Low Back Pain - a reliable cure ?

Randomised Controlled Trial of Alexander Technique lessons, exercise, and massage(A TEAM) for chronic and recurrent low back pain."

The video was created as part of the research to explain simply what exactly is the Alexander Technique. The technique was created by Frederick Matthias Alexander, an Australian actor who created it to help performers like himeself.

I have never tried the Alexander Technique but it seems to have a lot of promise.

If you want to know more about the Alexander Technique.

The American Society for the Alexander Technique.

If, like me you live in the Atlanta Metro Area - here is a local teacher of Alexander Technique.

A video from the 1940's showing Matthias Alexander.

Diet which is low on carbs and high on exercise

Low fat foods are finally finished !

For years the official nutrition advice has been to reduce fat intake. Most nutritionists have been trained to advise clients to follow a diet which is:

• rich in whole grains
• fruits and vegetables in abundance
• low-fat dairy
• lean meat
• minimal fat.

At last it is dawning that this is pretty poor advice.
The final conclusion:

• Get carbs down to 10% of total calorie intake. This means that just about all your carbs come from vegetables (and maybe some fruit)
• Push protein up to 30% total calories. This means that almost inevitably the fat eaten goes up as well.
• The fat calories in your diet is now 60%. Totally different to all previous official recommendations about keeping fat down to 30% total calories.
• Reduce your total calories by 600 calories a day (but do not go below 1200 calories a day)
• Resistance and/or weight training twice a week
• Walk or cycle 5 days a week.

Researchers like Donald Layman in Illinois and Jeffrey Volek in Conneticut have been beating a different drum. Their conclusions after years of research:

• keep carbohydrates low


• keep protein intake up


• eating fat will not make you fat


• a calorie is not necessarliy equivalent to any other calorie - it all depends upon what you are eating


• exercise is key.

None of this is particularly amazing but the strangest new knowledge is that keeping the carbs low (which means that fats are much higher than in a low fat diet) results in:

• easier to lose weight


• all the markers for health like good cholesterol increasing, bad cholesterol reducing, triglycerides reducing (even if weight is not lost)


• decrease in insulin resistance


• muscle is preserved through weight loss.
  
  

  Resistance Training (or Weight Training) is vital. Just doing cardio does not give you the same health and weight loss benefits of tough weight training.

Now all of this seems very Atkins-like because this is pretty much what Dr Atkins proclaimed over nearly 30 years. However now there is good research backing it all up.

This is a key paper from Professor Layman showing that increasing protein in the diet (while getting carbs down) plus exercise for an additive effect. Doing the two together is much better than just doing one on its own. This is also a significant paper from Professor Layman emphasising the importance of high protein and low carbohydrate.

Volek's research group on Connecticut has delivered very similar conclusions in their paper Carbohydrate Restriction and Resistance Training Have Additive Effects on Body Composition during Weight Loss in Men. Link even though it is difficult to access.

Do You Have an Undiagnosed Disease

Do You Have an Undiagnosed Disease ?
Do you wish Dr Gregory House actually existed ?





Step forward William Gahl at the US National Institute of Health who this year became head of the Undiagnosed Diseases Program at the US National Institute of Health (NIH).

Dr Gahl is quite clear on the differences between himself and House " I'm not a sociopath and I don't take drugs."


As of December 2008, Dr Gahl's Undiagnosed Disease Program had accepted 35 patients and they are actively working on 10 of them. Unlike the TV program, this real life program does not take patients who collapse on arrival at the hospital.

One example of a real world problem: A couple from New Jersey are desperate to know what is wrong with their 3 year old who was fine up to 10 months and then had a seizure. Now she holds her head crookedly and has difficulty walking. Many specialists later, nobody can pinpoint the problem let alone what to do about the child. Dr Gahl wanted a hair sample and went on to study a family video showing the child - very House-like.

The House plots have a formula - they have to to make for gripping TV - so we all know what to expect. Of course, some of the plots are totally off the wall but some might just come true.

Do you want to find the real Dr House - that is Dr Gahl.

Look here.

Functional Foods and Supplements

Amongst the odder things I read is the regular email from Food Navigator "Breaking news on food and beverage development". Functional Foods and Supplements get a lot of coverage because it is a food industry publication. Nevertheless I find it informative and interesting.

It's the end of the year and so they've just put out the top 5 stories, based on interest from their colleagues in Europe:

1. The most read article in 2008 was coverage of the second arm of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT II). Researchers, led by Allen Sawitzke from the University of Utah, School of Medicine in Salt Lake City reported in September that supplements of chondroitin sulphate and glucosamine, alone or in combination, may not positively affect joint health.

Almost 400 patients with osteoarthritis of the knee participated in the 24-month, double-blind, placebo-controlled study. The findings were published in the journal Arthritis & Rheumatism.In summary the report said that taking glucosamine and/or chondroitin made no difference to knee arthritis.

I blog'd at the time.

However, the study’s findings were dismissed by the industry as meaningless. Limitations admitted by the researchers included a smaller than expected number of participants, large variations in measurements, and slower decline in the knee joint.

The Washington-DC-based dietary supplements trade groups the Natural Products Association (NPA) and the Council for Responsible Nutrition (CRN) called the study’s findings irrelevant, as did a member of the study’s oversight committee.

“This study’s findings are useless and I am surprised it has been published at all,” said Jason Theodosakis, oversight committee member and assistant professor of medicine at the University of Arizona. Theodosakis, the author of a book on glucosamine and chondroitin and sports medicine expert, said the study should have been binned because it was deeply flawed for three major reasons:

• the sample size was too small (less than 400)
• the study length was too short (two years)
• the x-ray methodology was not sensitive enough to deliver meaningful measurement

2. Anti-oxidants were questioned - did they have the benefits claimed, did anti-oxidants have any benefits at all ?

"The findings of our review show that if anything, people in trial groups given the antioxidants beta-carotene, vitamin A, and vitamin E showed increased rates of mortality. There was no indication that vitamin C and selenium may have positive or negative effects. The bottom line is that current evidence does not support the use of antioxidant supplements in the general healthy population or in patients with certain diseases. So regarding these antioxidants we need more data from randomised trials," said Goran Bjelakovic from the Copenhagen Trial Unit at the Copenhagen University Hospital in Denmark.

The dietary supplements industry has responded strongly to the review, with the Council for Responsible Nutrition (CRN), an industry association, releasing a statement that read: "Although [the authors] have updated their meta-analysis, by handpicking additional studies and correcting a litany of minor mistakes made in previous versions, it is for all intents and purposes not a new study, nor is it truly new information.

"In fact, it appears to be a systematic attempt by the authors to publish work that supports their own pre-determined conclusions about antioxidants and the way they should be regulated."

John Hathcock, Ph.D., senior vice president, scientific and international affairs, CRN, was quick to draw attention to the exclusion criteria employed by the researchers "With nearly 750 studies to choose from, it's interesting that they chose to include only 67 studies - less than nine percent of the total clinical trials on antioxidants that are available," said Dr. Hancock. "Moreover, the possible 750 clinical trials do not even account for other sources of evidence, such as observational studies, which were not considered by the authors at all. It is their exclusions, not the inclusions, where the fault lies."

"The conclusions one can reach from this meta-analysis are very limited."

3. The third most popular science article was “Science: Is omega-3 omnipotent?”,

From heart health to better brain function, from reducing the risk of cancers to improving people’s moods, is there nothing omega-3 can’t do? In the first part of a four-part focus on omega-3 fatty acids, NutraIngredients reviews the science behind the headlines.

Different omega-3s, different benefits? The main omega-3 fatty acids present on the market consist of the marine sourced eicosapentaenoic acid (EPA, C20:5 n-3) and docosahexaenoic acid (DHA, C22:6 n-3) and alpha-linolenic acid (ALA, C18:3 n-3) from plants like flax.

The omega-3s are not created equal, and different fatty acids have been associated with different benefits.

Much attention has been paid to the conversion of ALA to the longer chain EPA, with many stating that this conversion is very small. Indeed, between 8 and 20 per cent of ALA is reportedly converted to EPA in humans, and between 0.5 and 9 per cent of ALA is converted to DHA.

In addition, the gender plays an important role with women of reproductive age reportedly converting ALA to EPA at a 2.5-fold greater rate than healthy men.

This conversion obviously contributes to the body's pool of EPA and DHA, which play a key role in, amongst other things, maintaining cardiovascular health.

There is still the question of how much Omega-3 to take every day - see this round-table discussion.

A previous Omega-3 blog.

4. Fourth on the top five list was taken by our coverage of how low levels of vitamin D may increase the risk of death.

A study, published in the Archives of Internal Medicine, reported that low levels of vitamin D may increase the risk of death by 26 per cent. Over 13,000 initially healthy men and women took part in the study. “This is the first study, to our knowledge, to explore the association between 25(OH)D levels and mortality in the general population,” wrote the authors, led by Michal Melamed from the Albert Einstein College of Medicine.

I blog'd at the time.

5. Bringing the top five to a close, was the article “Gut microflora and obesity - Nestle expands the possibilities”. Researchers from the Nestlé Research Center reported in May that modification of the population of bacteria in the gut may improve the regulation of glycemic control and reverse the insulin resistance that occurs with obesity.

Nestlé might have stumbled on the bacteria in the alimentary canal are different in obese as compared to non-obese people. If this is true then is it possible to change the composition of the gut flora and fauna so that anyone who is obese has a better chance of reducing weight ?

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You can see that the food industry is not shy about shooting down any report which might reduce sales.

Vitamin D - from sunshine or food ?

Everyone agrees that Vitamin D is essential. 

Usually I try to get some exposure to the sun every day that there is some sun to be had. Is this sensible behavior ? How much does this raise my skin cancer risk ?

The only question is how best to get enough Vitamin D safely ?

• Vitamin D from sunshine allowing your skin to make Vitamin D works if you get enough sunshine but carries a risk of skin cancer
  
• Vitamin D from food and the Vitamin D added to many foods which potentially means that you can protect your skin from all natural exposure to sunshine.

The American Academy of Dermatology (Academy) recently issued a position statement on vitamin D, drawing on the scientific literature to support its recommendation for safely obtaining an adequate amount of this vitamin. The Academy recommends that the public obtain vitamin D from 

nutritional sources and dietary supplements, and not from unprotected exposure to ultraviolet (UV) radiation from the sun or indoor tanning devices, as UV radiation is a known risk factor for the development of skin cancer.

"Vitamin D is essential for optimal health, and the medical literature supports safe ways to get it -- a healthy diet which incorporates foods naturally rich in vitamin D, vitamin D-fortified foods and beverages, and vitamin D supplements," stated dermatologist C. William Hanke, MD, MPH, FAAD, president of the American Academy of Dermatology. "And, according to the medical literature, unprotected exposure to UV radiation from sunlight (natural) or indoor tanning devices (artificial) is not safe. Individuals who intentionally expose themselves to UV radiation for vitamin D are putting their health at risk for developing skin cancer."

Pretty much on the opposite tack is the Vitamin D Council (as far as I can tell a reasonably sensible non-profit group of doctors passionate about the benefits of Vitamin D).

Their view is that if one regularly avoids sunlight exposure, research indicates a necessity to supplement with at least 5,000 units (IU) of vitamin D daily. To obtain this amount from milk one would need to consume 50 glasses. With a multivitamin more than 10 tablets would be necessary. Neither is advisable.The skin produces approximately 20,000 IU vitamin D in response 20–30 minutes summer sun exposure—100 times more than the US government's recommendation of 200 IU per day!

The Vitamin D Council's position is that there are 3 ways for adults to insure adequate levels of vitamin D:

1. Regularly receive midday sun exposure in the late spring, summer, and early fall, exposing as much of the skin as possible.

2. Regularly use a sun bed (avoiding sunburn) during the colder months.

3. Take 5,000 IU of Vitamin D per day for three months, then obtain a 25-hydroxy vitamin D test. Adjust your dosage so that blood levels are between 50–80 ng/mL (or 125–200 nM/L) year around.

A list of recent research output concerning Vitamin D.

At the moment I'm going to keep on getting some sunshine on my body but not taking any risks with sun burn and most definitely no tanning beds.

Balance Exercises - practice to avoid falls

Balance and Flexibility are just as important parts of your health and fitness workouts as muscle strength development or cardio conditioning. This post is about Balance. I've included 2 videos. The first is with a client doing some simple but challenging balance exercises.

This video showed the client using a BOSU which is a nice versatile piece of equipment costing about $120. The BOSU can be used in many different ways. 

In this small video we just use it for balance exercises.

After my client finished her balance exercises she took control of the camera and had me balancing on a Foam Roller. 

Look at this short video and smile.

A Foam Roller is good for Myofascial Release. 

In another post I'll show a video of a Foam Roller being used for Myofascial Release but in this video it is just a round object which I find difficult to balance on. 

Hence a good challenge for your balance.