Sunday, September 29, 2013

Is food addictive part 3?

Last week I did two blogs on how certain foods can be addictive and how we have a hereditary predisposition for wanting to eat foods with lots of calories. I also mentioned how we really don´t have strong instincts to engage in physical activity because, before in the past, physical activity used to occur automatically every time we needed to hunt. No one would just go for a run and waste precious calories, we needed all the calories we had. Now, everything has changed. It´s easy to get food and we barely move, and those are two of the reasons why obesity is a WORLD WIDE EPIDEMIC.

Well, in this third part of ´is food addictive´, I'm just going to mention some facts that most people don´t know and should, and that I consider pretty important. So let´s start off.
  1. Did you know that the last 10,000 years of our history only represents 1% of  human history? The body changes and adapts over time but it usually takes thousands of years for that to happen. Agriculture first arrived 9,000 years ago, if you think about it, in terms of human evolution, that´s not a long time ago.
  2. Before agriculture we were hunter-gatherers. Fossils records show that Paleolithic hunter-gatherers lifespan averaged 26 years, but with the invention of agriculture the lifespan went down to 19!!! (1)
  3. In Greece and Turkey, near the end of the Paleolithic hunter-gatherer era, men averaged 5´9 (175cm) and women 5´5 (166cm). By 3000 BC, with agriculture a way of life, the average height had dropped to 5´3 (161cm) for men and 5´ (152cm) feet for women (1,5). This could be because the Paleolithic hunter-gatherers ate hundreds of plants and animals, supplying lots of complete proteins and vitamins. Farmers ate mainly three crops, wheat, rice and corn, because they were the easiest to cultivate, harvest and store without spoiling.
  4. Human milk matches the exact proportions of amino acids and fats used for brain circuits and contains antibodies to prevent infections. Cows milk contains very different proportions of amino acid and much more fat. Babies fed on breast milk average 8.3IQ points higher by the age of 8 than those fed on milk-based formula.(3)
  5. Predators consistently have larger brains than herbivores. You require more cunning to catch prey than to find the next leaf. Omnivores, who must switch between these tasks, tend to have larger brains yet.
  6. Brains and nervous systems are for mobility; plants don´t have brains, animals do. Exercise especially generates neurons in the hippocampus, an organ associated with memory, and these new neurons have been demonstrated to enhance learning. What I´m basically stating here is: MOVE, it will make you smarter.
  7. Dieting, in the long run, almost never works! Maximal weight loss is typically achieved at around 6 months, followed by weight regain.(2)
  8. Evidence has been building up that if you consume less calories, far below that needed to maintain normal weight, but still consume vitamins, protein and other important nutrients, your lifespan could increased by up to 65 percent.. (8)
  9. They have done studies with a low-calorie diet on different animals such as rats, yeast, worms, flies, spiders, fish and several types of rodents, and have seen the lifespan of the animals increase from 25 to 65 percent.(6-7)
  10. The people who live the longest come from Okinawa, Japan. Their diet consists of a higher percentage of fresh vegetables than in most places, and fish and soy make up virtually all the protein. Okinawans consume 40 percent fewer calories than Americans and 17 percent fewer calories than the average Japanese.  (9)
  11. There have been studies that have demonstrated the effect of larger portions on consumption. Did you know that the standard serving portion size for almost everything is larger than it was a generation ago? We sometimes see this in restaurants, especially in the USA, were the servings are huge. The problem with huge serving sizes is that we eat more than we are supposed to. They did a experiment on people, where people were invited to a lab for a ¨taste test¨of soup. Some of  the participants got a bowl that had a tube connected to the bottom of the bowl, so that it was always full. The other participants ate from a normal bowl. All the participants thought they had a ¨normal¨ bowl. Those with the ¨bottomless¨ bowl ate 40 percent more!!
CONCLUSIONS ON ´IS FOOD ADDICTIVE´

Certain foods are addictive, we have a hereditary predisposition for storing fat and we don´t have a strong instinct to engage in physical activity. On top of that we have changed drastically the way we eat, especially the last 80 years. Remember, and I know I have stated this a couple of times but it´s quite important, the last 10,000 years only represent 1% of the human evolution. Before agriculture we were hunter-gatherers and ate hundreds of plants and animals. The animals we ate were animals that were in the wild and had a high content of protein. The animals we eat now, are in farms, fed ¨shit¨ food, and given hormones to grow as fat and as quick as possible.  Another problem is that we eat much more than what we are supposed to. Just bear in mind that the people who live the longest on the planet are the Okinawans and they eat quite less than the average American or Japanese. Also, let´s not forget that the bigger the serving the more we eat (compare the dishes you have now with the ones your grandparents have).

So, with all this said, I think I found a solution to the problem. Instead of moving more, eating well and drinking better......... just buy smaller dishes !!! ;)

My next blog will finally be about sports. It will talk abou the myth of high repetitions. I think we have all heard that if you want to lose weight and tonify you have to do more repetitions, but is this true??  We will see in my next blog.... until then .
    References.

    1. Deirdre B. Waistland. The Evolutionary Science behind our weight and fitness crisis. W.W. Norton & Company. New York, 2007. pg 11.

    2. Mann T, Tomiyamas J, Westting E, Lew A-M, Chatman J. Medicare´s Search for Effective Obesity Treatments. American Psychologist, 2007;220-30.

    3.Lucas A. Breast Milk and Subsequent Intelligence Quotient in Children Born Preterm. Lancet 339,1992; 261-4.

    4. Reuters, ¨Researcher Links Obesity , Food Portions.

    5. Angel. Paleoecology, Paleodemography and Health.

    6. Lawler F-D. Influence of Lifetime Food Restriction on Causes, TIme and Predictores of Death in Dogs. Journal of the American Veterinary Medical Association 226, 2005; 225-31.

    7. Delaney M, Walford L. The Longevity Diet: Discover Calorie Restriction. Marlowe & CO. New York, 2005.

    8. www.calorierestriction.org

    9. Wilcox B. How Much Should We Eat? The Association Between Energy Intake and Mortality in a 36 Year Follow-Up Study of Japanese-American Men. Journal of Gerontology: Biological Sciences 59,2004; 789-95.
     

Wednesday, September 18, 2013

Monday, September 16, 2013

Is food addictive part 2?

In our last post we talked about how certain foods can be addictive by producing chemical changes in our brain. We also saw that eating refined fatty meals makes us stop producing Leptin. Leptin is a hormone which signals the body to stop eating, but we also saw that the reverse can also happen. Meaning that if you stop eating the junk food and start eating healthy, the levels of those hormones return to normal, so there is hope. But what is eating healthy?

10,000 years ago, which may sound like a long time but it equals to only 1 percent of human history, most humans lived like hunter-gatherers. Back then we used to eat a lot of meat (this meat, contrary to what we eat now, contained much more protein), fish, fruits, leaves and seeds. We ate more than one hundred species of plant- most rich in vitamins, fiber and other nutrients. Fats and sugar were rare but we developed a craving for them because they contain lots of calories, which was important back then to survive. Thanks to our diet, and because we were always on the move, people were lean but whoever could store fat had an advantage. So we developed a predisposition for carrying fat on our bodies as well as wanting it in our foods. The problem is, back then it was difficult to get too much of these foods, now it´s the complete opposite. So not only do we get ¨addicted¨ to these foods when we eat them, we also have hereditary predisposition for wanting to eat them.

So I guess I´m not saying anything new about what is healthy eating. I think most people know what is healthy and what is un-healthy, the problem is people don´t do it. And now we know some reasons why that is. It´s the same thing with physical activity, most people know they have to move more but they don´t do it. They always use excuses like they don´t have enough time or that something hurts, ironically most of these problems are improved by exercise. Biologically we need exercise, but we don´t have strong instincts to engage in it. Before, physical activity used to occur automatically while trying to catch or find out food, now it´s not like that. Back then no one would just go for a run, that would be wasting precious energy and calories, you needed all the energy and calories you could have. Those extra calories could make the difference between life and death.

This blog just gets worse and worse, not only do we have a hereditary predisposition for wanting to eat foods with lots of calories, but once we eat them we get addicted to them - and to top that off I just said that we don´t have strong instincts to engage in sports!!! No wonder we are loosing against obesity and getting fatter and fatter every day. But there is hope, I have seen it, even done it!! You can fight back ...... I won´t tell you what you have to do because I want to keep the secret to myself but I´ll give you a hint: It has to do with eating and moving.

In my next blog, we will continue with the third part of ¨is food addictive¨ by mentioning some interesting facts that most people don´t know. Until next time I leave you with the second part of ¨The men who made us fat¨ http://www.youtube.com/watch?v=owekbSp7wU0.

Wednesday, September 11, 2013

Is food addictive?

Today in age people are getting fatter and fatter. Obesity is now a world wide epidemic. In the USA in 1995 two-thirds of Americans were overweight and obesity was killing 300,000 people a year, sickening millions and costing $99 billion annually. 10 years later and the Americans (the studies I have are from Americans but I bet in Europe it is the same thing) were eating 50 percent more fast food meals and five more pounds of sugar a year. US obesity related health costs have risen to $117 billion!!!(1) So what´s wrong? Why do we keep eating and getting fatter? We know it´s bad for us but we still don´t do anything about it. Are we just plain stupid? Or is there something more complicated that we still don´t understand? Can food be addictive........

There is growing evidence that sugary foods can trigger changes in the same brain chemicals affected by addictive drugs. Researchers at Princeton have shown that natural opioids are released when rats eat a large amount of sugar and that they are thrown into a state of anxiety when the sugar is removed. Biologist are also finding that overeating on refined fatty meals triggers similar physiological changes. Leptin is a hormone which signals the body to stop eating after a certain point when consuming natural foods (2). Well, researchers at Albert Einstein Medical College saw that when they fed rats unnaturally fatty meals, the rats would loss all of their ability to respond to leptin. They just kept eating!!! The reverse effect happened when they were taken off the high fat for a while. There was also a study at Rockefeller University that showed that a high fat diet reconfigures the body´s hormonal system to want yet more fat. Galanin, a brain peptide that increases eating and slows energy expenditure, rises in rats on a high fat diet (3). In fact, it only takes 1 high fat meal to stimulate galanin release and the craving for fat. So we are beginning to see that food can actually be addictive, but we can also stop this addiction by eating properly. But what is eating properly? Before I answer this question I want to try to clear some terms that I think are important:
  • Refined: We always hear this word but few people really know what it means. When ¨refining¨ flour, sugar or other foods, it means it is removing the hull and fiber, often even the cell wall of plant structures, leaving only simple carbohydrate or clear oil. Farming refines our food all the time. A recent study of nutrients in food found that, in the second half of the last century (1900-2000), fruits and vegetables suffered significant decreases in protein, calcium, phosphorus, iron, vitamin B2 and vitamin C.
  • Insulin: When we eat simple carbohydrates, glucose levels soar in the bloodstream. In the short term, our bodies release INSULIN to store the glucose as fat. Repeated surges in blood sugar make the pancreas work harder and can contribute to insulin resistance, thereby increasing the risk for type 2 DIABETES, in which blood sugar levels remain elevated, causing damage to our kidneys, eyes and immune system (4).
  • Trans Fats- ¨are produced by heating liquid vegetable oils in the presence of catalysts and hydrogen. This gives them a different shape from the original oil or the natural saturated fats found in meat. They don´t fit properly with cell membranes or with enzyme designed to digest fats. Trans fats cause a significant drop in HDL (good) cholesterol and a significant increase in LDL (bad) cholesterol, they make the veins and arteries more rigid, they cause major clogging of arteries and they contribute to the risk of death from heart disease. Because trans fats contain abundant calories without providing the beneficial fats found in natural vegetable oil, they lead to overeating with under nutrition. Trans fats now make up much of the fat in CANDY, COMMERCIAL COOKIES and cakes, and the oils in which FAST_FOOD CHAINS FRY FOOD¨  (*Taken from Waistland by Deirdre Barrett pg 34)


In my next post I will talk about what eating properly is and how we are doing right now the complete opposite. But in the meantime I would love for you guys to take a look at this link. It´s a series BBC did on obesity and it´s called THE MEN WHO MADE US FAT. It consists of 3 parts and each last 55 minutes but it´s very interesting. Here goes the link: http://www.youtube.com/watch?v=E6nGlLUBkOQ.

References

Barrett D. Waistland, The (R)Evolutionary Science behind Our Weight and Fitness Crisis.Norton & Company.2007

Egan S. Making the Case for Eating Fruit. New York Times. July 2013.

Colantuoni C. Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence.Obesity Research 10,6 (2002):478-88.

Martindale D. Burgers on the Brain:Can you really get addicted to fast food?, ¨New Scientist, February 1,2003.

Wang J. Overfeeding Rapidly Induces Leptin and Insulin Resistance. Diabetes 50(2001):2786-91.

Monday, September 9, 2013

Pain part 3

So we have talked already about how pain is produced in the brain, how posture really doesn´t affect pain and how pain can be divided into acute and chronic pain. Acute pain being pain that last 3 to 6 moths and chronic pain, pain that last more than 6 months. So how do you treat the different kinds of pain?

With acute pain it is usually quite easy, the pain is associated with the tissue injury that has been produced and, in many cases, pain medications do work reasonably well. For example, NSAIDs (Nosteroidal anti-inflammatory drugs) have been shown to be effective for injuries (like ankle sprain), and after surgery. But for chronic pain, medications are only slightly effective and this is due to the fact that pain can change your nervous system (1,2).

It has always been said that the brain and the nervous system couldn´t change. But since a decade ago we know that the brain is plastic and can indeed change, it´s called NEUROPLASTICITY. Scientists have seen from imaging and animal studies that persistent pain or pain which last for months and years can change the pain pathway, in other words we become more sensitive. This hypersensitivity causes the brain to interpret anything related to those tissues to be highly threatening. So basically the nervous system and the brain have become more efficient in producing and maintaining pain (3-5). You could say that in chronic pain, the pain has moved up to the nervous system and now has very little to do with the initial damage to the tissues that caused the pain.

Let´s try to clear this up and make it easier to understand with an example: John, age 45, has had lower back pain for the last 2 years. Everytime he bends down to pick up something he experiences pain, so he stops doing that. We know that tissues or bones usually heal in between 3 to 6 moths, so there is really nothing wrong with him from a anatomical point of view. And everytime he bends down it doesn´t mean that he got hurt again or that he re-injured himself. It is just that Johns brain and nervous system have become so good at constructing pain that the slightest of triggers - even those that don´t cause damage, cause pain. So how do we deal with this?

The most important thing would be to educate John about pain, to teach him the role of the brain in pain, and to explain to him that pain doesn´t always equal to damage. When education about pain physiology is included into physiotherapy treatment of patients with chronic pain, pain and disability are reduced (6,7). After this, the next thing would be to gradually expose John to the feared activity (bending down) without causing pain and thereby lowering the threat level in the brain. So we would teach him first how to bend down correctly and to only bend till the point before the pain starts. This process would start to decentralize his pain and eventually make his pain disappear.

To finish I want to hopefully think that people now understand a little bit more of how pain acts and how to deal with pain. These last 3 articles have been difficult and maybe hard to understand but I would be satisfied if people took at least these 3 points home:
  1. Damage does not equal pain; not all damage leads to pain, and not all pain is caused by damage. Example: a study in the journal Arthritis & Rheumatism looked at the relationship between knee osteoarthritis and pain (8). They found out that some people had little arthritis and high pain, and some people had severe arthritis but low pain. The researchers concluded that the level of knee pain was due to central sensitization, rather than the level of osteoarthritis. In other words, the level of pain had more to do with changes in their nervous system, not changes in their knee structure.
  2. You can have a bulged disc or degenerated spine, maybe even impinging on one of your nerves, and still not have pain. Or you could have none of these problems, and still have persistent pain (9-12).
  3. The International Association for the Study of Pain defines pain as an emotion. That is, pain is a perception rather than a sensation. Unless and until the brain senses danger or threat, nothing can cause pain.
To finish I will post 2 links.

In one of them Lorimer Moseley describes how to explain pain to patients and in the second one, which is quite long (44 minutes), he talks about the whole process of pain. Enjoy

http://www.youtube.com/watch?v=jIsF8CXouk8
http://www.youtube.com/watch?v=-3NmTE-fJSo


In my next blog we will change the topic drastically and talk about food. Is food a drug?? Can you get addicted to food? We will see and explain in my next blog. See you then.


Bibliography

1. Ekman EF, Ruoff G, Kuehl K, Ralph L, Hombrey P, Fiechtner J, Berger MF. THe COX-2 sècific inhibitor Valdecoxib versus tramadol in acute ankle sprain: a multicenter randomized, controlled trial. Am J Sports Med. 2006 JUn;34(6):945-55. Epub 2006 Feb 13. PubMed PMID: 16476920

2. Buvanendaran A, Kroin JS, Tuman KJ, Lubenow TR, Elmofty D, Moric M, Rosenberg AG. Effects of perioperative administration of a selective cyclooxygenase 2 inhibitor on pain management and recovery of cuntion after knee replacement a randomized controlled trial. JAMA. 2003 Nov 12,290(18):2411-8. PubMEd PMID: 14612477.

3.Flor H, Nikolajse Li, Stachelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity.
   Nat Rev Neuroscience 2006 Nov;7(11):873-81.

4. Flor H, Braum C, Elber T, BIlbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience 1997: March 7.224(1)5-8.

5. Ren K, Dubner R. Central nervous system plasticity and persistent pain. J Orofac. Pain.1999.Summer.13(3):155-63.

6.Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J pain 2004. Sept 20(5): 324-30.

7. Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiotherapy 2005: 31(1):49-52.

8.Dallinga JM, Benjaminse A, Lemmink KA. Which screening tools can predict injury to the lower extremities in team sports?: a systematic review. Sports Med. 2012 Sep 1;42(9):791-815.

9. Johnson C. Modernized Chiropractic reconsidered: beyond foot-on-hose and bones-out-of-place. J Manipulative Physiol Ther. 2006 May;29(4):253-4. PubMed PMID:

10. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage. 2008 May;35(5):544-62. Epub 2008 Feb 14. Review.

11. Homola S. Chiropractic: history and overview of theories and methods. Clin Orthop Relat Res. 2006 Mar;444:236-42.

12. Good CJ. The great subluxation debate: a centrist’s perspective. J Chiropr Humanit. 2010 Dec;17(1):33-9. Epub 2010 Sep 21.


Wednesday, September 4, 2013

Pain part 2 - Does bad posture cause pain?

The other day we saw that pain is very complex and that in most cases it´s produced in the brain. So, if it´s really produced in the brain, does posture or movement really matter? We have all gone to the physical therapist or doctor and have heard that ¨your back pain comes because you have too much of a curve in your back¨, or ¨your back pain or shoulder pain comes because of your forward head posture¨ or ¨your knee pain comes because you have too much of a pronation on your foot¨. Hell, I´ve done it, I´ve been saying that to my patients for years because that is what was taught to me.

Up to last year I had a client, XG, who always came to me because he had back pain. I would always tell him that his back pain was coming because of his posture. He had a forward head (still does) and a big lordosis (inward curve) in the lower back .I tried to correct his posture, I gave him exercises to do at home, I stretched him, I did everything you could imagine but his posture hasn´t really changed but guess what, his pain has, it´s gone!!

So what I´m basically trying to say is that there is no consensus on supporting a biomechanical (and posture) model of pain (1-10). Because:

• Postural and structural asymmetries cannot predict back pain and are unlikely to be its cause (1).
• Local and global changes in spinal biomechanics are not demonstrably the cause of back pain (1).
• A postural structural biomechanical model is not suitable for understanding the causes of back pain (1).

This is so because postural structural asymmetries and imperfections are normal!! The body has surplus capacity to tolerate such variation without loss of normal function. That is why there is little scientific evidence to show that posture will cause pain (2-5). If posture was a factor of pain how come you see thousands of people around with bad posture with no pain and thousands more with ideal posture in a lot of pain? That just shows that there is much more to pain than just posture.

This is not meant to deny that there is a correlation between pain and certain postures, but that this association is neither sufficient nor conclusive to justify our efforts to dictate people’s posture and movement. But what we do know for sure is that there is no ‘ideal’ posture, and any posture if maintained for too long will result in dysfunction, and maybe pain. The key is movement.

To end this article and the topic of posture and pain, and to confuse people even more, I will say that there actually is potential harm in  "addressing" the unsubstantiated claims of bad posture. Things just as: focus on "bad" movement or "bad" positioning have the potential to sensitize the individual into believing that a benign (wrong) positioning is in fact something that represents a threat. And as we saw yesterday in the video, pain is the response to threat, either real or perceived, and how we view our environment and ourselves within that environment can positively or negatively affect that threat response. So by addressing things that don't have evidence to support them (bad posture), we are actually increasing the chance that an individual might have the very real experience of pain. We are creating a self-fulfilling prophecy. That is real harm - and it is evidenced (2-5).

I will finish by quoting some of Lorimer's famous quotes and with a link to a video that demonstrates the tricks the mind can play on us.

Favorite Lorimer Quotes
  • “Pain is very complex.”
  • “We can’t treat every pain patient with a simple solution.”
  • “The best way to get rid of chronic pain is to chop the person’s head off.”
  • “As soon as you interact with the patient, you are in their brain.”
  • “Always do more today than you did yesterday.”
http://www.youtube.com/watch?v=sxwn1w7MJvk
P.S In my last post I said that you can have an injury without having pain. Some of you didn´t believe me, which is normal, so references 7-12 demonstrate just that.

Also, those that have been following me may be asking themselves why I still  haven´t talked about how to deal with pain. The simple answer is that I first wanted you guys to really understand what pain is and change the way you think about it. With these 2 posts maybe you haven´t really understood it yet, but I probably made you look at pain from a different perspective. Now that we have this different perspective, in my next post I will finally talk about how to ¨deal¨ with it. Hope you liked the article, until next time.

Bibliography

1. Lederman E. The fall of the postural-structural-biomechanical model in
manual and physical therapies: exemplified by lower back pain. J Bodyw Mov
Ther. 2011 Apr;15(2):131-8. doi: 10.1016/j.jbmt.2011.01.011

2. Loeser JD, Melzack R. Pain: an overview. Lancet. 1999 May
8;353(9164):1607-9.

3.Moseley, G. Lorimer. Reconceptualising pain according to modern pain
science. Physical Therapy Reviews 2007; 12: 169–178.

4.G Lorimer Moseley. Teaching people about pain: why do we keep
beating around the bush? Pain Manage. (2012) 2(1), 1–3.

5.Melzack R., Katz J. (2013), Pain. WIREs Cogn Sci, 4: 1–15.

6. Moseley GL. Pain, brain imaging and physiotherapy–opportunity is
knocking. Man Ther. 2008 Dec;13(6):475-7.

7.Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people
without back pain. N Engl J Med.1994 Jul 14;331(2):69-73.

8. Sher JS et al. Abnormal findings on magnetic resonance images of
asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5.

9.Melzack R, Wall PD, Ty TC. Acute pain in an emergency clinic: latency of onset
and descriptor patterns related to different injuries. Pain. 1982
Sep;14(1):33-43.

10. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magneticresonance
scans of the lumbar spine in asymptomatic subjects. A prospective
investigation. J Bone Joint Surg Am. 1990 Mar;72(3):403-8.

11. Kleinstück F, Dvorak J, Mannion AF. Are “structural abnormalities” on
magnetic resonance imaging a contraindication to the successful conservative
treatment of chronic nonspecific low back pain? Spine (Phila Pa 1976). 2006
Sep 1;31(19):2250-7.

12. Bhattacharyya T, Gale D, Dewire P, Totterman S, Gale ME, McLaughlin S,
Einhorn TA, Felson DT. The clinical importance of meniscal tears
demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J
Bone Joint Surg Am. 2003 Jan;85-A(1):4-9.


Monday, September 2, 2013