http://sports-diet-pain.com/

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

http://sports-diet-pain.com

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

http://sports-diet-pain.com

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

http://sports-diet-pain.com

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

http://sports-diet-pain.com

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

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.
 

International Chair on Cardiometabolic Risk part 2

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

International Chair on Cardiometabolic Risk

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

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.

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.

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.

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.

Pain part 1

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

Acupuncture

A quick side note before I start talking about acupuncture. I want to say that I did a Postgraduate degree on acupuncture 8 years ago, after finishing my Physical Therapist studies. I never got the hang of it, and I never really understood it, so I never used it with my clients, but during the time of my studies, I inserted needles and people inserted needles onto me.

OK, let´s begin by saying what acupuncture is: Acupuncture is a collection of procedures involving penetration of the skin with needles to stimulate certain points on the body. It is based on the notion that health and well-being relate to the flow of a life force through pathways (meridians) in the human body (1). In its classical form it is a characteristic component of traditional Chinese medicine. There are various schools of acupuncture but the majority support the notion of 12 meridians (there are 12 main rivers in China). Meridians supposedly are associated or connected to one of the mayor organs and there are hundreds of possible acupuncture points along the meridians. Before deciding on the acupuncture points, the acupuncturist must first diagnose the patient by inspection, auscultation, olfaction, palpation and inquiring. (1)

The thing that I always find funny is the way people defend acupuncture. They always say to me ¨it has existed for thousand of years so it has to be true¨, and this makes me believe they don´t know what they just said because right there, in that sentence, is part of the answer of why acupuncture doesn´t really work. First, I´ll start by saying that over 2000 years ago (the first mention of acupuncture was 2,600 BC), we didn´t really know how the human body worked, even now, with all the technology we still can´t explain certain things. So you think 2,000 thousand years ago in a culture that performed no DISSECTIONS, they knew what they were doing or where they were sticking their needles (1,2)? If you believe that, then you have to believe on the principles that a ¨life force¨ called qi flows through bodies along 12 channels or ¨meridians¨, and that illness and pain occur when qi cannot flow freely..........and if that´s the case then acupuncture is the right treatment for you.

Let´s just imagine that qi doen´t really exist, since it has never been proven by science (3), this doesn´t mean acupuncture doesn´t work. Maybe acupuncture works through a theory called ¨gate control theory of pain¨. The theory is based on the idea that the spinal cord contains a neural ¨gate¨ that can open and close to reduce or enhance pain messages passing to the brain. This theory seems more logical and maybe that´s why acupuncture does seem to work, or maybe it´s just all a placebo effect.

So to see if acunpuncture is a real treatment or a ¨trick¨, the scientific community has been doing trials, and a lot of trials have been done.

At the beginning these trials compared acupuncture with no treatment. These studies suffered from bias because as I mentioned in my last post: patients having any procedure tend to feel better than those who have none. So a lot of positive clinical trials came out in the 1970s, 80s and even 90s. Also a lot of positive clinical trials were coming in from China. But if you compared the clinical trials coming from China from the ones coming in from other countries, the Chinese trials were always positive!! (Most people don´t know that during the Daoguang Emperor (1782-1850) acupuncture was in decline and that it only experienced a revival in 1949 as a direct result of Mao Zedong, who promoted Chines traditional medicine during the Cultural Revolution as a way to boost national identity and deliver cheap healthcare (1,2) .

So in 2003 the World Health Organization did a review and analysis of reports on controlled clinical trials and they said that the benefits of acupuncture were either proven or had been shown in the treatment of 91 conditions!!!! (4). But... they had included all those clinical trials that I have mentioned before that were badly conducted and the ones coming in from China.

Cochrane Collaboration is a global network of experts coordinated via its headquarters in Oxford. They adhere to the principles of evidence-based medicine and what they do, is examine clinical trials and other medical research in order to offer clear conclusions about which treatments are genuinely effective for which conditions. It´s basically the  ¨gold standard¨ inside the scientific community. They disregard any clinical trial that is not reliable and only look at those in which their quality is reliable. They published their conclusions and said that there is no significant evidence that acupuncture is an effective treatment for the following conditions:  Smoking addiction, cocaine dependence, induction of labour, Bell´s palsy, chronic asthma, stroke rehabilitation, breech presentation, depression, epilepsy, carpal tunnel syndrome, irritable bowel syndrome, schizophrenia, rheumatoid, arthritis, insomnia, non-specific back pain, lateral elbow pain, shoulder pain, soft tissue shoulder injury, morning sickness, eggcollection, glaucoma,vascular dementia, period pain, whiplash injury and acute stroke (5). They did however say that it ¨could¨ help in the cases of pelvic and back pain during pregnancy, low back pain, headaches, post-operative nausea and vomiting, neck disorders and bed wetting - the important word here is ´could´.

The problem with clinical trials with acupuncture is how do you create a ¨sham¨ group or control group? With pills it´s easy, one group takes the real pill and the ¨control group¨ takes the fake pill, the patients don´t know what they are taking. After that, you just compare results between one group and the other, to see if the real pill does really have an effect or if it´s just a placebo effect. With acupuncture is quite hard because you HAVE to use needles, if not the patient is going to know the difference. So a doctor by name of Edzar Ernst and Jongbae Park created a telescopic needle- that is, an acupuncture needle that looks as if it penetrates the skin, but which instead retracts into the upper handle part (1). The needle offers some resistance as it is retracted into the upper handle. This meant that it would cause some minor sensation during its apparent insertion, so patients would think they were getting real acupuncture but were actually not.

After this new invention came out, new trials started to be conducted and the results of these trial were not that good for acupuncture (6). It showed that acupuncture is just as good as ¨sham acupuncture¨, meaning its benefits are only derived from its placebo effect. A lot of people will say who cares if it´s a placebo effect or something else, if the patient is deriving benefit from the treatment, why not just go ahead with it. I have my opinion regarding to this, which I stated in my last post. Some agree with it, some disagree with it and that´s perfectly fine, as long as you know the real reason why you are doing acupuncture or getting acupuncture.

My next post will be about pain. Do we really know what pain is?  How come people who have arthritis in their knee have no pain and some do have pain? How come people with herniation have pain in their back, and some don´t? Is pain really in the knee, back, arm......... or is it all in the head? If so, then maybe we have to start changing the way we deal with injuries or treat our patients. Until next time enjoy the weekend!

P.S. I have added a video to my last post. I would highly recommend that you take a look at it. Sometimes videos express things more clearly than I do. So far I have posted 2 videos. One in the ¨placebo¨ article and the other one in ¨the myth about fast and slow metabolism¨. Really interesting both of them.


Bibliography

1.Ernst E, Simon S. Trick or Treatment ? Alternative medicine on trial. Transworld Publishers.London,UK.2008.
2. Derbyshire D. Why acupuncture is giving sceptics the needle. The observer 2013.
3. Gorski D. A Trilogy of (Acupuncture) Terror. Science Based medicine 2013.
4.http://www.who.int/en/ . Word Health Organization.2003.
5.http://www.thecochranelibrary.com/view/0/AboutCochraneSystematicReviews.html
6. Ingraham P. Does acupuncture work for pain? http://saveyourself.ca/articles/acupuncture-for-pain.php 2009.
7. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009 Mar;15(3):213-6.

Placebo effect

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

Running

YOU CAN NOW FIND ALL MY POSTS AT http://sports-diet-pain.com/. I will not be writing anymore from here

Does performing cardiovascular exercise at lower intensity burn more fat?

I think we have all heard at one point or another that doing low intensity cardiovascular exercise will burn more fat than if we do a high intensity exercise. The explanation behind this is that fat needs more oxygen to burn. So if we are doing a high intensity activity or anaerobic activity, we will be using only carbohydrates because there is not enough oxygen to burn the fats. Well, this is false. Let me explain.
    
It´s true that you burn more fat at a lower intensity, but only as a PERCENTAGE of the total calories burned. This doesn´t mean that as exercise intensity increases, fat burned decreases. It simply means, that as intensity increases you just burn more of both (carbohydrates and fats), with carbohydrates making up the largest percentage of calories. So let´s put an example to clarify:

Low intensity exercise (walking) done during 45 minutes - imagine you burn 300 calories, of those 300 calories 60 percent are calories from fat. So of those 300 calories 180 were fat calories.

High intensity exercise (sprints) done during 30 minutes - let´s say you burn 800 calories, of those 800 calories 30 percent are calories from fat. So of those 800 calories 240 were from fat calories.

* Plus, it has been proved that, the higher the intensity is during your cardio, the more calories you will continue to burn after the exercise. This is also another reason why high intensity interval training is so effective and popular.

So in conclusion, low intenstity activity burns only a higher PERCENTAGE of fat calories, that doesn´t mean it burns more fat calories.


In my next blog I will talk about running, to see if it really is that efective in people who run to lose weight or get in shape. Hasta la proxima.

High Intensity Interval Training

There is a new trend going out there saying that High Intensity Interval Training is the best option if you want to lose weight and get in shape, and that aerobic exercise is not that useful. First like always let’s clear up the difference between one and the other.

1. High Intensity Interval Training (HIIT) - I will use the definition given by Wikipedia, since it’s pretty accurate: HIIT is an exercise strategy alternating periods of short intense anaerobic exercise with less-intense recovery periods. HIIT is a form of cardiovascular exercise. Usual HIIT sessions may vary from 4–30 minutes. These short, intense workouts provide improved athletic capacity and condition, improved glucose metabolism, and improved fat burning.

So basically the whole idea of using HIIT is to raise your heart rate and then allow it to come back down again. One example of this would be for example sprints. The person runs as fast as they can for 15 to 60 seconds, then stops, rests for 30 seconds (or until their heart rate reaches 60% of their capacity) and then does it again. They could do this for 3 series or more and that would be an example of training with HIIT (I highly recommend to train with a watch that measures your heart rate when training with HIIT).

  2.   Aerobic exercise. It’s light to moderate intense activities, and refers to the use of oxygen to meet energy demands. Running 5 km is an example of an aerobic exercise.

OK, now that we know what both things are, let’s see the benefits and risks of HIIT activity.

Benefits of HIIT.

1. A study published in the International Journal Sport Nutrition and Exercise Metabolism found that 2 minutes of intensive sprint interval training perform 3 times a week, during 6 weeks, was as good as running as 30 minutes, 3 times a week, during 6 weeks. So we can say it’s more effective for people who have less time to work-out.

2. Increases Aerobic capacity. This may seem strange to people, because when you are training HIIT you are actually doing Anaerobic, but different studies have shown that it also increases the aerobic capacity.

3. Increases Insulin sensitivity. This could be confusing to people so let me clear up what insulin sensitivity means: Insulin sensitivity describes how sensitive the body is to the effects of insulin. Someone said to be insulin sensitive will require smaller amounts of insulin to lower blood glucose levels than someone who has low sensitivity. Insulin sensitivity varies from person to person and doctors can perform tests to determine how sensitive an individual is to insulin. So the more insulin sensitive you are, the less likely you will develop type 2 diabetes. HIIT causes your muscles to absorb glucose more readily, preventing it from being stored as fat.

4. Improves fat burning. It has been proven that the higher the intensity is during your cardio the more calories you will continue to burn after the exercise!!    

Risk of High Intensity Interval Training

1. I think the greatest risk is that you probably have a higher probability of getting injured. I haven’t read any articles that say so, but that is my conclusion. The higher the intensity of the exercise, the more likely you will get injured.

2. You have to be in shape to do this kind of exercises. HIIT is not for everyone, especially people that are just starting to do sports. With HIIT your heart level reaches sometimes 90% or higher of your capacity. So I really don’t recommend this to any beginners.

Seeing the information we can see that HIIT is quite effective and probably can help you a lot in getting you in shape. HIIT will probably also help you get better physically at whatever sport you are practicing but the important thing to have in mind is that you first need a base to be able to do HIIT, and this base will only be acquired through aerobic exercise.

Having said that, I think a combination of both activities is the best option for most people. Aerobic activities have been proven to produce great effects on the body and mind of most people, but if you want to train a little harder and obtain better results you should try to “slowly” begin with HIIT.

My next blog will be about the topic or myth that exist out there, that low intense cardiovascular exercise will burn more fat than high intense cardiovascular activities. We will see if this is true and the explanation behind it. Until next time.

Does eating late make you gain weight

Most people out there think that eating food quite late or just before going to bed is going to make you gain weight, but that´s really not true. You gain weight because of calories not because of ¨TIME¨. The thing is, that most people have had their share of calories during the day and that extra meal you are going to eat before going to bed is going to add to the already enough calories you have consumed during the whole day. So let me put up an example to clarify things.

Imagine your body consumes or burns 2,000 calories (2.000 in Europe) a day. This means that if you  eat  more than 2,000 calories a day you will probably gain weight and if you eat less than 2,000 calories you will lose weight. So now imagine you have not been eating anything during the whole day and just before going to bed you decide to have a burger, with bacon , fries and everything you can imagine. If that meal you are going to eat has 1,500 calories, you are still going to lose weight because you still have a 500 calorie deficit when you go bed. Now this doesn´t mean I recommend that you have a heavy meal before going to bed, and i usually never recommend this to my clients. But I want people to understand that CALORIES make you gain weight not time.

Now once this is clarified I do want to state that the body has a biological clock that helps time our sleep patterns, alertness, mood, physical strength and blood pressure. Usually we experience a 24-hour pattern of light and dark, and our clock uses this signal to align biological time to the day and night. What this means is that under normal conditions our blood pressure decreases, body temperature drops and we get tired, meaning our metabolism slows down. Which is one of the reasons why I don´t recommend eating heavy before going to bed.

So in conclusion: CALORIES make you gain weight not time, but eating heavy meals at night is usually not a good idea.


I have done 3 blogs about diet, so now I will change topics and start talking about sports, in particular about cardio training. So until next time.

Metabolism - The myth behind slow and fast metabolism

You always hear people say that they are fat because they have a slow metabolism or that they are skinny because they have a fast metabolism, but research has shown that to be false, unless you have a problem with the thyroid gland or some other medical disorder, which very few people have. Most of the time the person that is overweight is so because either he is eating too much or moving too little and the person that is skinny is so because either he is eating too little or moving too much.

First let´s clear up a couple of confusing terms:

• Metabolism - is the name for the process your body uses to convert the food you eat into energy.
• Basal Metabolic Rate - is the energy your body burns when you are not ACTIVE. Basal Metabolic Rate is determined by how much weight and muscle your body has. Muscle burns more calories than fat, approximately in between 6-10 calories per pound (25 calories per kilo), and fat burns around 2 calories per pound. This is also very interesting because people always think (I was one of them) that muscle burns many more calories, but it actually only burns 4 to 6 calories more!! That´s nothing!
• Basal Metabolic Rate plus the energy required for physical activity make up our TOTAL ENERGY EXPENDITURE. Your total energy needs depend on how active you are.

Often, overweight people believe they eat very little and still put on weight, hence the 'slow metabolism' theory, but research has shown people tend to eat more than they think. Also, a very interesting fact is that overweight people usually use more energy to keep their bodies working because they need more energy to keep the blood flowing around their body, meaning their Basal Metabolic Rate is actually higher than skinnier people.

So analyzing all this information, it´s safe to say that people that are overweight are usally so because they are eating more than they are supposed to and moving less than they should, it´s that simple. 

Here is a link that BBC did on this Myth. It´s a two part presentation each lasting 9 minutes long. I highly recommend that you all take a look at it.

http://www.youtube.com/watch?v=bt-qKTaEMIQ

http://www.youtube.com/watch?v=PTx-D5NJ_kU

My next blog will talk about eating late. People always think that eating something heavy for dinner will make you fat. But is this is really true? We will see that next week, until then, enjoy the weekend!

Diet - Metabolism

Each week I will talk about one of three main topics that this blog is about, meaning sports, pain or diet. So I have decided that this week I will talk a little about diet since there are so many myths and questions about it.

Let´s start with some basic stuff everyone should know about:
                           1 gram of fat contains = 9 calories
                           1 gram of  protein = 4 calories
                           1 gram of carbohydrates = 4 calories
                           1 gram of alcohol = 7 calories (empty calories)

1 pound of fat contains around 3,500 calories, for my European friends 1 kilogram = 2.2 pounds, so that means that one kilo of fat is more or less 7,700 calories.

An active man burns about 2,800 calories per day naturally, followed by active women and sedentary men at 2,200 calories and sedentary women and older adults at 1,600 calories.

Given all this information we can see that loosing ¨FAT¨ is quite hard because it contains a lot of calories. So when you hear or read about these miracle diets that say ¨lose up to 8 pounds (3,6 kilos) in one week¨ or some other promise, you have to be careful because losing weight and losing fat is not the same thing. A lot of these diets cause you to lose weight because of water loss or protein (muscle) breakdown, not just because of fat. Remember ,1 pound of fat has 3,500 calories, so if you wanted to lose 8 pounds of fat in one week that would mean that you would have to burn 28,000 calories!! That´s 4,000 calories a day!! It´s almost impossible, unless you are running a marathon every day. So remember people, there are not such things as miracle diets and if you want to lose weight the ideal would be to lose around 1-2 pounds a week.

My next post will be about the metabolic rate. You always hear people saying ¨well I´m fat because I have a slow metabolism¨ or ¨I´m skinny because I have a fast metabolism¨, but does that really exist? I will talk about it in my next post.

Presentation

Hello, my name is Pedro Carnicero and I am a physical therapist/ personal trainer from Madrid, Spain.

I have worked and lived in four different countries : USA, SPAIN, GERMANY, and BELGIUM. 

During my years of work and travel I have noticed the obsession that people have with sports, diet and pain. 

For example, every time I introduce myself to someone and I tell them what I do I always get asked either a question about how to lose weight/ how to gain more muscle, or about a pain they have. I most of the time give them an answer but to my surprise many of them say ¨well my trainer says something else¨, or ,¨ I read in such and such magazine that you have to do this and that to get bigger¨, or ¨my physical therapist says something else¨. That is when I ask to myself why the hell did they ask me in the first place if they already have the answer? But I guess that is human nature, we want as much information as possible. And that is one thing we have too much of today... INFORMATION. 

With the new technologies and Internet, today in age you can get or read about almost anything you want and that is where the problem starts. How do you know if what you are reading or getting is the truth? Well, this is the purpose of this blog: to talk about the TRUTH and dismantle the MYTHS that exist in SPORTS/ DIET AND PAIN because nowhere else are there more MYTHS than in these three subjects. All the information that will be given will be scientifically proven information about the subjects in question.