Prelude

Prelude

by Oriah Mountain Dreamer

What if it truly doesn't matter what you do but how you do whatever you do?

How would this change what you choose to do with your life?

What if you could be more present and open-hearted with each person you encounter working as a cashier in the corner store, a parking lot attendant or filing clerk than you could if you were striving to do something you think is more important?

How would this change how you want to spend your precious time on this earth?

What if your contribution to the world and the fulfillment of you own happiness is not dependent upon discovering a better method of prayer or technique of meditation, not dependent upon reading the right book or attending the right seminar, but upon really seeing and deeply appreciating yourself and the world as they are right now?

How would this effect your search for spiritual development?

What if there is no need to change, no need to try and transform yourself into someone who is more compassionate, more present, more loving or wise?

How would this effect all the places in your life where you are endlessly trying to be better?

What if the task is simply to unfold, to become who you already are in your essential nature - gentle, compassionate and capable of living fully and passionately present?

How would this effect how you feel when you wake up in the morning?

What if who you essentially are right now is all that you are ever going to be?

How would this effect how you feel about your future?

What if the essence of who you are and always have been is enough?

How would this effect how you see and feel about your past?

What if the question is not why am I so infrequently the person I really want to be, but why do I so infrequently want to be the person I really am?

How would this change what you think you have to learn?

What if becoming who and what we truly are happens not through striving and trying but by recognizing and receiving the people and places and practises that offer us the warmth of encouragement we need to unfold?

How would this shape the choices you have to make about how to spend today?

What if you knew that the impulse to move in a way that creates beauty in the world will arise from deep within and guide you every time you simply pay attention and wait?

How would this shape your stillness, your movement, your willingness to follow this impulse, to just let go and dance?

Your Back

Advice on exercise and your lower back:

1. It is better to exercise a little every day then it is to do exercise more 3x/week.
2. Be careful in the early morning, your back is at it's greatest risk of injury (the discs and other tissues are stiff and not very flexible).
3. Back muscles are designed for endurance, not strength. Exercises that load the spine (such as using abdominal machines loaded with weights) can be really bad for you. If you are feeling pain, you are not likely getting any gain.

A Breathing Technique Offers Help for People With Asthma

By JANE E. BRODY

Published: November 2, 2009 

 

 I don’t often write about alternative remedies for serious medical conditions. Most have little more than anecdotal support, and few have been found effective in well-designed clinical trials. Such trials randomly assign patients to one of two or more treatments and, wherever possible, assess the results without telling either the patients or evaluators who received which treatment.

Now, however, in describing an alternative treatment for asthma that does not yet have top clinical ratings in this country (although it is taught in Russian medical schools and covered by insurance in Australia), I am going beyond my usually stringent research criteria for three reasons:
¶The treatment, a breathing technique discovered half a century ago, is harmless if practiced as directed with a well-trained therapist.
¶It has the potential to improve the health and quality of life of many people with asthma, while saving health care dollars.
¶I’ve seen it work miraculously well for a friend who had little choice but to stop using the steroid medications that were keeping him alive.
My friend, David Wiebe, 58, of Woodstock, N.Y., is a well-known maker of violins and cellos, with a 48-year history of severe asthma that was treated with bronchodilators and steroids for two decades. Ten years ago, Mr. Wiebe noticed gradually worsening vision problems, eventually diagnosed as a form of macular degeneration caused by the steroids. Two leading retina specialists told him to stop using the drugs if he wanted to preserve his sight.
He did, and endured several terrifying trips to the emergency room when asthma attacks raged out of control and forced him to resume steroids temporarily to stay alive.
Nothing else he tried seemed to work. “After having a really poor couple of years with significantly reduced quality of life and performance at work,” he told me, “I was ready to give up my eyesight and go back on steroids just so I could breathe better.”
Treatment From the ’50s
Then, last spring, someone told him about the Buteyko method, a shallow-breathing technique developed in 1952 by a Russian doctor, Konstantin Buteyko. Mr. Wiebe watched a video demonstration on YouTube and mimicked the instructions shown.
“I could actually feel my airways relax and open,” he recalled. “This was impressive. Two of the participants on the video were basically incapacitated by their asthma and on disability leave from their jobs. They each admitted that keeping up with the exercises was difficult but said they had been able to cut back on their medications by about 75 percent and their quality of life was gradually returning.”
A further search uncovered the Buteyko Center USA in his hometown, newly established as the official North American representative of the Buteyko Clinic in Moscow.
“When I came to the center, I was without hope,” Mr. Wiebe said. “I was using my rescue inhaler 20 or more times in a 24-hour period. If I was exposed to any kind of irritant or allergen, I could easily get a reaction that jeopardized my existence and forced me to go back on steroids to save my life. I was a mess.”
But three months later, after a series of lessons and refresher sessions in shallow breathing, he said, “I am using less than one puff of the inhaler each day — no drugs, just breathing exercises.”
Mr. Wiebe doesn’t claim to be cured, though he believes this could eventually happen if he remains diligent about the exercises. But he said: “My quality of life has improved beyond my expectations. It’s very exciting and amazing. More people should know about this.”
Ordinarily, during an asthma attack, people panic and breathe quickly and as deeply as they can, blowing off more and more carbon dioxide. Breathing rate is controlled not by the amount of oxygen in the blood but by the amount of carbon dioxide, the gas that regulates the acid-base level of the blood.
Dr. Buteyko concluded that hyperventilation — breathing too fast and too deeply — could be the underlying cause of asthma, making it worse by lowering the level of carbon dioxide in the blood so much that the airways constrict to conserve it.
This technique may seem counterintuitive: when short of breath or overly stressed, instead of taking a deep breath, the Buteyko method instructs people to breathe shallowly and slowly through the nose, breaking the vicious cycle of rapid, gasping breaths, airway constriction and increased wheezing.
The shallow breathing aspect intrigued me because I had discovered its benefits during my daily lap swims. I noticed that swimmers who had to stop to catch their breath after a few lengths of the pool were taking deep breaths every other stroke, whereas I take in small puffs of air after several strokes and can go indefinitely without becoming winded.
The Buteyko practitioners in Woodstock, Sasha and Thomas Yakovlev-Fredricksen, were trained in Moscow by Dr. Andrey Novozhilov, a Buteyko disciple. Their treatment involves two courses of five sessions each: one in breathing technique and the other in lifestyle management. The breathing exercises gradually enable clients to lengthen the time between breaths. Mr. Wiebe, for example, can now take a breath after more than 10 seconds instead of just 2 while at rest.
Responses May Vary
His board-certified pulmonologist, Dr. Marie C. Lingat, told me: “Based on objective data, his breathing has improved since April even without steroids. The goal now is to make sure he maintains the improvement. The Buteyko method works for him, but that doesn’t mean everyone who has asthma would respond in the same way.”
In an interview, Mrs. Yakovlev-Fredricksen said: “People don’t realize that too much air can be harmful to health. Almost every asthmatic breathes through his mouth and takes deep, forceful inhalations that trigger a bronchospasm,” the hallmark of asthma.
“We teach them to inhale through the nose, even when they speak and when they sleep, so they don’t lose too much carbon dioxide,” she added.
At the Woodstock center, clients are also taught how to deal with stress and how to exercise without hyperventilating and to avoid foods that in some people can provoke an asthma attack.
The practitioners emphasize that Buteyko clients are never told to stop their medications, though in controlled clinical trials in Australia and elsewhere, most have been able to reduce their dependence on drugs significantly. The various trials, including a British study of 384 patients, have found that, on average, those who are diligent about practicing Buteyko breathing can expect a 90 percent reduction in the use of rescue inhalers and a 50 percent reduction in the need for steroids within three to six months.
The British Thoracic Society has given the technique a “B” rating, meaning that positive results of the trials are likely to have come from the Buteyko method and not some other factor. Now, perhaps, it is time for the pharmaceutically supported American medical community to explore this nondrug technique as well.
 

Study Finds the Availability of Chiropractic Care Improves the Value of Health Benefits Plans

Foundation for Chiropractic Progress commissions landmark report delivers incremental impact on population health and total health care spending

Carmichael, CA - October 20, 2009 - A report, prepared by a global leader for trusted human resources and related financial advice, products and services, finds that the addition of chiropractic care for the treatment of low back and neck pain will likely increase value-for-dollar in US employer-sponsored health benefit plans. Authored by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD, the report can be fully downloaded at:

http://images.vortala.com/chiropractor/USA/California/Carmichael/Foundation%20for%20Chiropractic%20Progress/SiteGraphics/ChiropracticServicesReport.pdf

Accordingly, this report was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US.

According to Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and President of Life Chiropractic College West, ?While some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.?

Executive Summary:

Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment.

The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations.

High quality randomized cost-effectiveness studies have to date only been performed in the European Union (EU). To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU.

The results of the researchers' analysis are as follows:

-Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain.

Total cost of care per year:

-For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care.

-For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care.

Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.

These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve.

Anatomy of the Cervical spine

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

Depressing News about Treatment of Depression

Note from Brian O'Hea

This article is from Dr. Andrew Weil M.D., who was one of the first MD's to popularize the field of "integrative medicine." This looks at the whole person and addresses lifestyle, nutrition, exercise etc. to help people be healthier. "Integrative Medicine" is much like the version of chiropractic care that Dr. Susan and I preach. The big difference is that we don't prescribe medications. We believe that most of the time your body heals itself. In fact, it's doing so right now.

On another note, I just read the book Generation RX by Greg Crister. It is how the pharmaceutical companies turn the everyday emotions and conditions that we all experience into maladies that can be fixed with the magic pill. The book details how drug companies create new markets and profit handsomely by doing so. There is a glimmer of hope at the end of the book on how we can create our own state of health and well-being. Well worth reading.

And now the Article......


Depression can be devastating. Its worst form, major depressive disorder, is marked by all-encompassing low mood, thoughts of worthlessness, isolation, and loss of interest or pleasure in most or all activities. But this clinical description misses the deep, experiential horror of the condition; the suffocating sense of despair that can make life seem too arduous to bear.
Here's something else we can say confidently about depression: it is complex. The cause is often a mix of factors including genetic brain abnormalities, sunlight deprivation, poor nutrition, lack of exercise, and social issues including homelessness and poverty. Also, cause and effect can be hard to tease apart -- is social isolation a cause or an effect of depression?
Unfortunately, we can make one more unassailable observation about depression: the disorder -- or, more precisely, the diagnosis -- has gone stratospheric. An astonishing 10 percent of the U.S. population was prescribed an antidepressant in 2005; up from 6 percent in 1996.
Why has the diagnosis become so popular? There are likely several reasons. It's possible that more people today are truly depressed than they were a decade ago. Urbanized, sedentary lifestyles; nutrient-poor processed food; synthetic but unsatisfying entertainments and other negative trends, all of which are accelerating, may be driving up the rate of true depression. But I doubt the impact of these trends has nearly doubled in just ten years.
So here's another possibility. The pharmaceutical industry is cashing in.
In 1996, the industry spent $32 million on direct-to-consumer (DTC) antidepressant advertising. By 2005, that nearly quadrupled, to $122 million. It seems to have worked. More than 164 million antidepressant prescriptions were written in 2008, totaling $9.6 billion in U.S. sales. Today, the television commercial is ubiquitous:
A morose person stares out of a darkened room through a rain-streaked window.
Quick cut to a cheery logo of an SSRI (selective serotonin reuptake inhibitor, the most common type of antidepressant pharmaceutical).
Cross-fade to the same person, medicated and smiling, emerging into sunlight to pick flowers, ride a bicycle or serve birthday cake to laughing children.
A voiceover gently suggests, "Ask your doctor if [name of drug] is right for you."

The message -- all sadness is depression, depression is a chemical imbalance in the brain, this pill will make you happy, your doctor will get it for you -- could not be clearer. The fact that the ad appears on television, the ultimate mass medium, also implies that depression is extremely common.
Yet a study published in the April, 2007, issue of the Archives of General Psychiatry, based on a survey of more than 8,000 Americans, concluded that estimates of the number who suffer from depression at least once during their lifetimes are about 25 percent too high. The authors noted that the questions clinicians use to determine if a person is depressed don't account for the possibility that the person may be reacting normally to emotional upheavals such as a lost job or divorce (only bereavement due to death is accounted for in the clinical assessment). And a 15-year study by an Australian psychiatrist found that of 242 teachers, more than three-quarters met the criteria for depression. He wrote that depression has become a "catch-all diagnosis."
What's going on?
It's clear that depression, a real disorder, is being exploited by consumer marketing and is over-diagnosed in our profit-driven medical system. Unlike hypertension or high cholesterol -- which have specific, numerical diagnostic criteria -- a diagnosis of depression is ultimately subjective. Almost any average citizen (particularly one who watches a lot of television) can persuade him or herself that transient, normal sadness is true depression. And far too many doctors are willing to go along.
The solution to this situation is, unsurprisingly, complex, cutting across social, medical, political and cultural bounds. But here are three major changes that are needed immediately:
Medically, thousands of studies confirm that depression, particularly mild to moderate forms, can be alleviated by lifestyle changes. These include exercise, lowered caffeine intake, diets high in fruits and vegetables, and certain supplements, particularly omega-3 fatty acids. Physicians need to be trained in these methods, as they are at the Arizona Center for Integrative Medicine at the University of Arizona in Tucson. See Natural Depression Treatment for more about these low-tech methods, or the "Depression" chapter in the excellent professional text, Integrative Medicine by David Rakel, M.D. (Saunders, 2007).
Politically, if Congress -- which seems hopelessly addicted to watering down all aspects of health care reform -- can't manage to ban all DTC ads in one stroke, it should start by immediately ending those for antidepressants.
Personally, be skeptical of all DTC ads for antidepressants. The drugs may turn out to be no more effective than placebos. Many of them have devastating side effects, and withdrawal, even if done gradually, can be excruciating. While they can be lifesavers for some people, in most cases they should be employed only after less risky and expensive lifestyle changes have been tried.

Finally, recognize that no one feels good all the time. An emotionally healthy person can, and probably should, stare sadly out of a window now and then. Many cultures find the American insistence on constant cheerfulness and pasted-on smiles disturbing and unnatural. Occasional, situational sadness is not pathology -- it is part and parcel of the human condition, and may offer an impetus to explore a new, more fulfilling path. Beware of those who attempt to make money by convincing you otherwise.
Andrew Weil, M.D


Read more at: http://www.huffingtonpost.com/andrew-weil-md/are-you-depressed-or-just_b_307734.html

Run, Run, Run, Run Away...

The above is a reference to a line from a Jefferson Starship (or if you are an old hippie, the Jefferson Airplane) song and a lead in to a few of my thoughts on running. I often get asked if running is ok on the body, especially if you have a neck or back injury. And the answer is a resounding maybe! It depends on a bunch of factors-such as the severity of your problem, health of your joints (like your knees and hips), patterns of muscle imbalances, and your feet. Everyone is a little different and there isn't one simple answer.
Let me explain some of the ways you can get from where you are ( maybe sitting on the couch) to a place you would like to be (active, jogging, maybe competing in a race). First off, I start by looking at your feet. If your arches are flat or you notice your shoes wearing more on the outside of the heel, you probably need to start with orthotics. Orthotics are inserts that you put into your shoes to correct biomechanical problems in your gait. I use (both personally in my own shoes and in my practice) FootMaxx orthotics. They have a great method at determining the type of foot problem you have an have a semirigid orthotic that is comfortable to wear. Most of the patients at the office really feel they are helpful. Orthotics not only help your feet, but they can relieve pressure on your knees and back.
Next, I will see if any of the muscles in your legs are tight and imbalanced. It's very common to have a tight hamstring or ITB and it is important to deal with this. Otherwise, running will continue to strengthen the imbalance. People often have tight hamstrings; what I have learned ( and some recent research has shown) is that you can stretch and stretch and stretch your hamstrings, but they won't get any more flexible until you fix your back.
So what if your joints are already worn out? If you have a lot of wear and tear on your joints ( arthritis) walk, don't run. Sorry. You can make your walks more interesting by varying your pace. You can also get a nice heart work-out by carrying two water bottles in your hands and occasionally pumping them above your head. This was the idea behind the "heavy hand" wrist weights that were popular in the early 80's. Even though I don't recommend running, you need to walk, especially if you have arthritis. The right amount of movement and pressure stimulates cartilage growth. Supplements for joint health are a great ides and will be covered in a future post.
What about shoes? I can't keep up with all the brands so I recommend you get fit at a local store, Running in Motion, in Edmonds. The owner, Frank, knows his stuff. He put me in a size larger than I normally use and they feel good. The concept is that feet swell when you run so a tight fitting shoes gets too tight when you are exercising.
IF you "don't have a runners body" just remember that you do. It's in there, it just needs some help to come out.

How To Fix Bad Ankles

By Gretchen Reynolds

Ankles provide a rare opportunity to recreate a seminal medical study in the comfort of your own home. Back in the mid-1960s, a physician, wondering why, after one ankle sprain, his patients so often suffered another, asked the affected patients to stand on their injured leg (after it was no longer sore). Almost invariably, they wobbled badly, flailing out with their arms and having to put their foot down much sooner than people who’d never sprained an ankle. With this simple experiment, the doctor made a critical, if in retrospect, seemingly self-evident discovery. People with bad ankles have bad balance.Remarkably, that conclusion, published more than 40 years ago, is only now making its way into the treatment of chronically unstable ankles. “I’m not really sure why it’s taken so long,” says Patrick McKeon, an assistant professor in the Division of Athletic Training at the University of Kentucky. “Maybe because ankles don’t get much respect or research money. They’re the neglected stepchild of body parts.”

At the same time, in sports they’re the most commonly injured body part — each year approximately eight million people sprain an ankle. Millions of those will then go on to sprain that same ankle, or their other ankle, in the future. “The recurrence rate for ankle sprains is at least 30 percent,” McKeon says, “and depending on what numbers you use, it may be high as 80 percent.”

A growing body of research suggests that many of those second (and often third and fourth) sprains could be avoided with an easy course of treatment. Stand on one leg. Try not to wobble. Hold for a minute. Repeat.

This is the essence of balance training, a supremely low-tech but increasingly well-documented approach to dealing with unstable ankles. A number of studies published since last year have shown that the treatment, simple as it is, can be quite beneficial.

In one of the best-controlled studies to date, 31 young adults with a history of multiple ankle sprains completed four weeks of supervised balance training. So did a control group with healthy ankles. The injured started out much shakier than the controls during the exercises. But by the end of the month, those with wobbly ankles had improved dramatically on all measures of balance. They also reported, subjectively, that their ankles felt much less likely to give way at any moment. The control group had improved their balance, too, but only slightly. Similarly, a major review published last year found that six weeks of balance training, begun soon after a first ankle sprain, substantially reduced the risk of a recurrence. The training also lessened, at least somewhat, the chances of suffering a first sprain at all.

Why should balance training prevent ankle sprains? The reasons are both obvious and quite subtle. Until recently, clinicians thought that ankle sprains were primarily a matter of overstretched, traumatized ligaments. Tape or brace the joint, relieve pressure on the sore tissue, and a person should heal fully, they thought. But that approach ignored the role of the central nervous system, which is intimately tied in to every joint. “There are neural receptors in ligaments,” says Jay Hertel, an associate professor of kinesiology at the University of Virginia and an expert on the ankle. When you damage the ligament, “you damage the neuro-receptors as well. Your brain no longer receives reliable signals” from the ankle about how your ankle and foot are positioned in relation to the ground. Your proprioception — your sense of your body’s position in space — is impaired. You’re less stable and more prone to falling over and re-injuring yourself.

For some people, that wobbliness, virtually inevitable for at least a month after an initial ankle sprain, eventually dissipates; for others it’s abiding, perhaps even permanent. Researchers don’t yet know why some people don’t recover. But they do believe that balance training can return the joint and its neuro-receptor function almost to normal.

Best of all, if you don’t mind your spouse sniggering, you can implement state-of-the-art balance training at home. “We have lots of equipment here in our lab” for patients to test, stress, and improve their balance, Hertel says. “But all you really need is some space, a table or wall nearby to steady yourself if needed, and a pillow.” (If you’ve recently sprained your ankle, wait until you comfortably can bear weight on the joint before starting balance training.) Begin by testing the limits of your equilibrium. If you can stand sturdily on one leg for a minute, cross your arms over your chest. If even that’s undemanding, close your eyes. Hop. Or attempt all of these exercises on the pillow, so that the surface beneath you is unstable. “One of the take-home exercises we give people is to stand on one leg while brushing your teeth, and to close your eyes if it’s too easy,” Hertel says. “It may sound ridiculous, but if you do that for two or three minutes a day, you’re working your balance really well.”

Nutrition and Exercise

JULY 2, 2009, 1:29 PM
Eating to Fuel Exercise

By TARA PARKER-POPE
Leslie Bonci
No matter what kind of exercise you do – whether it’s a run, gym workout or bike ride – you need food and water to fuel the effort and help you recover.

But what’s the best time to eat before and after exercise? Should we sip water or gulp it during a workout? For answers, I spoke with Leslie Bonci, director of sports nutrition at the University of Pittsburgh Medical Center and a certified specialist in sports dietetics. She’s also the author of a new book, “Sports Nutrition for Coaches” (Human Kinetics Publishers, July 2009). Here’s our conversation.

How important is the timing and type of food and fluid when it comes to exercise?

I take the approach of thinking of food as part of your equipment. People are not going to run well with one running shoe or ride with a flat tire on their bike. Your food is just like your running shoes or your skis. It really is the inner equipment. If you think of it this way, you usually have a better outcome when you’re physically active.

What’s the most common mistake you see new exercisers make when it comes to food?

There are two common mistakes. Often somebody is not having anything before exercise, and then the problem is you’re not putting fuel into your body. You’ll be more tired and weaker, and you’re not going to be as fast.

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The second issue is someone eats too much. They don’t want to have a problem, so they load up with food, and then their stomach is too full. It’s really a fine line for getting it right.

At what point before exercise should we be eating?

I like it to be an hour before exercise. We’re just talking about a fist-sized amount of food. That gives the body enough food to be available as an energy source but not so much that you’ll have an upset stomach. So if you’re going to exercise at 3 p.m., you need to start thinking about it at 2 p.m.

What about water? How much should we be drinking?

About an hour before the workout you should have about 20 ounces of liquid. It takes about 60 minutes for that much liquid to leave the stomach and make its way into the muscle. If you have liquid ahead of time, you’ll be better hydrated when you start to be physically active.

Can you explain more about what you mean by a “fist-size” of food?

That’s just a good visual for the amount. It could be something along the lines of a granola bar. I’m not a fan of the low carb bars. You need carbs as an energy source. We can’t really just do a protein bar. You want something in the 150 to 200 calorie range. That’s not enormous. Maybe a peanut butter and jelly wrap cut into little pieces, a fist-sized amount of trail mix. The goal is to put some carbohydrate in the body before exercise as well as a little bit of protein.

What if I’m planning a long run or bike ride that’s going to keep me out for a few hours? Should I eat more?

If we put too much food in the stomach in advance of exercise, it takes too long to empty and that defeats the purpose. We want something that will empty fairly quickly. If you’re exercising in excess of one hour, then you need to fuel during the exercise. For workouts lasting more than an hour, aim for about 30 to 60 grams of carbs per hour. We’re not going to be camels here. Some people use gels, honey or even sugar cubes or a sports drink.

Does the timing of your food after you’re finished exercising make any difference?

Post exercise, my rule of thumb, I like for people to eat something within 15 minutes. The reason for that is that the enzymes that help the body re-synthesize muscle glycogen are really most active in that first 15 minutes. The longer we wait to eat something, the longer it takes to recover.

If people are really embarking on an exercise program and want to prevent that delayed-onset muscle soreness, refueling is part of it. Again, it’s a small amount – a fist-sized quantity. Low-fat chocolate milk works very well. The goal is not a post-exercise meal. It’s really a post-exercise appetizer to help the body recover as quickly as it can. You can do trail mix, or make a peanut butter sandwich. Eat half before and half after.

Why is it that peanut butter sandwiches come up so often as good fuel for exercise?

It’s about having carbohydrate with some protein. It’s inexpensive and nonperishable. That’s a big deal for people, depending on the time of day and year. They’re exercising and they don’t want something that will spoil. Peanut butter is an easy thing to keep around.

What do we need to know about replenishing fluids as we exercise?

Everybody has a different sweat rate, so there isn’t one amount of liquid that someone is going to need while they exercise. Most people consume about 8 ounces per hour – that’s insufficient across the board. Your needs can range from 14 ounces to 40 ounces per hour depending on your sweat rate. Those people who are copious sweaters need to make an effort to get more fluid in while they exercise. I’m a runner, and I can’t depend on water fountains, so either someone is carrying water or you bring money. Store keepers always love that when you give them sweaty bills!

But nobody can be a camel. If you aren’t taking fluid in you have a risk of heat injury and joint injury, and strength, speed and stamina diminish. This is an important part of any training. Put fluid back into the body during exercise.

Should we keep sipping fluids while we’re exercising?

How we drink can make a difference in how optimally we hydrate our body. A lot of people sip liquids, but gulping is better. Gulps of fluid leave the stomach more rapidly. It’s important to do this. It seems counterintuitive, it seems like gulping would cause a cramp. People are more likely to have stomach cramps sipping because fluid stays in their gut too long.

When you take more fluid in, gulps as opposed to sips, you have a greater volume of fluid in the stomach. That stimulates the activity of the stretch receptors in the stomach, which then increase intra-gastric pressure and promote faster emptying. This is why gulping is preferred.

Do you have any recommendations about the frequency of meals for people who exercise regularly?

If you have breakfast, lunch and dinner and a pre- and post-exercise snack, that’s at least five times a day of eating. When people are physically active, anything under three meals a day is not going to be enough.

Tour de Lance

Quote Of The Week

"Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever."

Lance Armstrong
Cancer Survivor and Athlete

Energy and Sports Drinks: Any Better Than Soda?

Remember when water was the drink of choice for athletes and just about anyone who needed to quench their thirst? These days, water is quickly being replaced with a variety of energy drinks, flavored waters and sports drinks - and they're being consumed at all hours of the day, not just after a workout or during an athletic competition.

Energy Drinks

One of the major health concerns with energy drinks is their caffeine content: up to 80 mg of caffeine per serving. According to Brown University, that's more than twice the caffeine in a can of Mountain Dew and more than three times the caffeine in a can of Coca Cola Classic. Too much caffeine can elevate the heart rate, increase blood pressure, and lead to insomnia. (Some manufacturers have now come out with decaffeinated versions, although that hasn't seemed to particularly impact the popularity of the caffeinated varieties.)

A recent study that investigated potential safety issues in energy drinks reveals that most energy drinks also contain some combination of natural products such as guarana, taurine and ginseng. And let's not forget about sugar, one of the major ingredients in addition to caffeine. Average sugar content can exceed 35 grams per can, according to the study.¹ (Sugar-free versions of some energy drinks are available, but remember, there are plenty of sugarfree sodas out there, and none of them has health benefits, either.)

Perhaps the most telling point appears in the authors' conclusion: "The amounts of guarana, taurine, and ginseng found in popular energy drinks are far below the amounts expected to deliver either therapeutic benefits or adverse events. However, caffeine and sugar are present in amounts known to cause a variety of adverse health effects."

According to Brown University, energy drinks should never be consumed while exercising, as they tend to promote dehydration, which can be dangerous when combined with fluid loss from sweating. They also should not be combined with alcohol (they often are); the former is a stimulant and the latter is a depressant, which can be a bad combination. And again, both tend to promote dehydration.

Sports Drinks and Flavored Waters

If you think sports drinks or flavored, vitamin-infused waters are any better than energy drinks, you may want to think again. Sure, they may not be filled with caffeine, but they definitely still have sugar and other additives, and according to a recent study, those added ingredients may contribute to dental problems.

In fact, studies have shown that the combination of sugar, acidic ingredients and additives in some sports drinks can damage tooth enamel to a larger degree than soda. A recent study presented at the International Association for Dental Research meeting in Miami affirms this, with study results suggesting sports drinks - including Gatorade, Vitamin Water, Life Water, Powerade and Propel Fit - cause softening of the dentin, while some may even "significantly" stain the teeth.²

"Sugar is bad, and acid is bad, but many of these [sports drinks and flavored waters] have both. The combination causes tooth decay," said Kimberly Harms, spokesperson for the American Dental Association.³

How to Garden without Breaking Your Back

Now that the weather is starting to warm up, a lot of our patients are heading out into the garden. Who can resist the allure of fresh air, sunshine, the feel of dirt in their hands, and the promise of delicious, homegrown fruits and vegetables? It's a wonderful thing to grow some of your own food. But gardening is an inherently challenging activity for people who have any kind of weakness in the back, so it's important to take precautions while in the garden.


Why does gardening cause back problems?
Part of the reason gardening causes back problems is that it's a weekend warrior activity. You go for months and months without gardening, and then you end up doing a physically demanding activity for an extended period of time that your body isn't used to doing. In particular, gardening involves a lot of forward bending, which loads a tremendous amount of pressure on the discs and joints. The Oklahoma State University website does a good job of explaining this phenomenon:

Think of your back as a lever. With the fulcrum in the center of the lever, it only takes ten pounds of pressure to lift a ten pound object. However, if you shift the fulcrum to the side, it takes much more force to lift the same object. Your waist actually acts like the fulcrum in a lever system, and it is not centered. In fact, it operates on a 10:1 ratio. Lifting a ten pound object actually puts 100 pounds of pressure on your lower back. When you add in the 105 pounds of the average human upper torso, you see that lifting a ten pound object actually puts 1,150 pounds of pressure on your lower back.[i]

Oftentimes, not only are you bent forward when you're gardening, but you're attaching something to the end of your hand, like a shovel with a mound of dirt, which makes the lever even longer and thus puts even more pressure on your back.

[1] Oklahoma State University. Back Safety. http://ehs.okstate.edu/kopykit/Back%20Safety.pdf

Tips for pain-free gardening

1. Be careful of forward bending for too long
Don't bend over in an uncontrolled position for hours and hours. Either kneel, sit on a little stool, or figure out what the best posture position is for you.

2. Take frequent breaks
Every 30 minutes, get up and stretch your back. Even short breaks can prevent back injuries.

3. Do backward bending exercises
To counteract all that forward bending, do some backward bending exercises if they work for you.

4. Hire out the hard stuff
If you need to do some digging, and digging is really hard on your back, hire someone to dig for an hour for you. The rest will be easy!

5. Quit when your back feels tired
If you feel your back starting to get tired or painful, stop. Frequently injuries happen when the back is tired.

Remember, a lot of chronic back problems start with either minor tears in the discs or strains to the ligaments, and those things can easily occur with gardening. That doesn't mean you shouldn't garden. Gardening gives you an opportunity to connect to the earth in a very profound and deep way. So do it, just take care of yourself while doing it!

Sincerely,

Marc Heller Matt Terreri

What you eat can improve your health, mind, and appearance

For many, springtime means revamping exercise regimens, improving appearance, reading more books, taking on a new hobby, and improving dietary habits.

Great news is that following good-for-you food goals will help your whole body -- from your skin to your brain -- so you can tackle those other resolutions with ease.

"The best way to have healthy hair, eyes, and skin is to take good overall care of yourself. That means eating well," said Dr. David L. Katz, director of the Yale Prevention Research Center at Yale University. So whether it's your heart, brain, bones, eyes, skin, or hair you seek to nurture, there are foods up to the task.

"The more colors you get into your diet, the better," Katz said. A variety of fruits and vegetables supplies antioxidants and vitamins that are most powerful when working together. Daily servings of whole grains, lean protein, and dairy round out your body's needs. A diet rich in fresh, whole foods, full of colors and rich textures, satisfies with abundant flavor, and nourishes every part of your body.

For Silky Skin and Hair

Antioxidants like lycopene and vitamin C, as well as soy protein and omega-3 fatty acids, help keep skin glowing. Antioxidants have long been the rage in topical skin care, but those same nutrients work even better from the inside out. When skin (the body's largest organ) is exposed to the sun's rays, free radicals can develop, Katz explained. "These free radicals attack the skin and impair blood flow to the area, causing premature aging. Antioxidants fight that process."

Vitamin C, found in citrus fruits, facilitates collagen production, a critical component for vibrant skin. Another antioxidant, lycopene, found in foods like canned tomatoes and red grapefruit juice, also promotes skin health. Tofu is a good option since its omega-3 fatty acids help regenerate new skin cells and reduce inflammation, while its soy protein has been shown to boost collagen.

Shiny, healthy hair starts with the vitality of cells in the hair follicle, where hair is manufactured, says Katz. Eat foods high in calcium and quality protein like eggs, dairy, or fish. Eggs also provide biotin, a structural component of both bone and hair. Vitamins B6, B12, and folate nourish follicle cells, too.

Eat For Your Eyes

According to a study published in the Archives of Ophthalmology, people who ate two servings of fish weekly benefited from an almost 50 percent decrease in the risk of age-related macular degeneration (AMD), said Dr. Emily Chew, deputy director of the division of epidemiology and clinical research at the National Eye Institute. Eggs, leafy greens, broccoli, winter squash, and Brussels sprouts all contain the antioxidants lutein and zeaxanthin (both associated with eye health), as well as vitamins C and E, zinc, and beta-carotene.

Scientists are still investigating how these foods promote eye health. Observational studies show they likely reduce the risk of AMD, Chew said. No one knows exactly what lutein and zeaxanthin do for the eye, but it's thought they filter damaging light and support cell structure. Expect more answers in 2012, when Chew and colleagues hope to publish research on the effects of lutein, zeaxanthin, and omega-3 fatty acids from a study following 4,000 patients for five years.

Build Better Bones

Calcium, vitamin D, and phosphorus work together to build strong bones. Even though green leafy and cruciferous vegetables (like spinach and broccoli) contain calcium, the body absorbs it best from dairy products, said Joan Lappe, a bone health researcher and professor at Creighton University in Omaha, Nebraska.

Dairy products offer a package deal: they are abundant in phosphorous, and vitamin D added to milk and dairy products aids in calcium absorption. Some nondairy foods high in calcium include canned salmon, sardines, and calcium-fortified firm tofu.

Greens are still good bone foods, however. Broccoli, kale, and bok choy may provide little calcium, but they offer plenty of vitamin K. Research is showing promise that vitamin K -- or some antioxidant or phytochemical in foods high in the vitamin -- boosts bone mineralization. Research published last year in Osteoporosis International followed postmenopausal women for three years, and found that those taking supplemental vitamin K maintained or enhanced bone strength, compared to those on a placebo.

Heart Helpers

Whole grains, fatty fish, and fresh fruits and vegetables are the keys to keeping your heart in prime condition.

A recent review of seven studies showed that two and a half servings of whole grains per day reduced heart attack and stroke risk by 21 percent, said lead author Dr. Philip Mellen, then an assistant professor at the Wake Forest School of Medicine in Winston-Salem, North Carolina. Whole grains are rich in antioxidants, especially vitamin E (also found in almonds, peanuts, and green leafy vegetables), which helps maintain healthy blood vessels. And soluble fiber from fruits, vegetables, and nuts helps lower harmful LDL cholesterol and control weight, both of which have a positive impact on heart health.

Further cut your risk of a heart attack by eating fish, especially those high in the omega-3 polyunsaturated fats like salmon, mackerel, or rainbow trout. Omega-3s make platelets in the blood less sticky, reducing clotting and the likelihood of a heart attack.

Brain Boosters

Omega-3 fatty acids and whole grains are good for your heart -- and they're good for your brain and mental health, too. "People who are heart healthy are brain healthy," said Dr. Joseph S. Kass, assistant professor of neurology at Baylor College of Medicine in Houston, Texas.

Kristen E. D'Anci, a research psychologist in the Nutrition and Neurocognition Laboratory at Tufts University and professor of psychology, noted, "Diets rich in vitamins C and E are consistently associated with lower levels of cognitive impairment in aging." Abundant in fruits, vitamin C may also reduce the risk of stroke.

Additionally, vitamins B12, C, E, and folate may play a direct role in keeping your mind sharp. Research shows that B12 (found in lean protein like turkey) and folate (found in many grains fortified with the vitamin) help improve memory and lower the risk of Alzheimer's. They may also help people over age 60 with learning, attention, and response speed, according to study results from Tufts University.

The pleasure of posture awareness

By Julie Duck

Maybe it is a childhood thing to slouch. Or simple laziness on the part of anyone, young or old, who finds themselves slumped in their seat. However you look at it, good posture plays an important role in overall wellness, including spine health. When your patient is not standing up straight, it is time to educate him on the reasons why he should, and guide him toward simple solutions to help raise his posture awareness.

The slump
Have you ever been told to sit up straight or stop slouching? There is more to it than manners, because good posture helps the body to stay in alignment, and contributes to everything from walking and running, to sitting and sleeping. Unfortunately, bad habits can lead to poor posture, and subsequent problems with the back, shoulders and neck.

Where does bad posture begin? It starts with being unaware of the body’s position. Slouching is simple and easy to revert to unless one is paying attention to their posture. Additionally, people with depression, spinal issues and those who are obese are at greater risk for poor posture because they tend to hunch down. Have you ever tried to “hide” yourself with a slouch?

To help your patients become more aware of their posture, point out the little things – the everyday occurrences – that can contribute to slouching, and show them how little changes can make big differences in their posture.

Bag the bag
Some of the biggest contributors to bad posture are the millions of heavy briefcases, handbags and backpacks that are lugged around by men, women and children every day. Stuffed to the gills, and generally oversized for fashion reasons, many of today’s bags are just too big to carry and get away with it. Slinging heavy objects, such as an overloaded backpack or humongous purse, over one’s shoulders puts a disproportionate amount of weight across one side of the body, leading to slumping shoulders, hunched backs and strain. The result is painfully poor posture.

Ideally, the weight of any backpack, bag or briefcase should be dispersed via two straps, but because most purses and messenger bags are not made that way, the next best thing is a bag with a wide, padded shoulder strap that allows one to pull it over the head and sling it across the body. There are several ergonomically correct bags available on the market that address the issue of posture, of which you can provide to patients who need to put more effort into their awareness. Or, suggest that the patient carry only what they need for the day in their bag, instead of the whole kit and caboodle, to promote good posture habits.

The super six-pack
Core strength can make a difference when it comes to bad posture and back pain. Without strong abdominal muscles, the back becomes weak and unable to optimally support the spine. Additionally, the muscles that reside closer and deeper to the spine have a greater overall effect on posture and, subsequently, a healthy back. By exercising on a regular basis, the stomach muscles can become strong, holding the spine correctly and allowing for naturally good posture. This knowledge alone, however, might not be the trick to getting your patients to do their crunches.

Let them know that good posture that is supported by regular exercise, can contribute to a more slender-looking body and reduce the appearance of a potbelly. This alone could motivate many patients who want to appear slimmer to stand up straight.

Healthy posture, healthy spine
Of paramount importance is spine health. Poor posture can be the culprit for spinal pain and problems with the shoulders and neck, as well as contribute to the worsening of pain that is already present. And because many people spend large chunks of time at their desks, slouching in their chairs, or performing repetitive lifting without good form, there is quite a bit of back pain all around. For these patients, teaching them about the benefits of good posture can help them to begin to utilize posture awareness to prevent possible future injury and additional pain. By simply keeping a neutral spine, your patients may finally realize just how superior good posture can feel

Fiber supplements lay foundation for health

In the world of wellness, the benefits of fiber may be too easily forgotten. After all, there is nothing flashy about fiber. In comparison to dietary stars such as “super foods” and antioxidants, fiber may appear downright pedestrian.

Years of solid research and scientific investigation, however, prove that fiber is no flash in the pan. In fact, this food staple helps lay a strong foundation for good health, as fiber has been linked to a number of physical benefits.

According to the Mayo Clinic, a diet high in fiber can decrease cholesterol, help with regularity, aid in the prevention of constipation and speed up the passage of material through the GI tract. It also may decrease your risk of digestive conditions, such as irritable bowel syndrome and hemmorhoids. Experts report that the consumption of fiber can slow the absorption of sugar as well, which is good news for diabetics and for the prevention of type 2 diabetes.

Added on to the list of benefits associated with fiber is the fact that it can help you feel full for a longer period of time, which may lead to weight loss. Plus, as people choose foods that are high in fiber, they usually are choosing foods that happen to be lower in fat, sodium and other unhealthy components as well. For example, good choices for high-fiber foods include grains, whole-grain products, fruits, vegetables, beans, peas, legumes, nuts and seeds.

However, not everyone may be able to meet their daily fiber needs through food intake. In this case, it is important to look toward fiber supplements to do the trick. Health experts recommend that men to get 30 to 38 grams of fiber per day, and that women get 20 to 25 grams per day. Study your diet, and figure out whether a fiber supplement would contribute to overall wellness.

In order to understand the importance of consuming adequate amounts of fiber, it’s important to know the definition of fiber. The Mayo Clinic defines it as “all parts of plant foods that your body can't digest or absorb.”

“Unlike other food components such as fats, proteins or carbohydrates — which your body breaks down and absorbs — fiber isn't digested by your body,” the Mayo Clinic reports. “Therefore, it passes virtually unchanged through your stomach and small intestine and into your colon.”

Fiber frequently is classified into two types: soluble and insoluble. Soluble fiber, found in foods such as oats, peas, beans, apples, citrus fruits, carrots and barley, dissolves in water to form a gel-like substance.

Insoluble fiber, on the other hand, does not dissolve in water. This type of fiber, found most often in foods such as whole-wheat flour, wheat bran, nuts and many different vegetables, promotes the movement of material through your digestive tract. It also increases stool bulk, which can be beneficial for those who have irregular stools or constipation.

The benefits of fiber are many, especially as it addresses the risk factors tied to so many diseases, including heart disease, diabetes, diverticular disease, constipation and metabolic syndrome.

If you do decide to up your fiber intake, be sure to choose a broad-spectrum dietary fiber supplement, which contains both soluble and insoluble fiber.

Study: Fruit and vegetable consumption inadequate worldwide

A new study that looks at the fruit and vegetable consumption of nearly 200,000 people finds that the prevalence of inadequate diet is “remarkably high” across the globe.

Overall, 77.6 percent of men and 78.4 percent of women consumed less than the suggested five daily servings of produce.

“Low fruit and vegetable consumption is a risk factor for overweight and obesity, and adequate consumption decreases risk for developing several chronic diseases,” said lead author Spencer Moore. “The release of the 2002-2003 World Health Survey data provided a unique opportunity to examine global differences in low fruit and vegetable consumption in a way that has until now simply not been possible.”

Moore is an assistant professor in the School of Kinesiology and Health Studies at Queen’s University in Ontario, Canada. He and his colleagues looked at data from 196,373 adults in 52 mainly low- and middle-income countries.

The study appears in the May issue of the American Journal of Preventive Medicine.

There were wide variations among nations, ranging from 37 percent of men in Ghana who did not meet that standard — to 99 percent of Pakistani men. The researchers saw similar findings in women with the same two countries at the high and low ends

The prevalence of low fruit and vegetable intake increased with age and decreased with income. These results surprised Moore, as surveys from the United States and other developed countries consistently show that fruit and vegetable intake increases with age.

“Most people regardless of the country that they live in simply do not meet the recommended guidelines for adequate fruit and vegetable consumption,” said co-author Justin Hall, a graduate student at Queen’s University. “Some countries appear to be better off than others in relative terms, but the overall prevalence of low fruit and vegetable consumption is remarkably high across the globe.”

Tim Byers, M.D., interim director of the University of Colorado Cancer Center at Denver, said that this study argues against the stereotype that those in tropical climates have better diets because fruits and vegetables surround them.

“Although the survey deals mainly with developing countries, their results are not substantially different from those we have seen in other surveys done in Europe or the United States,” said Byers, who was not involved in the study. “This is telling us that dietary quality is a global problem.”

Hall JN, et al. Global variability in fruit and vegetable consumption. Am J Prev Med. 36(5), 2009.

Cubicle stretches

By Jeannine Stein
March 2, 2009

If you don't move around nearly enough during the workday, you might need to compensate with these flexibility-enhancing moves. Some require minimal equipment such as dumbbells; others can be done at one's desk or against an unoccupied bit of wall space. Sure, the moves may raise a few eyebrows in the office, but while everyone else is reaching for pain relievers, you'll be sprinting out the door ready for after-hours socializing.

Pete McCall exercise physiologist with the American Council on Exercise, and a San Diego-based personal trainer:

For clients who sit all day, I like to do three different exercises.

* The first is a bridge, where you lie on your back with your feet on the floor, legs bent and push your hips up to the ceiling while squeezing the glutes. The activation of the glute muscles sends a signal to the hip flexors to relax, and it allows them to lengthen. Push the hips up on a one-two count, hold for about a second, and take about three to four seconds to come down. Do that about 12 to 15 times, and really emphasize the contraction of the glutes.

* The next one is a quadruped, or a bird dog. Begin on hands and knees, making sure your wrists are under your shoulders, knees are under your hips and your head and neck are aligned with your spine. Extend your right arm and left leg straight out at the same time. While you're doing this, contract your ab muscles and feel the stretch through the upper chest muscles and the hip flexor. Do this about 10 to 12 times on each side, either alternating, or staying on the same side and then switching.

* The third one is a plank. The body is supported on the forearms and the toes, and you should try to keep the hips and the shoulders at the same height. Contract the core muscles, and the glutes and the quadriceps. As with the bridge, as the glutes contract the hip flexors relax and lengthen. Do these about two to three times and hold for about 15 seconds. To modify this, drop down to your knees, but watch the hip position and avoid bending the body at the hips. You should still feel the extension in the hip flexors.

Then, for a great stretch for the neck and shoulders, let your left arm hang down at your side, and look over your right shoulder. Press your right hand into your chin. Do the other side as well. That gets the levator scapulae and the scalene muscles -- smaller muscles in the neck that get tensed up a lot.

For help with rounded shoulders, stand two to three feet in front of a wall, with your back toward the wall. Rotate the body to the right side and reach up and touch the wall with your right hand as if reaching for something on a shelf. Do the same on the left. This opens up the pectoral muscles and the obliques in the abdomen. It's also a good stretch for the hip flexors.

Tasha Turner

Personal trainer, t:

* The hip flexors tend to get tight if you sit all day, so you want to release that tension and stretch and strengthen them as much as possible. Before you do strengthening exercises, you want to stretch them out with something like a bridge.

* I love squats for strengthening the hips, and you can do them with just your body weight. Three sets of 20 reps is good, or you can try doing them continuously for one minute. If you want definition in your legs, do them with weights for three to four sets of eight to 10 reps. As you progress, increase the weight to shock the system and avoid plateaus.

* I'm a die-hard fan of lateral raises to strengthen the shoulders, but doing them with bent elbows really isolates the shoulder muscle and takes the strain off the neck. Start by holding light dumbbells (about 3 to 5 pounds) by your side, with elbows bent. Raise the arms, making sure the elbows and shoulders are in a straight line -- never go any higher than that. Hold that position for two seconds, then take the arms down slowly. Do three sets of 15 to 20 reps. You can do this standing or sitting, but sitting may be a little more challenging because you're less likely to use momentum to move the weights. This will take the pressure off the neck, especially if you sit at a computer all day and strain your neck trying to read the screen.

* In general, it's a good idea to work on core exercises. You move through your core, and you need a strong core for everything -- walking, standing, even sitting.

Eric Fleishman

, Powerhouse Gym, Burbank:

* One good quick stretch is putting your leg up on a desk or a chair and, keeping the knee slightly bent, reaching down and trying to grab your toe. This allows your hamstrings to get a stretch, which is good if you've been sitting all day. You'll really feel it in the back of your leg, and it has a great effect on the lower back because it promotes blood flow to the region. Then do the other leg. * You should pay attention to your posture, which is incredibly important for body alignment and feeling good, and how you're sitting. We do an exercise at the gym where we take a small bottle of water that's about one-third full and place it on someone's head and have them walk around, which is very "My Fair Lady," but it teaches you what proper posture feels like. You can do the same thing sitting at a desk.

* There's almost nothing better to stretch your shoulders, your trapezius muscles and your back by finding a chin-up bar and allowing yourself to hang. It's almost like picking up a necklace from a table -- it allows the spine and vertebrae to fall into place. It's important not to hold your breath, and you can hang anywhere from eight to 15 seconds. For a more advanced move, swing a little bit back and forth.

Next up on Ask the Trainers: exercises for people always on the move.

Getting health benefits from chocolate

Joe Graedon, Teresa Graedon, The People's Pharmacy
March 30, 2009

A column described health benefits from chocolate. Would high-quality chocolate include Snickers bars? What would be a moderate amount, to get the health benefits?

High-quality chocolate is dark chocolate (at least 70% cocoa solids, and not alkali processed). A good "dose" is 5 to 15 grams daily, which should be just under 100 calories. This is not a large piece of chocolate.

A traditional Snickers bar contains milk chocolate, weighs 58.7 grams and has 280 calories. Milk chocolate does not have the same benefits as dark chocolate.

::

I have been taking Protonix for heartburn. After I learned that long-term use might lead to complications, I tried to stop taking it. After about a week, I had to start taking it again due to severe heartburn. I asked my pharmacist how to discontinue acid-suppressing drugs, but she was unable to find out.

Rebound heartburn may make it difficult to stop medications such as Aciphex, Nexium, Prevacid, Prilosec and Protonix. As a result, people sometimes end up taking such drugs for years. The consequences might include an increased risk of pneumonia, hip fractures and vitamin B-12 deficiency.

Dr. Tieraona Low Dog, director of education for the Arizona Center for Integrative Medicine, recommends a gradual approach for discontinuing acid suppressors. She suggests taking ginger capsules and chewing DGL (deglycyrrhizinated licorice) tablets as you phase out Protonix. Probiotics also may be helpful.

Joe Graedon is a pharmacologist and Teresa Graedon is an expert in medical anthropology and nutrition. www.peoplespharmacy.com

Tea: Some like it hot, but that raises cancer risk

By Karen Kaplan

Los Angeles Times

Is there anything left that isn't linked to cancer?

Not hot tea, apparently. An international group of scientists has connected it with esophageal cancer. The problem doesn't appear to be the tea but the temperature at which it is consumed, the study found.

Residents of Golestan province in northern Iran have one of the highest rates of esophageal squamous-cell carcinoma in the world. They don't drink alcohol or smoke — the two primary risk factors for the disease in the West — but they do consume tea. Lots of it. Nearly 1.2 liters a day, on average.

Local researchers set out looking for a connection.

They recruited 300 esophageal-cancer patients who were diagnosed at the only gastrointestinal-specialty clinic in the eastern part of Golestan and matched them up with 571 healthy controls who shared their age, gender and place of residence. All but one drank tea, and they gave interviewers information about their tea consumption and brewing habits.

Teaming up with investigators from the United States, England, France and Sweden, the researchers calculated that people who said they drank "hot" tea — 149 to 156 degrees Fahrenheit — were more than twice as likely to develop esophageal cancer as people who said they drank the beverage "warm" or "lukewarm": less than 140 degrees.

Those who said they took their tea "very hot" — at least 158 degrees — were more than eight times as likely to get esophageal cancer, according to the study, published online Thursday in BMJ, formerly the British Medical Journal.

The researchers also asked people how long they waited to drink their tea after pouring it. Those who said they waited two to three minutes were nearly 2.5 times more likely to develop the cancer compared with people who said they waited at least four minutes. Impatient tea drinkers who waited fewer than two minutes were 5.4 times as likely to be diagnosed with esophageal cancer, the study found.

The study didn't assess the mechanism linking hot tea to esophageal cancer, but the researchers said the temperature of the liquid was almost certainly to blame rather than the compounds in the tea.

In an editorial accompanying the study, David Whiteman of the Queensland Institute of Medical Research in Brisbane, Australia, advised tea drinkers in Iran and elsewhere to simply exercise some patience and wait at least four minutes before enjoying their favorite beverage.

Fish oil pills don't boost benefit of heart drugs

By MARILYNN MARCHIONE

AP Medical Writer

ORLANDO, Fla. —

Heart attack patients who are already taking the right medicines to prevent future problems get no added benefit from taking fish oil capsules, a large study in Germany finds.

The study tested a 1-gram daily dose of a prescription version of highly purified omega-3 fatty acid - the "good fat" contained in certain oily fish that is thought to help the heart.

Researchers led by Dr. Jochen Senges of the University of Heidelberg gave fish oil or dummy capsules to more than 3,800 people who had suffered a heart attack in the previous two weeks. About 90 percent were already receiving all the medicines recommended to prevent a second attack, including aspirin, anti-clotting and cholesterol drugs.

After a year, it made no difference whether these patients took fish oil or dummy capsules. In both groups, fewer than 2 percent had suffered sudden cardiac death, 4 percent had another heart attack, and fewer than 2 percent had suffered a stroke.

If recent heart attack patients are already getting good care, "there is almost nothing you can do better on top of this" to further lower risk, Senges said. He presented the results Monday at an American College of Cardiology conference.

The research doesn't mean that fish oil is of no value, and the study didn't address whether it can help prevent heart disease in the first place, doctors said.

The prescription version used in the study, sold as Omacor and Lovaza in the United States and as Zodin in Europe, is a highly purified and standardized form, different from what many consumers buy off the shelf.

Omega-3 fatty acids also are found in wild oily fish such as salmon, tuna, mackerel, sardines and herring. Scientists think it raises HDL, or good cholesterol, lowers harmful fats called triglycerides and slows the growth of plaque that can clog arteries.

The American Heart Association recommends adults eat fish at least twice a week, said Alice Lichtenstein, a Tufts University nutrition professor and Heart Association spokeswoman. For people with heart disease, the association advises 1 gram of omega-3 a day.

"A modest, 3-ounce cooked salmon has a little more than a gram," she said.

Fish oil capsules are not for children or women who are pregnant or nursing, because the pills pose a bleeding risk. Taking more than 3 grams a day from supplements should only be done under a doctor's orders, the heart association warns. The capsules also should be stopped a week or so before surgery because of a risk of bleeding.

The German study shows that "we need to be a little more cautious about the prediction of individual benefit of any nutritional supplements," said Lichtenstein, who had no role in the research.

"We see this pattern - people are so willing to embrace the simple answer," as if it's possible "to crack a capsule over a hot fudge sundae" and undo the harm of harmful diets and lack of exercise, she said.

---

On the Net:

Cardiology meeting: http://www.acc.org

Heart Association advice: http://tinyurl.com/25x6z

Believing in Treatments That Don’t Work

April 2, 2009, 10:46 am

Believing in Treatments That Don’t Work

As Washington debates health care reform, emergency room physician Dr. David H. Newman explores how medical ideology often gets in the way of evidence-based medicine.

By David H. Newman, M.D.

In the early throes of a heart attack, caused by an abruptly clotted artery, the stunned heart often beats quickly and forcefully. For decades doctors have administered “beta-blockers” as a remedy, to reduce consumption of limited oxygen supplies by calming and slowing the straining heart. Giving these drugs in the early stages of a heart attack represents elegant medical ideology.

But it doesn’t work.

Studies show that the early administration of beta-blockers to heart attack victims does not save lives, and occasionally causes dangerous heart failure. While two studies support the use of beta-blockers after heart attack, there are 26 studies that found no survival benefit to administering beta-blockers early on. Moreover, in 2005, the largest, best study of the drugs showed that beta-blockers in the vulnerable, early hours of heart attacks did not save lives, but did cause a definite increase in heart failure.

Remarkably, the medical community has continued to strongly recommend immediate beta-blocker treatment. Why? Because according to the theory of the straining heart, the treatment makes sense. It should work, even though it doesn’t. Ideology trumps evidence.

The practice of medicine contains countless examples of elegant medical theories that belie the best available evidence.

• Recent press reports detailing the dangers of cough syrup for children have noted that cough syrup doesn’t work. True: No cough remedies have ever been proven better than a placebo, either for adults or children. Yet their use is common.
• Patients with ear infections are more likely to be harmed by antibiotics than helped. While the pills may cause a small decrease in symptoms (for which ear drops work better), the infections typically recede within days regardless of treatment. The same is true for bronchitis, sinusitis, and sore throats. Unnecessary antibiotics are still given to more than one in seven Americans each year for these conditions alone, at a cost of more than $2 billion and tens of thousands of serious adverse medication effects requiring treatment.
• Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment. Yet doctors perform 600,000 of these surgeries each year, at a cost of over $20 billion.
• More than a half million Americans per year undergo arthroscopic surgery to correct osteoarthritis of the knee, at a cost of $3 billion. Despite this, studies show the surgery to be no better than sham knee surgery, in which surgeons “pretend” to do surgery while the patient is under light anesthesia. It is also no better than much cheaper, and much less invasive, physical therapy.

Treatment based on ideology is alluring. Surgeries to repair the knee should work. A syrup to reduce cough should help. Calming the straining heart should save lives. But the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.

The critical question that looms for health care reform is whether patients, doctors and experts are prepared to set aside ideology in the face of data. Can we abide by the evidence when it tells us that antibiotics don’t clear ear infections or help strep throats? Can we stop asking for, and writing, these prescriptions? Can we stop performing, and asking for, knee and back surgeries? Can we handle what the evidence reveals? Are we ready for the truth?

The administration’s plan for reform includes identifying health care measures that work, and those that don’t. To place evidence above ideology, researchers and analysts must be trained in critical analysis, have no conflicts of interest and be a diverse group.

Perhaps most importantly, we as doctors and patients must be open to evidence. Pills and surgery are potent symbols of healing power, but our faith in these symbols has often blinded us to truths. Somewhere along the line, theory trumped reality. Administering a medicine or performing a surgery became more important than its effect.

During the first week of 2009, in what may be a hopeful sign, hospital administrators around the country received a short, unceremonious e-mail from the Centers for Medicare and Medicaid Services. The e-mail explained that, due to recent evidence, immediate beta-blocker treatment will be retired as a government indicator of quality care, beginning April 1, 2009. After years of advocacy that cemented immediate beta-blockers in the treatment protocols of virtually every hospital in the country, the agency has demonstrated that minds can be changed.

The much more important question for health care reform is, can ours?

Dr. Newman is author of “Hippocrates Shadow: Secrets From the House of Medicine.”

Find your balance

By KATE HANLEY

As happens with so many things in life, we rarely think about balance until we lose it. Yet balance is crucial to our wellbeing—it prevents falls, helps us navigate uneven terrain, and keeps us upright when walking, running, biking, dancing, or skiing.
FIGHT GRAVITY. Stability exercises can help you be more sure-footed. “The best way to work on your balance is to put yourself in unstable situations that force you to improve your relationship with gravity,” says Jen Weck, a Bosu ball master trainer. “This will strengthen your stabilizer muscles, improve your range of motion, and solidify your core.”
STEADY YOURSELF. Anything that challenges your proprioception (your body’s sense of where it is in space) will hone your sense of balance. This includes working out on an uneven surface like a wobble board or Bosu ball (ask a personal trainer to show you how). As your balance improves so will your posture and your ability to negotiate ski slopes, hiking trails, and neglected city sidewalks. Weck, who recommends doing exercises that challenge your balance two to three times per week, suggests you get started with this move.

Single Leg Balance
“This simple exercise is much more challenging than it sounds,” says master Bosu ball trainer Jen Weck. “Standing with all your weight on the unstable surface of the Bosu ball tones your core, legs, ankles, and feet. If practiced regularly, it can improve your balance, coordination, and posture.”
1. Stand up straight on top of a Bosu ball with your left foot on the center of the ball and your right foot resting next to your left foot. Shift your weight to your left leg and bring your arms straight out to your sides at shoulder height.
2. Point your right toes and either rest them on the side of the dome or, for more of a challenge, lift your right leg slightly out to the side. Aim to hold the position for 30 seconds. To increase the diffi culty, close your eyes and try to hold the position for 10 seconds. Repeat on the other side.

3 WAYS TO HOLD STEADY
1. TRY TAI CHI. Studies show that regular tai chi practice reduces falls and improves balance and leg strength. With its slow, rhythmic movements, tai chi offers a safe, effective way to build proprioception.
2. GO BAREFOOT. Whenever it’s convenient and safe (around the house, for example), kick off your shoes. “The soles of your feet have touch receptors that send information to the centers of your brain responsible for balance,” says Sandra Blakeslee, coauthor of The Body Has a Mind of Its Own (Random House, 2008). “The more signals you send, the more you will keep your sense of balance tuned and the steadier on your feet you’ll be.”
3. SEEK OUT UNEVEN SURFACES. You don’t need special equipment: If you walk for exercise, take a dirt path or stroll on the beach. “Walking on uneven surfaces challenges your proprioception, which keeps your balance sharp,” Blakeslee says.