumption. http://hypertextbook.com/facts/2006/LauraFalci.shtml

Cereal Breakfast Foods. http://www.answers.com/topic/cereal-breakfast-foods

Price GK. Cereal sales soggy despite price cuts and reduced couponing. Structural change in the U.S. food industry. May-August 2000. 21-28. http://www.ers.usda.gov/publications/foodreview/may2000/may2000d.pdf

Flexnews. General Mills sees more U.S. breakfast cereal consumption growth. 3/25/2010. http://www.flex-news-food.com/console/PageViewer.aspx?page=29207

Canadian Food Analysis. 2008. http://www.statcan.gc.ca/ads-annonces/23f0001x/hl-fs-eng.htm

It might start with mild shoulder pain. So you avoid certain exercises. No biggie. But this leads to atrophy of shoulder muscles and instability.

Then you start to notice impingement due to the atrophy. Then you notice strength and posture imbalances. The downward spiral has begun.

Next thing you know, your kids are dropping you off at the nursing home in time for Thursday afternoon shuffleboard. You’ll have the posture of Quasimodo and arms like T-Rex.

What is the rotator cuff?

The shoulder has an immense range of motion — the most of any joint in the body. But this comes with a catch: because of its range, it’s also the most unstable.

As a result, nearly 70% of us will experience some sort of shoulder disorder in our lifetime. Often, the injury includes one of the rotator cuff muscles.

Of all the injuries that take place during resistance training, 36% occur at the shoulder complex. The supraspinatus muscle is most often involved.

Yeah, we're pretty sure that those arms are facing the wrong way too.

The rotator cuff is made up of four muscles (or you could think of them as “active ligaments”) that collectively compress, depress, protect and stabilize the glenohumeral joint, helping to keep the upper ball of the humerus (think of this as a golf ball) in the glenoid fossa (think of this as a tee). Weak rotator cuff muscles prevent the humeral head from rotating properly on the glenoid fossa.

The supraspinatus, infraspinatus, teres minor, and subscapularis (the 4 rotator cuff muscles) originate on the scapula (shoulder blade) and help with various movements like bringing your arm out to the side, internal rotation (turning your arm inwards), external rotation (turning your arm outwards), and so on.

Attachments and functions of rotator cuff muscles

Source: Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal 2005;27:36-45.

Why is the rotator cuff important?

The challenge of stabilization

Shouder stabilization is a dynamic activity. Many muscles, from small to large, fire in a coordinated effort to stabilize the shoulder as it moves through a range of motion. Along with the rotator cuff, this includes:

• Serratus anterior
• Rhomboids
• Trapezius
• Levator scapulae

When looking at shoulder problems, it’s important to understand the complex roles that all of these muscles play. If they don’t work together — or more likely, if some muscles are strong and some are weak or inhibited, they can’t work together effectively in order to keep that golf ball on the tee.

The result: imbalance and eventually, injury.

68% of people with scapular instability have rotator cuff problems. If these muscles are weak or not firing properly, it’s harder to control that golf ball on the tee. Typically, the shoulder blades and the top of the humerus (upper arm) start to slip forward, which shrinks the subacromial space between the humerus and the acromion (bony structure at the top of the shoulder).

Many tendons pass through this space. When it’s constricted, these tendons can become inflamed. Over time, with repeated trauma, the tendons may become damaged or even — eventually — tear.

In addition, the surfaces and structures of the joint (such as the cartilage that lines the joint capsule) can become inflamed.

Shoulder injuries: You could be next

Head forward, upper spine rounded, reaching forwards... this is shoulder pain city.

Barring an acute event (like falling on an outstretched arm), most shoulder injuries come from repeated, cumulative damage.

The bad news: Almost everyone is at risk for shoulder injuries.

The subscapularis tends to get plenty of stimulation in our “front-of-the-body-internal-rotation” happy gyms. This means it’s usually pretty tight and strong. Combine this with things like:

• desk work
• driving
• using a mouse/keyboard
• stress (which often makes people tighten up their traps and hunch their shoulders)
• sitting/standing in “hunchback” posture
• lack of attention to the muscles you can’t see in the mirror

…and you have the perfect storm for shoulder pain.

Many people ignore the warning signs of shoulder trauma (such as pain and limited mobility) until the situation is serious.

Don’t go like that.

Whether you feel pain while bench pressing, reaching overhead, throwing, punching, paddling, or all of the above… if your shoulder hurts, take the time to deal with it immediately. Don’t push through the pain. It will not get better if you ignore it, and will probably get worse.

The good news: A strong, stable and flexible rotator cuff can preserve shoulder health and increase upper body strength.

Preventing injury

One of the keys to injury prevention is developing flexibility of the subscap and pecs while building strength and endurance in the opposing external rotators.

Anterior shoulder instability, limited internal rotation mobility and posterior shoulder tightness

Remedy – Need to improve posterior shoulder flexibility

Discussion – If you can’t do this, you have some tightness in the back of your shoulder. Posterior shoulder tightness may be a contributing factor in impingement and labral tears. This tightness doesn’t allow adequate internal rotation or horizontal adduction.

Exercises to consider:

Cross arm adduction stretch

Internal rotation sleeper stretch

Scapular wall slides

Shoulder dislocates

Unilateral presses and pulls (one side at a time)

Medicine ball wall tosses

Drop and catch push up (advanced)

Excessive external rotation mobility

Remedy – Need to increase internal shoulder rotation

Discussion – This is a rare shoulder problem to have; though it’s often seen in “overhead athletes”: folks whose sport involves throwing or pressing overhead, such as pitchers. With poor internal rotation flexibility, posterior shoulder tightness ensues. This can lead to the posterior rotator cuff muscles contracting with more force in an attempt to pull the humeral head back into place, leading to rotator cuff muscle fatigue and injury.

Exercises to consider:

Cross arm adduction stretch

Internal rotation sleeper stretch

Internal rotators stronger than external rotators

Remedy – Need to strengthen the external rotators

Discussion – The teres minor and infraspinatus are major external rotators involved with abduction and overhead motions.

Exercises to consider:

Face down Y exercise

Face down T exercise

Band external rotation at 30 degrees abduction

Seated press ups (advanced)

Power wheel crawls (advanced exercise – starts at 1:42 in video)

Pushup plus

Reverse push up

Cable external rotations at 90 degrees

Side lying external rotation at 30 degrees abduction

Scarecrow

Notes on the above exercises:

Performing these exercises on unstable surfaces can further enhance sensorimotor control.

Placing a towel between the arm and body during internal/external rotations can decrease deltoid activity, relax the supraspinatus, and lessen pain – all good for the prehab/rehab process.

Weak lower traps

Remedy – Need to strengthen the lower traps

Discussion – An important sign of good shoulder function during pushing and pulling movements is the ability to keep the shoulders down and away from the ears.

If the shoulders move up toward the ears during a pushup or row (as in the left-hand photo above), it signifies greater upper trap activity. This yanks the humerus out of alignment within the glenoid cavity (the golf ball on the tee) which results shoulder complex muscle weakness and limited range of motion. This is a particular problem because the upper traps can be so strong relative to other muscles.

Another screening tool is kyphotic posture, aka “the Quasimodo” or “E.T.” Again, this suggests the upper traps are considerably stronger than the mid- to low traps, serratus anterior and levator scapula.

Exercises to consider:

Balance out all of your pushing exercises with pulling exercises (using retracted shoulder blades)

Push up with some shrugging – not good	Push up without shrugging – good

Poor proprioception

Remedy – Need to build proprioception — awareness of where the body is in space.

Discussion – Damage to ligaments around the shoulder cause less sensory information coming in. Without proper incoming information, the shoulder isn’t protected from extreme ranges of motion.

Exercises to consider:

Swiss ball pushups (advanced)

1 arm ab plank on swiss ball (advanced)

Medicine ball wall dribbles or this option

Quadruped rhythmic stabilization

The following are advanced plyometric exercises helpful for later stages of rehab/prehab.

Deceleration med ball catches

Med ball external rotation toss to wall

Tips on rehab/prehab exercises

When shoulder muscles become fatigued, the joint becomes hyper mobile, and prone to injury. Thus, building endurance is important.

When doing shoulder stabilization exercises, use higher reps (10-20), and/or longer duration (e.g. 30-60 sec).

Also, it’s important to train external rotators with an emphasis on the eccentric phase. Use the “4-6” approach for the direct rotator cuff exercises. Use a 4 second count on the concentric phase and a 6 second count on the eccentric phase.

Don’t try this at home

A dangerous position for the rotator cuff (and the shoulder), is the “high five position.” The humerus is abducted (held away from the body) and externally rotated. This overloads the anterior capsule.

Beyond actually high fiving with buddies, this position is often replicated in the gym during old-school machine chest flies, behind the neck pulldowns, and behind the neck presses.

Could cause shoulder injury

Other exercises that may increase shoulder injury risk include bench press (flat and incline), dips, barbell back squats, upright rows, dumbbell flies, and arm curls.

The empty can position (raising the arms up with the palms down/back) can inflame the shoulder by reducing the subacromial space and causing impingement. Instead, use the full can exercise (raising the arms up with palms forward in the plane of the scapula).

Modifying exercises to improve shoulder health

Here are some tips to help you adjust common exercises to maximize shoulder health.

Bench press

• Tuck elbows a bit closer to your body
• Use a neutral grip with dumbbells – like this: Dumbbell Bench Press, Neutral Grip
• Don’t feel like you need to go down all the way until your elbows dip below your body – try floor presses: Lazy Floor Press or Regular Floor Press
• Retract your shoulders before starting a press

Change your squat

Instead of standard barbell back squats, try front, zercher, dumbbell front or goblet squats, which put less stress on the shoulders.

Front

Zercher

Dumbbell

Goblet

Pulldowns and overhead presses

• Bring elbows slightly forward instead of flared out
• Always go to the front of the body

Keep it scapular

When raising your arm out to the side, don’t force it back so it’s directly in line with your body. Keep it in the natural range of motion with the scapula – like this: Scapular Plane Lateral Raise, Neutral Grip

Upright rows

Not worth it. Try face pulls instead.

Posture

Keep a proud chest, tight shoulder blades, engaged core, and overall “good posture” when exercising (and with daily life).

Other exercise modifications

Source: Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal 2005;27:36-45.

Summary and recommendations

1. If it hurts your shoulders, avoid it. And don’t work through pain.
2. Activate your serratus (see shoulder circuits below) to save your shoulders.
3. Move around during the day. Check your posture.
4. If you do a push, follow with a pull. If you work your front, follow with your back. In fact, try to do more pulling than pushing — about a 2:1 ratio if possible.
5. Don’t be afraid to nix shoulder day. Between other exercises, the shoulders get plenty of work.
6. Use massage or active release therapy to keep soft tissues happy.
7. As much as possible, alternate which hands you use for daily-life tasks, such as brushing your teeth.
8. Foam roll the thoracic spine.
9. Be cautious with explosive overhead lifts.
10. Develop shoulder flexibility/mobility/strength with the circuits below.

Extra credit

“There is a fine line between physiotherapy and the training of the elite athlete.” – Dan Pfaff

Co-activation of the traps and serratus anterior are thought to have significant influence on scapulohumeral rhythm.

The infraspinatus and teres minor are extremely active during the “follow-through” with overhead throwing motions (or some overhead exercises like medicine ball slams). Train these muscles eccentrically.

Further resources

Optimal Shoulder Performance

Original Shoulder Savers Article Part 1 |  Part 2 | Part 3

The Amazing Shoulder

References

Wagner P. A comprehensive approach to shoulder-complex maintenance. Strength and Conditioning Journal. 2003;25:65-70.

Kolber MJ, et al. Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Research. 2010;24:1696-1704.

Kritz M, et al. Screening the upper-body push and pull patterns using body weight exercises. Strength and Conditioning Journal. 2010;32:72-82.

Corrao M, et al. Addressing posterior shoulder tightness in the athletic population. Strength and Conditioning Journal. 2009;31:61-65.

Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal. 2005;27:36-45.

Tyson A. Posterior rotator cuff strength: part 1 and 2. Strength and Conditioning Journal. 1995:21-23; 37-38.

Cressey E. Clearing up the rotator cuff controversy. January 2010.

Kolber MJ & Beekhuizen KS. The empty can exercise: considerations for strengthening the supraspinatus. Strength and Conditioning Journal. 2009;31:38-40.

Cressey E. Cracking the rotator cuff conundrum. T-nation.

We know that cooking food has some benefits:

• It can make food safer
• It can concentrate tastes and flavors
• It can reduce spoilage
• It can soften tough foods
• It increases the amount of energy our bodies can get from food
• It breaks starch molecules into more digestible fragments
• It denatures protein molecules

But before we get too excited about cooking, the modern diet can be overwhelmingly heat-processed. Higher cooking temperatures can create chemical reactions among amino acids, creatines, and sugars — reactions that may produce dangerous carcinogens and mutagens (compounds that can damage our DNA).

Now suddenly we have “unhealthy” compounds created in otherwise “healthy” foods — stuff like potatoes, fish, whole grains, etc.

Don’t freak out and throw your barbecue grill off the balcony just yet. Let’s start by learning more about what these compounds are, and how they work.

Cooking creates chemical compounds

Heat plus food molecules can create several products in the process of chemical conversion known as cooking. (And you thought you were just slapping a burger on the grill! Now you can say “I am chemically converting proteins!” Fancy.)

Some of the most notable end products include:

• Heterocyclic amines and polycyclic aromatic hydrocarbons
• Advanced glycation end products
• Acrylamide

Let’s look at each of these in more depth.

Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs)

What are they and where do they come from?

HCAs are made when creatines and amino acids (both found in meats) react together with heat. PAHs include over 100 different compounds formed by the incomplete burning of organic matter (e.g., oil, gas, coal, food, etc.) at temperatures in excess of 392 degrees F (200 C).

How heat from cooking forms HCA compounds

Thus, raw foods don’t have HCAs nor PAHs. Indeed, more than 90% of our exposure to HCAs and PAHs comes from cooked food.

The most concentrated sources include grilled/charred meats and fish. However, ready-to-eat commercial breakfast cereals, processed carbs, fats/oils, and tobacco smoke also contain high amounts of PAHs. PAHs in vegetables and fruits occur mostly due to environmental contamination of air and soil.

Four factors influence HCA formation:

• Type of food
• Cooking method
• Temperature
• Cooking duration

Temperature is the most important factor. Problems begin at 212 F (100 C), with the real nasty HCAs forming at about 572 degrees F (300 C).

PAH formation is influenced by:

• Temperature of cooking
• Duration of cooking
• Type of fuel used in heating
• Distance from heat source
• Fat content of the food

Essentially, the hotter and longer a meat is cooked, the more HCAs and PAHs. Direct heat methods like frying and grilling produce more than indirect-heat methods like stewing, steaming or poaching.

Studies estimating the intake of HCAs show an average 26 ng/kg body wt/day for a U.S. population.

Why should we worry about them?

HCAs are on the official list of cancer-causing agents published by the NIH. We’ve known about them since the 1970s — and they are straight up genotoxic, meaning that they work at the DNA level causing mutations, deletions, and insertions. Not good.

Thus far, we’ve identified 17 different HCAs that may increase cancer risk.

Along with heme iron and nitrates/nitrites, HCAs and PAHs may be the major reasons that “meat” is associated with cancer at all. Pickled, smoked, barbecued and processed meats (e.g., bacon, ham, sausage, hot dogs, salami, bologna, luncheon meats, corned beef, etc.) seem to cause the most health problems.

It’s the intake of these meats that are more related to cancer risk than total red meat intake alone. Other dense protein foods (milk, eggs, legumes, and organ meats) have very little or no HCA content naturally or when cooked.

What can we do about them?

We can start by changing our cooking methods. Opt for slower, indirect-heat methods of cooking such as poaching, stewing, braising, or steaming.

We can consume more plants in our diets. Plant-based diets typically contain insignificant amounts of HCAs and moderate amounts of PAHs. Those eating a higher raw plant-based diet tend to consume even lower amounts.

HCAs and PAHs can be removed from the body via detoxification in the liver. A plant-based diet can decrease the extent of DNA damage and oxidation from these compounds. Thus, not only do plants have fewer HCA/PAH-creating compounds, but they also help fight the effects of any of these compounds once created.

Source: Kapiszewska M. A vegetable to meat consumption ratio as a relevant factor determining cancer preventive diet. Local Mediterranean Food Plants and Nutraceuticals. Forum Nutr. 2006;59:130-153.

Experts recommend a ratio of greater than 2:1, plant foods:meats as the minimum recommended intake to support the body’s fight against cancer development. The protective effect seems to increase with ratios greater than this (3:1, etc.). The more plants, the less cancer.

Advanced glycation end products (AGEs)

What are they and where do they come from?

When you slap a burger on the grill and char it up good, pop a slice of bread into the toaster, or roast a marshmallow while camping, you’re creating the Maillard reaction, which occurs when sugars and proteins in the food react together with heat.

Sadly, while possibly increasing the scrumptiousness of these foods (which, by the way, also creates the characteristic flavours of caramel), this reaction can lower the nutritional value and create toxic/carcinogenic end products, including advanced glycation end products (AGEs), also known as glycotoxins.

Thanks, Maillard reaction!

Now take a look at the grill after cooking, or try to pry the sticky marshmallow off the campfire rock after it dropped from your roasting skewer. See how all those yummy brown roasty bits have glued themselves to the surface? That’s what happens in your body with AGEs. Stuff starts to stick together.

AGEs can be created inside our body with aging and high blood sugar. But we also eat AGEs. Virtually any food exposed to extreme heat can scorch, generating AGEs.

Adding dry heat to uncooked food can increase that food’s AGE content by 10 to 100 times. But AGEs can be produced during pasteurization, drying, smoking, frying, microwaving and grilling. Any food that contains sugars, fats, and proteins is fair game.

The standard American diet likely contains about 16,000±5,000 kU of AGEs each day. This is three times higher than the safety limit advised by professional organizations. Plant-based diets contain lower amounts, unless they are built upon processed and fried foods. Diets with more raw foods typically contain minimal AGEs.

Why should we worry about them?

Once in the body, AGEs have been shown to negatively affect a majority of cells, tissues, and organs (see diagram below). Fewer AGEs circulating in the system means a lower risk of diseases like Alzheimer’s, kidney, cardiovascular, and diabetes.

Source: Semba RD, et al. Does accumulation of advanced glycation end products contribute to the aging phenotype? J Gerontol A Biol Sci Med Sci 2010;May 17 Epub.

In animal models, AGEs contribute to:

• inflammation
• atherosclerosis
• kidney damage
• neurodegenerative disease
• muscle loss
• cancer cell metastasis
• insulin resistance
• alterations in cell receptors
• a shorter life
• oxidation

However, some suggest that rats/mice aren’t accustomed to the intake of heated food and might not be an accurate study model that translates to humans.

10% of dietary AGEs are absorbed. Of this 10%, about 1/3 are excreted in the urine within three days. This means they probably hang around the body wreaking havoc.

This will help you put it in perspective (click to enlarge):

Sources: Uribarri J, et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc 2010;110:911-916; Goldberg T. Advanced glycoxidation end products in commonly consumed foods. J Am Diet Assoc 2004;104:1287-1291.

What can we do about them?

Method of food preparation is critical here. Heating foods over 446 degrees F (230 C) seems to be the most problematic.

For example, the same 90 gram chicken breast can vary from 1000 to 9000 AGEs:

• Frying, grilling, roasting, or broiling: 4000 to 9000 AGEs
• Boiling, steaming, or stewing: 1000 AGEs

To immediately start consuming 50% less AGEs, poach, stew, or steam meals. This 50% reduction can decrease plasma levels of AGEs by 30% within a month.

Thus:

• Cook food at a lower temperature
• Don’t char it or cook the heck out of it
• Avoid processed foods, which have more AGEs — home prepared versions (such as French fries) have fewer AGEs compared to their processed counterparts
• Use liquid in cooking (for example, in braising)
• Use acids such as lemon juice or vinegar in marinades and cooking liquid — these will also help decrease AGE formation

Acrylamide

What is it and where does it come from?

Acrylamide is another one of the toxic Mallard reaction end products, forming when asparagine reacts with naturally occurring sugars in high carbohydrate/low protein foods subject to high cooking temperatures. Reactions start at 248 degrees F (120 degrees C).

The higher the cooking temperature and the longer the cooking duration, the more acrylamide.

Most foods that contain acrylamide are cooked commercially and contain the acrylamide when purchased. Think French fries, potato chips, breakfast cereals, crackers, pretzels, coffee, pastries, etc.

If those foods are part of your regular food rotation, you’d better be worried about more than acylamide, most notably grease stains on your couch, grease chunks in your arteries, and knowing the cashier at Winchell’s Donuts on a first name basis.

But we can’t just blame the food manufacturers, since acrylamide is formed during some home food prep. Significant formation requires temperatures greater than 248 degrees F (water simmers at 190 – 200 degrees F and boils into steam at 206 – 212 degrees F).

Diets high in baked or fried starchy foods will contain larger amounts of acrylamide. Diets including more animal products and raw plant foods will be lower.

We can also inhale and otherwise absorb this stuff. You’ll find acrylamide in body lotions, shampoos, tobacco smoke, food packaging, and human breast milk (if mom is ingesting acrylamide).

Why should we worry about it?

Early animal research indicates that acrylamide may be genotoxic, carcinogenic, neurotoxic and create reproductive problems. It’s currently classified as “probably carcinogenic.”

Still, results from human studies indicate that ingestion of acrylamide at current levels fails to produce any measurable neurotoxicity or increases in cancer.

Average intake is estimated to be 0.3 to 2 μg acrylamide/kg bodyweight/day for developed countries. The WHO concluded that an adequate margin of safety at 1-4 μg /kg bodyweight over a lifetime for humans.

What can we do about it?

While we don’t know for sure about acrylamide consumption and disease, it might be best to limit exposure and err on the side of caution.

And notice that the acrylamide-containing foods aren’t all that great for you anyway.

Summary and recommendations

This article is about majoring in the minor. HCAs, PAHs, AGEs, and acrylamide are nutritional details. So make sure to prioritize.

• If your diet is based on processed foods, meats and alcohol – then don’t worry about AGEs in your morning bran flakes. You’ll probably get a disease related to your overall lifestyle first.
• If your diet is already based on whole, unprocessed foods, including lots of plants – then you can start tweaking the finer points of your food preparation methods.

The information in this article adds to previous evidence that a diet based on highly processed foods/meats isn’t the best option for health and can contribute to a range of conditions, from obesity to cancer.

What to do

No matter your style of eating, the highly processed/heated stuff tends to be the most dangerous, including potato chips, French fries, commercial breakfast cereals, grilled meats, fast food meats, deli meats, etc. There are many reasons to avoid this stuff — this is just one more.

When preparing foods, consume unprocessed items that are boiled, steamed, stewed, sprouted, fermented or poached. Avoid high temperature grilling, broiling, roasting, and frying.

Reduce carcinogens by doing the following:

• Use leaner meats
• Use an acidic marinade for meats
• Use lower temperatures and moist heat
• Don’t show off for your grilling buddies with flare-ups
• Don’t overcook
• Hey, why not eat a veggie burger and a regular burger instead of two regular burgers?

It would be impossible to eliminate all carcinogens in food, so don’t think you’re above the system. Further, while high temperatures can create some harmful compounds, it can also destroy harmful compounds. There is a trade off. No need to opt for chicken sashimi just yet.

Extra credit

The AGE content of infant formula is higher than that of human or cow’s milk.

Some food derived AGEs may have beneficial antioxidative and desmutagenic (mutation-fighting) properties.

The main dietary advice that the American Institute for Cancer Research gives is: “Choose mostly plant foods, limit red meat and avoid processed meat.”

HCAs and PAHs seem to be more harmful than acrylamide and AGEs.

Tea and yerba mate may inhibit the formation of AGEs.

Microwaving increased AGE content more rapidly compared to conventional cooking methods in one study.

High levels of methylglyoxal, an intermediate product of the Maillard reaction, are found in commercial soft drinks that contain high fructose corn syrup.

Almonds in most raw almond butters from California are required to go through steam pasteurization. This only raises the temperature of the nut to around 160 degrees F (71 C).

Low carb baked goods with sugar alcohols (maltitol, xylitol) don’t create Maillard reactions. (Unfortunately, the trade-off is often intestinal distress. Maybe just consider cutting back on the pancake intake altogether.)

Further resources

Healthy French Fries? Not

Meat: Good for Us or Disease Waiting to Happen?

References

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Vlassara H, et al. Protection against Loss of Innate Defenses in Adulthood by Low Advanced Glycation End Products (AGE) Intake: Role of the Anti-inflammatory AGE Receptor-1. Journal of Clinical Endocrinology and Metabolism 2009;94:4483-4491.

Davis B & Melina B. Becoming Raw. 2010. Book Publishing Company.

National Cancer Institute. Heterocyclic Amines in Cooked Meats.

Cross AJ, et al. A large prospective study of meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association. Cancer Res 2010;70:2406-2414.

Carere A. Genotoxicity and carcinogenicity of acrylamide: a critical review. Ann 1^st Super Sanita 2006;42:144-155.

Goldberg T. Advanced glycoxidation end products in commonly consumed foods. J Am Diet Assoc 2004;104:1287-1291.

Santarelli RL, et al. Processed meat and colorectal cancer: a review of epidemiologic and experimental evidence. Nutr Cancer 2008;60:131-144.

Felton JS & Knize MG. A meat and potato war: implications for cancer etiology. Carcinogenesis 2006;27:2367-2370.

Sutandyo N. Nutritional carcinogenesis. Acta Med Indones-Indones J Intern Med 2010;42:36-43.

Zheng W & Lee S. Well-done meat intake, heterocyclic amine exposure, and cancer risk. Nutr Cancer 2009;61:437-446.

Gargas ML, et al. Acrylamide: consideration of species differences and nonlinear processes in estimating risk and safety for human ingestion. Food and Chemical Toxicology 2009;47:760-768.

Yamagishi S, et al. Food-derived advanced glycation end products (AGEs): a novel therapeutic target for various disorders. Current Pharmaceutical Design 2007;13:2832-2836.

Ferguson LR. Meat and cancer. Meat Science 2010;84:308-313.

Parzefall W. Minireview on the toxicity of dietary acrylamide. Food and Chemical Toxicology 2008;46:1360-1364.

Cheng K, et al. Heterocyclic amines: chemistry and health. Mol Nutr Food Res 2006;50:1150-1170.

Semba RD, et al. Does accumulation of advanced glycation end products contribute to the aging phenotype? J Gerontol A Biol Sci Med Sci 2010;May 17 Epub.

Xanthis A, et al. Advanced glycosylation end products and nutrition – a possible relation with diabetic atherosclerosis and how to prevent it. Journal of Food Science 2007;72:R125-R129.

Uribarri J, et al. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc 2010;110:911-916.

Kapiszewska M. A vegetable to meat consumption ratio as a relevant factor determining cancer preventive diet. Local Mediterranean Food Plants and Nutraceuticals. Forum Nutr. 2006;59:130-153.

Sebekova K & Somoza V. Dietary advanced glycation endproducts (AGEs) and their health effects – PRO. Mol Nutr Food Res 2007;51:1079-1084.

Henle T. Dietary advanced glycation end products – a risk to human health? A call for an interdisciplinary debate. Mol Nutr Food Res 2007;51:1075-1078.

What is fat loss?

We store fat in adipose tissue in our bodies — mostly under the skin (subcutaneous) or in the body cavity (visceral), with a small amount in our muscles (intramuscular). Body fat is an energy storage depot.

When the substances providing energy become sparse in your bloodstream, the body detects this and calls on fat reserves for backup.

Fat storage and energy

Fats are stored as triglycerides in fat cells and are released via the activity of an enzyme known as hormone-sensitive lipase (HSL). This allows fatty acids to enter the blood, where they circulate bound to a protein called albumin and enter muscles to be “burned.” “Burning” of fat is also known as beta-oxidation.

Tissues can break down fatty acids by way of this beta-oxidation. The process of beta-oxidation ultimately produces ATP, which is the energy source for cells. This takes place in the mitochondria. Fatty acids enter the mitochondria via carnitine.

When high amounts of fatty acids are being broken down and flood the mitochondria (as in starvation), there may be no immediate need for them. In this case, they form energy-rich fragments known as ketones. This is important, as fat cannot be converted into glucose, but it can provide fuel for the muscle and brain in the form of these ketones.

ATP produced from the breakdown of fat is used for metabolic processes in the body including breathing, body temperature regulation, digestion, and excretion. At rest and very low intensity exercise, we get approximately 70% of the ATP produced from fats.

Why is fat loss so important?

We need to lose fat…

As a group, people in most industrialized societies are likely to be over-fat.

This isn’t just a cosmetic problem. Excess body fat can negatively affect nearly every facet of life, including:

• decreased mobility
• poorer emotional health and self-esteem
• increased risk of organ failure
• poorer circulatory health
• increased risk of heart disease
• increased risk of stress fractures
• increased risk of strokes
• increased risk of cancers
• decreased sexual and reproductive health

Fat cells can act as endocrine factories and produce hormones that influence numerous processes in the body — most of which lead to more fat accumulation.

Beyond the health of it all, carrying a lower body fat is often considered more attractive and desirable as the underlying musculature is revealed.

Further, carrying a lower body fat is advantageous for many sport competitors (barring sumo wrestlers, linemen, etc) as extra fat weight adds drag and additional resistance that must be overcome.

Bottom line: Carrying a lot of excessive body fat makes health, body composition, and athletic performance worse.

…but it’s hard.

But here’s the problem — collectively, we’re not very good at losing fat either.

Even modern advancements in obesity treatment (e.g., bariatric surgery, medication, etc) have a success rate of less than 10% for permanent weight reduction/management.

About 95% of those who are overweight go on repeated diets, only to gain most or all of the weight back within one year. Nearly 70% of the United States is overweight or obese. The percentage of 12 to 17 year olds who are overweight has doubled since 1980.

We need a better solution. Knowing how fat loss works may be helpful.

What you should know

Fat cells are a major storage site for body fat, and are in a continuous state of turnover. Fat metabolism is regulated independently by nutritional, metabolic, and hormonal factors; the net effect determines levels of circulating fatty acids and the extent of body fat.

Fat loss and hormones

Fatty acid release and use requires lower insulin levels and an increase of the hormones glucagon, cortisol, epinephrine, and growth hormone. These “anti-insulin” hormones activate HSL. The other major hormone that influences fat metabolism is thyroxine (thyroid hormone).

After a large feeding, glycogen is synthesized until stores are replenished. If high blood sugar persists, glucose is converted to fatty acids. Amino acids can also be converted to fatty acids. The enzyme necessary for cells to accept triglycerides is lipoprotein lipase.

In the un-fed state, insulin concentrations fall, and the anti-insulin hormones increase. This accelerates fat use.

Fat loss and caloric deficit

When we decrease our caloric intake significantly, the body preserves fat stores very efficiently. Since insulin is low, thyroid hormone production is decreased. With this, resting metabolism is lowered. This can take place within 24 hours of starting an extreme diet.

The body’s response to calorie deprivation makes rebound weight gain all but definite once the diet is discarded. Muscle is usually lost, so the body usually becomes fatter.

Fats are more than just a fuel source during rest and lower intensity exercise. Fats restore phosphagens that have been exhausted during high intensity exercise. After intense exercise sessions, oxygen uptake is increased, which allows restoration to pre-exercise conditions (the “afterburn” effect).

Stages of fuel use during fasting

Fat loss is a complex problem

With our focus on specific nutrients, intense nutrition counseling, dieting and processed food consumption over the past 30 years, body fat levels have also increased. In other words, more information, more dieting, more junk food has given us more fat.

While some of this may seem counter-intuitive, it illustrates the importance of body awareness (hunger/satiety cues), avoidance of processed foods, regular physical activity and influential food advertising.

Summary and recommendations

To maintain a low body fat and/or lower body fat:

• Exercise at least 5 hours per week
• Eat whole/unprocessed foods at regular intervals, while being aware of physical hunger/fullness cues
• Sleep 7-9 hours per night
• Don’t engage in extreme diets
• Stay consistent with your habits
• Incorporate non-exercise physical activity
• Ignore food advertising

For extra credit

Aspartame was approved for use in 1981, and while this non-caloric sweetener was hypothesized to help control body weight, since 1980, levels of body fat have increased.

Factors associated with lower levels of body fat include:

• nuts
• green tea
• low energy-density foods
• dietary protein
• avoiding refined carbohydrates
• adequate hydration
• dietary fibre
• fruits and vegetables
• regular exercise
• adequate sleep
• a supportive social network

While cortisol can break down muscle tissue, it can also break down body fat.

If you increase physical activity and nutritious food intake, metabolism will increase.

Blaming weight gain on calories is like blaming wars on guns. The diet is not the cause of excessive body fat levels. Rather, it’s the entire lifestyle.

Severe calorie deprivation inhibits the production of serotonin, a brain chemical needed to control appetite and maintain harmony with food.

Further reading

CLA & Bodyfat

Good body fat?

Gaining body fat with exercise

4 reasons you’re not losing fat

Sex differences in fat loss

Abdominal fat and your fate

References

Potenza MV & Mechanick JI. The metabolic syndrome: definition, global impact, and pathophysiology. Nutr Clin Pract 2009;24:560-577.

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Mahan LK & Escott-Stump S. Eds. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Saunders Publishing, Philadelphia, PA. 2004.

Murray RK, Granner DK, Mayes PA, Rodwell VW, eds. Harper’s Illustrated Biochemistry. 26th ed. McGraw Hill. 2003.

Barnard ND, et al. Nutrition Guide for Clinicians. 1st ed. PCRM. 2007.

Howley ET & Franks BD, eds. Health Fitness Instructor’s Handbook, 4th ed. Human Kinetics. Champaign, IL. 2003.

Bullo M, et al. Inflammation, obesity and comorbidities: the role of diet. Public Health Nutr 2007;10:1164-1172.

Garcia OP, et al. Impact of micronutrient deficiencies on obesity. Nutr Rev 2009;67:559-572.

Anderson AS & Caswell S. Obesity management – an opportunity for cancer prevention. Surgeon 2009;7:282-285.

Dennis EA, et al. Beverage consumption and adults weight management: A review. Eat Behav 2009;10:237-246.

In Part 1, we looked at what some of the world’s cultural traditions have said about gluttony, and what relevance that has for us as eaters today. In this second part, we’ll look more at how gluttony — though it might seem like an antiquated idea — is still meaningful for folks trying to get lean and healthy.

The spiritual concern with gluttony

Just to recap, early thinkers weren’t concerned with maintaining six-pack abs and taut heinies. They were concerned with people’s relationship to daily pleasures. Thus gluttony (behaviour), not girth (body size), is the concern. You won’t find spiritual texts condemning excess body fat.

It’s been said that gluttony is overcome only when someone has a “full soul” and derives pleasure from passions that come from simple pursuits in life. Someone engulfed in the pleasures of gluttony might turn away from spiritual pursuits and weaken their moral defenses (think: alcohol).

Major sins like gluttony can lead to successor sins. The medieval Christian philosopher Thomas Aquinas claimed that overeating can initiate:

• Excessive joy
• Unseemly joy
• Loutishness
• Uncleanness
• Talkativeness
• Dullness of mind

Come to think of it, when I double up on dessert, my thoughts do become a bit irrational.

Gluttony and society

Today, gluttony is more about living in a society that over-consumes, and wastes resources.

As times changed and our culture evolved, gluttony went from a sin to a badge of honour. Over-consuming meant we were better off (at least monetarily). We became a society that rejoiced in overconsumption, yet denounced those who put on weight.

Our judgments of food/drink are often shaped by our desires, and our desires are often shaped by social and cultural forces. Food consumption can mirror the moral equivalent of substance abuse, but food is legal and often socially accepted.

We’re eating things without nutrients, chewing things not meant to be swallowed, drinking things that provide physical stimulation so we can grind through our stressful day. We’re consuming foods that don’t digest properly and popping pills that block our intestines from doing their job – just so we can consume more without responsibility.

We want the unrestricted pleasure of eating, but caloric consequences are in place for a reason. Without them, we have unlimited potential for consumption, limited only by our cravings.

Not only do we avoid taking responsibility for our actions, we also throw the body’s natural appetite, hunger, and satiety signals out of whack. We don’t allow our physiologies to work the way Nature intended.

Gluttony and fasting

While at PN, we don’t advocate strict restriction, we do advocate honest, potentially difficult self-reflection.

If you suspect that food/drink is ruling your life in some realm, giving something up for a designated amount of time — whether that’s desserts, alcohol, caffeine, meat, fast food, etc. — can be an excellent exercise in self-examination. Wondering what your triggers, deeper issues, and demons are? Then try giving up your coping mechanism briefly.

Self-examination through fasting teaches us to be content and satisfied with simple foods. Fasting can help us take control of gluttonous thoughts and redirect the appetite to something constructive. If we’re always full of food/drink we might grow overconfident in our abilities, forgetting about spiritual growth. Fasting has been said to increase hunger for spirituality.

Fasting for spiritual purposes is about becoming spiritually “full”, building discipline, and learning (and respecting) the body’s true hunger signals. Conversely, dieting tends to put the focus on appearance, which can be self-centered, or on adhering to an externally imposed regime that has nothing to do with psychological wellness.

Brief periods of fasting also teach us that hunger is not an emergency that requires immediate action at all times. Ideally, we learn to distinguish true, natural, physical hunger signals from “Ooh, there are brownies in the lunchroom!” or “Man, I could totally go for a party-sized pizza.”

At PN, we aim to honour our true hunger, while gaining mastery over our passing whims and desires for self-indulgence.

Regulation vs restriction

Those who regulate food tend to enjoy it more. Someone who just did a Lenten or Ramadan fast will probably enjoy a strawberry more than the person who eats fast food every day.

On the other hand, people who restrict food stringently often end up in over-indulgence. Strict dieting usually leads to binge eating eventually.

Thus, some spiritual leaders claim that a daily moderate amount of food is better than severe fasts. Just like overindulging on food, excessive fasting can also become selfish and weaken spiritual endeavours.

The purpose of regulating our food intakes, then, are:

• To learn about and respect our natural physiological hunger and fullness cues
• To respect our food intake, and enjoy it mindfully and appreciatively
• To eat responsibly, aware of the consequences of our eating decisions
• To get beyond excessive focus on food and eating into the wide world of other intellectual, social, and spiritual pursuits

Probably not the path to enlightenment.

Summary

We all feel cravings and desires. It’s what makes us human.

Those who are successful at overcoming gluttony — the excessive, disproportionate indulgence of desire — make their natural appetite serve them in relationships with others and bettering the world. Appetites are linked, and those who might be full of food can still be spiritually empty.

While none of us want to pollute our body, we also don’t want to make it overly sacred. It’s important to address our needs and enjoy life’s pleasures. If you can’t figure out when enjoyment exceeds necessity, check in with the classifications of gluttony described in part 1.

Sometimes we rely on the gratification of food to compensate for a deficiency of rest, relaxation and happiness in a hassled life. These are learned coping strategies.

If you struggle with cravings and food behaviours, you might need to stay away from certain foods/drinks. Food manufacturers have deliberately created products that are harder for us to resist. And you might need to:

• learn new coping strategies, such as meditation;
• restructure your meal habits and times; and/or
• address the real problem.

Indulging food cravings only results in temporary satisfaction. No matter how amazing the dessert, we’ll be hungry again… and the dessert cannot fill up emotional, intellectual, or spiritual emptiness.

Further resources

All About Appetite Part 1 | Part 2

References

Cook J. Seven. Zondervan. 2008

Deyoung RK. Glittering Vices. Brazos Press. 2009.

U.S. Religious Landscape Survey

Okholm D. Rx For Gluttony. Christianity Today Sept 4 2000;62-66.

Shipley O. A Theory About Sin. Macmillan and Co. 1875.

Diamond A. If gluttony is a sin, perhaps we are all sinners. Nursing Standard. 2009;24:28.

Prose F. Gluttony. Oxford University Press. 2003.

Phillips R. Thou Shalt Not Overeat. BeliefNet.

Kirkham T. Endocannabinoids and the neurochemistry of gluttony. J of Neuroendocrinology 2008;20:1099-1100.

Okholm D. Gluttony: Thought for food. Wheaton College. Email correspondence.

Davis C & Carter JC. Compulsive overeating as an addiction disorder. A review of theory and evidence. Appetite 2009;53:1-8.

Centers for Disease Control. Statistics on Overweight/Obese.

Centers for Disease Control. Statistics on Death.

All About Alcoholic Beverages

All About Food Waste

All About “Natural” Sweeteners

Bringle ML. The God Of Thinness. 1992. Abingdon Press.

What is gluttony?

Gluttony is the excessive consumption that deprives another being of a life-giving necessity. Gluttons devour more, leaving others with less. It’s immoderation.

Beyond consumption, gluttony describes worship of food and deriving excessive pleasure from it.

In this painting, The Last Judgement, the gluttons have actually become food. Heaven is on the left, and hell on the right. On the right, the eaters are being eaten. Click to enlarge.

Gluttony also extends into material goods and other physical pleasures. “-aholic” is the suffix attached to the glutton’s “meal” of choice.

Those with excess body fat often carry the burden of gluttony, but weight doesn’t necessarily indicate gluttonous patterns. “Healthy” eaters can be immoderate too. Just as someone can be angry about the right thing but express it in the wrong way, someone can eat healthy food in a way that is gluttonous.

The more natural and necessary the activity (e.g., eating and sex), the more pleasurable it is. If we didn’t get pleasure from eating and procreating, we’d have a population of 100 and suffer from rickets.

Gluttony creeps in when our desires spiral out of control and get excessive with food. This is challenging in modern society, since our appetite is subject to external authoritative psychological influences. For more, see All About Appetite Part 1 and Part 2.

Grasping gluttony

Thinkers, philosophers, and social regulators have struggled for centuries with how to define and understand gluttony.

• Is it a normal, acceptable part of human nature?
• Should we view gluttony as a natural response to abundance or as a moral or personal failure of self-control?
• Is it harmful to individuals or society?

Late Roman and medieval European thinkers in particular were quite preoccupied with this question, as attempts to impose new, more austere religious regimes on rural societies conflicted with traditional, often highly indulgent, “pagan” celebrations held by people whose “nasty, brutish, and short” daily lives were organized by the feast-famine cycles of harvest.

However, other world religions and spiritual traditions have also offered their thoughts on what gluttony means. (More on this below.)

Generally, gluttony can include:

1. Not savouring a reasonable amount of food
2. Eating outside of a prescribed time (mindless eating)
3. Anticipating eating with preoccupied longing
4. Consuming costly foods (eating lavishly simply for the purpose of conspicuous consumption)
5. Not being content with “common” foods; always seeking delicacies (or, perhaps, Supersizing)
6. Paying too much attention to food (which includes paying too much attention to how we look – which, they argue, can become idolatry)

In the Bible, the word “glutton” is used to portray someone who eats because they want food rather than need it. Christian religious thinker Thomas Aquinas, writing in the 1200s, equated gluttons to children, since they are governed by pleasure from appetite and their behavior is ruled by it.

Interestingly, many of these insights sound very familiar to those of us trying to teach and practice “mindful eating” and the PN-style way of living.

Such insights also raise questions about our own consumption habits.

Does “gluttony” involve simply how much we eat?

Or should it apply more broadly to our overall consumption patterns?

For instance, what about:

The massive fast food burger?	The expensive coconut ice cream?	The apple shipped from New Zealand?

Gluttony as a sin

The concept of “sin” is a contentious one. In 2010, we think of the world differently than, say, medieval Europeans.

The Christian concept of seven “deadly sins” originated from early Christian monk Evagrius’ original list of eight evil thoughts (later modified by Saint John Cassian and Pope Gregory to what we’re familiar with). Gluttony is considered a deadly sin.

(For reference, the other deadly sins include are pride (vanity), greed (covetousness), lust, envy, anger, and sloth.)

In the original context, a sin was only deadly if it opposed one’s love of God (their higher power).

For example, if someone merely ate more than necessary, they have committed an “excusable” sin. It’s only “deadly” when they’re so taken by the pleasure of eating that it turns them away from spiritual instructions.

In the modern context, we might say that when something governs our life, it can become a destructive habit that undermines our goodness of character, getting worn in over time. And really, at its core, gluttony is about separating ourselves from others (family, friends, culture, etc.).

For instance, writers such as Geneen Roth and Allen Zadoff describe isolating themselves socially — locking themselves into their homes alone — so that they can over-consume food. Nowadays, we might call this “binge eating disorder”. But the outcome — self-harm and social/spiritual isolation — is the same.

Gluttony and spiritual traditions

Given the philosophical importance of the concept of gluttony, it’s no surprise, then, that world spiritual traditions have often tackled the question of gluttony. Here’s a sampler.

Buddhism

One of the Buddhist precepts is: “To abstain from taking food at inappropriate times.” They also encourage avoiding sensory excess. Some Buddhists say that if gluttony cannot be conquered, any ambitious spiritual pursuit is doomed to fail. Gluttony is referred to as one of the vices.

General Christianity

Jesus taught humans that they cannot live by bread alone.

Gluttony (related to food) is rarely mentioned in the Christian Bible. You’ll see more about enjoying food rather than warning against excess. (After observing the donut spread at a Methodist church last Sunday, this doesn’t surprise me.)

Still, the New Testament encourages one to be sensible with intake and observe the body as a temple. The concept of willpower actually came from Christian teachings about temptation. Deuteronomy 21:20 ordains that “a glutton and a drunkard” is to be stoned to death by the elders in his city. Yikes.

Hinduism

Hinduism considers greed a root of other evils and discusses the importance of avoiding excess in all areas.

Islam

Those of Islam faith practice regular fasting and discourage overeating. They claim that gluttony feeds on itself, with the appetite growing when indulged. When appetite is restrained, it becomes frail.

Judaism

Eating is a sacred act and the idea of keeping kosher relates to self-control. Still, on the holiday of Purim, overconsumption is encouraged.

Why is gluttony important?

If someone is preoccupied with food, they tend to neglect relationships with others. This includes relationships with significant others, society and the more intangible dimensions of life. Gluttony resembles any form of disordered eating, since they all reflect disordered relationships.

Faith vs food

Around the world, people devote their entire lives to a spiritual doctrine. Many say that there is nothing more powerful than spiritual pursuits.

As we’ve seen, major world faiths generally suggest that their adherents avoid immoderation. Yet based on current food/drink consumption trends in developed nations, it appears that most people don’t believe eating too much food is a crime against anyone or anything.

Indeed, this is a paradox: Nearly all religions have sanctions against gluttony. Still, data indicate that those who claim to observe organized religion are more likely to be overweight than other Americans.

• 78% of U.S. adults claim to be Christian
• 67% of U.S. adults are overweight or obese
• 1 out of 2 adults in industrialized countries die of either cancer of heart disease (diseases generally due to excess)

(Note: 16% of U.S. adults say they are unaffiliated to any organized religion; 5% of U.S. adults claim to follow other religions)

In religion, we’re often reminded about wrongdoing — lying, stealing, cheating, murder, abortion, and so forth. Gluttony is forgotten.

Or is it?

For every one book about adultery, stealing, or abortion – we have nearly 10 covering diet/overeating. We also have many books about dealing with the consequences of social and spiritual isolation.

Cultural language has replaced moral language in our society. We hear about diets, nutrition and eating disorders – but little about gluttony and sins. Our way of offsetting gluttony is with dieting, Weight Watchers and gyms… until the next plunge into immoderation and excess.

Excessive tendencies

Gluttony is about excess. And beyond weight, we tend to get excessive in North America with many areas related to food.

• In the U.S., we waste about 20-25% of all food purchased for the home. This equates to about 474.5 pounds per year.
• Added sweeteners comprise nearly 20% of the U.S. diet.
• Americans eat over 220 pounds of meat per person, per year.
• The U.S. diet is primarily processed and animal foods.
• The average American consumes 12.28 lb of chocolate per year.
• Nearly 70% of those above the age of 18 years in most industrialized countries drink alcohol. Chronic liver disease and cirrhosis is the 12th leading cause of death in the U.S.
• A study of 19-30 year olds revealed that 45% of men and 27% of women reported heavy drinking in the past two weeks.
• Today, 18,000 kids will die because they are malnourished. That’s 6 times the number killed on September 11th.

Many wealthier nations not only fail to solve these problems, they fail to even look for them. Does gluttony feed into this ignorance?

Summary

It may seem strange to use an “old” concept in a modern world. Yet the notion of gluttony, and what it implies, is still very relevant in a food-saturated world where people are searching for health and a higher purpose.

Regardless of your spiritual leanings, gluttony can thus be defined as some kind of excessive consumption that:

• harms us physically and psychologically;
• isolates us from ourselves and others;
• shifts our focus to unhealthy domains and preoccupations; and
• wastes resources.

Before part 2, here are a few questions to establish where you stand with gluttonous tendencies:

1. Do you consume food/drink (or other things) past the point of fullness/satiation/satisfaction?
2. Do you focus excessively on this consumption?
3. Is your consumption harming your body?
4. Is it harming your relationships?
5. Is the well-being of others compromised by your food/drink cravings?
6. Are your food/drink habits dedicated to serving your own immediate gratification rather than serving your life mission and deeper values?

Further resources

All About Appetite Part 1

All About Appetite Part 2

All About Alcoholic Beverages

All About Food Waste

All About “Natural” Sweeteners

References

Cook J. Seven. Zondervan. 2008

Deyoung RK. Glittering Vices. Brazos Press. 2009.

U.S. Religious Landscape Survey.

Okholm D. Rx For Gluttony. Christianity Today Sept 4 2000;62-66.

Shipley O. A Theory About Sin. Macmillan and Co. 1875.

Diamond A. If gluttony is a sin, perhaps we are all sinners. Nursing Standard. 2009;24:28.

Prose F. Gluttony. Oxford University Press. 2003.

Phillips R. Thou Shalt Not Overeat. BeliefNet.

Kirkham T. Endocannabinoids and the neurochemistry of gluttony. J of Neuroendocrinology 2008;20:1099-1100.

Okholm D. Gluttony: Thought for food. Wheaton College. Email correspondence.

Davis C & Carter JC. Compulsive overeating as an addiction disorder. A review of theory and evidence. Appetite 2009;53:1-8.

Centers for Disease Control. Statistics on Overweight/Obese.

Centers for Disease Control. Statistics on Death.

CalorieLab.com. United States of Obesity map using CDC data.

International Cocoa Initiative. Background Information.

Bringle ML. The God Of Thinness. 1992. Abingdon Press.

What is muscle growth?

Muscle growth — sometimes known as hypertrophy — is the development of mass, density, shape, and function of muscle cells. This adaptation allows the muscle to meet exercise/function-induced stress.

Muscle cells are sort of like a bunch of sticks bundled up for firewood. Myofibrils (“myo”, from the Greek mys, refers to muscle) are cylindrical bundles of filaments composed of sarcomeres. Sarcomeres are the fundamental unit of muscle contraction and are composed of myosin and actin.

All of these proteins comprise about 20% of muscle. Water, phosphates, and minerals comprise the other 80% of muscle.

Where does muscle growth come from?

When someone does resistance training consistently, they may notice muscle growth. The growth is due to an increased water, number of myofibrils, and connective tissue.

Scientists often break hypertrophy down into two types:

• Sarcoplasmic hypertrophy increases muscle size by increasing the volume of sarcoplasmic fluid in the muscle cell.
• Myofibrillar hypertrophy (sometimes called “functional hypertrophy”) increases muscle size by increasing the contractile proteins.

Some people in the fitness industry will argue that bodybuilders demonstrate sarcoplasmic hypertrophy, and that their muscles look “puffy”; while weightlifters demonstrate myofibrillar hypertrophy, and their muscles are “denser”.

Bodybuilder	Weightlifter

Muscle growth and fibre types

Although growth can occur in all muscle fibre types, different types of muscle fibres vary in their potential for growth. Fast twitch fibres are more likely than slow-twitch fibres to grow with intense strength training. This may be one reason why athletes such as sprinters tend to be bigger and more muscular than endurance athletes, and why heavier loads tend to stimulate more muscle growth than light loads.

Marathoner (left) vs sprinter (right)

Muscle growth and hormones

Muscle growth is further influenced by type of exercise, nutritional intake, and hormonal status. The type of exercise and hormonal status influence nutrient partitioning — in other words, whether you increase muscle depends on the kind of activity you do and your hormonal environment, which both tell your body where to allocate the nutrients you eat.

Eat a lot, train hard, and get lots of recovery, and you’ll put on muscle. Be malnourished, be sedentary, and be stressed out — and you won’t.

Hormones that modulate muscle growth include:

• growth hormone
• testosterone
• IGF-1
• cortisol
• beta-endorphin, and
• parathyroid hormone.

For more on a few of these hormones, see here:

• AA Growth Hormone
• AA Testosterone
• AA Cortisol

Why is muscle growth so important?

Subjectively, muscle growth improves the appearance of the body. Women who gain muscle mass while remaining relatively lean appear tighter, firmer, and more “toned.” Men who gain muscle mass while remaining lean appear stronger, larger, and more athletic.

Objectively, muscle growth improves function. Larger muscles are often stronger muscles, leading to improved daily functioning in most individuals. Muscle is metabolically active, and affects the way the body handles nutrients. For instance, people who are more muscular (especially combined with lower body fat) typically have better insulin control.

From a health perspective, advancing age is associated with a loss of muscle mass, better known as sarcopenia. Preserving muscle mass can preserve strength, and strength is a predictor of survival as one ages. Loss of muscle function appears to be due to decreased total fibres, decreased muscle fibre size, impaired contraction mechanisms, and decreased motor unit recruitment.

What you should know

Muscles respond to demands

Muscles respond to the demands we put on them. Ask your muscles to lift loads, and they’ll respond by getting stronger. Ask your muscles to help you make a butt groove in the La-Z-Boy and they’ll shrivel up from disuse, leaving you weak and skinny-fat.

Intense training (such as heavy weight training) damages muscle, which then remodels to prevent future injury. Thus, including relatively intense exercise, particularly resistance training, in your fitness regime is essential — no matter what your ability or age.

Muscles respond to calories

Restrict calories and you risk muscle loss and metabolic slowdown.

Studies show that people who restrict their calories (i.e., diet) without also doing resistance training do lose weight, but it’s an even distribution of muscle and fat — not what you want. Indeed, sometimes calorie restricters who don’t exercise end up fatter (as a %) than when they started!

How many calories to build muscle?

You need roughly 2,800 calories to build a pound of muscle, largely to support protein turnover, which can be elevated with training.

The contractile proteins and fluid (sarcoplasm) in muscle fibres are broken down and rebuilt  every 7 – 15 days. Training alters the turnover by affecting the type and amount of protein produced. Again, muscles respond to the demands placed on them.

However, muscles that are overloaded appropriately can actually grow during starvation (energy from fat stores can be liberated and stored in muscle tissue), although ample nutrients (e.g., protein, carbohydrate, etc.) can greatly enhance the extent of the growth response. Although growth can take place during starvation/restriction, especially for newbies, muscle growth with inadequate calorie consumption is less likely to take place with advanced trainees, as their threshold for growth is elevated.

If you’re more experienced and looking to get big and strong, you’ll probably have to eat more.

Muscles respond to protein

The way our hormones respond to training, and how they affect our muscle growth, depends a lot on our nutritional status — not just how many calories we’re taking in.

In a rested state, muscle protein breakdown exceeds protein synthesis. This net balance can be improved with strength training, but still, normally, we’re breaking down more than we’re building up.

We want the opposite — to be building up more than we’re breaking down, especially after resistance training. We need adequate protein to do this.

One bout of resistance training can stimulate protein turnover for at least 48 hours. During this time, if energy intake is adequate and protein represents at least 12 – 15% of our energy intake, growth can occur.

For those on an energy restricted diet for fat loss, protein needs for muscle recovery and growth are likely closer to 1.5 – 2.0 grams of protein/kg of bodyweight.

What helps stimulate muscle protein synthesis?

• Just 6 grams of essential amino acids can stimulate muscle protein synthesis after training.
• We don’t need nonessential amino acids for this stimulation to occur.
• Elevated levels of insulin can generate muscle growth when amino acid consumption is ample, which demonstrates the importance of carbohydrate consumption after exercise.
• Frequent amino acid consumption (from food or supplements) during the waking hours may also play a role in muscle growth.

For more on this:

• All About Protein
• All About BCAAs

Summary and recommendations

Muscle growth seems to occur best when training with relatively higher volumes, close to muscle fatigue, and with shorter rest periods between sets/reps.

Thus:

1. When training, 6 – 12 repetitions per set is the optimal range for muscle growth.
2. Train towards contraction failure.
3. Take relatively short rest periods — 30 – 90 seconds. Rest-pause techniques can also be effective.
4. Perform 12 – 20 sets per muscle group. Supersets can help add volume and improve efficiency.
5. Be consistent with training.
6. Consume enough energy (calories), with a minimum of 12 – 15% of calories from protein or 1.0 gram of protein per kilogram of bodyweight.
7. Sleep 7 – 9 hours per night.

For extra credit

The amount of muscle growth that occurs depends on upper genetic limits of cell size.

An increase in the number of muscle fibres, rather than just the size of those that already exist, is known as hyperplasia. It has yet to be definitively measured in humans. If it does occur, it probably accounts for a small portion of muscle growth (less than 10%).

Changes in cellular oxygen, reactive oxygen species, ATP levels, and metabolite concentrations during exercise stress may be fundamental stimuli that lead to muscle growth.

Further reading

Limit protein to 20 grams per meal?

Minutemen: Rest Intervals

Leucine vs. Whey

Comparing Number Of Sets For Muscle Growth

References

Spangenburg EE. Changes in muscle mass with mechanical load: possible cellular mechanisms. Appl Physiol Nurt Metab 2009;34:328-335.

Phillips SM. Physiologic and molecular bases of muscle hypertrophy and atrophy: impact of resistance exercise on human skeletal muscle (protein and dose effects). Appl Physiol Nutr Metab 2009;34:403-410.

Kumar V, et al. Human muscle protein synthesis and breakdown during and after exercise. J Appl Physiol 2009;106;2026-2039.

Tipton KD & Ferrando AA. Improving muscle mass: response of muscle metabolism to exercise, nutrition and anabolic agents. Essays Biochem 2008;44:85-98.

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Borsheim E. Enhancing muscle anabolism through nutrient composition and timing of intake. SCAN’s Pulse. Summer 2005. Volume 24.

Brock Symons T, et al. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc 2009;109:1582-1586.

Elango R, et al. Evidence that protein requirements have been significantly underestimated. Curr Opin Clin Nutr Metab Care 2010;13:52-57.

Mettler S, et al. Increased protein intake reduces lean body mass loss during weight loss in athletes. Med Sci Sports Exerc 2009 Nov 13 [Epub ahead of print]

What is yoga?

The word yoga comes from the Hindi yoga, originally from pre-Indo-European yeug, meaning “union” or “to join.”

Eastern vs Western styles

Classic yoga from the east follows ancient Hindu discipline, incorporating asanas (physical exercises and postures), pranayama (breathing techniques), and meditation designed to move someone towards peace of mind and spiritual enlightenment. For Hindus and Buddhists, the goal of yoga is union with Brahman (the eternal or absolute) and Atman (your true self) – not so much about sculpting a “yoga booty.” Yoga is not a religion, but many followers use it to enrich their spiritual practice.

In the west, modern yoga styles are generally thought of as physical exercises to build flexibility and strength.

East meets West…

Yoga history

T. Krishnamacharya hitting a scorpion pose

Yoga practice can be traced back 5000 years to Indus-Sarasvati civilizations in India. (And we thought using free weights was old school.)

A Hindu teacher named Patanjali was said to  have recorded the first principles of yoga in religious scriptures known as the Yoga Sutra. Many forms of yoga have been developed since – each focusing on a new realm of personal development.

Hatha yoga came to the west in the 1920s thanks to T. Krishnamacharya and remains the most popular style today.

Why yoga is important

Yoga’s popular

The number of people practicing yoga in the U.S. has more than doubled since 1998, from 7 million to 15 million.

Nearly 5% of U.S. businesses offered yoga at the workplace in 2008. Approximately 75% of U.S. health clubs offer yoga instruction.

Yoga may make you healthier

Yogis claim numerous physical and psychological benefits result from yoga. But is there any data showing this?

Well, the double-blind test, adored by many Western health professionals, isn’t possible with yoga. If one group in a study is practicing healthy yoga, it’s hard to recruit a blind group that isn’t, and doesn’t know it. Still, yoga data does exist.

Heart disease

Yoga may help reverse heart disease. Well, when combined with aerobic exercise and a low-fat plant-based diet. The author of one study said, “Adherence to the yoga and meditation program was as strongly correlated with the changes in the amount of blockage [in the arteries] as was the adherence to diet.” Yoga may help to control inflammation throughout the body as well.

Pain, balance and flexibility

What is one of the greatest fears among the elderly? Falling. Yoga can help with balance in older folks. Just two sessions of Hatha yoga per week can increase stability. Before you dismiss yoga as a Friday night nursing home activity, yoga can improve balance in people under 60 years old too.

Yoga interventions have been shown to be effective for alleviating back pain and symptoms of carpal tunnel syndrome.

Stress and mood

Yoga has long been used for relieving stress and improving mood. Plus, since some people overeat due to stress, conquering stress with yoga might indirectly improve nutrition.

Women undergoing treatment for cancer have found yoga to be helpful for mood and controlling stress levels.

Yoga may help control anxiety and the meditation aspect of yoga can assist those in prison with self-control.

Most yoga is parasympathetic dominant, which may promote recovery from intense workouts. See the following for more on the importance of parasympathetic activities:

• All About Recovery
• JB’s Getting Control of Stress
• JB’s Ultimate Stress Busting Workout

Disordered eating and weight

Body image disturbances and disordered eating continue to increase. Authentic yoga studios have no mirrors. Rather, students’ awareness is tuned to internal sensations. Yoga offers a non-verbal adjunct to standard eating disorder therapy and provides an opportunity to unite the physical body with inner experience.

When someone encounters awkward or painful postures in yoga, they are trained to observe the tension and breathe while coaxing their muscles or joints open, or just accept it as is. This same technique can be applied to other uncomfortable situations, such as a craving for junk food or drugs.

Since yoga can help to unite the mind and body, it can be useful in regulating appetite, decreasing food preoccupation, enhancing body awareness, and boosting body satisfaction. The longer one participates in yoga, the more self-awareness and positive impact on body image/eating they develop (i.e., years may be more effective than months).

Yoga can help eliminate binge-eating patterns. This may be due to the meditation aspect and ability to heighten mindfulness.

People who practiced yoga regularly for four years or more gained less weight as they got older. Moreover, overweight individuals who practiced yoga for four or more years managed to lose weight over a 10-year period.

Yoga’s effect on neurotransmitters. From: Douglass L. "Yoga as an intervention in the treatment of eating disorders: does it help?" Eating Disorders 2009;17:126-139.

Menopause

Yoga may be useful for alleviating symptoms of menopause.

Lymphatic system

Exercise, particularly yoga can help increase lymph drainage.

Epilepsy

There have been few reliable studies using yoga for epilepsy, but the results are encouraging. Yoga may stimulate the vagus nerve, which can decrease seizure frequency.

Getting injured

This just in: You can get injured doing yoga (like most physical endeavours).

13,000 Americans have visited the ER or doctor’s office during the past three years due to yoga-related injuries. That’s outrageous. Oh, wait a minute, no it’s not. 7.6 million ER visits each year are associated with alcohol.

Yoga is dangerous for people who do too much, too soon — the folks who haven’t stretched since high school band camp and want to show off for the cute girl/guy in the front row of Saturday morning yoga. Goodbye hamstring attachment site; hello physical therapy office. You’ll see case reports of serious injuries in those attempting advanced yoga poses when they shouldn’t be.

Those who are pregnant or have glaucoma should check themselves before trying to perform any postural yoga that increases pressure in the torso and head (like inversions).

Finally, folks with hypermobility of the lumbar spine (lower back) might increase their risk of low back problems and vertebral stress fractures with poses that involve excessive hyperextension of the lumbar spine, like this:

What you should know about yoga

Be aware of your yoga instructor’s background, qualifications, experience and training. Check their style and figure out who attends their classes. Just like a coach, teacher or trainer, we all have different preferences.

Yoga styles

Virtually all forms of yoga can be traced back to the four cornerstones: ritual, knowledge, devotional and tantric.

There are many varieties of yoga to choose from. Here’s a brief description of the more popular styles.

Ayurveda

Ayurvedic yoga combines Asanas, Pranayama, and meditation. Asanas strengthen muscles, improve flexibility, and rejuvenate the body. The aim of this style is to bring natural order and balance to hormones and metabolism. Adherents see this as a natural way to treat stress-related disorders.

Anusara

All levels are invited here. There is a focus on creative freedom and individuality – so get ready to express yourself. This is a “recent” style started in 1997. You’ll probably be doing some chanting here.

Ashtanga

This discipline involves synchronizing the breath with a progressive series of postures. The result is internal heat and sweating, which detoxifies the muscles and organs.

Adherents of Ashtanga, which is the most vigorous form practised, claim that the results include improved circulation, a light and strong body, and a calm mind. It is fast paced and a high strength to bodyweight ratio is necessary.

Bikram (often called “hot”)

Imagine doing yoga in a dry sauna. Bikram yoga is a series of 26 traditional Hatha yoga postures and breathing exercises, all performed in a heated room. The entire workout takes approximately 90 minutes, and will leave you sweaty.

Hatha/Ananda (often called “restorative”)

Hatha yoga is the most commonly practised form in the West – its combination of Asanas, Pranayama and meditation providing a balanced approach to physical and mental health. It is the least strenuous yoga. If you have exercise ADD, you may get bored. If you are intimidated and figuring out where to start with yoga, this is the class.

Iyengar

This is purist yoga, named after B.K.S. Iyegar. It has a slow pace with a priority of mastering poses in isolation. Feel free to get assistance from blocks, straps or pads. Good for learning yoga fundamentals. Folks who need constant variety might get bored.

Kundalini

Are you ready to awaken kundalini? This is a form of vinyasa yoga. More spiritual than others. You’ll be getting your chant on during this class. Kundalini incorporates a number of elements, including Pranayama, Asanas, mantras (chants), and meditation. Regular practice will help you develop a healthy body and balanced mind.

Prenatal

This is an excellent way to stay in shape and prepare for the rigors of both pregnancy and childbirth. The stretching and strengthening work is of great preparation for labor, with exercises which can be safely practiced in all stages of pregnancy.

Vinyasa/power yoga

A breath-synchronized form of yoga. Most modern “power yoga” classes are this format. Requires more strength than most other styles.

Summary and recommendations

Most exercise enthusiasts acknowledge that yoga isn’t the most comprehensive workout. Yet even though it’s not optimal for increasing strength, muscle, or cardiovascular health in isolation, it’s mindful physical movement.

For those who participate in regular forms of exercise, incorporating yoga 1-2 times each week might assist in stress relief, recovery, balance, mood, and flexibility. If you try a class and don’t like it, try another one. They are all different.

For those looking to get a grasp on mindful eating habits, meditation, and body awareness, taking yoga 1-2 times each week may help.

Extra credit

“Learning to meditate means taking back control.” Bernard Young (Prisoner in California)

Further resources

Enlighten Up (DVD)

CNN: Man loses 365 pounds with yoga

References

Sherman KJ, et al. Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial. Trials 2006;11:36.

Hartfiel N, et al. The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scand J Work Environ Health 2010;April 6^th Epub.

Paul P. When yoga hurts. Time 2007;170:71. http://www.time.com/time/magazine/article/0,9171,1668470,00.html

McDonald AJ 3^rd, et al. US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000. Arch Intern Med 2004;164:531-537.

Corliss R. The power of yoga. 2001;157:54-63. http://www.time.com/time/magazine/article/0,9171,999731,00.html

Ornish D, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-133.

Manchanda SC, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India 2000;48:687-694.

Telles S, et al. Short term health impact of a yoga and diet change program on obesity. Med Sci Monit 2010;16:CR35-CR40.

Michalsen A, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit 2005;11:CR555-CR561.

Javnbakht M, et al. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract 2009;15:102-104.

Faturechi R. Jail’s meditation course is not a hard sell. LA Times. April 18^th, 2010. http://www.latimes.com/news/local/la-me-jail-meditation18-2010apr18,0,2800953.story?page=1

Vadiraja HS, et al. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther 2009;8:37-46.

Oken BS, et al. Randomized, controlled, six-month trial of yoga in healthy senior: effects on cognition and quality of life. Altern Ther Health Med 2006;12:40-47.

Ramaratnam S & Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000;3.

Rajesh B, et al. A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy. J Altern Complement Med 2006;12:367-371.

O’Connor D, et al. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003;1.

Bertschinger DR, et al. Yoga can be dangerous – glaucomatous visual field defect worsening due to postural yoga. Br J Opthalmol 2007;91:1413-1414.

Kiecolt-Glaser JK, et al. Stress, inflammation, and yoga practice. Psychosom Med 2010;72:113-121.

Patel SC & Parker DA. Isolated rupture of the lateral collateral ligament during yoga practice: a case report. J Orthop Surg (Hong Kong) 2008;16:378-380.

Schmid AA, et al. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study. Arch Phys Med Rehabil 2010;91:576-583.

Dittmann KA & Freedman MR. Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga. Eating Disorders 2009;17:273-292.

Carei TR, et al. Randomized controlled clinical trial of yoga in the treatment of eating disorders. J of Adolescent Health 2010;46:346-351.

Yoga in the modern world. Eds: M. Singleton and J. Byrne. Routledge. 2008.

Scime M, et al. Group prevention of eating disorders with fifth-grade females: impact on body dissatisfaction, drive for thinness, and media influence. Eating Disorders 2006;14:143-155.

McIver S, et al. Yoga as a treatment for binge eating disorder: a preliminary study. Complementary Therapies in Medicine 2009;17:196-202.

Scime M & Cook-Cottone C. Primary prevention of eating disorders: a constructivist integration of mind and body strategies. Int J Eat Disord 2008;41:134-142.

Mitchell KS, et al. Innovative interventions for disordered eating: evaluation dissonance-based and yoga interventions. Int J Eat Disord 2007;40:120-128.

Lundgren T, et al. Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Epilepsy & Behavior 2008;13:102-108.

McElroy-Cox C. Alternative approaches to epilepsy treatment. Current Neurology and Neuroscience Reports 2009;9:313-318.

Boudette R. How can the practice of yoga be helpful in recovery from an eating disorder? Eating Disorders 2006;14:167-170.

Douglass L. Yoga as an intervention in the treatment of eating disorders: does it help? Eating Disorders 2009;17:126-139.

What are plant-based diets?

Plant-based diets, usually called “vegetarian” diets, consist of vegetables, fruits, beans/legumes, whole grains, nuts, seeds and sometimes animal products such as dairy and eggs. A total vegetarian, also known as a vegan, includes only foods from the plant/fungi kingdom without the addition of dairy or egg products.

“Vegetarianism” vs “vegetarians”

“Vegetarianism” is a set of choices; “vegetarian” is an identity or a label.

Most vegetarians do not eat animal flesh, although people’s actual diets vary. Some folks call themselves “vegetarian” but also incorporate some animal products, such as seafood or fish. A few vegetarians will even occasionally eat things like poultry or red meat. For most vegetarians, the conscious and purposeful choices they make about nutritional habits are what really define a vegetarian diet.

Thus, vegetarianism (as a collection of dietary choices) is mostly about what people eat (or don’t) but also about how they view and understand their eating habits.

“Vegetarian” vs “vegan”

In 1944, the first Vegan Society was created in England, and the name vegan (pronounced VEE-gan) was developed to differentiate vegans from vegetarians.

Vegans abstain from eating all meat, fish, or fowl, as well as any other foods of animal origin such as butter, milk, yogurt, honey, eggs, gelatin, or lard, and any prepared foods containing these ingredients. Vegans typically avoid animal products in other domains too (e.g. leather products).

The Vegan Society in England defines veganism as follows:

“Veganism is a way of living which excludes all forms of exploitation of, and cruelty to, the animal kingdom, and includes a reverence for life. It applies to the practice of living on the products of the plant kingdom to the exclusion of flesh, fish, fowl, eggs, honey, animal milk and its derivatives, and encourages the use of alternatives for all commodities derived wholly or in part from animals.”

Currently, about 1% of the population follows a vegan lifestyle, while 3% of the U.S. is vegetarian (see below).

“Plant-based” vs “vegetarian”

For our purposes, it’s more useful to talk about plant-based diets rather than “vegetarianism”.

The concept of “vegetarianism” has taken on a life of its own, and implies certain moral and/or philosophical beliefs, or dietary practices, that may not apply to everyone. The term “plant-based diet” doesn’t carry the same cultural baggage as “vegetarianism”.

And, after all, a proper vegetarian meal plan is based on eating mostly/only foods that come from plants — not meat-free processed junk foods, which is something many vegetarians do.

Why are plant-based diets so important?

To understand the importance of plant-based eating as a lifestyle and set of dietary choices, it’s helpful to understand why people choose this way of eating.

Why vegetarianism?

Just like there are many ways to be plant-based eaters, there are many reasons that people choose plant-based diets.

• Ethical – nonviolence: Some people may choose a plant-based diet because their ethical beliefs include a commitment to nonviolence — both towards the animal killed for food and the human responsible for killing it. (As you read above, this motivates many vegans.)
• Ethical – food production: Many plant-based eaters have strong concerns about animal treatment within industrial food production systems such as factory farming.
• Environmental: Evidence suggests that raising livestock (particularly factory farming) and industrial fishing has ecological impacts. For more on this, see:
  • All About Environmental Eating Part 1 and Part 2
  • All About Local Food
• Religious: Some world religions (such as some sects of Buddhism) forbid meat consumption and/or limit certain animal products (such as abstaining from pork and shellfish to keep kosher in Judaism), which adherents then develop further into plant-based eating.
• Health: Evidence suggests that a diet high in plant products can help us get and stay healthier. We know that almost 70% of Americans are suffering from ailments associated with dietary intake — problems that can be improved by adding more plants.
• Economic: For many folks, animal products (especially non-industrially produced animal products) are too expensive; plant-based protein sources (such as dried beans) are often cheaper.

What you should know

What to eat?

“Vegetarianism” only indicates what a person eliminates from their diet. It doesn’t indicate how much healthy food that person will consume. Nor does being a vegetarian automatically make you healthier. (After all, potato chips, candy apples, and soda are vegan!)

Just like an omnivorous diet, a plant-based diet should involve whole, unprocessed foods, and the bulk of a person’s intake should consist of:

• vegetables
• fruits
• beans & legumes
• whole grains
• nuts & seeds

Plant-based eating and health

Regardless of why people follow a plant-based diet, it’s important to understand that plant-based eating carries important physiological implications.

Many individuals who choose a plant-based diet only plan their intake based on what they’re eliminating, which is animal products. But when people avoid or minimize animal products, it’s more difficult for them to get adequate amounts of certain dietary ingredients, including dietary protein and/or a host of other vitamins and minerals.

Luckily, eaters can make up common nutrient deficiencies with supplements and/or careful planning.

The American Dietetic Association concluded in 2009 that:

• Well-planned vegetarian diets are appropriate for all individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood and adolescence, and for athletes.
• Plant-based diets tend to be lower in saturated fat and cholesterol, and have higher levels of dietary fiber, magnesium and potassium, vitamins C and E, folate, carotenoids, flavonoids and other phytochemicals.
• Vegetarians and vegans, including those who are athletes, “meet and exceed requirements” for protein… if their diets are well-planned.

Plant-based eaters must be conscious of getting enough of the following nutrients.

Summary and recommendations

Regardless of how you define yourself, including more plants in your diet can make you healthier, provide important nutrients, and possibly help conserve environmental resources.

However, just being a self-described “vegetarian” or “vegan” does not mean that you will automatically eat a better diet. When following a plant-based diet, focus on whole foods including vegetables, fruits, legumes, whole grains, nuts and seeds. Avoid processed meat substitutes, refined carbohydrates, and other highly processed products. Don’t consume junk just because it’s labeled “vegetarian” or “vegan”.

Also be careful to consume enough vitamin B-12, calcium, iodine, omega-3 fatty acids, and vitamin D.

Near-vegetarians (those eating a largely plant-based diet while still including meat) can achieve similar health benefits as full vegetarians.

When making food choices, consider all of the implications and costs for the environment, animals, and economy.

More reading

Earthlings

Vegetarian Eating Q & A With JB

Are Vegetarians Too Skinny?

All About Meat

Omnivore…flexitarian?

References

Lock K, et al. The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. Bull World Health Organ 2005;83:100-108.

Becoming Vegan The Complete Guide To Adopting A healthy Plant-Based Diet by Brenda Davis, R.D. & Vesanto Melina, M.S., R.D.

Eshel G & Martin PA. Diet, Energy, and Global Warming. Earth Interactions 2006;10:1-17.

McMichael AJ, et al. Food, livestock production, energy, climate change, and health. Lancet 2007;370:1253-1263.

FAO report, Livestock’s Long Shadow – Environmental Issues and Options
http://www.fao.org/docrep/010/a0701e/a0701e00.HTM

Ogino A, et al. Evaluation environmental impacts of the Japanese beef cow-calf system by the life cycle assessment method. Animal Science Journal 2007;78:424-432.

Barnard ND, et al. Nutrition Guide for Clinicians. 1st ed. PCRM. 2007.

Harmon AH & Gerald BL. Position of the American Dietetic Association: food and nutrition professionals can implement practices to conserve natural resources and support ecological sustainability. J Am Diet Assoc 2007;107:1033-1043.

Craig WJ & Mangels AR. American Dietetic Association Position Paper – Vegetarian Diets. J Am Diet Assoc 2009;109:1266-1282.

Ford ES, et al. Healthy living is the best revenge: findings from the European Prospective Investigation into cancer and nutrition – Potsdam study. Arch Intern Med 2009;169:1355-1362.

Jenkins DJ, et al. The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects. Arch Intern Med 2009;169:1046-1054.

WorldWatch Institute. Livestock and Climate Change. Nov/Dec 2009. Pages 10-20. http://www.worldwatch.org/files/pdf/Livestock%20and%20Climate%20Change.pdf

Most people have an idea about how to “warm up.”

1. Touch toes.
2. Swing arms.
3. Bounce pecs.
4. Put on sweatband.

But is this the optimal way? And what is a warm-up really supposed to accomplish?

Homer shows us how not to warm up

What is warming up?

Warming up prepares the body for more intense movement and activity. It literally “warms up” the body by increasing core temperature.

A proper warm-up consists of movements that:

• Move joints through their ranges of motion (ROM) — and enhance this ROM
• Enhance mobility
• Release connective tissue bonds
• Distribute fluid in the joint space
• Boost speed/force of muscle contractions
• Amplify nerve impulse transmission
• Promote oxygen uptake
• Keep you out of the whirlpool

Movement types

Movements used during a warm-up might include:

• Movements intended to get the core temperature up and the whole body moving, e.g. brisk walking or light jogging while swinging the arms
• Static movements (moving into a position and briefly holding it) — the classic “stretch and hold”, e.g. touching your toes for 30 seconds.
• Dynamic movements such as:
  • stretching while moving (e.g. walking lunges for hip flexibility, or tipping your head side to side for neck mobility)
  • moving against light resistance (e.g. a few single-legged Romanian deadlifts with light or no weight, or jumping)

Why warming up is important

What do athletes, exercisers and old folks complain about? Well, lots of things. But I’m constantly hearing about stiffness, injuries and poor flexibility.

While age-related connective tissue changes and water loss can contribute to inflexibility, most of it comes down to “use it or lose it.” A proper warm-up helps to counteract negative effects of aging while enhancing performance.

Not warming up can lead to poor mobility/flexibility, injuries and stiffness. These are the people at the senior center, on a basketball court or at the family reunion who can’t move, pick up kids, play sports, exercise to their full capacity, or clean up spilled hemp seeds. In all cases, life sucks for them.

Major components of an effective warm up before exercise. Click to enlarge. (Source: Vandervoort AA. Potential benefits of warm-up for neuromuscular performance of older adults. Exerc Sport Sci Rev 2009;37:60-65.)

Flexibility, mobility, and injury

Some consider the warm-up a time to build flexibility and mobility. Flexibility is the capacity of a joint to move freely through a full range of motion. Mobility is our ability to produce a desired movement. Both are based on the elasticity of muscle, ligaments, and connective tissues, but while poor mobility is correlated with injury, poor flexibility is not necessarily.

We want some areas to be more mobile but other areas to be more stable and strong. For most folks, this means it’s important to mobilize:

• front of shoulders
• ankles
• front of hips and IT band
• hamstrings
• thoracic spine

Tightness in these areas can contribute to tears and impingements.

For instance, nearly 70% of the population will suffer from a shoulder disorder at some point in their lifetime — largely due to the inherent instability of the joint combined with our modern “desk monkey” posture that pulls the shoulders forward and hunches the upper back.

While minimal flexibility is related to injury, performing static stretching (exclusively) during a warm-up doesn’t seem to decrease injuries. And too much stretching and flexibility may even increase the rate of injury. Many people, in fact, suffer from injuries caused by excessive movement and flexibility in the:

• shoulder joint
• knees (especially women)
• cervical and lumbar spines

Motor learning

Beyond the physiological benefits of warming up, engaging in movements you’re about to execute during exercise/sport allows for visualization of positive motor outcomes. In plain language, that means you practice the movement pattern so that your body knows what it’s about to do.

Muscle soreness

Despite the many benefits of warming up, it will not prevent muscle soreness — no matter what type of warmup  you choose.

What you should know

Static exercises

Warming up with static movements has pluses and minuses.

Static stretching can improve flexibility at a given range of motion. It can also improve balance — a bonus for yogis and gymnasts.

However, static stretching can create a temporary strength deficit, diminish jump performance and decrease running economy for up to 1 hour, since the sensitivity of tension receptors in muscle is decreased. On the other hand, physiotherapists and strength coaches can actually use this strength inhibition to their advantage, by stretching areas that commonly tighten up and contribute too much to a movement (for example, stretching the front of the hips before running to weaken the involvement of the hip flexors, which tend to be over-strong and tight).

Static exercise examples

Dynamic exercises

A dynamic warm-up can improve nervous system activation, power, and range of motion at the joint. Dynamic exercises performed before exercise/sport that requires high muscular forces can increase blood flow, metabolic activity, temperature, oxygen uptake, muscle compliance, nerve impulses, decrease resistance of connective tissues and reduce muscle tension. This type of warm-up creates minimal (to no) muscle damage, so it’s fine to do on a regular basis.

When you have mobile soft tissue and a rapid response nervous system, you’ll be able to move better and perform exercises that challenge your body. This means more productive workouts and a healthier physique.

Adding static exercises to a dynamic warm-up may diminish the force increases from a purely dynamic protocol.

Dynamic exercise examples

Dynamic exercises should not result in any sharp pains, but should feel challenging and strangely pleasant, especially after you get done. Find the edges of your range of motion, and work to gently expand these edges. If mild discomfort felt during the exercise continues afterwards, find an easier/modified version.

Foam rolling can be included as part of a warm-up since it helps with mobility and breaks down scar tissue/adhesions. This relaxes the fascia and makes muscle more pliable.

Foam rolling exercise examples

Summary and recommendations

Consider your warm-up period an essential part of the workout – not optional free time. It’ll make you stronger and improve your body control, balance, movement mechanics, and agility.

Find a warm-up that makes your body feel the best, and one that you can stick with. The variation in responses to warming up emphasizes the unique nature of individual reactions to different protocols. Targeting ankles, hips, back and shoulders will likely result in the most benefit. See example warm-up protocols below.

Extra credit

IT band pain

Iliotibial band (ITB) pain is one of the most common complaints among exercisers/athletes. If your ITB hurts, you probably have poor adductor and ITB flexibility along with weak abductors and glutes.

To remedy this, start including stretching exercises for the ITB (like in the following table):

Stretching exercises for ITB. Click to enlarge. (Source: Lininger MR & Miller MG. Iliotibial band syndrome in the athletic population: strengthening and rehabilitation exercises. Strength & Cond J 2009;31:43-46.)

Then, you must strengthen the hips. This includes:

• Hip hikes
• Clams
• Step downs
• Lateral band walks
• Straight leg & 45 degree exercises (with or without bands) that focus on the gluteus medius (straight leg abduction, bridge, monster walks, etc.)

Further resources

Partner relay warm-up ideas (Source: Swanson JR. A functional approach to warm-up and flexibility. Strength & Cond J 2006;28:30-36.)

Movement chain warm-up ideas (Source: Swanson JR. A functional approach to warm-up and flexibility. Strength & Cond J 2006;28:30-36.)

Dynamic warm-up PDF (Source: Carter Schoffer)

Guide to foam rolling

Performance U: Warm-up Progressions

Assess & Correct, Magnificent Mobility

References

Guidetti L, et al. Precompetition warm-up in elite and subelite rhythmic gymnastics. J Strength Cond Res 2009;23:1877-1882.

Judge LW, et al. An examination of the stretching practices of Division I and Division III college football programs in the Midwestern United States. J Strength Cond Res 2009;1091-1096.

O’Sullivan K, et al. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord 2009;10:37.

Costa PB, et al. The acute effects of different durations of static stretching on dynamic balance performance. J Strength Cond Res 2009;23:141-147.

LaRoche DP, et al. Chronic stretching and voluntary muscle force. J Strength Cond Res 2008;22:589-596.

Herman SL & Smith DT. Four-week dynamic stretching warm-up intervention elicits longer-term performance benefits. J Strength Cond Res 2008;22:1286-1297.

Hold BW & Lambourne K. The impact of different warm-up protocols on vertical jump performance in male collegiate athletes. J Strength Cond Res 2008;22:226-229.

Fletcher IM & Anness R. The acute effects of combined static and dynamic stretch protocols on fifty-meter sprint performance in track-and-field athletes. J Strength Cond Res 2007;21:784-787.

Curry BS, et al. Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women. J Strength Cond Res 2009;23:1811-1819.

Woods K, et al. Warm-up and stretching in the prevention of muscular injury. Sports Med 2007;37:1089-1099.

Lai K, et al. Active isolation stretching does not improve hamstring flexibility better than traditional stretching methods. Med Sci Sports Exerc 2003;35:S79 (Poster).

Vandervoort AA. Potential benefits of warm-up for neuromuscular performance of older adults. Exerc Sport Sci Rev 2009;37:60-65.

Thacker SB, et al. The impact of stretching on sports injury risk: A systematic review of the literature. Med Sci Sports Exerc 2004;36:371-378.

Kikkonen J. Chronic static stretching improves exercise performance. Med Sci Sports Exerc 2007;39:1825-1831.

Corrao M, et al. Addressing posterior shoulder tightness in the athletic population. Strength & Cond J 2009;31:61-65.

Lininger MR & Miller MG. Iliotibial band syndrome in the athletic population: strengthening and rehabilitation exercises. Strength & Cond J 2009;31:43-46.

Swanson JR. A functional approach to warm-up and flexibility. Strength & Cond J 2006;28:30-36.

What is fish oil?

Fish oil is, well, oil from fish.

It’s rich in two specific groups of omega-3 fatty acids known as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA and EPA, along with alpha-linolenic acid (ALA), found in things like flax and walnuts, fall under the subheading of omega-3 fatty acids. (See All About Healthy Fats for more.)

EPA and DHA are often cited as being the beneficial components of fish oil. EPA and DHA actually originate in algae, which is the base of the food chain for fish. Fish consume these algae and thus concentrate high amounts of the beneficial fats.

Omega-3 fatty acid metabolism (click to enlarge)

Why is fish oil so important?

Overall health

Omega-3s are very important for health, including:

• cardiovascular function
• nervous system function and brain development
• immune health

Research shows that low DHA consumption (and blood levels) is associated with memory loss, difficulty concentrating, Alzheimer’s disease and other mood problems.

Cell membranes

Essential fats have an integral role in promoting cell health.

Cells in the human body have a fatty membrane (known as the lipid bilayer). This membrane is semi-permable: It regulates what gets into the cell and what goes out of it. The fluidity of cell membranes depend on the fatty acid composition of the diet.

• If the fatty membranes surrounding brain cells are relatively fluid, as they are with lots of omega-3s, then messages from neurochemicals such as serotonin can be transmitted more easily.
• On the other hand, if people eat too many saturated fats (which are solid at room temperature), without enough omega-3s, then these membranes become more rigid, and stuff can’t get through.

Fatty membrane of cells

Cells also require these good fats for repair and regeneration.

With lots of omega-3s, muscle cells become more sensitive to insulin, while fat cells decrease. This may mean that the body can divert more nutrients to muscle tissue.

Metabolic health

Finally, DHA and EPA can increase metabolism by increasing levels of enzymes that boost calorie-burning ability.

What you should know

We can’t make omega-3 and omega-6 fatty acids in our bodies, so we need to get them from our diets.

Omega-3 to omega-6 ratio

It’s easy for us to get omega-6 fatty acids. These are found in plant oils, for instance, and factory-raised animals (which are fed a lot of corn and soy) will usually have a lot of omega-6 too. (See All About Plant Oils for more.)

But it’s hard for people in Western countries to get omega-3 fats from dietary sources. We eat a lot more processed foods and a lot less wild game and plants than our ancestors did. And we don’t usually eat things like snails and insects, which are also high in omega-3s, although many folks worldwide still eat these as part of traditional diets. We rely heavily now on omega-6 vegetable oils.

We evolved with a fat intake ratio of about 1:1 omega-3 to omega-6 fatty acids. Now, it’s closer to 1:20.

Because omega-3s and omega-6s compete with each other for space in cell membranes and the attention of enzymes, the ratio matters more than the absolute amount consumed of either fat.

Fat heads

When it comes to fat intake, you (and your cells) really are what you eat.

Years of research has linked lower fat diets with aggression, depression, and suicidal ideation. Over time, the cells in your brain take on the dietary fat you consume. DHA is the active fat in the brain, and especially important throughout developmental stages.

Depletion of fish oil resources

About 1/3 of the world’s total fish catch goes toward fish meal/oil for farmed fish and other animals. Many open ocean fish like menhaden, anchovies, herring and mackerel are caught mainly for this purpose. Competition for fish meal/oil can drive up the price of fish, which pushes this food source out of reach for many of the world’s poorest.

For more, see All About Eating Seafood.

Summary and recommendations

Aim for 6-12 daily grams of total fish oil (about 3-6 grams of EPA + DHA) per day from a supplement company that doesn’t contribute directly to the depletion of fish (e.g., they use primarily fish discards). We suggest liquid fish oil, because it’s hard to take so many capsules, and because some supplement companies put lower-quality oil into capsules (or secretly cut it with soy oil). Buy from a reputable company.

Look for small-fish-based formulations (e.g. herring, mackerel). Small fish are lower on the food chain and less likely to accumulate environmental toxins. Or choose krill oil or algae oil (see All About Algae Supplements).

Add up the amounts of EPA & DHA listed on the back of the product and make sure the total is at least 300 mg per 1000 mg capsule. This will make it easier to get the suggested dose.

Avoid cod liver oil.

Find a fish oil supplement that you can tolerate the taste of, otherwise you won’t use it (unless it’s in capsule form).

Fish oil can taste much better when combined with your favorite protein powder in a super shake.

Avoid trans fats; they can interfere with EPA & DHA in the body.

Use fewer omega-6 rich vegetable oils, which will negatively alter your fatty acid ratio.

For extra credit

The amount of DHA in a woman’s diet determines the amount of DHA in her breast milk.

Omega-3 fats are not typically used in processed foods because of their tendency to oxidize.

NIH researchers have said that the billions we spend on anti-inflammatory drugs such as aspirin, ibuprofen, and acetaminophen is money spent to undo the effects of too much omega-6 fat in the diet.

It’s hypothesized that populations may drift toward a lower omega-3 intake because a faster metabolism (from high omega-3 intake) increases the need for food and the possibility of hunger.

Fish oil seems to be safe (except for those on blood thinning medications).

References

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Mahan LK & Escott-Stump S. Eds. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Saunders Publishing, Philadelphia, PA. 2004.

Groff JL & Gropper SS. Advanced nutrition and human metabolism. 3rd ed. Wadsworth Thomson Learning. 2000.

Barnard ND, et al. Nutrition Guide for Clinicians. 1st ed. PCRM. 2007.

Hibbeln J, et al. Health intakes of n-3 and n-6 fatty acids: estimations considering worldwide diversity. Am J Clin Nutr 2006;83 (suppl):1483S-1493S.

Daviglus ML. Fish consumption and the 30-year risk of myocardial infarction. NEJM 1997;336:1046-1053.

Arterburn LM, et al. Bioequivalence of docosahexaenoic acid from different algal oils in capsules and in a DHA-fortified food. Lipids 2007;42:1011-1024.

Church MW, et al. Abnormal neurological responses in young adult offspring caused by excess omega-3 fatty acid (fish oil) consumption by the mother during pregnancy and lactation. Neurotoxicol Teratol 2009;31:26-33.

Nair GM & Connolly SJ. Should patients with cardiovascular disease take fish oil? CMAJ 2008;178:181-182.

Lee KW, et al. Effects of dietary fat intake in sudden death: reduction of death with omega-3 fatty acids. Curr Cardiol Rep 2004;6:371-378.

Jacobson TA. Beyond lipids: the role of omega-3 fatty acids from fish oil in the prevention of coronary heart disease. Curr Atheroscler Rep 2007;9:145-153.

What is fibre?

Plant cellulose (yellow), magnified

Dietary fibre is a non-digestible polysaccharide, which means it’s a complex form of carbohydrate (poly = “many”; saccharide = “sugar”). (See All About Carbohydrates for more on the various types of saccharides.)

These polysaccharides give plants their structure — think plant cell walls.

Types of dietary fibre

We can divide fibre into two general categories, based on their structure and what they do in our bodies.

• Soluble fibres are viscous and fermentable, and can lower our blood cholesterol.
• Insoluble fibres help to bulk up stool volume and improve motility.

We need both types of fibre in our diets.

However, within these general groups, there are many types of dietary fibre, including:

As you can guess from the table above, grains, vegetables, legumes, fruits and nuts account for 85% of the fibre in the U.S. food supply. These same plant foods provide lots of other nutrients.

However, since we live in a world of refined and fortified foods, there are now “functional dietary fibres.” These are the isolated, non-digestible carbohydrates that fortify foods not usually containing fibre — stuff like “fibre-ed up” Splenda and Apple Jacks. This allows many unhealthy products to claim that they are “healthy”.

Fibre found in nature
Fibre NOT found in nature

Why fibre is so important

In 1972, scientists proposed a “dietary fibre hypothesis”, which suggested that common GI diseases like colon cancer, diverticulosis and appendicitis were due, in part, to lack of dietary fibre. It’s not hard to see why:

• Americans consume about 15 grams of fibre per day, on average (17.8 g for males and 13.6 g for females). I eat that much before 8:00 am.
• Refined sugars, oils, dairy products and alcohol contain no fibre and comprise 48% of the energy in the average U.S. diet.
• When asked about their dietary fibre consumption, 73% of individuals with a fibre intake below 20 grams/day think the amount of fibre they ingest is “about right.” The Institute of Medicine recommends 19 to 38 grams of fibre per day (varies based on age and gender).
• White flour and white potatoes provide the most fibre to the American diet. This isn’t because these foods contain lots of fibre, it’s because we eat lots of these foods. Legumes only provide about 6% of the fibre in the U.S. diet.

In other words, people eating a standard Western diet aren’t getting anywhere near the fibre that they should.

A low-fibre diet is associated with many health problems, including:

• Cardiovascular diseases and high blood fats – fibre helps bind and eliminate blood cholesterol/fat
• GI disorders, cancers and poor bowel function – fibre helps keep the GI tract clean and can ease constipation and diverticular disease
• Diabetes – fibre controls blood sugar, insulin and body fat
• Excess body fat – fibre contributes to satiety and dilutes energy density
• High blood pressure – see all the above

A study with over 500,000 people in 10 European countries showed that people who ate more than 30 grams of fibre per day had approximately half the risk of colon cancer as those who ate 12-15 grams of fibre daily.

Fibre in common foods

Fibre and cardiovascular disease

In one study, researchers followed more than 16,000 middle-aged men from around the world for 25 years. The higher the consumption of beans, the lower the risk of death from heart disease — up to 82% reduction in risk! Dietary fibre from whole grains seems to also have a strong protective effect against cardiovascular diseases.

Fibre and blood lipids

In randomized controlled trials, compared to baseline values, vegetarian diets with additional fibre, soy, and nuts were associated with a 20% decrease in total cholesterol and a 35% decrease in LDL cholesterol.

Fibre and GI function

Fibre can stimulate bacterial fermentation (prebiotic fibre is fuel for colon cells) in the large intestine or pass through the GI tract unfermented. Since GI health is synonymous with immune function, fibre seems to play an important role in immunity. See All About Probiotics for more.

Without adequate stool bulk, the colon will panic and respond with excessive contractions. This leads to the creation of diverticula, which are herniations of the mucosal layer through weak colon muscles (essentially little inflamed intestinal pouches). Consuming sufficient fibre can prevent this.

Fibre and diabetes

Consuming more fibre, especially from legumes, seems to help prevent type 2 diabetes. This is likely due to the moderation of blood sugar and insulin release. (See All About Insulin for more.) Oh – and fibre can help control body fat (see next section).

Fibre and body fat

Fibre thinks body fat is a joke. Fibre increases dietary bulk, decreases energy density and reduces energy intake. This is helpful for the 75% of Americans who are overfat. (On the other hand, because fibre increases satiety, eating lots of fibre isn’t helpful for those trying to maintain or increase body weight. We talk about this in All About Raw Food. Also see All About Appetite Regulation.)

More fibre means more fecal energy losses, since GI transit time speeds up. Rapid GI transit leads to less time for digestion and absorption of nutrients. This can be a problem if mineral intake is lacking. Up to 32 grams of fibre each day doesn’t seem to diminish mineral balance in adults. Same thing is noticed with up to 25 grams in kids.

Resistant starches aren’t degraded in the small intestine; they act as a fibre source in the large intestine. Legumes are the big boys of resistant starch. Nearly 35% of legume starch escapes digestion because it’s resistant. American youth and adults are estimated to consume approximately 3 to 8 grams of resistant starch per day.

What you should know

Eat more plants

Plant foods contain fibre. The best sources are legumes, whole grains, vegetables, fruits and nuts/seeds. (See All About Fruits and Vegetables.)

Plant-based diets tend to be higher in fibre – with vegan diets being the highest. People eating these types of diets tend to have lower rates of cardiovascular disease, cancer, lower blood fat, lower blood pressure, and lower body weight. This could be in part due to a higher fibre intake, or because they’re biking all over the city to protest.

Remember that whole grains are whole grains, as in the entire thing — not whole grain flour, whole grain pasta, whole grain “nutrition bars”, or Fruit Loops with whole grains. (See All About Grains and The Safe Carbs: Whole Grains.)

Kids need fibre too

Adequate fibre during youth can reduce the risk of cardiovascular disease, cancer and diabetes. Fibre goals for kids:

• All children 1 to 3 years, 19 g/day
• All children 4 to 8 years, 25 g/day
• Boys 9 to 13 years, 31 g/day
• Girls 9 to 13 years, 26 g/day

The adequate intake (AI) of fibre for children and adolescents is based on the data cited for adults, which showed that 14 grams per 1,000 calories reduced the risk of heart disease. The 2005 U.S. Dietary Guidelines recommend a fibre intake of 14 grams per 1,000 calories as well.

However, too much fibre in kids can reduce overall food intake (due to its satiating effect), increase fecal energy loss, and decrease mineral absorption. In children consuming a standard Western diet, this is rarely a problem, though.

Also, grain and legume intolerance (most commonly to wheat, corn, soy, and peanuts) is common in children, so parents should look for other sources such as vegetables, fruit, other seeds/nuts, and other beans/legumes if necessary. (May we suggest a kid-friendly, fruit-filled Super Shake? You can sneak all kinds of things in there!)

Downsides of fibre

Lots of fibre can mean less absorption of nutrients and calories. In the U.S., this might actually be a positive thing.

Bezoars have been reported in the esophagus from glucomannan and the large intestine from other dense fibre foods.

Fermentation of fibre and other non-digestible carbohydrates by bacteria in the colon can produce hydrogen, methane and carbon dioxide gases. This may lead to distention and expired gas.

Many people are intolerant of some forms of fibre, such as grains. There is evidence that the lectins in grains and beans/legumes can cause health problems for susceptible people, because they affect the lining of the gut. (See All About Lectins for more.) However, there’s also evidence that prebiotic fibre sources such as inulin and glucomannan can help with inflammatory bowel disorders. If you have inflammatory bowel symptoms, review your fibre sources.

Summary and recommendations

Getting enough fibre is important for overall health and disease prevention. And it keeps your plumbing in good working order.

If you build your diet around vegetables, fruits, legumes, whole grains, nuts and seeds, you’re probably getting enough fibre.

If you want a goal:

• Women should aim for at least 30 to 35 grams of fibre per day.
• Men should aim for at least 40 to 45 grams of fibre per day.

You should get your fibre from whole foods. Fibre supplements (or fibre-supplemented foods) don’t provide the micronutrients, phytochemicals and water found in whole plant foods. Anyone who relies on a fibre supplement because they don’t get enough from food has a crappy diet (excluding those with unique medical situations).

When you eat enough fibre, you need to consume enough fluids. See All About Dehydration for more.

Extra credit

Eating one cup of beans = about 16 grams of fibre.

The fibre of apples and pears can be recovered from the juicing process and used as a food ingredient.

In those consuming adequate fibre, symptoms associated with hemorrhoids can substantially decrease.

Inulin, oligosaccharides, resistant starch, and other fibres have actually been found to enhance mineral absorption, particularly calcium.

There is a 1% increase in fecal energy loss for every 6 grams of dietary fibre added (check yourself disordered eaters – avoid over-consuming fibre supplements in the hopes of losing weight. You’ll likely end up with a bezoar and/or gut hemorrhage). This might explain why plant-based eaters tend to be lean.

3 additional grams of dietary fibre from oats can decrease blood cholesterol by 2%.

Further resources

Forget the milk – got Fiber?

Fiber-o-meter

Dietary Fibber: Don’t be fooled by polydextrose and other fiber additives

References

De Natale C, et al. Effects of a plant-based high carbohydrate/high fibre diet versus high monounsaturated fat/low carbohydrate diet on postprandial lipids in type 2 diabetic patients. Diabetes Care 2009;32:2168-2173.

Marcason W. What is the “Age + 5” rule for fibre? 2005;105:301-302.

Hiza H, et al. USDA fibre Fact Sheet. December 2007.

Position of the American Dietetic Association: Health Implications of Dietary fibre. J Am Diet Assoc 2008;108:1716-1731.

Williams CL. Important of dietary fibre in childhood. J Am Diet Assoc 1995;95:1140-1146,1149.

Craig WJ. Health effects of vegan diets. Am J Clin Nutr 2009;89:1627S-1633S.

Hu FB. Diet and lifestyle influences on risk of coronary heart disease. Curr Athero Rep 2009;11:257-263.

Ruottinen S, et al. Dietary fibre does not displace energy but is associated with decreased serum cholesterol concentrations in healthy children. Am J Clin Nutr 2010;91:651-661.

Anderson JW, et al. Health benefits of dietary fibre. Nutr Rev 2009;67:188-205.

Ferdowsian HR & Barnard ND. Effects of plant-based diets on plasma lipids. Am J Cardio 2009:104:947-956.

Mounsey AL & Henry SL. Which treatments work best for hemorrhoids? The Journal Of Family Practice 2009;58:492-493.

Robson AA. Preventing diet induced disease: Bioavailable nutrient-rich, low-energy-dense diets. Nutrition and Health 2009;20:135-166.

Weisberger L & Jamieson B. How can you help prevent a recurrence of diverticulitis? 2009;58:381-382.

What are greens supplements?

Greens supplements are veggies, fruits, algaes and/or grasses that have been compacted and distilled into powdered form.

They typically contain an assortment of nutrient rich foods like barley grass, wheat grass, spirulina, chlorella, alfalfa, herbs, vegetables, legumes, and fruits.

Greens supplements can function as a serving of fruits and vegetables, and contain vitamins, minerals, fibre, and phytonutrients.

Why are greens supplements so important?

Greens supplements can help augment a diet that is low in fruits and vegetables.

Do you know how many people are consuming 5 or more servings of fruits/vegetables each day?

• Less than 1% of men & 4% of women ages 18 to 24
• Less than 6% of men & 9% of women ages 25 to 34
• Less than 14% of men & 16% of women ages 35 to 49
• Less than 24% of men & 22% of women ages 50 to 64

Basically, almost everyone is coming up short.

But we know fruits and veggies are good for us. Consuming fruits and vegetables appears to reduce:

• Cardiovascular disease
• Various cancers (colon, prostate, breast, cervical, endometrial, gastric, lung, lymphoma, ovarian, pancreatic, thyroid)
• High blood cholesterol
• High blood pressure
• Type 2 diabetes
• Obesity
• Stroke
• Eye disease
• Asthma
• Chronic obstructive pulmonary disease
• Osteoporosis

(For more about the benefits of fruits and vegetables, see All About Fruits and Vegetables.)

On average, people tend to consume a lot more protein than fruits and veggies. This can create an acid load in the body and potential low grade acidosis. (See All About Dietary Acids and Bases) Introducing more vegetables and fruits (including a greens supplement) can help counteract this acid load and preserve bone and muscle, as our PN Informal Experiment showed.

How do you use greens supplements? Why, you can Turn Your Protein Shake Into A Super Shake, of course!

What you should know

Supplementation with greens supplements can benefit energy, recovery, antioxidant status, and bone health.

Greens are very alkaline and can help to balance dietary acids. If you consistently consume at least 10 servings of fruits and veggies per day, then supplementing with a greens product will likely be unnecessary.

Regular exercise training can increase acid production in the body due to repeated muscle contractions. You can enhance your recovery with alkalizing foods, along with protein. However, if you consume a lot of protein without fruits and veggies it can compound acid production. Thus alkaline foods, like greens supplements, are essential if your fruit and vegetable intake comes up short.

Greens supplements can also be helpful for traveling and days when whole fruits and vegetables aren’t available.

Greens supplements are not a substitute for actual food. Don’t fool yourself into believing that a few greens drinks a day make up for your lack of other healthy plants!

Summary and recommendations

Use greens supplements in addition to real foods and when you don’t have access to real foods.

Not all greens supplements are created equal. Find a reputable product.

Find a greens supplement with a taste you enjoy, otherwise you won’t use it. If you don’t like the taste, try mixing it in to something like a Super Shake.

Each greens product has a unique makeup. Read the labels to be sure you’re getting what you want, and that there are no additives.

For extra credit

Barley grass contains fibre and oil that may help to lower cholesterol.

Wheat grass is rich in chlorophyll.

In Chinese medicine, alfalfa is used to treat digestive disorders.

Spirulina is full of vitamins and minerals, but it isn’t a reliable source of vitamin B-12. There have been case reports of liver toxicity with high dose spirulina.

The use of bipolar compounds (such as phosphatidylcholine or lecithin) in greens formulas can help increase bioavailability of both water-soluble and non-water-soluble nutrients.

Further resources

Greens Taste Test

Supplement Suggestions

Informal Experiments: Greens Supplements & pH

References

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Mahan LK & Escott-Stump S. Eds. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Saunders Publishing, Philadelphia, PA. 2004.

Groff JL & Gropper SS. Advanced nutrition and human metabolism. 3rd Wadsworth Thomson Learning. 2000. ed.

Barnard ND, et al. Nutrition Guide for Clinicians. 1st ed. PCRM. 2007.

Lock K, et al. The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. Bull World Health Organ 2005;83:100-108.

Boon H, et al. Effects of greens+: a randomized, controlled trial. Can J Diet Pract Res 2004;65:66-71.

Schorah CJ. Micronutrients, vitamins, and cancer risk. Vitam Horm 1999;57:1-23.
Berardi JM, et al. Plant-based dietary supplement increases urinary pH. J Int Soc Sports Nutr. 2008;5:20.

What is the thyroid?

The thyroid gland is found in the neck, right below the voice box (larynx). It’s made of two large lobes that are connected in the middle. In an adult, the thyroid usually weighs about 1 ounce.

The thyroid is filled with cells that contain protein-iodine complexes. These complexes are precursors of thyroid hormones.

Thyroid hormones

Although they’re often referred to as “thyroid hormone”, singular, the thyroid gland produces two hormones: triiodothyronine (T3) and thyroxine (T4). These hormones play a vital role in regulating growth and metabolism.

The hypothalamus releases TRH (thyrotropin releasing hormone), which stimulates the release of TSH (thyroid stimulating hormone) from the pituitary gland. TSH makes its way to the thyroid and promotes its growth and development. The release of T3 and T4 is controlled by TSH.

Thyroid gland feedback loop

Once T3 and T4 are released from the thyroid, they attach to proteins (mainly TBG and albumin) and move through the bloodstream.

The thyroid gland releases about 20 times more T4 than T3. But T3 is more potent than T4. Once T4 enters target tissues, it is converted to T3.

When T3 and T4 arrive at a target cell, they detach from the carrier protein and work their magic. Thyroid hormones are then degraded in target cells and the liver.

Molecular structures of T3 and T4

Why is the thyroid so important?

The thyroid is one of the “master controllers” that regulates nearly every major metabolic function in the body.

Thyroid hormones regulate the metabolic rate of all cells, as well as the processes of cell growth, tissue differentiation, and reproductive function. Thyroid hormones can potentially interact with any cell in the body.

Thyroid hormones are necessary for (and promote) protein anabolism when ample carbohydrates and fats are available. When the amount of thyroid hormones is excessive or when energy from food is deficient, T3 and T4 may then promote protein breakdown.

What you should know

Hormone status can influence metabolic rate, particularly in those with endocrine disorders such as hyperthyroidism and hypothyroidism. It’s also possible for one disorder to shift into another — for instance, hyperthyroid can become hypothyroid. Thyroid disorders are most often autoimmune, although they can have other causes.

Hyperthyroidism

In hyperthyroidism, or over-active thyroid function, it’s as if your body’s “motor” is revving at high speed. Symptoms can include:

• racing heart and palpitations
• trouble sleeping
• tremor and nervousness
• weight loss
• hair loss
• muscle aches and weakness
• diarrhea and over-active digestive system
• sweating and trouble tolerating heat
• exophthalmos (bulging eyes)

Hypothyroidism

Hypothyroidism refers to low thyroid function — the opposite of the above. The “motor” slows down.

If you’re struggling to lose fat even with a solid nutrition plan and regular, intense exercise, and you have some or all of the symptoms below, consider hypothyroidism as a possible contributor, especially if you’re female.

Indeed, 1 in 8 women will develop a thyroid problem at some point in life. Unexplained weight gain is one symptom of hypothyroid, but others include:

• tiredness, fatigue, lethargy
• depression and losing interest in normal activities
• forgetfulness
• dry hair and skin
• puffy face
• slow heart rate
• intolerance to cold
• constipation
• brittle nails
• muscle cramping
• changes in menstrual cycle

Women may also develop a temporary thyroid inflammation after pregnancy.

Screening for thyroid function

Some organizations recommend that any person over the age of 40 be screened periodically for thyroid function. This can be done with a blood test measuring TSH.

As previously mentioned, TSH stimulates the thyroid. If the thyroid does not respond, then TSH levels will rise. Overly high TSH levels mean that the signal is being released, but the thyroid isn’t listening. (Imagine screaming louder and louder at a person who can’t hear well.)

TSH reference ranges (may be different if on thyroid replacement): 0.4 – 4.0 mIU/L

If diagnosed, hypothyroidism is controlled with thyroid hormone replacement (specific to the individual). Many people assume that correcting the thyroid imbalance will result in a miraculous decrease of body fat – but the changes are usually subtle and take time. Nutrition, exercise and lifestyle issues all need to be addressed.

The role of iodine

As you might guess from the “iodo” in T3 and T4′s full names, we need dietary iodine to synthesize thyroid hormones. To meet the body’s demand for thyroid hormones, the thyroid gland traps iodine from the blood and uses it for the synthesis of T3 and T4.

Iodine deficiency results in a lower production of T4. The body normally contains 20 to 30 mg of iodine, with more than 75% in the thyroid gland. The RDA for iodine is 150 mcg/day for adult men and women. Diets that exclude iodized salt, fish, and seaweed have been found to contain very little iodine. Iodine from seaweed appears to enhance thyroid function.

Goitrogens and soy

A goiter is a mass of tissue in the thyroid gland. Left untreated, this can become extremely large.

A goiter

Substances that contribute to this are known as “goitrogens”.

Goitrogens, which exist naturally in foods, can cause goiter by blocking the uptake of iodine from the blood by the thyroid. Goitrogens are inactivated by heating or cooking. Most goitrogens are not of clinical importance unless they are consumed in large amounts or there is coexisting iodine deficiency.

Some evidence suggests that soy acts as a goitrogen. Soy intake in controlled amounts, from unprocessed foods, doesn’t seem to negatively impact thyroid function; the effects of large amounts of processed soy are less clear. If using a synthetic thyroid medication, notify your doctor of soy food intake.

Summary and recommendations

• Consume adequate iodine
• Don’t drastically restrict calories
• Consume adequate carbohydrates and fats
• Maintain a 5 hour per week exercise regimen
• If symptoms of hypothyroidism are suspected, request a TSH test from your physician
• Get 7-9 hours of sleep each night
• Avoid synthetic chemicals found in conventional food items, body products and food containers when possible

For extra credit

Recent findings also indicate that smoking tobacco may be associated with an increased risk of goiter in iodine-deficient areas.

Hyposecretion of thyroid hormone during years of growth can lead to cretinism. This is characterized by low metabolic rate, poor growth status, and even mental retardation.

Nervous system stimulation increases thyroid hormone release and is associated with increased food intake and weight gain.

Basal metabolism, which accounts for up to 65% of daily metabolism, decreases in starvation because of reduced thyroid hormone secretion (among other things).

T3 and T4, at higher concentrations, increase the number of beta-adrenergic receptors and augment the fat and carbohydrate metabolizing actions of catecholamines.

Avoiding some chemicals found in pesticides, herbicides, eating containers (e.g., plastics), and body products (e.g., lotion, shampoo) may help to preserve thyroid function (Chemicals that contribute to thyroid dysfunction)

Further reading

T2 – The Fat Terminator?

All About Energy Balance

Thermogenesis

References

Mahan LK & Escott-Stump S. Eds. Krause’s Food, Nutrition, & Diet Therapy. 11th ed. Saunders Publishing, Philadelphia, PA. 2004.

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Beers MH, Berkow R eds. Merck Manual. 17th ed. Merck Research Laboratories. Whitehouse Station, NJ. 1999.

An Evidence-Based Approach to Vitamins and Minerals. Jane Higdon. The Linus Pauling Institute. 2003.

Teas J, et al. Seaweed and soy: companion foods in Asian cuisine and their effects on thyroid function in American women. J Med Food 2007;10:90-100.

Dillingham BL, et al. Soy protein isolates of varied isoflavone content do not influence serum thyroid hormones in healthy young men. Thyroid 2007;17:131-137.

Messina M & Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid 2006;16:249-258.

Boas M, et al. Environmental chemicals and thyroid function: an update. Curr Opin Endocrinol Diabetes Obes 2009;16:385-391.

Triggiani V, et al. Role of iodine, selenium, and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets 2009;9:277-294.

Miller MD, et al. Thyroid-disrupting chemicals: interpreting upstream biomarkers of adverse outcomes. Environ Health Perspect 2009;117:1033-1041.

What are probiotics?

Yep, this is the guy whose scientific work paved the way for those "tummy bubbles" Activia ads.

Who could forget Élie Metchnikoff? Don’t know him? He’s only considered the inventor of probiotics. He came up with a theory that aging  is caused by toxic bacteria in the gut; to prevent this, he drank sour milk every day. He was born in 1845 and made it to 71, so he may have been on to something.

The term probiotic comes from the Latin or Gree pro, “before, forward”, and bios, or “life” — thus probiotics are life-promoting. In this case, we use the term probiotics to refer to beneficial bacteria.

We have billions of friendly bacteria living in our digestive tract. If you extracted all of the microbes that live in your body, you’d have over a quart of sludge. Each person’s bacterial flora may be as unique as fingerprints.

Friendly bacteria help us digest our food and absorb nutrients effectively. In a sense, we don’t actually digest many components of our food — the bacteria digest it.

The probiotic bacteria used in commercial products today are largely members of the genera Lactobacillus and Bifidobacterium.

Check out a food or supplement with probiotics and the label might say something like “Lactobacillus rhamnosus GG.”

The first name that appears is the genus (Lactobacillus).

The second name designates the species within the genus (rhamnosus).

The third name or number that appears is the specific strain within the species (GG).

Why are probiotics so important?

To understand why probiotics are important, we first need to understand how valuable beneficial bacteria are to our health, and how prevalent they are in our bodies.

What do gut bacteria do?

In our gut, good bacteria can displace bad bacteria and influence our overall health, metabolism, digestion, and body composition.

Gut bacteria are involved in immunity and help to ensure our immune system doesn’t have an itchy trigger finger (think food sensitivities).

Gut bacteria also:

• help synthesize B and K vitamins
• enhance gastrointestinal motility and function
• enhance digestion and nutrient absorption
• obstruct the growth of “bad bacteria” and other pathogens
• help metabolize other plant compounds/drugs
• produce short-chain fatty acids (SCFAs) and polyamines
• produce coagulation and growth factors
• produce cytokines (cell signaling molecules)
• help regulate intestinal mucus secretion and ultilization
• help regulate blood flow to the viscera

Uhmm… how much are in there anyway?

Imagine how many cells you must have making up your body. Zillions, right? Well, imagine 10 times that. That’s how many bacteria we have.

Our internal bacterial environment is very lively and complex. Scientists estimate that we have over 50 genera of bacteria that provide over 500 different species! There’s a party in our tummies!

Some researchers even suggest that our bacteria are like an entirely distinct organ — a “microbe organ” that is nearly as big and important (if not more so) than the liver.

Thus, given the extent of bacteria’s roles, and the importance of these good bacteria to proper physical functioning, it’s important for us to help keep a healthy bacterial environment.

Probiotics can help replenish and nourish this internal supply of good bacteria.

Adequate consumption of probiotics can help to eliminate abdominal pain, gas, bloating, reflux, allergies, nausea, food poisoning and vomiting. Probiotics may even alleviate irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and dermatitis. You guessed it – this means they are anti-inflammatory.

What you should know

What causes intestinal dysbiosis?

While our intestinal bacteria are pretty tough little critters, their health can be compromised. The most common causes of poor gut health are:

• medication use, especially antibiotics
• stress (stress hormones may encourage bad bacteria growth)
• poor diet (e.g. sugar, preservatives, alcohol, processed foods, over-eating, inadequate fibre)
• aggressive medical therapies such as radiation or chemotherapy
• over-consumption of animal-based protein, especially highly processed (e.g. luncheon meats)
• poor gut motility (which can be caused by the above factors)