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.

Your Marathon
Coaching, tips and inspiration to get you race-ready.

Sign up for a Run Well Training Plan
Meet the Coaches
Kara Goucher on First Marathons
Dropping Out of the Big Race
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.