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!