The truth about sports, nutrition and pain!

Archive for November, 2013

Proteins and Carbohydrates – When to eat them, before or after the workout?

This has to be up there with the questions I get asked more often. Everyone always wants to know, what they should be eating before a training or what they should be eating after a training?  It´s an important question because, as we are about to see, it could influence your objective. What I am going to talk about in this blog regards all those that are looking to build up muscle. Aerobic exercise is different from resistance exercise and the intake of protein- carbohydrate is also different. Let´s first explain some certain things.

Glycogen- Glucose is stored in the  muscles and liver as glycogen. Glycogen is what gives you the energy when you do resistance training. One study even said that as much as 80% of ATP production during such training is derived from glycolisis (1). And different studies have shown that, after high volume bodybuilding workouts involving multiple exercises and sets for the same muscle (2-3), there is a depletion of glycogen in those muscles. Also, various studies have proven that a low muscle glycogen level impairs anabolic (building) signaling and muscle protein synthesis (3-4). And to top that off, another study has shown that glycogen availability also has been seen to slow muscle protein breakdown (5). So, it is pretty safe to recommend a high intramuscular glycogen content at the beginning of the training.

But what about after the training? Well, according to a recent study (6) it depends. They say that ¨consuming post-exercise carbohydrate does not meaningfully enhance anabolism. Moreover, unless you are performing two-a-day workouts involving the same muscle group(s), glycogen replenishment will not be a limiting factor in those who consume sufficient carbohydrate over the course of a given day¨. In other words, it is recommend to eat carbohydrates 2-3 hours before the training, if you do this then you should not worry about eating carbohydrates right after training, you still have a 3-4 hour window. If you train on a empty stomac (which I don´t recommend), it would be wise to eat  something as soon as you are done with your training.

Proteins- The building blocks of our muscles. Whenever we train we ¨damage¨ our muscle, so there is a breakdown in proteins. Studies have shown that muscle protein breakdown is only slightly elevated after the post exercise but rapidly rises after that. On an empty stomac this increase is even bigger. When we are building muscles, we don´t want this, we want the opposite, that is why training on a empty stomac is horrible for muscle building.

Insulin- When we eat, the insulin level rises in our blood. Insulin has been demonstrated to reduce protein breakdown (8). And consuming a combination of carbohydrates and proteins has been shown to elevate insulin levels more than just eating carbohydrates alone. So it would make sense to eat (or drink) carbohydrates-protein after the workout. But, if we had eaten something 2-3 hours before our workout those insulin levels would still be high and there wouldn´t be such a rush to eat something right away after the training. You see, when we eat something, insulin concentrations rise up over time. So, for example, if you ate a 45g dose of whey protein it would take approximately 50 minutes to cause blood amino acid levels to peak (9). If you would add carbohydrates to that, the insulin leves would even stay elevated longer.

So to summarize this in plain English: It is recommend for muscle building to eat carbohydrates and proteins 2-3 hours before the training. If you do this then you don´t have to worry about eating (protein-carbs) right after the training!!! You still have a 3-4 hour window space to eat those proteins and carbohydrates. If for whatever reason you train on a empty stomac (which you shouldn´t for muscle building), then it is recommended to eat those carbohydrates-protein right after the training, waiting would just cause more protein breakdown!!!

Hoped you enjoyed it. Until next time.


  1. Lampbert CP, Flynn MG. Fatigue during high-intensity intermittent exercise:application to bodybuilding. SPorts Med 2002,32(8):511-22.
  2. MacDougall JD,  Ray S,  Sale DG,  McCartney N,  Lee P,  Garner S.  Muscle substrate utilization and lactate production. Can J Appl Physiol 1999,  24(3):209-15.
  3. Robergs RA,  Pearson DR,  Costill DL,  Fink WJ,  Pascoe DD,  Benedict MA,  Lambert CP,  Zachweija JJ. Muscle glycogenolysis during differing intensities of weight-resistance exercise. J Appl Physiol 1991,  70(4):1700-6
  4. Churchley EG,  Coffey VG,  Pedersen DJ,  Shield A,  Carey KA,  Cameron-Smith D,  Hawley JA.  Influence of preexercise muscle glycogen content on transcriptional activity of metabolic and myogenic genes in well-trained humans. J Appl Physiol 2007,  102(4):1604-11.
  5.  Dennis PB,  Jaeschke A,  Saitoh M,  Fowler B,  Kozma SC,  Thomas G. Mammalian TOR: a homeostatic ATP sensor. Science 2001,  294(5544):1102-5.
  6. Lemon PW,  Mullin JP.  Effect of initial muscle glycogen levels on protein catabolism during exercise. J Appl Physiol 1980,  48(4):624-9
  7. Schoenfeld BJ, Aragon AA. Nutrient timing revisited: is there a post-exercise anabolic window? Journal of the international society of sports nutrition 2013,10:5
  8. Greenhaff PL,  Karagounis LG,  Peirce N,  Simpson EJ,  Hazell M,  Layfield R,  Wackerhage H,  Smith K,  Atherton P,  Selby A,  Rennie MJ: Disassociation between the effects of amino acids and insulin on signaling, ubiquitin   ligases, and protein turnover in human muscle. Am J Physiol Endocrinol Metab 2008,  295(3):E595-604.
  9. Power O,  Hallihan A,  Jakeman P: Human insulinotropic response to oral ingestion of native and hydrolysed whey protein. Amino Acids. 2009,  37(2):333-9.

Massage- what does it really do?

Everyone always wants a damn massage, and they always ask me, especially my family. Even though I studied physical therapy and massage is only a tiny little piece of what we do, everyone associates physical therapy with massage. So, of course, I get asked all the time for a massage. The worst thing about it is that no one ever gives me a massage, so I don´t even know what it feels like anymore, but I do know the benefits of a massage. So what does a massage really do? Lets find out.

Massage reduces depression and massage reduces anxiety, and it does this because it is relaxing (1-2). It is also said to reduce blood pressure (3) and help people to sleep, even when under stress. Massage also helps patients with sub-acute or chronic lower back pain, but not with acute back pain!(5). And that´s about it, folks. Scientifically, those are the only things that massage has been proven to do, nothing else! (It may help with other diseases but it´s usually due to one of these factors I just mentioned) But, what about all those other things we always hear massage is good for? Like, for example, it helps with circulation, it detoxifies and so on. Well, they are basically myths!! So let´s start talking about those myths.

Circulation – massage helps with circulation but very, very, very, VERY little!! If you want to improve your circulation go for a walk, it´s cheaper and MUCH more effective in increasing circulation (6-7,10).

Detoxifies or gets lactic acid out – Massage doesn´t do either of these, in fact it could do the opposite! When we give a massage we produce a mildly toxic state know as rhadomyolysis(8-10).

Massage helps with muscle soreness – Like I stated in my last post (, almost nothing helps with muscle soreness and that includes massage.

Massage helps you recover after an exercise – Actually it doesn´t!! This may surprise more than one (including me), but the evidence says that ¨massage significantly impairs lactic acid and hydrogen ion removal from muscles after strenuous exercise by mechanically impeding blood flow¨(9-10).

Massage releases ¨fascia¨-  First let me explain what fascia is. Fascia is the connective tissue that wraps around all of our muscles and is heavily interconnected with muscular function. Fascia is also very, very, strong. In a study done in 2008, Chauldhry found that forces outside the physiological range would be required to produce just 1% compression and 1% shear of the fascia lata and plantar fascia. In another study done in 2012, Simmons and Martinez found that the relatively low level of forces used by manual therapists is not enough to cause significant deformation of collagen in the fascia. In other words, massage does not release or change fascia, fascia is too tough for that to happen! What may happen, and this is still a hypothesis, is that myofascial release is thought to stimulate intra-fascial mechanoreceptors, which cause alterations in the afferent imput to the central nervous system, leading to a reduction in the activation of specific groups of motor units. So, in plain English what this means is that whenever we touch a patient we are giving information to the central nervous system, and how the central nervous system perceives this information will affect the fascia.

And the last myth about massage is when the therapist giving you the massage tells you ¨You are really tight¨. I have also done this lots of times, but research tells me I was wrong. First, tissue texture correlates poorly with pain(11)  and second we, therapists, are bad at detecting the painful side just by feel (12). So, next time you get a therapist and he tells you how tight you are…..just play along with it…..because we all do it 🙂

In conclusion: a massage is GREAT and probably helps us with a lot of our physical problems, including stress, anxiety and may even help with pain.  There are also things that massage doesn´t do and that I mentioned in this blog, but the good thing with a massage is that you can almost never go wrong. Even if the therapist tells you that he will ¨detoxify¨ you (which he won´t), you probably will come out feeling great!! So go out and get yourself a massage but please don´t ask me 😉

  1. Hernandez-Reif et al. High blood pressure and associated symptoms were reduced by massage therapy. Journal of Bodywokr & Movement Therapies.199
  2. Cady et al. Massage therapy as a work place intervention for reduction of stress.Perceptual & Motor Skills 1997.
  3. Shulman et al. The effectiveness of massage therapy intervention on reducing anxiety in the work place. Journal of Applied Behavioral Science.1996
  4. Moyer. Affective massage therapy.. Int J Ther Massage Bodywork 2008.
  5. Furlan et al. Massage for low-back pain. Cochrane Database of Systematic Reviews.2008
  6. Hovind et al. Effect of massage on blood flow in skeletal muscle.  Scandinavian Journal of Rehabilitation Medicine 1974.
  7. Ramos-González et al. Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women.  Complementary Therapies in Medicine,2012.
  8. Wiltshire et al. Massage Impairs Post Exercise Muscle Blood Flow and “Lactic Acid” Removal. Medicine & Science in Sports & Exercise.2009
  9. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors Sports Med. 2003;33(2):145-64.
  11. Andersen et al. Increased trapezius pain sensitivity is not associated with increased tissue hardness. Journal of Pain 2010. PubMed     
  12. Maigen et al. Lower back pain and neck pain: is it possible to identify the painful side by palpation only? Ann Phys Rehabil Med.2012

Rest Interval – How much time should you rest in between sets

¨When I´m doing an exercise, how much time do I have to rest in between sets?¨, it´s probably one of the questions I get asked most often. And the answer to this question depends on a lot of factors, but first, let me explain what repetitions and sets are. Repetitions are the number of times you  are going to perform an exercise. So, if I tell you to give me 10 push-ups, 10 are the repetitions. Once you are finished with the 10 repetitions, that would be called a set. So, if you did 3 x 10 repetitions, that would mean you have done 3 sets and each of those sets consisted of 10 repetitions. Ok, now that we got that out of the way let´s answer the question.

Well, the answer is ….it depends on your objective (also intensity and volume are very important but I will not get into that today). You see, depending on what your objective is (losing weight, gaining muscle, gaining strength) you will rest more or less. So, resting too long or too short can negatively affect your results.

Rest intervals can be classified into 3 categories: (Resistance Training)

  1. 30 seconds or less,
  2. 1-2 minutes,
  3. 3 minutes or more.

Resting 30 seconds or less – is beneficial for endurance and size because  metabolic accumulation increases and this enhances the body´s anabolic (building) environment.  The bad thing is that short rest intervals do not allow enough time to regain your strength. And according to different studies, a loss of 50% in strength in the following sets is seen when rest intervals are limited to 30 seconds. Meaning, it is difficult to build a lot of muscle(1-2).

Resting 1-2 minutes – allows you to recover most of your strength and according to different studies, is the best way for developing more muscle. In other words, this is best for hypertrophy (1-3)!!

Resting 3 minutes or more – allows your muscle to completely restore its strength on a given exercise. Full recovery allows you to train with the heaviest weight. On the other hand, any metabolite buildup that may have been created disappears over the course of the rest period, this is good for strength but not for size(1-3).

So to summarize:

  •  I would rest 30 seconds or less if I wanted to build up endurance and gain a bit of muscular size. Resting 30 seconds or less keeps your heart rate up and will lead you to burn more calories. High Intensity Interval Training bases itself a little on this method (
  • It´s been scientifically proven that for muscle building the best is to rest in between 1-2 minutes(1-2).
  • And if I wanted to gain strength I would rest 3 minutes or more.

Rest Interval is very important to obtain your goal, but it´s only a small piece of the puzzle. Intensity (the amount of weight lifted), volume (the total amount of repetitions), effort (the energy you expend during a set), tempo (the velocity in which you do the exercise), frequency (the number of exercise sessions you perform in a given period of time), and exercise selection (the exercises you decide to do) are equally important! Work on all these pieces and you will obtain your goal!!


  1. Willardson J. A brief review: Factors affecting the length of the Rest Interval Between Resistance Exercise Sets. Journal of Strength and Conditioning Research. 2006;20(4):978-84.
  2. de Salles BF, Simão R, Miranda F, Novaes Jda S, Lemos A, Willardson JM. Rest interval between sets in strenght training.Sports Med.2009;39(9):765-77.
  3. Schoenfeld B. The Max Muscle Plan. Human Kinetics.2013

Stretching – is it useful?

Anyone who has ever played any sports has probably heard, or knows, that stretching is good for you. That you have to stretch before a game to warm-up to prevent injuries and to perform better. And we also have to stretch after the game to try to avoid the muscle soreness. It´s something everyone has done, it´s sacred and it works……….. or doesn´t it?

Well, I hate having to do this again but stretching has not been proven to do ANY of these!! Stretching before a game does not prevent injuries, does not warm you up, does not make you perform better (it actually does the opposite) and it does not avoid muscle soreness (1-12)!!

Researchers have discovered in recent years, that static stretching can lessen jumpers heights and sprinters speeds without reducing people´s chances of hurting themselves. They also found that static stretching reduces strength in the stretched muscles by almost 5.5 percent(5-6)!! So, for all those that lift weights and want to lift and train harder, you may want to stop stretching before a lift from now on.

But, what about stretching after the activity, that helps for sure? You have to stretch after an intense work-out, if not, you are not going to be able to move the day after. But, that is not true!! Evidence suggests that stretching is completely useless for  preventing muscle soreness (8,9). In fact, studies show that almost nothing can prevent muscle soreness (8-10).

So what the hell is stretching good for? Well, it makes you more flexible but, remember, more flexible doesn´t mean anything in the sense of preventing injuries(11-13). And it feels great! Also, stretching could affect the peripheral and central nervous system. Meaning, the novel stimulation (stretching) may help the brain downregulate the perceived threat of current stimuli and thus decrease the muscle tension that may be causing you pain.

Ok, then what should we do before we engage in a physical activity? Warm-up, by trying to imitate the activity that you are going to perform but a lower level. For example, if I´m going for a light run, walking can be a good warm-up. Do mobility drills, move  the extremities you are going to use for that physical activity, for example if I´m going to play tennis, I would do mobility drills for the shoulder and arm area. In simple words: warm-up dynamically by moving the muscles that will be called upon in your workout.

In conclusion, stretching feels great and improves flexibility, and if those are your goals then you should be stretching. But if you are stretching because you think you are going to warm-up, prevent injuries, perform better and prevent muscle soreness, then you are mistaken.

Hoped you enjoyed it. Until next time.

  1. Shrier.Stretching before exercise does not reduce the risk of local muscle injury: a critical review of the clinical and basic science literature. Clinical Journal of Sports Medicine.1999
  2. Herbert et al. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. British Medical Journal. 2002
  3.  Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and mata-analysis of randomised controlled trials. Br J SPorts Med 2013.
  4. Costa PB, Ryan Ed, Herda TJ, Walter AA, Defreitas JM, Stout JR, Cramer JT. Acute effects of static stretching on peak torque and the hamstrings-to-quadriceps conventional and functional ratios. Scand J.Med Sci Sports, 2013 Feb;23(1):38-45.
  5. Pope et al. A randomized trial of preercise stretching for the prevention of lower-limb injury. Medicine Science in Sports Exercise.2000.
  6. Kay et al. Effect of Acute Static Stretch on Maximal Muscle Performance: A Systematic Review. Medicine & Science in Sports & Exercise.2011.
  7. Gergley JC. Acute effect of passive static stretching on lower-body strength in moderately trained men. J Strength Cond Res. 2013 Apr;27(4):973-7.
  8. Lund et al. The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise.Scandinavian Journal of Medicine & Science in Sports 1998.
  9. Cheung et al. Delayed onset muscle soreness: treatment strategies and performance factors.Sports Medicine 2003 .
  10. Weber et al. The Effects of Three Modalities on Delayed Onset Muscle Soreness.  Journal of Orthopaedic & Sports Physical Therapy 1994.
  11. Hart. Effect of stretching on sport injury risk: a review. Clinical Journal of Sports Medicine. 2005
  12. Beckett et al. Effects of Static Stretching on Repeated Sprint and Change of Direction Performance. Medicine & Science in Sports & Exercise. 2009
  13. Sandler R, Sui X, Church T, Fritz S, Beattie P, Blair S. Are flexibility and muscle-strengthening activities associated with a higher risk of developing low back pain. Journal of Science and Medicine in Sport: April 2013.

Yoga, is it really that good for you?

As I write this blog I am trembling with fear, as I am afraid that all those yoga lovers will hunt me down for even questioning if yoga is really that good for us. Because, as we have all heard or even been taught, yoga is amazing. Yoga improves flexibility, yoga improves sex, yoga improves balance, yoga reduces stress, yoga helps menopausal women, yoga lowers the risk of heart disease, yoga reduces anxiety, yoga, yoga, yoga(1-4). Whatever your problem is, yoga will have a solution. I am surprised there is not a yoga phone line to help us in the need of an emergency.

But all kidding aside, yoga is good for us, as is any other physical activity. And if someone ever asked me if they should do yoga, I will 90% of the time say yes, the same as if anyone asked me if they should start walking, or if they should sign up to the gym, or if they should do dancing, or if they should do pilates. Exercise is great and it produces a great benefit to anyone who practices it (, so if that exercise is called yoga then great, go for it, but as with any other activity it has risks, especially more in men.

Yoga plays around with different postures and in some of them you need a lot of flexibility. So yoga enhances flexibility, but we must not forget that more flexibility doesn´t mean a lower risk of getting an injury, sometimes even the opposite is true, the more flexible you are the greater chance of getting injured (5).

We all know that women are more flexible than men and this is where yoga poses some threat to men. Some of the postures that you have to do in yoga are almost impossible for some men (and even women), because of their lack of flexibility and also because of their bone structure. That bone structure will suffer if forced into a position that anatomically is not possible for them. And according to William J .Broad, ¨men will sometimes use their muscle to get into these challenging poses and this is where they get hurt and why men get injured more often than women and suffer damage that is far worse, including fractures, dislocations and shattered backs¨( 6).

But women also suffer, especially in the hip area, due to the mechanical limitations of the joint. Extreme leg motions could cause the hip bones to repeatedly strike each other, leading over time to damaged cartilage, inflammation, pain and crippling arthritis (7). This is called Femoroacetabular Impingement, and is often found in middle-aged women who do yoga ( it also happens a lot to dancers). Yoga has also been associated with a higher risk of meniscus injury compared to badminton, jogging and climbing hills (8). So you see, yoga also has its risks as with any other physical activity.

The last thing I want to touch upon before I leave is the ¨back topic¨. I always hear people say that ¨yoga is wonderful for the back and anyone who has back pain should do yoga¨, and this is not true. Exercise and movement are great for the back and those are two things you do with yoga. But with yoga you also do a lot of bending.When you bend forward, or when you move any joint for that matter, ligaments really aren’t on tension until you get to the end range, so they aren’t loaded. What this means is that when you bend forward or round your low back, you don’t really put strain on the ligaments so long as your muscles are keeping you from end range . This seems fine, right? Well, there is this thing called the flexion-relaxation phenomenon that happens when people round their lower back: the muscles relax and people end up hanging on their ligaments and discs. And this is not a good thing. As I  mentioned in one of my previous blogs (, it is almost impossible to herniate yourself without being in full flexion. Well, guess what? In yoga you are doing a lot of flexion and in some cases even full flexion. Now this doesn´t mean that you should stop doing yoga, or that yoga is going to cause you a herniation. It probably won´t and I will say it again, YOGA IS GOOD, but if you have back problems, depending on your problem yoga can do more harm than good.

The good thing about yoga compared to other physical activities is that it promotes a healthy lifestyle effect like non-smoking, reduced alcohol consumption, increased exercise, vegetarianism and reduced stress, this could all be factors that lead people to say that yoga is amazing and that it does wonders. If we all changed our way of life, did more sports, ate better and reduced our stress, we would all feel much better.


  1. Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev; 2012 Mar;17(1):21-35.
  2. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med.2010 Jan;16(1):3-12
  3. Innes Ke, Vincent HK. The influence of yoga-based progams on risk profiles in adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement Alternat Med 2007 Dec;4(4):469-86.
  4. Oken Bs, Zajedl D, Kishiyama S, Elegal K, Dehen C, Hass M, Kraemer DF, Lawrence J, Leyva J. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med 2006 Jan-Feb;12(1):40-7.
  5. 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.
  6. William J. Broad.
  7. Ganz R, Leunig M, Leuing-Ganz K, Harris  W. The Etiology of Osteoarthritis of the Hip.Clin Orthop Relat Res 2008 February;466(2):264-272.
  8. Zhuj JK, Wu LD, Zheng RZ, Lan SH. Yoga is found hazardous to the meniscus for Chinese women. Chin J Traumatol 2012 Jun1;15(3):148-51.
 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.
Kelsey JL. An Epidemiological Study of Acute Herniated Lumbar Intervertebral Disc. Int J. Epidemiol:4;197-204

Osteopaths-Chiropractors: Cracking of the bones

This is a complicated subject since there is a lot of controversy surrounding manipulations. When we think of manipulation, we think of cracks, and those cracks to ¨us¨ means that our bone just went back into its place. I think we have all had someone in our life ¨crack¨, our back, and usually afterwards we all felt better. But, what is that cracking sound, is it really our bones? Or is it something else?

Well, it´s not the bone, sorry to tell you. When you manipulate a vertebrae (bones in your back) you forcefully separate the joint surfaces, the resultant vacuum pulls in nitrogen gas to fill the space, producing a ¨POP¨(1). Once the joint pops, it may take a few hours before the gas is absorbed and the joint surfaces settle back(1). So the popping sound is really just liquid and not the bone. Most people don´t know that the vertebrae are so fixed together that you coudn´t even separate them even with a crowbar(1)!! , and that´s a good thing. So why does it feel so good when they ¨crack¨ our back and is it really safe to let someone ¨manipulate¨ your back?

The scientific community has done different trials on manipulations and they have seen that manipulating is ineffective in treating different disorders as neck pain, headache, non-spinal  primary and secondary dysmenorrhea, infantile colic, asthma  allergy, cervicogenic dizziness, just to name a few(2). They only found out that spinal manipulation was considered superior to sham manipulation but not better than conventional treatments in dealing with acute low back pain.  So their conclusion, which was published in the ¨Journal of the Royal Society of Medicine¨, stated that ¨Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition(2). Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment¨. So, how come sometimes it feels so good when someone ¨cracks¨ your back? Well, it could be simply the placebo effect, the ¨pop¨ can do magical things to people´s head, ( or to the body´s production of endorphins. It is well known, for example, that spinal manipulation, acupuncture, massage, and other forms of physical treatment can stimulate the body´s production of endorphins to relieve pain.

It could also be that manipulation works, but not for the reason most people think it works. When you go to a chiropractic or osteopath they usually assess you through motion palpation test, positional faults assessments, clinical postural assessments or some other test, the funny thing is that these test usually have, at best, poor to fair reliability (5-13). What I mean by this is that, if you first go to one osteopath and then you go to another, they probably wouldn´t agree on what you have. One would say you have too much mobility, while they other one would say something else. The intertester reliability is horrible and if you don´t believe me look at the studies (5-13). So how come sometimes it works? Well, it could be because when someone manipulates you, he is in fact affecting the peripheral and central nervous system. Meaning, the novel stimulation (manipulation) may help the brain downregulate the perceived threat of current stimuli and thus decrease the pain.(

But what I can tell you for sure, and it has been demonstrated, is that your bone is not out of place, there is no such thing as a ¨subluxation¨(1-3). So next time you go to a physical therapist, chiropractic, osteopath or whatever, and that person tells you that you have a ¨subluxation¨and that he is going to put that bone in its place, get up and walk away. Manipulations can have some serious effects. In 2001, a systematic review of 5 studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches(3,4).  But the greatest risk comes from manipulating the cervical area (neck). This region is hugely vulnerable as it carries all the lifelines between the head and the body. In particular 2 vertebral arteries which are very close to the cervical vertebrae. Cervical manipulation has not been shown to be more effective than a massage in dealing with acute neck pain or chronic neckpain. But they are more dangerous. So my recommendation is not to let anyone manipulate your cervical area (neck).

To summarize, and not bore people to death, I will make a list of what the scientific community says with respect to when manipulation by a professional is in order and when they should NOT be manipulating you.


  • A manipulation could  be beneficial in acute non specific lower back pain. In their own words ¨Manipulation is often more effective than physical therapy in relieving the symptoms of simple, uncomplicated back pain. But such treatment should be discontinued after one month if no improvement results¨.


  • Herniated disk, as suggested by sciatica (pain radiating dow on leg below the knee)
  • Spinal stenosis (narrowing of the spinal canal)
  • Ankylosing spondylitis
  • Cauda equina syndrome
  • Cancer or Infection, which might be suggested by history of cancer, unexplained weight loss, immunosuppression, urinary infection, fever, back pain not improved with rest, and age of patient over 50.
  • Spinal or compression fracture.

Hope you enjoyed it!!


  1. Homola S. Inside Chiropractic.Prometheus Books 1999. Amherst, New York.
  2. Ernst E, Canter P H. A systematic review of systematic reviews of spinal manipulation. Journal of the Royal Society of Medicine 2006 April 99 (4): 192-96.
  3. Ernst E, Singh S. Trick or Treatment? Alternative Medicine on trial.Transworld Publishers 2009, London, UK.
  4. Hall H. Update: Chiropractic Neck Manipulation and Stroke.
  5. Berneck J G, Kulig K, Landel F. R, Powers . The Relationship Between Lumbar Segmental Motion and Pain Response Produced by a Posterior-to Anterior Force in Persons With Nonspecific Low Back Pain, J Orthop Sports Phys Ther Vol 2005: 35;4.
  6. Cornwall J. Lubar Zygapophysial Joint Palpation. NZ Journal of Physiotherapy Nov 2004: 32;3.
  7. Zegarra-Parodi R, Rickards L, Renard E-O. Cranial Palpation Pressures Used by Osteopathy Student: Effect of Standardized Protocol Training. JAQA Vol 109 No 2 Feb 2009 79
  8. Simpson R, Gemmell H. Accuracy of spinal orthopaedic tests: a systematic review, Chiropractic & Osteopathy 2006, 14:26.
  9. Landel R, Kulig K, Fredericson M, Li B, Powers M C. Intertester Reliability and Validity of Motion Assessments During Lumbar Spine Accessory Motion Testing. Physical Therapy, Jan 2008. Vol 88 Number 1.
  10. Kmita A, Lucas N. Reliability of physical examination to assess asymmetry of anatomical landmarks indicative of pelvic somatic dysfunction in subjects with and without low back pain. Internationl Journal of Osteopathic Medicine in press(2208) 1 e10.
  11. Huijbregts P. Spinal Motion Palpation: A review of reliability Studies. The Journal of Manual & Manipulative Therapy Vol. 10 No. 1( 2002) 24-39.
  12. Hughes P, Taylor N, Green R. Most clinical test cannot accurately diagnose rotator cuff pathology: a systematic review. Australian Journal of Physiotherapy 2008 Vol 54.
  13. Tullberg T, Blomberg S, Branth B, Johnson R. Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine 1998, 23(10):1124-29.

Is saturated fat and cholesterol really that bad – part 2?

In my last blog I talked a little about saturated fat and cholesterol, and how they became our number 1 enemy. I also mentioned that there is now new evidence that suggests that they aren´t really that bad and that maybe we have been fighting the wrong ¨war¨ for the last 50-60 years. But, any doctor will tell you that saturated fat leads to cholesterol and that cholesterol is a mayor indicator of a cardio vascular disease, so what do we do??

If you go into PubMed and search for scientific articles that talk about risks of cardio-vascular disease you will find a lot of studies that say that saturated fat increases cholesterol, and that elevated blood cholesterol increases the risk of having a heart attack (1,2). But most of these studies are usually short termed controlled diet trials, or studies from more than a half a century ago. However, more recent and higher quality trials do not support that idea (3-6). Meaning, saturated fats don´t lead to higher levels of cholesterol in the blood. So it seems that, after all, saturated fat and cholesterol weren´t that bad. But if they are not the cause of this cardio-vascular epidemic  then was is??.

In the 1970´s after Ancel Keys study came out and he become member of American Heart Association, the US government and the Heart Association started waging  their war on saturated fat and people started listening. Saturated fat consumption went down over the next 30 years but Cardio-vascular diseases did not, instead there was even more. What happened is that when you take fat out of the food, the food tastes like crap, it really doesn´t taste like anything. So what manufactures did was take the fat out of the food but add on ¨sugar¨, especially high  fructose corn syrup sugar to give it some taste.  In 1978 High fructose corn syrup (HFCS) entered the sweetener market and we changed drastically the way we ate. We started eating a diet high in carbohydrates and low on fat, which leads to a greater insulin production and insulin resistance at the same time. Insulin is the number one indicator for inducing inflammation of blood vessels.

Now, try to stick with me because it´s going to get a little complicated. Cancer, heart disease, hypertension, Alzheimer, osteoarthritis, rheumatoid arthritis,diabetes, osteoporosis, are examples of conditions that develop and exist as a consequence of chronic inflamation (7-10). Dietary imbalances are responsible for creating a diet-induced, pro-inflammatory state that leads to chronic inflamation. So, when the American Heart Association and the USA government recommended to reduce our intake of fat and increase our intake of carbohydrate to 60%, well they probably weren´t doing us a favor. Instead, the Mediterranean Diet, that consist of more saturated fat and less intake of sugar has been demonstrated to reduce the risk of heart disease (11-12).  So, yes, saturated fat is not that bad and nearly every high-quality observational study ever conducted found that saturated fat intake is not associated with heart risk.  So, in conclusion, I wouldn´t be so worried about saturated fat and cholesterol, but instead I would be fearful of all the ¨sugar- high corn fructose syrup¨ we are consuming.

In my next post I will change topics and start talking about ¨pain¨.  Most of us have at one point or another gone to the chiropratic or osteopath, when they ¨manipulate¨ us, what exactly are they doing? Is there really a subluxations (bone out of its place) and are they really putting the bone back in its place? We will find out.

P.S Here is a link to an interesting article


  1. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acidas and carbohydrates on the ration of seum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr,2003 May;77(5):1146-55.
  2. Iso H, Jacobs DR Jr, Wentworth D, Neaton ID, Cohen ID. Serum Cholesterol levels and six-year mortality from strok in 350,977 men screened for the multiple risk factor intervention trial. N Engl Med. 1989 Apr 6;320(14):904-10-
  3. Kahn HA, Medlie JH, Neufeld NH, Riss E, Balogh M, Groen IJ. Serum cholestero: its distruibution and association with dietary and other variables in a survey of 10,000 men. Isr J Med Sci. 1969 Nov-Dec;5(6) 1117-27.
  4. Djousse L, Gaziano IM. Dietary cholesterol and coronary artery disease: a systematic review. Curr Atheroscler Rep,2009 Nov;11(6):418-22.
  5. Santos FL, Esteves SS, da Costa Pereira A, Yancy WS, JR, Nune JP. Systematic reviw and meta-analysis of clincal trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 2012 Nov; 13(11):1048-66.
  6. Yamagishi K, Iso H, Yatsuya H,, Tanabe N, Date C, Kikuchi S, Yamamoto A, Inaba Y, Tamakosi A, Dietary intake of saturated fatty acids and mortality from cardiovascular diseae in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk. Am J Clin Nutr, 2010 Oct;92(4):759-65.
  7. Balkwill F, Mantovani A. Inflammation and cancer back to Virchow? Lancert.2001;357:539-45.
  8. Ban WA, Man SF, Senthilselvan A, Sinn DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and meta-analysis. Thorax 2004;59:574-80.
  9. Fernandez-Real JM, Ricart W. Insulin resitance and chronic cardiovascualr inflammatory syndrome. Endo Rev 2003;24:278-301.
  10. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med 1999;340:115-26.
  11. Mackenbach JP. 2007. The Mediterranean diet story illustrates that ‘‘why’’ questions are as important as ‘‘how’’ questions in disease explanation. Journal of Clinical Epidemiology 60(2): 105-109.
  12. Serra-Majem Ll, Roman B y Estruch R. 2006. Scientific evidence of Interventions using the mediterranean diet: A systematic review. Nutrition Reviews 64 (Supl 1): S27-S47

Is Saturated Fat and Cholesterol really that bad?

We have always heard and even been taught that saturated fat leads to cholesterol, and that cholesterol leads to heart disease but is this really true?

This all started in the 1950´s when a doctor by the name of Ancel Keys did a study in which he compared the rate of Heart Disease and Fat consumption in 6 countries: USA, Canada, Australia, England-Wales, Italy and Japan, and found a perfect correlation, meaning the more fat the countries ate, the higher the risk of heart disease. Except, there was one problem, he withheld data from other 16 countries. Later, when scientists plotted all 22 countries, the correlation wasn´t so perfect. In other words, he used only the data that would demonstrate his hypothesis, but you could show just the opposite with all the data, that the more saturated fat people ate, the less heart disease they had.

In between 1960-1975, there were probably a half a dozen of studies that failed to confirm that saturated fat was the cause of heart problems(1), but Ancel Key was in the American Heart Association and his idea prevailed. So, from then on, the number one enemy was saturated fat and cholesterol. The funny thing with this is that most people don´t even know what cholesterol is, they just think it is a bad thing but is it really?

Cholesterol is actually essential for life. It is a mayor component of brain and nerve tissue, and central for the production of hormones. In fact, it is so important that almost every single cell in the body makes it!!! 80 % to 90 % of your cholesterol is made by your body, and it is basically genetic, meaning most people are always going to stay in a range. So even if you cut all the cholesterol out of your diet, your body will simply start making a bit more to bring it backup into ¨its range¨ (2). But we have always heard that cholesterol is produced by saturated fats, although the literature regarding this is highly inconsistent and there are even many long-term studies that disagree with this idea (3,4,5). One study in particular is the one going on in Framingham Massachusetts, where they are studying the potential causes of heart disease(6). This study started in 1948 and is still going on!! And so far, they have seen that certain habits like cigarette smoking or emotional stress do lead in the direction of heart disease. Also, cholesterol correlates with heart disease but only until the late 40´s. In fact, after the age of 47 high cholesterol seems to be protective, meaning that the people who had the highest cholesterol lived the longest……. so could cholesterol actually be a good thing? And, if saturated fats and cholesterol aren´t a ¨bad thing¨ then what´s behind the epidemic of cardio-vascular diseases?? That and more in my next ¨blog¨ ;).


  1. Mann G. DIet-Heart end of an era. NEJM 1977 297;644-50.
  2. Curtis N E. The Cholesterol Delusion
  3. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr, 2010 Mar;91(3):535-46.
  4. Stamler J, Neaton D J. The Multiple Risk Factor Intervention Trial (MRFIT)- Importance Then and Now. JAMA.2008:300(11);1343-45.
  5.  Mann V G. Coronary Heart Disease Doing the Wrong Thing. Nutrition today 1984
  6. Kannel WB. RIsk stratification in hypertension: new insights from the Framingham Study. Am J Ypertens, 2000 Jan;13(1 Pt2):3S-10S.

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