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.

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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.

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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.

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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

Click here to join the waiting list.

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

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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.

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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.

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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.

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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/

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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.

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