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Archive for December, 2013

The magic pill

Imagine I had something that could make a lot of your daily problems go away. Would you take it?  I think most of us would. I surely would, but guess what? That ¨pill¨ is already out there and it´s easy to get.

I´ll admit it. I have experimented with that ¨pill¨ and let me tell you something, it´s some gooodd shit, if you know what I´m talking about. This ¨pill¨ is so good it relaxes me, it makes me feel happier, it takes stress and anxiety(1,2) away from me, it makes me feel less tired and it makes me remember things better (well, that has to be a side effect).

Truth be told, sometimes I don´t feel like taking that pill, but when I do, I feel so good  that afterwards I ask myself why the hell was I even doubting to take it. But, the days that I really don´t feel like taking it, I just read the prescription. And that usually does it for me. I mean, come on, this pill has been DEMONSTRATED  to be effective against low back pain, cardiovascular disease, arterial hipertension, osteoporosis, colon cancer, breast cancer, managing your weight, knee arthritis, heart attacks, prostate cancer, hip fractures for menopausal women, depression, and most importantly ERECTILE DYSFUNCTION (not that I have any problems with that, but I´m just saying, you know, in case one of you does)(1-9). And the list goes on.

But it gets even better, this pill is not racist or sexist. Doesn´t matter if you are rich or poor, or where you live, because this¨pill¨ is free and you can take it whenever you want. If you take this ¨pill¨you will live longer and yet some people don´t take it. They complain they are too tired, or have no time, or that their knee or back hurts, not knowing that the ¨pill¨improves all those symptoms.

By now you have probably guess that the ¨pill¨ I´m talking about is called EXERCISE. I highlighted the word because a lot of people don´t know what it is, to be exact 5,3 million people, that´s the number of people that will die in 2014 from inactivity (https://sports-diet-pain.com/2013/10/18/international-chair-on-cardiometabolic-risk/). So let´s try to move a little bit more in 2014!!

This will be my last blog of the year,hopefully you have enjoyed it.  I wish you all happy holidays and a happy new year!

P.S. To all my spanish followers, here is a facebook page for all those that love sport and want to keep up with the latest information. It´s in spanish  https://www.facebook.com/#!/saludando

 

 

 

References:

  1. Martines EW. Physical activity in the prevention and treatment of anxiety and depression. Nord J Psychiatry,2008;62 Suppl 47:25-9.
  2. Hammer M, Endrighi R, Poole L. Physical activity, stress reduction, and mood: insight into immunological mechanism. Methods Mol Bio, 2012;934:89-102.
  3. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ, 2006 Mar 14;174(6):801-9.
  4. Penedo FJ, Dahn JR. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry,2005 Mar;18(2):189-93.
  5. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Health GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc, 2007 Aug:39(8):1423-34.
  6. Blair SN, ChenY, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc,2001 Jun;33(6Suppl): S379-99.
  7. Sculco AD, Paup DC, Fenhall B, Sculco MJ. Effects of aerobic exercise on low back pain patients in treatment. Spine J,2001 Mar-Apr;1(2):95-101.
  8. Cooper R, Kuh D, Hardy R; Mortality Review Group; FALCon and HALCyon Study Teams. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ, 2010 Sep 9;341.
  9. Pohjantähti-Maaroos H, Palomäki A, Hartikainen J. Erectile dysfunction, physical activity and metabolic syndrome: differences in markers of atherosclerosis. BMC Cardiovasc Disord,2001 Jun 27;11:36.
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Vitamin D

I´m not a big fan of taking  multi-vitamin pills and usually don´t recommend my patients or clients to take them. I think most of the time if you eat properly you will get all your vitamins necessary from there. A recent study by the Food Standards Agency showed that the average Briton gets all of his recommended daily allowance of every dietary vitamin from their normal food and drink(1). And we all know how the Brits eat……; if they are able to get their daily allowance from their normal diet, I think the rest of us also can.

And the thing with vitamins is that if you take too much, two things can happen. One, your body doesn´t store them, it´s just pisses them away. So, you are basically throwing your money down the toilet. Or two, you can harm yourself – look at what a recent systematic study on vitamins and minerals said ¨We found no evidence to support antioxidant supplements for primary or secondary prevention [of diseases of any kind]. Beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A. Antioxidant supplements need to be considered as medicinal products and should undergo sufficient evaluation before marketing¨(2,3)!!! Did you all see the increase mortality??? That means you die earlier…. the opposite of why most people take vitamins and minerals.

But, if you had to take one vitamin supplement then I would recommend that supplement to be vitamin D. Vitamin D is a fat-soluble nutrient and is one of the 24 micronutrients critical to human survival. It is found naturally in fish and eggs and is sometimes added to dairy products, but the sun is the major natural source of nutrient. The body produces vitamin D from cholesterol (https://sports-diet-pain.com/2013/11/03/is-saturated-fat-and-cholesterol-really-that-bad/), provided it receives adequate amounts of UV light from sun exposure(2,5). However, there are only sufficient amounts of UV light coming from the sun when the UV index is 3 or higher. And in latitudes between 42.3 – 55  there is less amount of UV, especially in winter(9-10).  Also, weather patterns that reduce solar exposure such as clouds or darkness leads to less amount of UV. So, people who live in cities such as Brussels or Dortmund (2 cities where I have lived) are more vulnerable to deficiencies in vitamin D, because the sun never comes out there ;). It is also almost impossible to overdose with vitamin D. The recommend daily allowance is between 400-800IU/day, but this is probably too low for adults. The safe upper limit in the USA is 2.000Iu/day and 4000IU/day in Canada(8-11). To intoxicate yourself you would need probably more than an excess of 20.000IU/day!! So we can say it´s pretty safe.

Furthermore, interest in vitamin D supplementation is increasing in response to studies indicating that vitamin D deficiency exists in athletic populations. Vitamin D does about a million and one things in the body but one thing it is strongly related to is muscular function and performance (7). As well, Vitamin D regulates genes all over the body, and controls inflammation and immune system function. Of more relevance to athletes is that Vitamin D status is tied to muscular function and Vitamin D affects the expression of a number of genes involved in muscular function and performance; all issues relevant to athletes.

Why do I recommend vitamin D?  Because there is sufficient evidence that it COULD help with the following:

  1. Risk of falls
  2. Pain – there is a correlation between low vitamin D and musculoskeletal pain. This correlation might not mean anything, but there is a good chance that it does.
  3. Cardiovascular disease risk
  4. Colorectal cancer risk
  5. Bone fracture risk
  6. Blood pressure
  7. Parathroid hormone. This one is proven!!
  8. Fat loss
  9. Risk of Multiple Sclerosis. In southern countries there are very few cases of MS compared to northern countries. The hypothesis being that there is less sunlight (= vitamin D).
  10. Parkinson
  11. Sleep quality
  12. And the list goes on……(4-11)

Oh yeah, I almost forgot, it is also impossible to produce Vitamin D when you have sunscreen on. So, now we are starting to see that a lot of southern countries are also starting to have a deficiency in Vitamin D due to the overuse of sunscreen. Now, this doesn´t mean that sunscreen is bad or that I don´t recommend it, of course it´s good and I recommend it,  but just saying, that a little direct sun exposure once in a while is not that bad either.

So in conclusion, I think vitamin D is pretty safe, it is difficult to intoxicate yourself with it and it CAN help with a lot of problems we face today. In any case, you should contact your doctor before taking any kind of supplementation.

I will now just give the latitude of  4 cities where I have lived.

  1. Madrid:  40.25
  2. New York City 40.42
  3. Brussels 50.50
  4. Dortmund 51.30

And a video that talks about vitamin D: http://www.youtube.com/watch?v=Cq1t9WqOD-0

References

  1. http://www.food.gov.uk/multimedia/pdfs/ndns5full.pdf
  2. http://www.nhs.uk/Conditions/vitamins-minerals/Pages/vitamins-minerals.aspx
  3. Bjelakovic G, Nikolova D, Gluud C, Antioxidant supplements to prevent mortality, The Journal of the American Medical Association, 2013
  4. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C, Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases, Cochrane Database of Systematic Reviews, 2012
  5. Heany R, Garland F-C, French C, Baggerly L, Heney Robert. Vitamin D Supplement Doses and Serum 25-Hydroxyvitamin D in the Range Associated with Cancer Prevention. International Journal of Cancer Research and Treatment.2011
  6. Leventis P, Kiely. W.P.D..The tolerability and biochemical effects of high‐dose bolus vitamin D2 and D3 supplementation in patients with vitamin D insufficiency. Scandinavian Journal of Rheumatology 2009, Vol. 38, No. 2 , Pages 149-153
  7. Angeline ME, Gee AO, Shindle M, Warren RF, Rodeo SA. The effects of vitamin D deficiency in athletes. Am J Soports Med.2013 Feb;41(2):461-4.
  8. Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005 Nov;135(11):2739S-48S
  9. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr.2008 Apr;87(4)
  10. Holick MF. Sunlight and Vitamin D for bone health and prevention of autoimmune diseas, cancers, and cardiovascular disease. Am J Clin Nutr.2004 Dec; 80(6 Suppl):1778S-88S.
  11. Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrino Metal 1987 Jun; 64(6):1165-8)
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Does eating more frequently help you lose weight?

One day you hear one thing, the next day you hear something completely different.  It got to the point that I didn´t even know what to say to my clients when they asked. So, I decided to do a little investigation to find out for myself what the ¨truth¨ is.

Usually, people who defend that you should have more meals during the day, base their claims on that the ¨furnace is always on¨.  If the furnace is always on it releases more heat. The more heat you release, the more calories you burn. And what do you do to keep the ¨fire¨ on, you put more wood (meals) more frequently. But, the body is not like a furnace and it works kind of differently.

 This ¨furnace¨ is called dietary thermogenesis ( DT) and is the process of energy production in the body caused directly by the metabolizing of food consumed. Dietary thermogenesis is influenced by factors relating to the composition of the food and the physical state of the individual.  So, in simple words, dietary thermogenesis is the energy expended as heat resulting from the digestion of food sources. A 2004 analysis published in “Nutrition and Metabolism” on dietary thermogenesis showed that macronutrients have different thermic effects, with protein causing the greatest energy expenditure and fat the least (interesting). It also showed that the dietary thermogenesis of a typical mixed meal (carbs-fat-proteins) is around 10%(1-2).

So let´s use an example. Imagine you consume per day 1800 calories, if one day you ate 3 meals and each meal contained 600 calories, you would burn 60 calories (10%) per meal due to the DT. 60 x 3 meals equals 180 calories – that would be the total calories burned during the day due to DT. Now let´s say you ate 6 meals instead of 3. Each meal contains 300 calories, 30 would be the calories burned due to DT per meal, we multiply that by 6 and we get 180 calories. In other words, there is no difference and this is what has been demonstrated in different studies(1).

But, what about controlling hunger? It´s said that if you eat more frequently you will have less hunger and eat less. However, research doesn´t support that claim either. I do have to admit there have been a couple of studies that have said it helps but there have been more that have said that it doesn´t (3-6!!

So with all this said, you may be asking what do I do. And the only thing that I can say is, experiment for yourself and see what works best for you. From what I have read, there really isn´t a big difference between eating 3 or 6 meals per day. If you prefer to eat 6 meals per day and it works for you then go right ahead with it!!

Hoped you have enjoyed it.

References:

  1.  Westerterp KB. Diet induced thermogenesis. Nutr Metab (Lond),2004 Aug 18;1(1):5
  2. Verboeket-van de Venne Wp, Westerterp KR. Influence of the feeding frequency on nutrien utilization in man. Consequences for energy metabolism. Eur J Clin Nutr 1991 Mar; 45(3):161-9.
  3. Ohkawara K, Cornier MA, Kohrt WM, Melanson EL. Effects of increas meal frequency on fat oxidation and perceived hunger. Obesity ( silver Spring). 2013 Feb;21(2):336-43
  4. Stote KS, Baer DJ, Spears K, Paul DR, Harris GK, Rumpler WV, et al. A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr. 2007 Apr;85(4):981-8.
  5. Speechly DP, Rogers GG, Buffenstein R. Acute appetive reduction associated with an increased frequency of eating in obese males. Int J Obes Relat Metab Disord.100 Nov;23(11):1151-9
  6. Cameron JD, Cyr MJ, Doucet E. Increased meal frequency does not promote greater weight loss in subjects who were prescribed an 8-week equi-energetic energy-restricted diet. Br J Nutr. 2010 Apr;103(8):1098-101.

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Homeopathy- the truth behind it!!

It´s one of the fastest alternative therapies that exist out there. Annual sales  in the United States only are $300 million (1)!! But, is homeopathy really effective and if so how does it work?

The funny thing about homeopathy is that people really don´t know what it is or how it came about. So, let´s explain that a little bit.

Homeopathy was invented by a Geman named Samuel Hahnemann at the end of the 18th century. One day when he was healthy he decided to experiment with a drug called Cinchona, which is derived from the bark of a Peruvian tree. Cinchona contains quinine and was being used to treat malaria. When he took this drug, his health deteriorated to the point at which he developed the sort of symptoms usually associated with malaria. He experimented with other drugs that were being used for other diseases and obtained the same results, meaning he would always get sick. So by ¨logic¨ he came to the following conclusion: ¨that which can produce a set of symptoms in a healthy individual, can treat a sick individual who is manifesting a similar set of symptoms(1)¨. But, on top of that, he added that diluting the substance would produce greater effects in curing a person, while reducing its potential to cause side effects. !!Voila!!! There you have it,  the ¨science¨ behind homeopathy…..but it gets better ;). How do they dilutate the substance, you ask? Well let´s go ahead and explain that with an example.

They put a plant in a sealed jar with water or alcohol, which dissolves some of the plant´s molecules. After several weeks the plant or solid material is removed, the remaining water with its dissolved ingredients is called mother tincture. The mother tincture is then diluted to such an extent that there will be NO molecules of the original substance left in the dose you get.  The typical homeopathic dilution is 30C: this means that the original substance has been diluted by one drop in a hundred, thirty times over. This means that less than one part per million of the original solution is in the final product. But this is not important to homeopaths because (this is the best thing) they say that ¨water has memory¨. Ah, I almost forgot: it´s also very important to vigorously shake the homeopathic remedy at each dilution(1-2).

With all this said, you can imagine that all the serious(3-5) trials that have been done have shown that homeopathy is no better than placebo (homeopaths will defend themselves mentioning some poor quality trial). Even after explaining all this to some people, I will still get the typical homeopathy fan that says to me ¨All I know is, I feel better when I take it¨. So how do you answer that statement? Well, you could simply explain to them about placebo and the effect it causes. Or about ¨regression to the mean¨ (https://sports-diet-pain.com/2013/12/02/why-do-%C2%A8alternative%C2%A8-therapies-seem-to-work/), which basically means that all things have a natural cycle, meaning  you will have good days and bad days. It´s like with a cold. It´s going to get better after a few days, but at the moment you feel the worst, that´s when you will do dramatic things to try to get better, like taking a homeopathic remedy. Then, when you get better ( as you surely will from a cold), you will naturally assume that the homeopathic remedy must be the reason for your recovery.

Here are couple of videos that talk about homeopathy. The first video is a MUST SEE!!! It explains what homeopathy is and how scientific trials work.

Until next time!

http://www.youtube.com/watch?v=iUt15WbF1_4       It´s called Homeopathy: The Test (BBC Documentary Films)

http://www.youtube.com/watch?v=YiwaGnj8kPU

http://www.youtube.com/watch?v=DHVVKAKWXcg&feature=share

References

  1. Goldacre B. Bad Science. Fourth Estate. London.2009.
  2. Singh S, Ernst E. Trick or Treatment? Alternative medicine on trial. Transworld Publishers.2009
  3. Shang A, Huwiler-Müntener K, Nartey L, Jüni P, Dörig S, Sterne JA, Pewsner D, Egger M. Are the clinical effect of homeopathy placebo effects? Comparative study of placebo-controlled trials of homoepathy and allopathy. Lancet.2005
  4. Ernst E. Homeopathy: what does the ¨best¨evidence tell us? Med J Aust. 2010 Apr 19;192(8):458-60.
  5. Wilson P. Analysis of a re-analysus of a meta-analysis: in defence of Shang et al. Homeopathy,2009 Apr;98(2):127-8.
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Why do ¨alternative¨ therapies seem to work?

Whenever we feel sick, or have pain, we tend to go to the doctor or to a therapist of some kind. The thing is that most of us usually don´t  like going to the doctor or therapist and we wait a long time before we finally decide to go. And then when we finally decided to go, the symptoms usually improve. This makes us think that the doctor we decided to go to or the therapy we decided to do worked. I mean it´s quite simple, A leads to B, or doesn´t it? Let´s take a closer look at that.

When we think that just because two things happen together,  then one must have been the cause of the other is called a LOGICAL FALLACY and this is something we do a lot.

Let me give you an example: When the rooster crows, the sun rises.  Therefore, the rooster causes the sun to rise.

We do this more than we can imagine, and especially in my field (physical therapy) I see it a lot, I have also done it. Patients would come to me, I would treat them and they would get better, so I would naturally think ¨I´m the best¨ and ¨he got better because of me and my new wonderful technique that I applied on him¨ . We tend to base clinical convictions on personal experience and this, my friends, is a mistake. We have to base our treatments on randomized, placebo-controlled trials.  Any treatment that doesn´t base itself on that is ¨bogus¨. This is the foundation of modern healthcare.

And which treatments usually don´t base themselves on that……¨alternative medicine¨(https://sports-diet-pain.com/?s=acupuncture). But sometimes ¨alternative medicine¨ works, why is that? Well, here are just a couple of reasons why sometimes it ¨works¨.

  1. The natural history of a disease- Many diseases are self-limiting. If the condition is not chronic or fatal, the body´s own recuperative processes usually restores the sufferer to health.
  2. Regression to the mean- Many diseases are cyclical, meaning they get worse or better temporarily, but always move back to an average severity(1). Back pain, arthritis, allergies, and multiple sclerosis are cyclical, meaning sometimes they get worse and sometimes they get better. Usually, we go to the therapist or doctor when we have the most pain, so it´s bound to get better no matter what the therapist does to you.
  3. Placebo effect – ineffective treatment that can nevertheless be consoling. But the placebo effect is not restricted only to fake treatments, it also plays a role in the impact of real medicine. For example, although a patient will derive benefit from taking aspirin largely due to the pill´s biochemical effects, there can also be an added bonus as a result of the patient´s confidence in the aspirin itself or in the doctor who prescribes it (2). That is why sometimes the doctor´s reputation, the cost of the treatment, its novelty, a gentle touch, a nurse´s smile, a diploma-covered wall, could all increase the placebo effect(3-5). https://sports-diet-pain.com/2013/10/18/placebo/
  4. Confirmation bias- We desire treatment success because illness is unpleasant. Recently there was a study (6 ) that measured objectively and subjectively the effectiveness of active albuterol against placebo (the patients were given a fake active albuterol), sham acupuncture or no intervention.  Active albuterol is used for those who have asthma, it’s a bronchodilator. Subjectively ALL experienced an improvement (they used a visual analog from 0 to 10, in which 0 means no improvement and 10 means complete resolution). With albuterol the subjective improvement was of  50%,  with placebo it was 45%, sham acupuncture 46% and the no-intervention control group getting a 21%. So, all improved subjectively but there was a big difference between placebo-sham acupuncture and the no intervention group, even though all 3 were INEFFECTIVE for the disease, crazy right?! Well, objectively (which means we can measure it), they made each of the 4 groups blow to measure lung function. And not surprisingly, the albuterol group improved the best, in fact, the real albuterol did 3 times better than all the other three groups. But, what was amazing is that all 3 ¨fake¨ groups improved a little, even thought NOTHING was being done to them. And also, objectively there was a HUGE difference between the real treatment and the fake treatment although subjectively there was barely any difference!!!! I hope you all understood the importance of this.

Alternative medicine is called alternative because it really doesn´t work. If it worked it would be called MEDICINE. Physical therapists out there reading this, let´s try to base our treatments on randomized, placebo-controlled trials and not on our own clinical or personal experience.

Here is a nice video that talks about alternative medicine. It´s 45 minutes but very interesting.

http://www.youtube.com/watch?v=2M7x9wuKswI

References

  1. Streiner DL. Regression toward the mean: Its etiology, diagnosis, and treatment. Can J Psychiatry. 2001;46:72–76
  2. Ernst E, Simon S. Trick or Treatment ? Alternative medicine on trial. Transworld Publishers.London,UK.2008
  3. Benedetti F, Mayberg HS, Wager TD, Stohler CS, Zubieta JK. Neurobiological mechanisms of the placebo effect. J Neurosci. 2005;25:10390–10402.
  4. Ernst E, Resch KL. Concept of true and perceived placebo effects. BMJ . 1995;311:551–553.
  5. Evans D.  Placebo: Mind over matter in modern medicine. Oxford University Press; 2004
  6. Michael E. Wechsler, John M. Kelley, Ingrid O.E. Boyd, Stefanie Dutile, Gautham Marigowda, Irving Kirsch, Elliot Israel, Ted J. Kaptchuk. Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in AsthmaN Engl J Med. Author manuscript; available in PMC 2012 January 14.Published in final edited form as: N Engl J Med. 2011 July 14; 365(2): 119–126
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