Oil & Vinegar: More Nutrition Nonsense

Is there anything that apple cider vinegar and coconut oil can’t do?!

After a long break to move and take care of my newborn, I’m back with more tips and trick to help you out! And today is a fun look at what coconut oil and apple cider vinegar are doing for you. So let’s dive right into the science and science fiction.
The Claims
Here’s the deal with many of the latest fads and crazes. Marketers take some basic science (stuff done in a petri dish) and extrapolate it out to having actual effects in humans. Often times it makes sense on paper but doesn’t work out when it’s actually tested. So what are some of the highly touted test tube trappings of success for oil and vinegar? Well according to some, it’s great for helping prevent heart disease, weight loss, immunity, digestion, dental care, candida (yeast), organ health, and they even have the audacity to say it’s beneficial for those with HIV and cancer. The latter claims are absolutely disgusting to me because these “tips” can not only be harmful, but deadly.
Apple cider vinegar can apparently help you body maintain an alkaline PH level, regulate blood sugar, lower blood pressure, improve heart health, “detox” you from something, prevent candida overgrowth, ease digestive ailments, help with weight loss, prevent osteoporosis, slow the aging process… somehow, and fight free radical damage. Is there anything that apple cider vinegar and coconut oil can’t do?! Well, the fact that there are so many health claims is the first sign that something fishy is going on.
 
Going Nuts For Coconuts
Lame puns aside, there is a lot of fiction and some truth to the health benefits of coconut oil (CO). First of all, mice aren’t humans and making medical comparisons is not only futile but potentially dangerous (1). That being said, claims that rely on health benefits being seen in mice but not tested in humans (i.e. improvements in heart health) can be tossed out for now (2). Also, because we know that CO is very high in saturated fat, which we know, at least for now, is linked to heart disease (3). As far as weight loss goes, CO consumption isn’t very helpful, to begin with, and isn’t as effective as using olive oil (4). CO is also touted for its MCT’s (medium chain triglycerides) which are supposed to all sorts of health benefit. However, CO only contains 4% MCT’s which means that the majority of its fat content will have a major impact on cholesterol status (5). Finally, CO may actually have negative effects on immune function and may cause abdominal distress and diarrhea is some (6).
The news isn’t all bad. CO is delicious, although it has a low smoking point which can be hazardous for us less skilled fry cooks (7). It may also help prevent cavities (8), it’s good for your hair (9), helps with skin health (10), and help prevent dermatitis (11). Finally, CO is expensive. So you may be better off sticking with olive oil if your budget is tight.
Salty About Vinegar
I think someone found an Olympic sized pool of apple cider vinegar (ACV) and decided to invent reasons for people to buy it. Because really, who drinks vinegar?! In any case, ACV is useful in some ways but disgusting for most. First of all, ACV doesn’t help with making your body more alkaline. If it did, you would die! Your body needs to stay between 7.35 and 7.45 pH for your organs to function (12). So as far as the alkaline diet goes, it’s as useful as hot garbage soup. When it comes to weight loss, ACV may actually help! But that might actually be due to nausea caused by vinegar consumption (13). ACV hasn’t been shown to be particularly useful for lowering blood lipid levels and has never been shown to reduce heart disease in humans (14). It’s not helpful when it comes to cancer (15), wound/skin care (16), it’s bad for your teeth (17), no data to support its use as an anti-inflammatory agent, and detoxes are scams so it’s not helpful in that area (18). The good news is that ACV can help with blood glucose control in diabetics (19), but does nothing for your blood sugar in those who are healthy (20).
Oil and Vinegar Have Their Place
When it comes to CO and ACV, their roll in your health is limited and possibly detrimental. A lot of marketing and great salesmanship may have you thinking otherwise, but when it comes to real benefits, the evidence has been found wanting. So when it comes to oil and vinegar, it’s healthiest when accompanying a salad.
As always, I’m interested in hearing your thoughts on this week’s subject. If you have any questions or tips related to the post or suggestions for future topics, feel free to contact me anytime.
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Resources
1. Zaragoza, C., Gomez-Guerrero, C., Martin-Ventura, J. L., Blanco-Colio, L., Lavin, B., Mallavia, B., … & Egido, J. (2011). Animal models of cardiovascular diseases. BioMed Research International, 2011.
2. Glukhov, A. V., Flagg, T. P., Fedorov, V. V., Efimov, I. R., & Nichols, C. G. (2010). Differential K ATP channel pharmacology in intact mouse heart. Journal of molecular and cellular cardiology, 48(1), 152-160.
3. Zong, G., Li, Y., Wanders, A. J., Alssema, M., Zock, P. L., Willett, W. C., … & Sun, Q. (2016). Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. bmj, 355, i5796.
4. Valente, F. X., Cândido, F. G., Lopes, L. L., Dias, D. M., Carvalho, S. D. L., Pereira, P. F., & Bressan, J. (2017). Effects of coconut oil consumption on energy metabolism, cardiometabolic risk markers, and appetitive responses in women with excess body fat. European Journal of Nutrition, 1-11.
5. Karupaiah, T., Tan, C. H., Chinna, K., & Sundram, K. (2011). The chain length of dietary saturated fatty acids affects human postprandial lipemia. Journal of the American College of Nutrition, 30(6), 511-521.
6. Wanten, G. J., & Naber, A. H. (2004). Cellular and physiological effects of medium-chain triglycerides. Mini reviews in medicinal chemistry, 4(8), 847-857.
7. Boateng, L., Ansong, R., Owusu, W., & Steiner-Asiedu, M. (2016). Coconut oil and palm oil’s role in nutrition, health and national development: A review. Ghana medical journal, 50(3), 189-196.
8. Peedikayil, F. C., Remy, V., John, S., Chandru, T. P., Sreenivasan, P., & Bijapur, G. A. (2016). Comparison of antibacterial efficacy of coconut oil and chlorhexidine on Streptococcus mutans: An in vivo study. Journal of International Society of Preventive & Community Dentistry, 6(5), 447.
9. Rele, A. S., & Mohile, R. B. (2003). Effect of mineral oil, sunflower oil, and coconut oil on prevention of hair damage. Journal of cosmetic science, 54(2), 175-192.
10. Agero, A. L., & Verallo‐Rowell, V. (2004). P15 A randomized double‐blind controlled trial comparing extra‐virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Contact Dermatitis, 50(3), 183-183.
11. Verallo-Rowell, V. M., Dillague, K. M., & Syah-Tjundawan, B. S. (2008). Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis. Dermatitis, 19(6), 308-315.
12. Bonjour, J. P. (2013). Nutritional disturbance in acid–base balance and osteoporosis: a hypothesis that disregards the essential homeostatic role of the kidney. British Journal of Nutrition, 110(7), 1168-1177.
13. Darzi, J., Frost, G. S., Montaser, R., Yap, J., & Robertson, M. D. (2014). Influence of the tolerability of vinegar as an oral source of short-chain fatty acids on appetite control and food intake. International Journal of Obesity, 38(5), 675.
14. Panetta, C. J., Jonk, Y. C., & Shapiro, A. C. (2013). Prospective randomized clinical trial evaluating the impact of vinegar on lipids in non-diabetics. World Journal of Cardiovascular Diseases, 3(02), 191.
15. Radosavljević, V., Janković, S., Marinković, J., & Dokić, M. (2003). Non-occupational risk factors for bladder cancer: a case-control study. Tumori, 90(2), 175-180.
16. Rund, C. R. (1996). Non-conventional topical therapies for wound care. Ostomy/wound management, 42(5), 18-20.
17. Willershausen, I., Weyer, V., Schulte, D., Lampe, F., Buhre, S., & Willershausen, B. (2014). In vitro study on dental erosion caused by different vinegar varieties using an electron microprobe. Clinical laboratory, 60(5), 783-790.
18. Klein, A. V., & Kiat, H. (2015). Detox diets for toxin elimination and weight management: a critical review of the evidence. Journal of human nutrition and dietetics, 28(6), 675-686.
19. Johnston, C. S., White, A. M., & Kent, S. M. (2009). Preliminary evidence that regular vinegar ingestion favorably influences hemoglobin A1c values in individuals with type 2 diabetes mellitus. Diabetes research and clinical practice, 84(2), e15-e17.
20. Panetta, C. J., Jonk, Y. C., & Shapiro, A. C. (2013). Prospective randomized clinical trial evaluating the impact of vinegar on lipids in non-diabetics. World Journal of Cardiovascular Diseases, 3(02), 191.

Going Keto: Is It Worth It?

A short and sweet summary of what Keto is, what actually happens, and who all should consider using it.

The Ketogenic diet has been all the rage lately with its claims of weight loss glory and sciency sounding words used to describe it. However, like all extreme diets, there are reasons both to jeer and cheer. So today, I wanted to give a short and sweet summary of what Keto is, what actually happens, and who all should consider using it.
 
What Is Keto?
In short, if you don’t eat carbs, your body will turn fat into ketone bodies that act like sugar in the tissues that need them. More specifically, the ketogenic diet involves severely restricting carbohydrate intake to about 10-20 grams per day while having a high fat intake, along with moderate protein consumption. So when people hear that the Keto diet forces your body to burn fat, they think “Eureka! It’s the holy grail of weight loss!!!!” In the short term, you will lose a lot of weight, which will get you motivated to stick with the diet. But this is water weight that will return once you eat carbs again and restore the glycogen (muscle fuel) to your muscles. However, what we do know is that ketogenic diets don’t seem to provide a metabolic advantage or result in a higher rate of fat loss when compared to isocaloric non-ketogenic diets with equal amounts of protein (1). Just because you burn fat doesn’t mean you lose fat!
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Other Claims
Those who swear by Keto also say that fat is good for you, sugar is bad,the diet can reduce inflammation, high fat diets make you burn more calories, carbohydrates are stored more easily than fat, eating fat before a meal makes you eat less, you eat less when you eat high-fat meals, and fat is more satiating than carbohydrates. Almost sounds like this diet is too good to be true! Well… it is.
No, sugar is not by itself bad for you when used in moderation. The old notion that specific foods will raise and lower your insulin (glycemic index) has been called into question, and can in large part be dismissed because we all react differently even when given the same foods (2).
Pretty much anything that you eat will cause inflammation/bloating (3).
High-fat diets won’t make you burn more calories (4).
Sugar isn’t stored more easily as fat when compared to other calorie sources (5), and the adverse effects of a high-glycemic diet are likely due to increased energy consumption rather than to increased fat storage (6).
Consuming fat before a meal won’t make you eat any less, however, consuming carbs or protein will (7).
Eating meals that are energy dense is a bad idea whether it’s fat or sugar that we are talking about (8).
Fat is the LEAST satiating (filling) macronutrient (9).
How It Can Work For You
Keto isn’t all nonsense and fairy tails. It can, and will, actually work for many people who use it. However, it works because it restricts a number of calories your taking in which can be done just as easily by reducing calories from your fat intake (10). In the long term, going the Keto route seems to work great because it in part forces you to avoid calorie dense foods (11). And while similar high-fat diet fads such as Paleo/bullet proof are bad for your blood lipid/cholesterol levels (12), Keto does not encourage consumption of large amounts of saturated fat (13). In fact, Keto seems to increase the amount of HDL (good cholesterol) and other hormones (14).

Summary
Much of the Ketogenic diet mythology revolves around false claims and over exaggeration of the truth. However, it works. As long as you can handle the restrictions, Keto works the same as every other successful diet. You burn more calories than you consume. It’s also safe and comes with other health benefits like a better blood lipid profile. So if it sounds doable for you, give it a shot and let me know how it works for you!
Resources
1. Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., … & Ravussin, E. (2016). Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. The American journal of clinical nutrition, 104(2), 324-333.
2. Zeevi, D., Korem, T., Zmora, N., Israeli, D., Rothschild, D., Weinberger, A., … & Suez, J. (2015). Personalized nutrition by prediction of glycemic responses. Cell, 163(5), 1079-1094.
3. Dror, E., Dalmas, E., Meier, D. T., Wueest, S., Thévenet, J., Thienel, C., … & Vallois, D. (2017). Postprandial macrophage-derived IL-1 [beta] stimulates insulin, and both synergistically promote glucose disposal and inflammation. Nature immunology.
4. Thomas, C. D., Peters, J. C., Reed, G. W., Abumrad, N. N., Sun, M. I. N. G., & Hill, J. O. (1992). Nutrient balance and energy expenditure during ad libitum feeding of high-fat and high-carbohydrate diets in humans. The American journal of clinical nutrition, 55(5), 934-942.
5. Veum, V. L., Laupsa-Borge, J., Eng, Ø., Rostrup, E., Larsen, T. H., Nordrehaug, J. E., … & Mellgren, G. (2017). Visceral adiposity and metabolic syndrome after very high–fat and low-fat isocaloric diets: a randomized controlled trial. The American Journal of Clinical Nutrition, 105(1), 85-99.
6. Bosy-Westphal, A., Hägele, F., & Nas, A. (2016). Impact of dietary glycemic challenge on fuel partitioning. European journal of clinical nutrition.
7. Stubbs, R. J., Harbron, C. G., Murgatroyd, P. R., & Prentice, A. M. (1995). Covert manipulation of dietary fat and energy density: effect on substrate flux and food intake in men eating ad libitum. The American journal of clinical nutrition, 62(2), 316-329.
8. Rolls, B. J. (2000). The role of energy density in the overconsumption of fat. The Journal of nutrition, 130(2), 268S-271S.
9. Weight, L. (1995). A satiety index of common foods. European journal of clinical nutrition, 49(9), 675-690.
10. Sacks, F. M., Bray, G. A., Carey, V. J., Smith, S. R., Ryan, D. H., Anton, S. D., … & Leboff, M. S. (2009). Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med, 2009(360), 859-873.
11. Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(07), 1178-1187.
12. Smith, M., Trexler, E., Sommer, A., Starkoff, B., & Devor, S. (2014). Unrestricted Paleolithic diet is associated with unfavorable changes to blood lipids in healthy subjects. International Journal of Exercise Science, 7(2), 4.
13. Zong, G., Li, Y., Wanders, A. J., Alssema, M., Zock, P. L., Willett, W. C., … & Sun, Q. (2016). Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. bmj, 355, i5796.
14. Silva, J. (2014). The effects of very high fat, very low carbohydrate diets on safety, blood lipid profile, and anabolic hormone status. Journal of the International Society of Sports Nutrition, 11(1), P39.

Can You Get Too Much Protein?

Let’s break down protein problems into bite-sized chunks so that you can easily digest the info!

Today’s post will be a quick one in response to a question I received last week. The question was, “what happens when you get too much protein?” There’s not a simple answer because it’s really multiple questions all in one. For instance, is there such thing as too much protein? If so, how much is too much? What types of protein are we talking about, and how many meals? Are there negative consequences to over consumption, or positive ones? I could go on and on. However, I wanted to break down protein problems into bite-sized chunks so that you can easily digest the info!
Can’t Get Enough
For healthy people, there is no such thing as getting too much protein. You can eat and drink it to your heart’s content without having to worry about bodily injury (1). While dieting, an increased amount of protein will only help you retain muscle mass, and not be a tremendous source of fat mass gain (2). Below are some general recommendations; however, more is better.
If you are an athlete or highly active person currently attempting to lose body fat while preserving lean muscle mass, a daily intake of 1.5-2.2g/kg bodyweight (0.68-1g/lb bodyweight) would be a good target.
If you are an athlete or highly active person, or you are attempting to lose body fat while preserving lean mass, then a daily intake of 1.0-1.5g/kg bodyweight (0.45-0.68g/lb bodyweight) would be a good target.
If you are sedentary and not looking to change body composition much, a daily target of 0.8g/kg bodyweight (0.36g/lb bodyweight) and upwards would be a good target.
Inline image 3
Metabolism
Protein does have a positive role when it comes to the rate of your metabolism. However, your metabolism is incredibly complicated. The image below shows just how different individuals will respond to protein in their diets (3). So increasing your protein will not necessarily be a cure-all.
Inline image 2
Do Sources Matter?
In short, yes the source of protein matters. You want to get a wide variety of protein to get all of the essential, and nonessential, amino acids. Which is why taking BCAA’s is useless. With rapid absorbing sources, like whey, consuming up to 40 grams at a time is useful after a workout (4). Some sources are also better for appetite/hormone control (5). Regardless of the source, it’s important just to try and eat a little bit more protein.
Inline image 4

Summary

As short as this post may be, it’s important to recognize a few things. First, no, you cannot get “too much” protein. Second, there are a lot of nuances when it comes to protein ingestion so a broad overview such as this may not give you perfect information. Consult a registered dietitian, or other healthcare professionals, for details into exactly which sources and quantities you should be getting. Finally, don’t let fear mongering or sensational headlines deter you from doing the right thing. Unlike high fat or high sugar diets, it’s really difficult to gain fat from over-consumption of protein. So go grill up some chicken and be happy!
Resources
1. Leidy, H. J., Carnell, N. S., Mattes, R. D., & Campbell, W. W. (2007). Higher protein intake preserves lean mass and satiety with weight loss in pre‐obese and obese women. Obesity, 15(2), 421-429.
2. Antonio, J., Ellerbroek, A., Silver, T., Vargas, L., & Peacock, C. (2016). The effects of a high protein diet on indices of health and body composition–a crossover trial in resistance-trained men. Journal of the International Society of Sports Nutrition, 13(1), 3.
3. Bray, G. A., Smith, S. R., de Jonge, L., Xie, H., Rood, J., Martin, C. K., … & Redman, L. M. (2012). Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial. Jama, 307(1), 47-55.
4. Macnaughton, L. S., Wardle, S. L., Witard, O. C., McGlory, C., Hamilton, D. L., Jeromson, S., … & Tipton, K. D. (2016). The response of muscle protein synthesis following whole‐body resistance exercise is greater following 40 g than 20 g of ingested whey protein. Physiological Reports, 4(15), e12893.
5. Pal, S., & Ellis, V. (2010). The acute effects of four protein meals on insulin, glucose, appetite and energy intake in lean men. British journal of nutrition, 104(08), 1241-1248.

Perfecting Your Normal

Many anatomical differences mean each person will need to move in a customized way that suits their body, and unless you’re ambidextrous you shouldn’t expect to move the same way with each side of your body.

Pretty much everyone who has worked out at a gym has had the experience of getting advice (frequently unsolicited) about how to do an exercise properly. frequently, this advice comes with the intent of helping you avoid injury, maximize your efficiency, or to hit on you. However, I am about to blow your mind with a revelation. People come in all shapes and sizes. Brilliant as this view of human nature may be, it is something that is forgotten far too often in the gym. People are not machines. We are not all built the same way, move uniformly, or require the same fuel. Many anatomical differences mean each person will need to move in a customized way that suits their body, and unless you’re ambidextrous you shouldn’t expect to move the same way with each side of your body. So all that advice you’re getting on how to squat normally may be a load of crap, but I am here to explain how you can do the best with what you got to perfect your body’s normal. 
 
🚩Red Flags🚩
Don’t go running off to the gym and start using the equipment all willy nilly thinking that there is no wrong way to move. Because there is. It’s a large part of my job to make sure you don’t jack yourself up by doing something you saw on Instagram. When it comes to movement, I worry about the red flags, not the minutia. A red flag that can be revealed by a squat test might include knee valgus, or knock knees. We know this can lead to knee pain and ACL tears in athletes (1). There you have it, folks! If you’re an athlete and you have knock knees then you should work on that. Do you have back pain? Well if you hurt you back by falling down, doing a dead lift, or in a car accident, then those are red flags. But there is no magic stretch, strengthening program, or posture that are red flags or fixes for that matter. I’ve written about it before, but I’ll say it again “Neck pain is not greatly associated with neck posture (2). Sagittal (front to back) spinal curve does not relate to spinal health or back pain (3). It is highly likely that we all have disc degeneration, a bulging disk, and/or protruding disk in our back right now, and that’s normal (4). It’s not an unequal leg length that’s causing your back pain (5). Even the best athletes in the world have asymmetrical muscle size and movement patterns, and they don’t have issues caused by them (6,7).
Inline image 1
 
Why We Must Move Differently
I’ll keep this brief. We must all move differently because of our bone structure, muscle/tendon location, and injury history requires us to. We are all so different that it’s impossible to define perfect posture let alone perfect movement. As our bones grow and change, they don’t do so uniformly. Most people know that women have wider hips than men because of the birthing process. Well, there are similar genetic differences amongst everyone that can lead to the bones of the hip to stop you from moving in an “optimal” way (8). It’s also why the phrase “squat like a baby” is total crapThe image bellow gives a good visual on how the hip can be different from person to person. This is why no amount of foam rolling, stretching, or muscle activation will help with “tight hips” in some individuals. 
 
Inline image 2
 
Making It Work For You
So here’s where we get down to business. If you, or someone you know, have specific questions about pain, performance, or application of any of the following suggestions, be sure to set up a one on one session with me by replying to this email so we can get into specifics for you. 
It’s no secret that exercising can come with aches and pains. Commonly, the shoulder, back, and knee joints. What you need to know is that pain does not always mean there is tissue damage. It may simply mean you are overstressing a particular structure. Which is why switching from back squat to front squat can alleviate knee pain even though you are still putting pressure on the joint. If your knees move towards the outside of your feet too much try taking off your shoes (9). If squatting makes your back hurt, decrease the amount of weight that you use, squat deeper, and allow your knees to go in front of your toes as seen in the picture below (10). You can also adjust the depth of the squat, foot stance, and barbell location to target specific muscles which I wrote about extensively in this post.
 
Inline image 4
If you want to build a bigger chest, use less weight on your bench press because of the heavier the weight the more you use your shoulders and triceps (11). In fact, getting more reps in is the name of the game. Stretching before you exercise will decrease the strength and muscle gain you can achieve, and may not even be achieving anything worthwhile, to begin with (hip flexors in particular) (12). A little cheating isn’t always a bad thing if a bit of a swinging/momentum gets you to squeeze out an extra few reps (13). At the end of the day, perfecting your normal means you are experimenting with technique so you don’t feel pain/do feel the targeted muscles work, you are getting as many weighted reps in a possible, and you gradually increase your body’s ability to do more work. This may require a trained eye, but it will never require a universally true way to do things.
Resources
1. Quatman, C. E., Kiapour, A. M., Demetropoulos, C. K., Kiapour, A., Wordeman, S. C., Levine, J. W., … & Hewett, T. E. (2014). Preferential loading of the ACL compared with the MCL during landing: a novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. The American journal of sports medicine, 42(1), 177-186.
2. Grob, D., Frauenfelder, H., & Mannion, A. F. (2007). The association between cervical spine curvature and neck pain. European Spine Journal, 16(5), 669-678. doi:10.1007/s00586-006-0254-1
3. Christensen, S. T., & Hartvigsen, J. (2008). Spinal curves and health: A systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics, 31(9), 690-714. doi:10.1016/j.jmpt.2008.10.004
4. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American Journal of Neuroradiology, 36(4), 811-816. doi:10.3174/ajnr.A4173
5. Grundy, P. F., & Roberts, C. J. (1984). Does unequal leg length cause back pain? A case-control study. Lancet (London, England), 2(8397), 256.
6. Hides, J., Fan, T., Stanton, W., Stanton, P., McMahon, K., & Wilson, S. (2010). Psoas and quadratus lumborum muscle asymmetry among elite australian football league players. British Journal of Sports Medicine, 44(8), 563-567. doi:10.1136/bjsm.2008.048751
7. Hespanhol Junior LC, De Carvalho AC, Costa LO, Lopes AD. Lower limb alignment characteristics are not associated with running injuries in runners: Prospective cohort study. Eur J Sport Sci. 2016 Jun:1–8. PubMed #27312709.
8. Pollard, T. C. B., Villar, R. N., Norton, M. R., Fern, E. D., Williams, M. R., Murray, D. W., & Carr, A. J. (2010). Genetic influences in the aetiology of femoroacetabular impingement. Bone & Joint Journal, 92(2), 209-216.
9. Southwell, D. J., Petersen, S. A., Beach, T. A., & Graham, R. B. (2016). The effects of squatting footwear on three-dimensional lower limb and spine kinetics. Journal of Electromyography and Kinesiology, 31, 111-118.
10. Hartmann, H., Wirth, K., Mickel, C., Keiner, M., Sander, A., & Yaghobi, D. (2016). Stress for Vertebral Bodies and Intervertebral Discs with Respect to Squatting Depth. Journal of Functional Morphology and Kinesiology, 1(2), 254-268.
11. Król, H., & Golas, A. (2017). Effect of Barbell Weight on the Structure of the Flat Bench Press. The Journal of Strength & Conditioning Research, 31(5), 1321-1337.
12. Junior, R. M., Berton, R., de Souza, T. M. F., Chacon-Mikahil, M. P. T., & Cavaglieri, C. R. (2017). Effect of the flexibility training performed immediately before resistance training on muscle hypertrophy, maximum strength and flexibility. European journal of applied physiology, 1-8.
13. Arandjelović, O. (2013). Does cheating pay: the role of externally supplied momentum on muscular force in resistance exercise. European journal of applied physiology, 113(1), 135-145.

What Is Chronic Fatigue Syndrome?

Take a look at what we know and don’t know about recognizing and treating the enigmatic epidemic.

Are you tired all the time? Feeling mentally foggy all the time? Sleep just doesn’t feel as good as it used to? Well, you’re not alone. Up to 2.5 million Americans have similar symptoms, and as many as 1/4 are homebound or bedridden (1). These symptoms are some of the few that describe systemic exertion intolerance disease (chronic fatigue syndrome); however, little is understood about the issue. Several individuals have asked me about this topic recently, so I thought I would do my best to shed light on this tired topic. So let’s take a look at what we know and don’t know about recognizing and treating the enigmatic epidemic.
 
What Is It Exactly?
Let’s start out with talking about what a syndrome is. It is a set of medical signs and symptoms that are correlated with each other. This is different from a disease which is a health condition that has a clearly defined reason behind it. So, to be diagnosed with chronic fatigue syndrome, you need to meet the following criteria (2):
Diagnosis requires that the patient have the following 3 symptoms:
1. A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest AND
2. Postexertional malaise(aAND
3. Unrefreshing sleep(a)
At least 1 of the 2 following manifestations is also required:
1. Cognitive impairment(a) OR
2. Orthostatic intolerance
 a. Frequency and severity of symptoms should be assessed. The diagnosis of systemic exertion intolerance disease (myalgic encephalomyelitis/chronic fatigue syndrome) should be questioned if patients do not have these symptoms at least half of the time with moderate, substantial, or severe intensity.
In other words, substantial reductions or impairments in the ability to engage in pre-illness activities, unrefreshing sleep, post-exertional malaise (general feeling of not being healthy or happy), and either cognitive impairment or orthostatic intolerance.
Orthostatic intolerance: hypotension, and symptoms, such as lightheadedness, that occur when upright and are relieved by sitting down (3).
 
What It’s Not
Chronic fatigue syndrome is not just the feeling of being tired all the time. If sleep is an issue because you drink a gallon of coffee a day, well then the problem is your nutrition. See the article Woman Who Drinks 6 Cups Of Coffee Per Day Trying To Cut Down On Blue Light At Bedtime for more details. The fact that you’re tired all the time is more than likely self-sabotage in one form or another. You could be anxious about work, nervous that your newborn isn’t breathing because she hasn’t made a noise in over 2 minutes, or jacked up on Mountain Dew. So, don’t go rushing to your doctor because you read this and realized that you’re tired during your work days after you eat lunch!
Chronic fatigue syndrome also is not adrenal fatigue syndrome. Although the reported symptoms are similar, the fact of the matter is that adrenal fatigue DOES NOT EXIST (4)!!! It is a made up disease, developed by quacks, that’s used to sell people supplements/treatments that they don’t need. The real issue probably has more to do with cortisol control, and by trying to treat adrenal fatigue, you are simply prolonging the diagnosis of the real problem. 
Chronic fatigue also is not leaky gut syndrome. Because leaky gut syndrome also DOES NOT EXIST (5)!!! Yes, the permeability of the intestines can be altered. However, there is a complex but dynamic association between mucosal permeability and immune system homeostasis. In other words, things in the gut happen for a reason, they’re not always good or bad, and we don’t know enough one way or another to say what exactly is going on. To be clear, leaky gut syndrome also doesn’t not exist either. But there is no use treating a sick leprechaun with fairy dust in the real world. 
 
Treatment
It has been brought to my attention that the research I cited in this portion of the blog post has been called into question. It seems that the use of cognitive behavioral therapy is not a valid treatment. Instead of deleting this portion of the post, I am striking it out for transparency.
As of right now, there seems to be no gold standard for the treatment of chronic fatigue. However, if you suspect that you have some of the signs or symptoms, please speak with your doctor. You could be mistaking your symptoms ask chronic fatigue when they could be symptoms of a more serious issue such as thyroid dysfunction. Should a treatment become available, I will be sure to update this blog post.
To date, the only real treatment that seems to work is cognitive behavioral therapy (CBT) (6). CBT is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. The fact that CBT works as well as it does, and other physical treatments like exercise don’t seem to work well, leads me to believe that chronic fatigue syndrome does not stem from a physical ailment (7). However, I am no expert on the subject of psychotherapy vs. physical medicines so I will leave it at that. I will say, that if you feel as if you are a prime candidate for a chronic fatigue syndrome diagnosis, see your doctor and discuss the possibility of seeing a mental health professional. 
Resources
1. Marshall, R., Paul, L., & Wood, L. (2011). The search for pain relief in people with chronic fatigue syndrome: a descriptive study. Physiotherapy theory and practice, 27(5), 373-383.
2. Clayton, E. W. (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness. Jama, 313(11), 1101-1102.
3. Stewart, J. M. (2013). Common syndromes of orthostatic intolerance. Pediatrics, 131(5), 968-980.
4. Cadegiani, F. A., & Kater, C. E. (2016). Adrenal fatigue does not exist: a systematic review. BMC endocrine disorders, 16(1), 48.
5. Ahmad, R., Sorrell, M. F., Batra, S. K., Dhawan, P., & Singh, A. B. (2017). Gut permeability and mucosal inflammation: bad, good or context dependent. Mucosal Immunology, 10(2), 307-317.
6. Gluckman, S. J., Aronson, M. D., & Mitty, J. Treatment of systemic exertion intolerance disease (chronic fatigue syndrome).
7. White, P. D., Goldsmith, K. A., Johnson, A. L., Potts, L., Walwyn, R., DeCesare, J. C., … & Bavinton, J. (2011). Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. The Lancet, 377(9768), 823-836.

Cramp Twitch Shake: What’s Making It Happen?!

Why can’t you control your own body while trying to work out?!?!

It’s a plague, a natural disaster, and a nightmare we have all experienced. Calf cramps that hurt so bad you don’t want to move, uncontrollable twitching in the thighs after a heavy squat or an embarrassing whole body tremble while trying to hold a plank. Muscle cramps, twitches, and shakes affect us all in one way or another. But what’s going on with the body when they happen? Why can’t you control your own body while trying to work out?!?! Well, the answer, as usual, is complicated yet very simple.
Image result for muscle cramp gif
Exercise-Induced Muscle Cramps
Let’s start with a list of things that don’t help with cramping:
 x Magnesium supplements
 x Hydration status
 x Sports drinks
 x Electrolytes
 x Shoe type
Muscle cramps happen for a wide variety of reasons, but for today we will focus in on the kind you get while exercising. It may surprise you to know that cramps do not happen because of dehydration or electrolyte loss/imbalance. Losses in fluids and electrolytes, plasma, blood volume, and body weight are similar in people who experience cramps and those who do not experience cramping (1). Ever get a cramp while doing calf raises? I certainly have, and I bet if you try to do calf raises until fatigue now, you will get a cramp regardless of your hydration status. The “until fatigue” part is important because that is why muscle cramps happen. The scientific way to put it is (2):
The muscle spindle responds to length changes in the muscle. As length increases, the muscle spindle increases impulses to the agonist muscle to contract and decreases impulses to the antagonist muscle so it relaxes. The golgi tendon responds to length changes in the tendon and causes the agonist muscle to relax. Both work together to protect the muscle from over stretching. However, with fatigue, it has been noted that the muscle spindle activity increases while the golgi tendon activity decreases.
In other words, your body thinks it’s going to injure itself through overtraining/overstimulation so it shuts down activity (3). The body does this by firing the nerves up to 150 electrical discharges every second (4). Aside from intensity of exercise, some causes of cramps include a family history of cramps, muscle damage, and heat illness (5).
The best treatments include (4,6,7)
 – Static stretching of the muscle
 – Acetic acid (found in pickle juice) to increase neurotransmitter inhibition to cramping muscles
 – Maintaining safe body temperature via hydration and rest intervals
 – Increasing total body strength to delay target muscle fatigue
 – Avoiding stimulants
 
Shake Spasm and Twitch
Shakes, spasms, and twitching kind of come with the exercise territory. There are medical classifications for all of the following information; however, we will be talking about them from a benign exercise-induced standpoint. Shakes (tremors) are almost always harmless and will never be explained. They are a huge category of involuntary muscle activity, ranging from the trivial to the disastrous, from teeth chattering in the cold to the wobbles of Parkinson’s Disease. In healthy people, they are usually stress induced. So if your hands or legs are ever a bit shaky after a hard workout, it’s because our motor control systems are a bit delicate. This is why unwanted contractions are so common and yet usually meaningless. Muscle spasms are an informal, non-specific term often used to “explain” musculoskeletal pain. Back spasms specifically do not cause pain, but rather are caused by pain (8). Muscles are always turned on and active in healthy people, and there is no such thing as normal muscle tone which is why “feeling tight” really doesn’t mean too much. A “muscle spasm” is really just the body preparing for a task (9). Twitching/rippling (Myokymia) happens when your muscle gets fatigued, so the motor units of your muscle fibers, rather than firing all at once, alternate their contractions, like pistons. Essentially, there aren’t enough motor units available for smooth contraction, so muscles start to ripple and quiver with intense exertions.
A Riddle To Ponder
What’s caused by doing exercise, and what’s caused by not doing exercise? Cramps, shakes, spasms, and twitches! It all comes down to how you’re training. If you’re doing enough exercise, you will start to see these issue go away. If you increase your exercise intensity, you will see them return… temporarily. The body is a crazy mystical web of mysteries. We are still discovering a lot, but the more you learn, the more it seems like we only know the tip of the iceberg. So don’t be embarrassed if you shake like a leaf while holding a plank, it’s completely natural.
References
1. Schwellnus, M. P., Drew, N., & Collins, M. (2011). Increased running speed and previous cramps rather than dehydration or serum sodium changes predict exercise-associated muscle cramping: a prospective cohort study in 210 Ironman triathletes. British journal of sports medicine, 45(8), 650-656.
2. Miller, Kevin. The Neurological Evidence for Muscle Cramping. NATA Symposium, June 2011, New Orleans Convention Center, New Orleans, LA. Conference Presentation.
3. Nelson, N. L., & Churilla, J. R. (2016). A narrative review of exercise‐associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications. Muscle & nerve, 54(2), 177-185.
4. Miller, T. M., & Layzer, R. B. (2005). Muscle cramps. Muscle & nerve, 32(4), 431-442.
5. Shang, G., Collins, M., & Schwellnus, M. P. (2011). Factors associated with a self-reported history of exercise-associated muscle cramps in Ironman triathletes: a case–control study. Clinical Journal of Sport Medicine, 21(3), 204-210.
6. Miller, K. C., Mack, G. W., Knight, K. L., Hopkins, J. T., Draper, D. O., Fields, P. J., & Hunter, I. (2010). Reflex inhibition of electrically induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc, 42(5), 953-961.
7. Casa, D. J., Armstrong, L. E., Hillman, S. K., Montain, S. J., Reiff, R. V., Rich, B. S., … & Stone, J. A. (2000). National Athletic Trainers’ Association position statement: fluid replacement for athletes. Journal of athletic training, 35(2), 212.
8. Friedmann, L. W. (1989). The myth of skeletal muscle spasm. American journal of physical medicine & rehabilitation, 68(5), 257.
9. Szeto, G. P. Y., Straker, L. M., & O’Sullivan, P. B. (2009). Neck–shoulder muscle activity in general and task-specific resting postures of symptomatic computer users with chronic neck pain. Manual Therapy, 14(3), 338-345.

Organic Food: My Current Stance

Part of my job is to stay up to date with the latest trends in the health and fitness world and vet the information for quality. From shake weights, ketogenic diets, and fasted cardio to magic weight loss wraps, diet pills, and green coffee beans, I need to know what it is and why it does or does not work. My stance always comes from that of a skeptic, especially if the claims made about a particular trend are extraordinary. And because science is always pushing forward, my opinions can change over time. The topic of organic food vs. conventional food has been a real SOB to tackle. However, today I wanted to go over where I currently stand. So, is organic food really worth all the extra $$$, or are you buying a Ferrari when a Honda Civic is really all you need?
 
What Makes It Organic?
Let’s first take a quick look at what goes into making a particular food organic. Being certified organic is really a matter of farmers adhering to USDA guidelines. There’s way too much info for me to go over in this post, but check out this link for the specifics. For something to be deemed organic, it needs to be in the condition of being ordered as a living being, or of any chemical that contains the element carbon, regardless of its source. So that means there are chemicals that are allowed in organic farming other than cow poop, such as copper sulfate, boric acid, elemental sulfur, sodium hypochlorite (bleach), ammonium carbonate, and magnesium sulfate. But don’t be worried about all those chemicals. For you to feel any negative side effects of eating conventional herbicide, you would need to eat tons of it per day. I’m sure it’s the same for the organic stuff too. 
chem.png
Organic Food Health Implications
So I’m going to dive right into the heart of the matter and start off by talking about what’s good for your health. And I’m sad to say that there really is no evidence to say that eating organic has any positive, or negative, health outcomes (1). However, there are a bunch of indicators that suggest there may be benefits. For instance, organic food has been shown to have:
 – More Antioxidants (between 18% and 69%)
 – Less cadmium (on average, about 48 % lower)
 – Four-times less likely to contain detectable pesticide residues 
 – Slightly more omega-3 fatty acids (good for the heart)
 – Slightly less saturated fatty acids (good for the heart)
 However, conventional foods have been shown to have;
 – higher concentrations of iodine and selenium (iodine deficiency can lead to impaired fetal brain development)
 – higher concentrations of protein, nitrogen, nitrate, nitrite, respectively (these can have both positive and negative health impacts)
 
At the end of the day, organic foods are not really any more nutritious on a meaningful level but do have some small advantages (2). For instance, it may reduce exposure to pesticide residues and antibiotic-resistant bacteria (3). Although pesticide residues for both conventional and organic crops are negligible compared to the safe minimum daily dosage, these are a small but meaningful difference for some individuals.
 
The Cost Of Organic
While everyone knows that the price of organic is greater than conventional foods (by about 47% in fact), what are the other costs of eating organic? Well, the thought of paying more to help out your local farmer is certainly noble, and I highly recommend buying from a farm that you trust and want to support. However, simply buying organic from the supermarket does not help out the little guy despite all the advertising. Organic farming is also bad for the environment
environmental impact
 
Growing organic means you get 35% less food per acre when compared to conventional methods (4). It also means greater ammonia emissions (eye & lung irritant), nitrogen leaching (gets into our water), and nitrous oxide emissions (greenhouse gas) (5). Organic farming can be better for soil health, however. 
 
Final Thoughts
At this point, it may seem like I have been bashing organic foods, but I want to be clear that I am laying out the facts and not making this about one ideology vs. another. The reality is that everyone should be eating more fruits and vegetables regardless of where they come from. No one should feel ashamed because they can’t afford to eat organic foods. Making the choice to eat organic should be about preferences. Although “organic” doesn’t mean it’s any healthier or tastes better if you prefer it over food stuff then go for it (6,7). Don’t let the PR firms fool you; you won’t have any worse health outcomes by eating non-organic foods. Just choose whole food sources from the produce section, and if you want to ensure the highest quality, grow it yourself and/or get to know your local farmers. 
References
1. Barański, M., Rempelos, L., Iversen, P. O., & Leifert, C. (2017). Effects of organic food consumption on human health; the jury is still out!. Food & Nutrition Research, 61(1), 1287333.
2. Dangour, A. D., Dodhia, S. K., Hayter, A., Allen, E., Lock, K., & Uauy, R. (2009). Nutritional quality of organic foods: a systematic review. The American journal of clinical nutrition, 90(3), 680-685.
3. Smith-Spangler, C., Brandeau, M. L., Hunter, G. E., Bavinger, J. C., Pearson, M., Eschbach, P. J., … & Olkin, I. (2012). Are organic foods safer or healthier than conventional alternatives?: a systematic review. Annals of internal medicine, 157(5), 348-366.
4. Seufert, V., Ramankutty, N., & Foley, J. A. (2012). Comparing the yields of organic and conventional agriculture. Nature, 485(7397), 229-232.
5. Tuomisto, H. L., Hodge, I. D., Riordan, P., & Macdonald, D. W. (2012). Does organic farming reduce environmental impacts?–A meta-analysis of European research. Journal of environmental management, 112, 309-320.
6. Fillion, L., & Arazi, S. (2002). Does organic food taste better? A claim substantiation approach. Nutrition & Food Science, 32(4), 153-157.
7. Johansson, L., Haglund, Å., Berglund, L., Lea, P., & Risvik, E. (1999). Preference for tomatoes, affected by sensory attributes and information about growth conditions. Food quality and preference, 10(4), 289-298.