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Archive for October, 2013

Sugar, the hidden enemy – part 2

In the last blog I talked about what sugar is, what it consist of, and how it is broken down in the body. I also mentioned that High Fructose Corn Syrup and sugar are basically the same thing, and that the difference between these two things and other carbohydrates is the molecule fructose. This fructose molecule and the way the body metabolizes it, may make it singularly harmful, at least if consumed in sufficient quantities(1-3).

They have done different studies on animals and have seen that if the fructose hits the liver in sufficient quantity and with sufficient speed, the liver will convert much of it to fat(4). This, according to the studies, will lead to a condition know as Insulin Resistance. So what is Insulin Resistance?

  • INSULIN RESISTANCE – When you eat something ( particular carbohydrates) your body responds by secreting insulin, to keep blood sugar in control after a meal. When your cell´s become resistant to insulin, your pancreas responds to rising blood sugar by pumping out more and more insulin. At the end your pancreas will no longer be able to keep up, this will lead to your blood sugar to rise out of control, and eventually you will probably get type 2 diabetes. Some people who are insulin resistance may NOT get diabetes, as somehow their body will continue to secrete enough insulin to overcome their cell´s resistance. But having elevated insulin levels is also quite bad, as it can lead to heart disease.

So basically the theory goes like this, accumulation of fat in the liver will lead to insulin resistance. You may ask yourself that maybe simply getting fatter leads to a fatty liver? But, this does not explain fatty liver in lean (skinny) people. According to Prof Lustig, the fat in the liver is caused by the fructose found in the SUGAR (5)!! Because the fructose component of sugar is metabolized primarily by the liver, while the glucose from sugar is metabolized by every cell in the body. So consuming sugar means more work for the liver. And this has been demonstrated in laboratory rats (6).  Whenever they wanted to create insulin resistance on them, they would just simply feed them diets consisting of pure fructose or sugar.

Now, I don´t want people to panic and think that fructose is horrible. Fructose is horrible if eaten in abundance. The dosages of fructose required to produce negative effects are quite high. Not impossible to reach through dietary means but almost impossible through fruit alone!!  I say this because, as most of us, know fruit is made up of fructose, and some people may think this is bad and the reason why they aren´t losing weight. But this is FALSE. What´s bad for you is the regular consumption of sugar sweetened beverages and all that sugary food we are always eating. Plus, fruit contains a lot of vitamins, minerals and other important nutrients, as well as fiber (7,8). Fiber helps slow your absorption of fructose. The slow absorption minimizes any surge in blood sugar(9).

So how much Fructose should you be eating? According to different clinical trials, 25-40 grams of fructose per day is totally safe. That´s 3-6 bananas, 6-10 cups of strawberries, or 2-3 apples per day(11). But for all those who drink a lot of sugar sweetened beverages or other ¨ junk food¨, I want to give an example so that you guys understand where the problem is really coming from(11).

  • A 20- ounce bottle of soda contains 35 grams of fructose (10,11)!!
  • If you eat a dessert with 50 grams of sugar – remember sugar is made up of 50% glucose, 50 % fructose – you are getting about 25 grams of fructose(11).
  • And let us not forget that HIGH FRUCTOSE CORN SYRUP is about 55% fructose, 45 % glucose, and this is found in many processed foods, fruit juices, sports-drinks, energy drinks and so on(11).

So now you tell me, where is the problem coming from? Why is sugar the hidden enemy? And how can we stop this obesity and diabetes epidemic?

Here is a link to a great video done by Prof. Lustig it has gotten 4 million views., it´s 1 hour and 20 minutes but it´s worth it.


  1. Wiernsperger N. Hepatic function and the cardiometabolic syndrome. Diabetes Metab Syndro Obes, 2013 Oct 10;6:379-88.
  2. Song M, Schuschke DA, Zhou Z, Chen T, Shi X Zhang J, Zhang X, Pierce WM jr, Johnson WT, Vos MB, McClain CJ. Modest fructose beverage intake causes liver injury and fat accumulation in marginal cooper deficient rats. Obesity (silver Spring). 2013 Aug:21(8):1669-75.
  3. Botezelli JD, Cambri LT, Ghezzi AC, Dalia RA, Voltarelli FA, de Mello Ma. Fructose-rich diet lead to reduced aerobic capacity and to liver injury in rats. Lipids Health Dis. 2012 Jun 19;11:78
  4. de Castro UG, Dos Santos RA, Silva ME, de LIma WG, Campagnole-Santos MJ, Alzamora AC. Age-dependent effects of high-fructose and hig-fat diets on lipid metabolism and lipid accumulation in liver and kidney of rats. Lipids Health Dis.2013 Sep18;12(1):136.
  5. Lustig RH. Fructose: It´s ¨alcohol without the buzz¨. Adv Nutr, 2013 Mar 1; 4(2):226-35.
  6. Lanaspa MA, Ishimoto T, Li N, Cicerchi C, Orlicky DJ, Ruzicky P, Rivard C, Inaba S, Roncal-Jimenez CA, Bales ES, Diggle CP, Asipu A, Petrash JM, Kosugi T, Maruyama S, Sanchez-Lozada LG, McManaman JL, Bonthron DT, Sautin YY, Johnson RJ. Endogenous fructose production and metabolism in the liver contributes to the developmetn of metabolic syndrome. Nat Commun.2013;4:2434
  7. Larsson SC, Virtamo J, Wolk A. Total and specific fruit and vegetable consumption and risk of strok3: a prospective study. Atherosclerosis, 2013 Mar; 227(1):147-52.
  8. Steinmetz KA, Potter JD. Vegetables, fruit, and cancer prevention: a review. J Am Diet Assoc.1996 Oct;96(10):1027-39.
  9. Ulrich IH, Albrin MJ. The effect of dietary fiber and other factors on insulin response: role in obesity. J Environ Pathol Toxicol Oncol.1985 Jul;5(6):137-55.
  10. Bray GA, Popkin BM. Calorie-sweetened beverages and fructose: what have we learned 10 years later. Pediatt Obes 2013 Aug;8(4):242-8.
  11. Matthew M. Do Fructose and Fruit Make You Fat and Unhealthy? www.muscleforlife. com April 15,2013.

Sugar, the hidden enemy!

As I have mentioned in other posts(, there has been a huge increase in obesity and diabetes in the last 50-60 years. It is such a huge problem that obesity is now a World Wide Epidemic, and recent studies are suggesting that a reason for this is the increase in amount of sugar we are eating. First, let´s explain what sugar is.

Sugar is not only the white granulated stuff that we put in coffee and sprinkle on cereal -which by the way is called sucrose- but also high-fructose corn syrup. High-fructose corn syrup replaced sugar in sodas and other products in the early 1980s, in part because refined sugar then had the reputation as generally noxious nutrient (meaning a bad nutrient). High-fructose corn syrup was portrayed by the food industry as a healthful alternative, and that is how the public perceived it. But recently this has started to change, companies have realized that high-fructore corn syrup was getting a bad rap and have decided to start using sugar again, saying that it is healthier, but is this true?

Well, according to professor Robert Lustig -a specialist on pedriatic hormone disorders and the leading expert in childhood obesity at the University of California- sugar and high fructose corn syrup are the same, meaning they are both bad, he even uses the word poisonous!

Refined sugar (that is sucrose) is made up of a molecule of the carbohydrate glucose, bonded to a molecule of the carbohydrate fructose, so it is 50-50. The fructose, which is almost twice as sweet as glucose, is what distinguishes sugar from other carbohydrate rich foods like bread or potatoes that break down upon digestion into glucose alone. High-fructose corn syrup is 55% fructose and 45% glucose. So you see, there isn´t really a big difference between sugar and high fructose corn syrup. Now let us get to the important  information and find out why both of them are quite bad.

  1. Refined sugar and high fructose corn syrup don´t come with any protein, vitamins, minerals, antioxidants or fiber, in other words they are basically empty calories.
  2. According to Prof Lustig ¨sugar has unique characteristics, specifically in the way the human body metabolizes the fructose in it¨. So let me give an example to explain things better. Imagine we eat 100 calories of glucose (from a potato or bread) or 100 calories of sugar (half glucose and half fructose). Those 100 calories which are the same will metabolize differently and have a different effect on the body, because the fructose component of sugar and high fructose corn syrup will primarily be metabolized by the liver, while the glucose from sugar and carbohydrates(potato, bread) will be metabolized by every cell in the body.
  3. They have done studies on animals and have seen that if the fructose hits the liver in sufficient quantity and sufficient speed, the liver will convert much of it to fat. When you take sugar in liquid form (sodas), the fructose reaches the liver faster. This apparently induces a condition know as insulin resistance, which is considered the fundamental problem in obesity, diabetes and heart disease.

Since I want you guys to stay with me I´m going to recap.

  • Sugar (sucrose) is 50% glucose and 50% fructose
  • High Fructose Corn Syrup (HFCS) is 45% glucose and 55% fructose.
  • Refined sugar and HFCS are basically empty calories.
  • The molecule of fructose found in sugar and HFCS is broken down by the liver. If the fructose hits the liver in sufficient quantity and with sufficient speed, the liver will convert much of it to fat. This apparently induces a condition know as INSULIN RESISTANCE.

I will leave it like that for the moment since there is a lot of information for you guys to absorb, but in my next post I will try to explain what insulin resistance is, why it leads to diabetes, and how all this is related to SUGAR.


Lustig RH. Fructose: It´s ¨alcohol without the buzz¨. Adv Nutr, 2013 Mar 1; 4(2):226-35.

BasuS, Yoffe P, Hills N, Lustig RH. The relationship of sugar to population-level diabetes prevalence: an econometri analysis of repeated cross sectional data. Plos One, 2013:8(2)

Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann N Y Acad Scie, 2013 Apr; 1281:123-40.

Lower back pain part 3: Prevention

Ok, so in part 2 of lower back pain I explained a little about what a herniation is, now I want to start talking about how to prevent a herniation. First, let me go into a little more detail about what a disc is. ( read and )

A disc is the substance between the vertebrates. It has a nucleus and a annulus. The annulus surrounds the nucleus and prevents it from coming out. The nucleus is a gel like substance, and a herniation is when the annulus breaks and the nucleus comes out ( more or less). The disc varies in size depending on the time of day. In the morning the discs are usually bigger than at night, because we have been laying down for hours and the discs have absorbed liquids. That is why in the morning we are usually taller than at night and a reason why we shouldn´t be doing flexion activities in the morning. The bigger the disc, the more stress you put on it and on your ligaments. A study estimated that disc-bending stresses were increased by 300% and ligament stresses by 80% in the morning compared to the evening (1). In another study it was demonstrated that simply avoiding full lumbar flexion in the morning reduced back symptoms (2). So first factor in preventing herniation and lower back pain, don´t do flexion activity in the morning, wait at least 30 minutes to an hour, that is usually what it takes for the disc to return to normal size.

Spine has memory. The function of the spine is modulated by certain previous activity. This occurs because the loading history determines disc hydration, which in turn modulates ligament rest length, joint mobility, stiffness and, load distribution. In simple words, when we are sitting down, we are in flexion. This means that the nucleus of the disc has moved posteriorly, and we have ¨stretched¨ the posterior ligament (3). So it would be unwise to lift things after a bout of prolonged flexion, like for example when we are sitting for a long time . Then, a second factor in preventing herniation and lower back pain, don´t lift things up after being in flexion for a long time. Meaning if you have sat down the whole day, don´t go right away and try to pick up something heavy, the changes of hurting yourself are going to increase. All you have to do is stand up, wait 5 minutes, and your changes of getting hurt will greatly diminish. This can also be said to all those that play sports like for example, basketball. When you are on the bench sitting down, you are in flexion. So it would be much wiser, if you know that you are going to go into the game, to stand up, or to try sit in a way that your back isn´t in flexion.

Too much of anything is usually bad. In a study done in 1975 (4-5) , it proved that seated work posture creates an increase in lower back pain (LBP).  Another one  in 1996 (6)  also suggested that people who sit for long periods of time have a greater risk of low back troubles (8%), but what was even more interesting is that active workers, meaning people who worked moving around or standing up, reduced their probability of getting back pain by 14% if they would sit once in a while. This suggest that variable work, and not too much of any single activity is the best thing. In other words, if your job consist of sitting down the whole day, it would make sense to get up and move around once in a while. And if your job consist of being active the whole day, it would be clever to do the opposite. So any business man out there thinking of creating their own business or ones who already have one, make your workers do VARIABLE WORK, and you will save up money in the long run.

I already said how easily it is to hurt yourself from flexing your back, how you shouldn´t pick up heavy things after prolonged bouts of flexion, how the best thing to do to prevent LBP is to do variable work, but the number one thing you should really try to avoid is FREQUENT BENDING AND TWISTING (gardening is an example of frequent bending and twisting). The U.S. Department of Labor (1982) and many more studies noted the increased risk of lower back pain from frequent bending and twisting (7-8). In this report vibration was also included, especially seated vibration. So all those power plates fanatics carefull with the vibration (7,9).

80 % of us will probably get back pain at one point or another, that´s a lot! But I´m pretty sure that if we try to avoid things I have mentioned in this blog the chances of us getting hurt will greatly diminish.

Hope you enjoyed it


  1. Adamas M, Dolan P. Diurnal variations in the stresses on the lumbar spine. Spine 1987,12(2):130.
  2. Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann KB. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. Spine 1998, 23: 2601-07.
  3. Mcgill S. Low Back Disorders Evidence Based Prenvention and Rehabilitation 2nd. Human Kinetics 2007.
  4. Kelsey JL. An Epidemiological Study of Acute Herniated Lumbar Intervertebral Disc. Rheumatol Rehabil 1975:14;144-5.
  5. Kelsey JL. An Epidemiological Study of Acute Herniated Lumbar Intervertebral Disc. Int J. Epidemiol:4;197-204.
  6. Liira JP, Shannon HS, Chambers LW, Haines TA. Long-term back problems and physical work exposures in the 1990 Ontario Health Survey. Am J Public Health. 1996;86:382–387.
  7. The U.S Department of Labor Report (1982)
  8. Marras WS, Lavender SA, Leurgans SE, Fathallah FA, Ferguson SA, Allread WG, Rajulu SL. Biomechanical risk factors for occupationally related low back disorders. Ergnomics 1995 Feb:38(2):377-410.
  9. Seroussi RE, Wilder DG, Pope MH. Trunk muscle electromyography and whole body vibration. J Biomech 1989:22(3):219-29.

How much water do we really need to drink?

I think we have all heard at one point or another in our life that drinking 2 liters of water per day does wonders to your mind and body. But is this really true? Let´s find out.

2 Liters per day is about drinking 8 glasses of water per day, and if you have ever tried doing that, you have realized that you spent a lot of time in the toilet. So, where did this mythical number come from? Why 2 liters and not for example 1.5 or 3 liters?  Well, it probably started from a study done in the 1940s, where researches calculated that 2 liters is how much water a person’s body consumes in 24 hours, so WALLAH, there you have it, that´s where the magical number comes from. But what also came out of that study, and what a lot of people don´t know, is that we get much of the water we need each day from our food, and this does not include the number of drinks like coffee and tea most of us consume every day. And NO, coffee and tea DON´T DEHYDRATE YOU. Although coffee and tea may act as diuretics, the amount of dehydration caused by these beverages is not equivocal to the volume of the fluid. Caffeine has been shown to cause one milliliter of fluid loss per milligram of caffeine. So let´s give an example to explain.

  • A normal cup of 260 milliliter of coffee has around 90 milligrams of caffeine, so if the caffeine causes one milliter of fluid loss per milligram you would still have 170 milliliter of liquid, So, in other words you gained 170 milliliter of liquid, that´s called hydration.

So we know half of our body is made up of water, we know water is vital to keep the important chemical reactions in our body functioning. But the idea that you should drink 2 liters of water per day has absolutely no evidence to back it up. So what should you ? Drink when you are thirsty, if you have to drink more than 8 glasses per day do it, if you have to drink less than that also do it. In other words, listen to your body and you will be perfectly fine.


Fink H, Burgoon L, Mikesky A. Practical Application in Sports Nutrition. Jones and Bartlett Publishers, Inc 2006.

Grandjean AC, Reimers KJ, Bannick KE, Haven MC. The effect of caffeinated, non-caffeinated, caloric and non-caloric beverages on hydration. J Am Coll Nutr. 2000;19:591–600.

Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2004). Accessed October 11, 2006.

Lower back pain part 2: Herniation

In one of my  previews blogs I already talked a little about herniation (, but this one is going to be entirely about it.

People are afraid of  a herniation and whenever they hurt their back they automatically think they have a herniation. So, what they do when they hurt their back is go straight to the doctor. The doctor (hopefully) will do a couple of test on you to see that you don´t have any ¨red flags¨, meaning serious injuries, and he might do an X-ray or an MRI on you. Hopefully, if he is a good doctor and has seen that you don´t have any red flags, he will just reassure you that you don´t have anything serious, tell you to try to keep active, and maybe give you something for the pain. I say ¨keep active¨ because different studies have seen that bed rest worsens the condition. At most, and if the pain is really bad, you could do bed rest for 1 or 2 days but never more than 2 days (1). However, if he is not such a good doctor he will send you to have an X-ray or MRI. Patients with simple back pain and no red flags do not need any diagnostic investigations in the first month of symptoms (2). Now, you may ask yourself why this is bad. This is bad because, as I´ve mentioned before in other blogs, 70% of us possible have a disc herniation, disc degeneration, or some other structural abnormality and are asymptomatic, meaning we have no pain (3). So if we have back pain and the doctor sends us to have an MRI he will probably find something wrong with us, but this is probably not the cause of our pain. So, now we will be mislabeled and potentially be receiving unnecessary treatments, but even worse, now we will think ourself as being ¨sick or having something wrong with us¨. And this will probably lead us to having more pain, more absenteeism (sick leave, time off work), decreased productivity while at work, loss of earning, and having a poorer health status (4) . But anyway, this is beyond the scope of this blog. So let us get back to herniation and how we can prevent it.

In one of my previous blogs, I mentioned that it is almost impossible to herniate yourself without being in full flexion and having a compressive force act over the vertebrae (5). A compressive force can be produced by an external weight, like for example a backpack, or by our own muscle. Every time a muscle contracts it produces a compressive force somewhere in the body, so you don´t even have to be picking up something heavy to herniate yourself. Now this is where I´m going to surprise more than one, when you are sitting down you are basically in flexion, your lower back is bend, this causes the nucleus inside the disc (the disc is made of an annulus and a nucleus, the nucleus is gel-like substance and is surrounded by the annulus) to deform posteriorly. This is why sitting down for a long time is bad, because it stresses the tissues. Human beings were not made to perform repetitive work that emphasizes only a few tissues. Nor were humans designed not to be stressed. Research has established that tissues adapt and remodel in response to load (6-8). Too little activity can be as problematic as too much(9) .So let me give an example for you guys to understand what I have just said:

  • In the 1960s, in a power plant in the USA, operators had to respond to a vigilance buzzer on their desk that went off every 10 minutes. At each buzzer interval they would stand and walk around the control panel making adjustments. There was no history of back trouble. As technology got better, they changed the plant so that workers did not have to get up anymore from their desk every 10 minutes. These workers worked 12 hour shifts but now most of the time they were seating down. Well guess what, back problems increased and they had to hire a consultant to help them with their problem.

So, what I basically want you guys to understand is that too much of anything is bad and sitting down for long periods of time is horrible. So all you have to do is get up once in a while.  I always recommend my clients that at least once an hour they have to stand up. And if you have a boss that won´t let you get up, just tell him, first and foremost to read my blog and second that you are saving him money!!

This was only part 1 of herniation, in part 2 I will talk about things you can do to prevent a herniation.


  1. Deyo RA, Diehl Ak, Rosenthal M. How many days of bed rest for acute low back pain? New England Journal of Medicine 1986;315:1064
  2. Liebenson Craig. Rehabilitation of the Spine. A practicioner´s manual. Lippicott Williams & Wilkins 2007. pg 131.
  3. Kim S, Lee Hoo T, Lim Mee S. Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 1: Lumbar Spine. Journal of Korean Neutrosurgical Society 2013 January;53(1): 31-8.
  4. Kendrick D, Fielding K, Bentler E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: Randomized controlled trial. BMJ 2001;322:400-05.
  5. McGil S. Low Back Disorders 2nd Edition. Human Kinetics 2007 pg 45.
  6. Carter DR. Biomechanics of bone. In: Nahum HM, Melvin J. Biomechanics of trauma. Norwalk, CT: Appleton Century Crofts.
  7. Porter RW. Is hard work good for the back? The relationship between hard work and low back pain-related disorders. International Journal of Industrial Egonomics 1992;9:157-60.
  8. Woo Y, Gomez MA, Akeson WH. Mechanical behaviors of soft tissues: Measurements, modifications, injuries, and treatment. In: Nahum HM, Melvin J. Biomechanics of trauma (pg 109-33). Norwalk, CT:Appleton Century Crofts.
  9. McGill S. Low Back Disorders 2nd Edition. Human Kinetics 2007 pg 153.

Lower back pain

I don´t want to sound negative or anything, but most of you who will read this blog will, or already have had, an episode of lower back pain. To be exact and according to different studies, low back pain affects 80% of the population at one time or another in their life. Just so that you get a sense of how big lower back pain is I will mention some statistics:

  1. It is the 2nd most common reason for seeing a physician/doctor.
  2. It is the 2nd most common reason for disability, 100 million lost work days a year (1)!!
  3. It is also tremendously expensive, 100 billion dollars are spent each year treating this problem (2-3)!

So seeing its importance, I think we should talk about it a bit and try to dismantle some myths about it. First, I want people to understand that lower back pain can usually be classified into 3 different groups:

  • First red flags: These are caused by serious disease such as a tumor, infection or a fracture. Less than 2% of the people who have lower back pain, have it because of ¨red flags¨(4-6).
  • Second-Nerve compression: This affects less than 10% of the people who get back pain. An example of this could be sciatica.
  • Third Non specific mechanical factors: This basically means we have no IDEA why your back hurts and around 85-90% of the cases fall into this third class (4-6).

So, if you take into account what I just told you, less than 15% of the patients who have lower back pain (LBP) can be given a precise pathoanatomical diagnosis!! The other 85% are sometimes labeled with general terms such as sprain/strain or ¨non-specific¨, in other words they don´t know why your back hurts. The ¨good¨ thing about lower back pain is that it usually has a favorable natural history, meaning that only 5% of the patients with lower back pain will go on to have chronic lower back pain while the rest will (more or less) recover.

Ok, now that we know a bit about what lower back pain is and how it is classified, let´s start talking about some of the myths that exist out there on LBP.

  1. First myth and probably one that you have all heard at one point or another. Strengthen muscles in torso (back) or abdomen to prevent LBP. Until today there has been NO study that has demonstrated this. What has been demonstrated is that ENDURANCE and not strength is a key factor in preventing LBP (7).
  2. Second myth: performing sit-ups or crunches will increase back health. I already talked about this in my blog (here is a link to where you can read it, but just to summarize: no one should be performing sit-ups (8).
  3. Third myth: Tight hamstrings lead to back trouble. This is false, there is no study that demonstrates this. What can lead to back trouble is asymmetry, meaning if you have more flexibility in one leg compared to another (7-10). Also, some studies have shown that the more flexibility one has in the back, the greater the risk of having future back troubles, at least in ¨normal people¨. This doesn´t mean that people should not stretch, mobility is important and so is flexibility but too much can maybe lead to back trouble.
  4. Fourth myth: If you sit straight or on a Pilates ball you will prevent back troubles. First I want people to understand that there is no such thing as an IDEAL sitting posture. Tissue loads must be migrated from tissue to tissue to decrease the risk of any single tissue´s accumulating microtrauma. This is accomplished by changing posture. Even the ideal posture, where they tell you to adjust the chair so that the hips and knees are bent 90 degrees and the torso is upright, is only ideal for about 10 minutes. After 10 minutes tissues deform and the best thing to do is change posture again. So let me repeat this again, THERE IS NO SUCH THING AS AN IDEAL SITTING POSTURE, the best thing is to change posture every 10 minutes (11).
  5. Fifth myth: To avoid back injury when lifting, bend the knees not the back. This is partly right but also partly wrong, because to bend your knees or your back depends on a lot of things. Like the dimensions and properties of the load, the characteristics of the lifter, the number of times the lift is to be repeated, and so forth, and there may in fact be safer techniques altogether. Let´s use an example of a golfer, imagine every time he has to pick up a golf ball he has to squat, meaning bend his knees. Ok, maybe his back wouldn´t get hurt but his knees are sure going to hurt after 18 holes of play. So, to keep a straight back would be ideal but in most cases this is not REALISTIC. What you should always avoid when picking things up is a fully flexed spine.

I could go on with more myths but I think those are the most important. So it´s time to move and start talking about factors that we can do to prevent low back pain, but before this I will first talk about herniation. What exactly is a herniation? Is it really that bad, and how do we avoid herniation. This and more in my next blog. Until then.


  1. Biering-Soerense F. A prospective study of low back pain in a general population. Occurence, recurrence, and etiology. Scand S Rehabilitation Med 1983;19:71.
  2. Cats-Banil WL, Frymoyer JW. Demographic factors associated with the prevalence of disability in the general population. Analysis of the NHANER I data base. Spine 1991;16:671-71.
  3. Hashemi L, Webster BS, Clancy EA, Volinn E. Length of disability and cost of workers compensation on low back pain claims. J Occup Environ Med 1998:40:261-66.
  4. Agency for HEalth Care Policy and Research (AHCPR). Acute low back problems in adults. Clinical Practice Guideline Number 19. Washington DC, US. Government Printing. 1994.
  5. Danish Health Technology Assessment (DIMTA). Manniche C, et al. Low back pain. Frequency Managemente and Prevention from an HAD. Perspective. 1991.
  6. Royal College of General Practioners (ACGP). Clinical Guideline for the management of Acute Low Back Pain. London Royal College of General Practicioner.1999.
  7. Biering-Sorense F. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine, 1984: 9:106-19.
  8. Battie MC, Bigos SJ, Fisher LD, Spengler DM, Hansson TH, Nachemson AL, Wortley MD. The role of spinal flexibility in back pain complaints within industry: A prospective study. Spine 1.
  9. Axler CT, Mcgill SM. Choosing the best abdominal exercises based on knowledge of tissue loads. Medicine and Science in Sports and Exercise. 1997: 29:804-11.
  10. Hellsing AL. Tightness of hamstring and psoas major muscles. Upsala Journal of Medical Science 1988. 93:267-76.
  11. Callaghan J, McGill S. Low back joint loading and kinematic during standing and unsopported sitting. Ergonomic 2001 :44(3):280-94.


I think by now we all know how good exercise is and the benefits we receive from it, like for example, reducing most people´s risk of developing diabetes and growing obese, but still people don´t do it. So how can we change this? Maybe by giving them more information and making them realize that exercise is not only going to improve their quality of life but also help them in their job.

For some people their job is everything, so if we can show that exercise will help them in their job, then maybe this will make them live a more active lifestyle.

A recent study published in the Journal of Neuroscience has seen that physical activity reorganizes the brain, so that its response to stress is reduced and anxiety is less likely to interfere with normal brain function. What this study did was to compare two groups of mice. One group was given unlimited access to a running wheel, while the other group had no running wheel. Usually, a normal mouse will run up to 4 kilometers any given day. After 6 weeks, the mice were exposed to cold water for a brief period of time. And what the scientists were able to see is that the brains of active and sedentary mice behaved differently almost as soon as the stressor (cold water) occurred. What happened is that in the brains of active mice there was a spike in the activity of neurons that shut off excitement in the ventral hippocampus, a brain region shown to regulate anxiety, while in the sedentary mice this did not happen.

This basically means that physical activity reorganizes the brain so that its response to stress is reduced and anxiety is less likely to interfere with normal brain function. This is very important and something we should not forget, but something almost as important is that the brain can be extremely adaptive!! What I mean by this is that the brain may create anxiety in less physical fit people for a reason. Anxiety often manifests itself in avoidant behavior and avoiding potentially dangerous situations would increase the likelihood of survival (Remember that the last 10,000 years only represent 1% of human evolution). So from an evolutionary point of view, maybe anxiety was good to protect the less physical fit people, but now in age we don´t really need it.

So in conclusion:

  1. Exercise reorganizes the brain to be more resilient to stress.
  2. The people who exercise will usually have less anxiety.
  3. Anxiety, from an evolution stand point, was good to protect the less physical fit people, but now in age we don´t really need it.
  4. The brain can be extremely adaptive.


Scoenfeld T, Rada P, Pieruzzini P, Hsueh B, Gould E. Physical Exercise Prevents Stress.Induced Activation of Ganule Neurons and Enhances Local Inhibitory Mechanisms in the Dentate Gyrus. Journal of Neuroscience. May 2013.

Abdominal part 2

Last week we talked a little about certain myths that exist around the abdominal and about what the abdominal really is. This time we will talk about how to properly train the abdominal and things you shouldn´t be doing, like for example sit-ups.

Before talking about sit-ups, I first have to talk a little about the lower back, so that everyone understands what I will be saying later on in this blog.

As most people know, the back is made up of vertebrae and in between these vertebrae we have discs. A herniation occurs when a disc comes out posteriorly (it can also come out anteriorly but this is very rare). The bad thing of a herniation is when it ¨pinches¨ a nerve, this can lead to the terrible ¨sciatica pain¨. Well, recent studies have shown that a herniation is almost impossible without full flexion of the back, to be exact you need a compressive load and flexion (1). This is where it gets interesting: a compressive load doesn´t have to be produced by an external weight, like for example carrying a backpack, but compressive load is also produced by our own muscle!!

Every time a muscle contracts, it produces a compressive load somewhere in the body. That is normal but some exercises produce more than others and the traditional full sit-up imposes approximately 3300 N of compression load on the spine (2), you might think this is not a lot but the National Institute for Occupational Safety and Health (NIOSH) has set the action limit for low back compression at 3300 N (3); repetitive loading above this level is linked with higher injury rates in workers!! So if you take into account that when performing a sit-up you are in flexion, and then the compression force produced by the exercise, you realize just how bad sit-ups really are. A curl-up, for example, produces a compression force of 2009 N (2) but the good thing is that with a curl-up you don´t really flex your back. But even a curl-up really doesn´t work the abdominal the way it is supposed to. So how do you really train the abdominal? Let´s first explain what the abdominal really does.

The main purpose of the abdominal is not to flex the body, most of  us think that is the main purpose and that is why we have always done curl-ups and sit-ups and other flexion exercises, but it really isn´t. The main purpose of the abdominal is to transmit forces produced in our hips to our shoulder, or the other way around, and it does this by preventing as little movement as possible and maintaining a stiff torso. For example, if a sprinter didn´t have a stiff torso he would lose energy, that is why most sprinters run with very little motion in the spine (Michael Johnson, Usain Bolt) and have a great abdominal. There are of course exceptions, if your job or your physical activity requires a lot of flexion then maybe you should train with curl-ups and sit ups, but very few people have those kinds of activities. So to train the abdominal we should be ¨straight¨. For example, most people don´t know this but, when you are doing push-ups your abdominal is working and it only produces a compression force of 1838 N on the back (2).

With this information you should be able to think of some good abdominal exercises, but just in case I will name some. These exercises are not for everybody because some of them are quite hard, but even the hard ones can be made easy. You just have to remember that in all the exercises there should be spine stability, meaning there should not be any movement in the spine. Let us take an example of a hard exercise that can be made easy: the plank on the ground. This is quite hard but can be done on the wall standing up, which is much easier and for beginners. So let´s start listing a couple of good abdominal exercises. I will just mention four. These exercises are quite hard and are not for beginners.

  1. Planks: You are in a typical push-up position but instead of resting on your hands, you rest on your forearms. In that position, squeeze your ass as hard as possible, and at the same time try to bring your elbows back towards your legs. You are not actually moving your elbows, you are just producing a force without movement. You should really feel it in your abdominal.
  2. Side bridge: this one is hard to describe so I add a link so that you can take a look at it.
  3. Stir the pot: this is a very hard exercise. You are in a plank position but your forearms are on a fitball. From this position you make circles with your arms. The important thing here is that there should not be any movement in your spine. Everything comes from your arms and shoulders:
  4. Medicine ball tosses are an excellent progression to power and speed strength. Quick catch and throw sequences are a form of plyometric training to enhance the elastic energy storage and recovery system of the abdominal wall. The important thing with medicine ball tosses is that the hip and the shoulder move at the same time. This video explains 3 medicine ball tosses perfectly:

And to finish off, I will recommend this video where Dr. Stuart Mcgill explains different exercises and basically everything I have written about in this blog:  I highly recommend you guys watch this one, it´s only 5 minutes long!!


  1. Callaghan JP, Mcgill S. Intervertebral disc herniation: Stuides on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clinical Biomechanics 2001, 16(1):28-37.
  2. Axler C, Mcgill S. Low back loads over a variety of abdominal exercises: Searching for the safest abdominal challenge. Med Sci.Sports.Ex 1997,29(6):804-11.
  3. The National Institude for Occupational Safety and Health 1981.


Abdominal, I don´t think there is a more popular muscle group than this one. Everyone is obsessed with it. But why this obsession? And are they really that important?

First, let me describe what the abdominal muscle group is. The abdominal muscle group is composed of:

  1.  Rectus abdominis:  this is a muscle that goes from your sinfisis pubis, pubic crest and pubic tubercle, to the xiphoid process and costal cartilages from the 5th to the 7th (1). So in other words, this is the famous ¨6 pack¨ or ¨8 pack¨ muscle we sometimes see people have at the beach. Important note: although the muscle seems like it is divided, it actually is not. Meaning it is just one muscle, and a upper rectus and a lower rectus does not exists. (2) Thus, training the rectus for nearly everyone can be accomplished with a single exercise. So all that raising the legs, lowering the legs, and other stuff we usually see when we go to the gym, is BS. If we want to train the rectus abdominis one exercise is sufficient to activate all portions of the muscle. So a simple curl up would work.
  2. Obliques:These are the muscles which some of us see to our sides. There is an internal oblique and an external oblique. The external oblique is more superficial than the internal oblique. The upper portion and lower portions of the obliques are activated separately, meaning, here it would be useful to have an exercise for the upper portion and another for the lower portion of the obliques (2).
  3. Transverse abdominis: This is the muscle that is under the rectus abdominis. So it is quite deep inside. You cannot see this muscle. This is a muscle that became very popular especially thanks to pilates, where they would teach you to  ¨hollow¨ (drawing in the abdominal wall) to activate the muscle. Let me explain that you don´t need to hollow to activate the transverse, the transverse can be activated when you activate the other abdominal muscles. For example, imagine someone is going to punch you in your stomach, what do you usually do? You brace, which is a contraction of all the abdominal muscles. This bracing is much more effective for stability than hollowing, and this is the technique you should be using whenever you want to pick up something heavy (3,4). To demonstrate this, let us do an experiment. Sit on the edge of a chair and hollow (draw in the abdominal wall), and while maintaining that position try to get up. Then sit on the edge of a chair again, but this time brace (just a little), and  try to get up. You see the difference?

Ok, now that we know a little about the ABDOMINAL, let´s try to clear up some of the myths that exist.

  1. First myth: ¨By having a strong abdominal you won´t get back pain ¨ or¨ you have back pain because of your weak abdominal or because of your weak core¨. That is the biggest BULLSHIT there is (and something I used to say, I´ll admit it) !! The only thing that consistently prevents low back problems is exercise (5-6). Doesn´t matter what you do, just move and the chances of having back pain will diminish. And when you have back pain, specialized exercises like targeting the ¨core¨ will do no better than for example going for a walk (7-8).
  2. Second myth: ¨Do abdominal exercises to lose the fat¨. If you are overweight, you want to burn as many calories as possible. Doing curl ups or other abdominal exercises doesn´t really burn up that many calories. And even if doing curl ups would burn a lot of calories, it probably wouldn´t burn the fat that you have around your belly. So if you are overweight you should be doing more important things than ¨curl ups¨.
  3. Third myth: ¨Do a lot of abdominal exercises and you will get the 6-8 pack¨. We all have the 6 or 8 pack, the problem is that there is a lot of fat that is preventing us from seeing it. Lose the fat and you will see the abdominal muscle. This doesn´t mean you should not be working out your abdominals, of course you should! But you should not be obsessed with them. The best way to get a 6-8 pack is eating properly and doing exercise. Most people who have a 6 pack is thanks to the fact that they have an incredible active lifestyle that makes them burn a lot of fat. They have that 6 pack because of their way of life, not because they exercise with that specific goal to have a 6 pack.

So in conclusion, the abdominal muscle is important and everyone should train it but you should not be obsessed with it. Everyone has a 6-8 pack, the problem is that it is hidden under our ¨fat¨. Burn that fat and you will see that 6 pack. There is no point in trying to train the upper and lower abdominal because, as I have stated before, there is no such thing. What you feel when you raise your legs is another muscle called the psoas iliacus. A simple curl up is good enough to activate the whole rectus abdominis. With all that said, there are still exercises that target and make the abdominal work in a much more effective way than the simple curl-up or sit-up, which by the way I wouldn´t recommend anyone doing. That is something I will talk about in my next blog, why you shouldn´t be doing sit-ups and what exercises are the most effective for the abdominal. Stay tuned and until next time.


1.Mcgill S. Low Back Disorders: Evidence Based Prevention and Rehabilitation. Human Kinetics. 2007.

2.Mcgill S. Ultimate Back Fitness and Performance, Fourth Edition. Backfitpro Inc. Waterloo, Ontario, Canada 2009.

3.Brow S, McGill SM. Transmission of muscularly generated force and stiffness between layers of the rat abdominal wall. Spine 2009, 34(2): E70-E75.

4.Kavcic N, Grenier S, Mcgill S. Quantifying tissue loads and spine stability while performing commonly prescribed stabilization exercises. Spine 2004. 29(20):2319-29.

5.Kavcic N, Grenier S, Mcgill. Determining the stabilization role of individual torso muscles during rehabilitation exercises. Spine 2004. 29(11): 1254-65.

6.Bigos SJ, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. Spine J 2009 Feb;9(2):147-68.

7.van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW. Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol.2010 Apr;24(2):193-204.

8.Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. Eur Spine J.2012 Jan 24.

The myth of high repetitions. Do you really tone up by doing more repetitions?

Everyone who has ever gone to the gym probably has heard that ¨if you want to tone up or lose fat you have to do more repetitions¨, but is this really true? Well, in principle it is, but most people do it wrong, let me explain.


It´s not the repetitions that make you lose weight, it´s the time that your muscles are under stress, which it turn will make them burn more calories and at the end cause you to tone up or lose fat. So when the trainer at the gym gives you a training plan and tells you to do certain exercises, and tells you that you have to do 12-25 repetitions, you have to have certain things in mind:

  • First, you should chose a weight that allows you to perform 12-25 repetitions at a slow controlled tempo. Meaning chose a heavy enough weight, but a weight that you can control.
  • Second, like I said before, the most important thing is TIME. It makes no sense to do the exercise fast,  that is the mistake most people make.
  • Third, the object of high repetitions is to increase the time our muscles are under stress to burn more calories.
  • Fourth, when you do the exercise your muscle should be under continuous tension for 60-120 seconds.

So now, let us imagine you have to do 20 repetitions for an exercise, every repetition should at least take you 3 seconds to perform, to reach the minimum objective of 60 seconds. The American College of Sports Medicine, the National Strength and Conditioning Association, and the National Academy of Sports Medicine usually recommend a tempo of 2 seconds up, 2 seconds hold and 2 seconds down.


Also, something very important and that people usually forget is that, after you are done with your ¨set¨ or exercise, you should only rest in between 30 to 60 seconds. We don´t want our heart-rate to go down and we need to keep moving to continually burn calories.


A good training that is effective for this type of workout is a circuit training. A circuit training consist of for example 6-8 machines or exercises. You do one machine and go right to the next one. After you are done with all the machines (that´s called a set) then, and only then, you rest 30 to 60 seconds. You do can do that 3 times and that would be an effective training for weight loss.


In my next blog I will talk about the abdominal. Why are we so obsessed with this muscle? Is it so important? What´s the best exercise for the abdominal and is there such a thing as upper and lower abdominal? I will try to answer all this questions in my next blog. Until next time.




Clark M, Corn R. NASM OPT Optimum Performance Training for the Fitness Professional, 2nd Edition. National Academy of Sports Medicine.2001


Baechle T, Earle R. Essentials of Strength Training and Conditioning. 1994 National Strength and Codition Association.2nd Edition:2000.



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