Improving Running Economy: Hands on Head

Recently I wrote an article for Canadian Running Magazine looking at a system of drills developed by Pete Grinbergs to help improve the efficiency of your running stride.  It is definitely a teaser to what the system is all about.    To see what it actually looks like in action, check out Pete's video here.

In my opinion, hands on head (HOH) is a novel and intriguing solution to something that is often neglected, and sometimes unnecessarily complicated.  Does it work?  And if so, to what degree?  That is yet to be determined.  Regardless, it's free, it's safe, it's easy, so why not try it to find out?

Here is the article:

Lab Rat- Hands on Your Heads

Want to run more efficiently? Peter Grinbergs, head coach of Wilfrid Laurier University’s cross-country team, has a suggestion: Put your hands on your head. Grinbergs’s Hands on Head (HOH) system, developed after 30 years of coaching, involves a series of drills that focuses on diagnosing and correcting stride inefficiencies. His athletes will follow up hard workouts with light strides, walking high knees and barefoot drills - all with their hands firmly placed on their heads....
Click here to read the full article.

The complex nature of back pain

This post is from this month's health section of the New Hamburg Independent.  It takes a brief look at the complex nature of back pain.  Research is continuing to show that people experience pain for reasons far beyond what can be explained with x-ray and MRI machines- keep reading to find out why!

   

Researchers show back pain is more than just muscle and joint damage

 Low back pain is an extremely common condition, and is something approximately 80% of us will experience at some point in our lives. When we suffer a flare up, it is often assumed that we have done something wrong.

“I slept wrong and sprained a joint,” or “I lifted wrong and strained a muscle,” are common explanations I hear in practice.

However, there likely is more to the story, especially with chronic low back pain.

A group of prominent researchers have recently reviewed and summarized all of the best studies on this common type of low back pain.  Surprisingly, these researchers showed that many lifestyle, social and psychological factors are more strongly linked to back pain than are many anatomical causes.

For instance, a common anatomical change we often attribute back pain to involves degenerative changes throughout the spine. In short, this involves a decrease in fluid content in the spongy discs that separate your vertebrae, and a wearing down of the cartilage of the joints at the back of your spine.

While it is logical to suspect that these anatomical changes are associated with low back pain, these researchers have shown that they are not nearly as concerning as we once thought.

Instead, lifestyle factors such as smoking, being overweight, and perceiving yourself as generally unhealthy is more strongly connected to back pain. In addition, psychological and social issues such as depression, anxiety, low job satisfaction, monotonous work, and poor social support are all linked to an increased risk of back pain.

Thus, while strained muscles and associated joint issues play a role in low back pain, this review clearly shows that any pain you may be feeling, especially if it is chronic, is likely a result of a collection of factors involved in your life.

Since the cause of the chronically painful low back is a result of a multitude of factors, logically the solution should also include a number of approaches.

That being said, it is important to note that we are only referring to the most common type of back pain, which is called ‘mechanical low back pain’.

There are less common, but quite serious, conditions that must be ruled out if you are suffering from back pain. Some of these include tumors, infections, and traumas. Also, if there are neurological symptoms such as shooting or electrical pain down your leg, or numbness and tingling, then something beyond mechanical low back pain is affecting you that must be diagnosed and treated.

If you do fall into the category of suffering from mechanical low back pain, the solution comes down to identifying and addressing all of the contributing factors of your pain. For some, that may mean quitting smoking, losing weight, and finding a more enjoyable job. For others, that may mean learning to cope with stress more effectively, developing a better social network, and putting into place a plan to treat their depression.

Regardless of the person, mechanical low back pain should always be treated with some form of physical activity. Specific exercises for the back that help to strengthen and stabilize the entire core should be implemented. General cardiovascular and strength training should also be added to the plan of management for the best results.

So is back pain related to problems with our anatomy? Absolutely. Tearing a muscle, spraining a joint, and developing osteoarthritis undoubtedly hurts, and these factors should not be ignored. However, this line of researcher shows that you should not just stop there, and that improving your psychological, social and lifestyle health will go a long way.

Why doping should not be allowed in sport

In a recent post I looked at the Lance Armstrong saga (which is kind of old news now), and doping in the sport of cycling as a whole. In response to that post, I received a number of e-mails and messages, which was great to see. 

Interestingly, most of the comments were not about a solution to doping in cycling, but rather were focused on this article written by J. Savulescu, B. Foddy and M. Clayton. The general consensus was that doping in sports is wrong, but that the  authors make a pretty convincing case to the contrary. 

Rather than actually exploring a solution to doping in cycling as promised, this blog will take a quick look at why performance enhancing drugs (PEDs) in sport should not be allowed in direct response to the arguments presented by Savulescu, Foddy and Clayton. To get a full appreciation for their arguments, take a read through the article first.

Argument #1

(1) In the article, the authors state that the pros of doping outweigh the cons for athletes given today’s risk/reward infrastructure for athletic success versus getting caught. The financial gain of being the best seems to outweigh the relatively small risk of being caught, and then the diminutive punishment handed out if caught is not enough of a deterrent.

While this argument clearly shows why some athletes do opt to dope, it by no means presents a reason why PEDs should be allowed. Instead, this argument actually helps in identifying an area that we can work on to further discourage the use of PEDS. In addition, it has recently become apparent that agencies, such as USADA, are taking steps in the right direction in correcting this supposed imbalance with the risk/reward to doping.

Take the Lance Armstrong scenario and how USADA has now set a strong precedent with this case. Armstrong was banned for life and stripped of all of his major accomplishments, despite never testing positive (room for debate here). He was not simply banned for 2 years, nor was he stripped of only a couple of victories. Instead, almost his entire career was erased. Granted, this type of punishment was justified based not only on his personal use of PEDs, but also his involvement with trafficking and covering up the cheating. Regardless, this sanction should undoubtedly act as a deterrent to any rider who wants to become the best. It shows that whether you test positive or not, you will eventually get caught, and unless you confess, everything you’ve ever worked for will be taken away. So are the penalties too forgiving? Maybe in some cases, but the punishments are headed in the right direction.

The second part of the authors' argument assumes that the relatively low likelihood of getting caught makes it impossible to discourage athletes from doping. The article references the fact that only 10-15% of athletes at a major competition are tested. Of that 10-15%, a majority will not test positive simply because the type or dose of the PED is not detectable.  However, does this mean that only 10-15% of athletes need to be worried, and the others can relax? No. The testing is random, and therefore the entire collection of athletes must consider being tested as a real possibility. While this does not have the same impact of testing every single athlete, it undoubtedly will impact the decision to dope beyond just 10-15% of athletes. In addition to this, as mentioned above, athletes can still be sanctioned without positive tests, adding an additional deterrent.

The authors state that cleaning up the sport is unattainable, and see this as reason to allow drug use. Instead, this seems to represent where we have room for improvement, rather than a reason to allow PEDs. The good news is that these improvements are already being put into place.

Argument #2

(2) The article’s second argument discusses the assumption that the use of PEDs violates the spirit of sport. They argue that if everybody had equal access and equal opportunity, the use of PEDs would level the playing field and ensure that race winners are not those who have won the genetic lottery. As with the implementation of training, tactics, and nutrition, the use of PEDs would provide an additional parameter that an athlete can manipulate, and thus add more uncertainty and variability to who wins. As a result, the authors believe that it is a misunderstanding to think that using PEDs violates the spirit of sport.

The issue with this argument is that it completely ignores what the spirit of sport entails, despite listing its tenants in the article itself. They are as follows:

· ethics, fair play and honesty

· health

· excellence in performance

· character and education

· fun and joy

· teamwork

· dedication and commitment

· respect for rules and laws

· respect for self and other participants

· courage

· community and solidarity

How does sticking a needle into your arm show courage (I guess if you have a phobia of needles, then you might be able to convince me)? How does rubbing a cream into your skin display dedication and commitment? How does popping potentially harmful pills display a concern for health? Even after reading the argument, I fail to understand how the use of PEDs does not violate these tenants.

If one trains to his or her maximum ability and competes with integrity and courage, yet fails to win, this is undoubtedly an unsettling feeling. However, this effort satisfies all of the components to the spirit of sport, and I think most athletes can agree that there is a sense of pride for going down swinging with this type of defeat.

Now, take this same athlete, conduct the same training, and win because a needle was injected at the right time. At this point, the dignity the athlete had for losing despite an honest effort is taken away. Even if the athlete wins, he or she knows that that their victory had not been earned. This reminds me of Rocky 4 . Rocky ran up mountains and threw logs around; Drago trained with drugs and fancy 1980’s technology. Even if Rocky lost that fight, we all would still love his courage and will to fight for victory in an honest way. Rocky exemplified the spirit of sport in its truest form. Now picture that same movie, except Rocky has the needle injected into him. All of a sudden, that honesty and integrity is lost, and the spirit of sport he represented disappears with it.

The spirit of sport is not to drug away genetic differences, but to compete in spite of them. After all, a true underdog victory is one of the greatest things to watch in any sport!

Argument #3

(3) The third argument the authors present takes a closer look at how allowing PEDs would facilitate leveling the playing field in terms of the genetic lottery. As we have already touched upon, some people are born with physical attributes that leave them better equipped to compete in certain sports. For instance, those who have a genetic pre-disposition to a higher hematocrit, or red blood cell density, will have an increased ability to transport oxygen to their muscles and thus perform better in endurance oriented sports. Then, with the use of drugs like EPO, this genetic advantage can be taken away, which the authors believe is fair.

Here, the authors falsely assume that the genetic lottery is the only type of “lottery” that results in unfair advantages in sport. What about the individual who is born into a rich family and thus has access to the best equipment? What about the athlete who is fortunate enough to be surrounded by intelligent and encouraging mentors earlier in their life? What about the athlete who is born in a part of the world where higher education in fields such as human physiology, athletic training, and other topics advantageous to performance are easily attainable? What about the athlete who is born where proper nutrition itself is accessible?

Genetics is not the only reason why some athletes are born lucky.

If you haven’t done so already, check out the book ‘Outliers’ by Malcolm Gladwell. It discusses how hockey players with birthdays in the first 3 months of the year are the most likely to make it to the NHL. Why? Because they were bigger as kids. This size advantage got the athletes more attention and better coaching early in life.  They made the AAA teams, and this all carried through into adulthood.

Some have the advantage of the genetic lottery, some have other advantages. Just because some are born with lucky genes, that does not translate into definite success. It is only a single piece to the puzzle.

I would have to say it is fairly safe (and by fairly I mean extremely) to argue that Lance Armstrong has much better genes than me. There is no way I will ever be able to develop the V02 max he possesses when in peak form. However, with training, my 1^st marathon ever was faster than his 1^st marathon ever. Genetics does not equate to winning.

If this issue is looked at a little more closely, the leveling of the playing field that the authors discuss may not actually be taking place at all.  Imagine how legalizing PEDs would impact the poor, neglected athlete who has no training experience and a serious lack of proper equipment, yet still manages to excel because of his or her genetic aptitudes. Who are we to decide that these types of individuals should no longer excel? 

Allowing PEDs would not level the playing field; it would simply skew in favour of the genetically disadvantaged and otherwise advantaged subset of the population.

Argument #4:

 The next argument presented by the authors is essentially a counter argument to the notion that PEDs would just be for the rich. It references the cost to train, race, purchase high altitude tents ($7000 US) among other expenses, and how they compare to the relatively “inexpensive” EPO ($122/month).

This argument fails to acknowledge that (1) $122/month actually IS expensive and (2) even if the PEDs are affordable, it is not a reason to use them.

$122/month equates to just under $1500/year. Is this cheaper than some expenses that high end athletes accrue? Yes. But this is an expense that most athletes cannot incorporate into the baseline cost of doing business. Consider, for example, the 2011 Boston marathon. The prize structure is set up so that the 15^th place runner received $1500. Just enough to cover the cost of EPO for the year. In 2011, that 15^th place runner finished in 2:16:54. A blazing time at one of the highest profile races in the world gave him just enough money to use EPO for the year. The 16^th place runner finished in 2:17:35, still an amazing time and a great finishing position. This runner is elite, and yet received no prize money. So would the use of PEDs be affordable to all high end athletes? I think it is pretty clear that the answer is no.

While it is true that PEDs are not affordable to many athletes, arguing this is irrelevant. Does being able to buy drugs provide reason to use them? The core reasons why PEDs should not be allowed has nothing to do with unequal distribution. Even if each and every athlete had the same access to the drugs (which they do not), it still violates spirit of sport and competition.  

Argument #5:

The next argument this article presents looks into how allowing and subsequently regulating the use of PEDs would result in an increased level of safety. They argue that the use of EPO, for example, is only dangerous when you start to increase your hematocrit over 0.5. So, athletes should be allowed to dope up to that level, and then be monitored to ensure that they stay there.

This is a complicated issue because it must be looked at on a case-by-case basis. First of all, the authors do admit that any drug that induces potential danger to the athletes should be banned (such as anabolic steroids).

“We should permit drugs that are safe, and continue to ban and monitor drugs that are unsafe,” they state.

That's a step in the right direction.

One of the main  "safe drugs" that is discussed in this argument is EPO. Once you start increasing your hematocrit above 0.5, the viscosity of your blood starts to get to the point where it is a challenge for your heart to push the blood through your blood vessels. This can result in death, simply due to an inability to adequately transport oxygen throughout your body.

So yes, keeping the hematocrit at 0.5 would decrease the risks associated with the drug. But those are not the only risks. A recent study did a great job of summarizing some of the key adverse reactions to the use of EPO:

"Adverse effects of recombinant human erythropoietin

•  Flu-like symptoms: Commonest side effect which subsides within 24 hours
•  Allergic and anaphylactic reactions
• Seizures and hyperkalemia: Rare
• Hyperviscosity
• Thrombosis: A meta-analysis involving nearly 10,000 cancer patients indicates that treatment with rhEPO increases the risk of thrombosis
• Hypertension
• Possibility of cancer progression: There is somewhat less convincing evidence that rhEPO enhances tumor progression
•  Pure red cell aplasia (mainly reported in patients with CKD): Autoantibodies in the serum can neutralize both rhEPO and endogenous EPO. This was mainly observed in CKD patients, especially after SC injection. Its incidence after 2000 has reduced, especially with the IV formulations”

Do these issues only arise when the drug is used in excess? Or would the chronic use of EPO to maintain a hematocrit level of 0.5 throughout a 15-20 year career also lead to these adverse reactions? At the end of the day, I would not want to take the risk, and I know I would not be alone. This drug may be safer to use if hematocrit levels are monitored, but the legalization of EPO would also encourage people to use a drug that could potentially lead to a number of other adverse reactions.

The only fool-proof way to ensure that nobody suffers adverse reactions to EPO is fairly simple; don't use it. It is extremely difficult to die at the hands of a drug that never enters your system. This is where the money should be spent; discouraging athletes from using EPO rather than monitoring and regulating its use.

Conclusion:

There is no doubt that J. Savulescu, B. Foddy and M. Clayton present some arguments that warrant debate and thought.  But when this debate and thought is applied to what they present, the flaws in their logic quickly shine through.  Our testing protocols may not be perfect, but they are headed in the right direction.  Taking away the genetic lottery would not level the playing field, but only skew it in favour of a select group.  The use of PEDs is not a cost that most athletes can or should attempt to afford, and the side effects will still be a worry even if the drugs are regulated.   Finally, and most importantly, the use of PEDs quite clearly violate the spirit of sport.  When logic is applied to what  J. Savulescu, B. Foddy and M. Clayton present, our thoughts quickly match up with what the intuition of most have been saying all along: the use of PEDs in sport should not be allowed. 

Frozen Shoulder

Here is my article from this month's addition of the New Hamburg Independent health section.  It is a basic summary of a common and poorly understood shoulder condition: adhesive capsulitis.

As always, feel free to comment or e-mail if you have any questions!


The truth about frozen shoulder

Shoulder pain is a very common problem affecting Canadians. There are a diverse range of tissues that can become injured and lead to shoulder pain including; muscles, ligaments, nerves and even cartilage within the joint.

However, there is another relatively common source of shoulder pain that seems to be poorly understood and is often misdiagnosed. This condition is referred to as ‘frozen shoulder’ or ‘adhesive capsulitis’.

Adhesive capsulitis affects 2-5% of the general population, but affects anywhere between 10- 34% of people who suffer from diabetes or thyroid conditions.

Common symptoms of this disorder include pain and/or reductions in range of motion that get progressively worse, sharp pain with certain movements, and an abnormally hard or abrupt end feel when moving the shoulder.

This collection of symptoms, while concerning, does not mean you suffer from adhesive
capsulitis by necessity. Rotator cuff tears, fractures and even arthritis can present in a similar fashion. However, the key issue with adhesive capsulitis is the length of time it requires
to heal. In fact, research has shown that adhesive capsulitis can take anywhere between 18-24 months to completely resolve.

Throughout this time frame, the condition is typically divided into three phases. Stage one, otherwise referred to as the ‘freezing’ stage, is characterized by a progressive loss of range of motion of the shoulder and increased pain. Stage two, the ‘frozen’ stage, describes a period of time where the shoulder pain and range of motion reaches and remains at a plateau. Finally, the third ‘thawing’ stage is marked by range of motion that slowly improves, accompanied by gradually decreasing pain.

So, why does adhesive capsulitis take so long to improve? The honest answer is that scientists and doctors are not completely sure. Some studies have shown it is related to blood flow, and how your arm connects to the shoulder blade.

Surrounding the joint where the humerus connects to the shoulder blade, there is a bag
of connective tissue that contains a joint fluid to help facilitate smooth and frictionless
motion. Studies have shown that with adhesive capsulitis, there is a significant amount of inflammation and adhesions that build up between that joint capsule and the joint itself.

In order to be symptom free, the joint capsule must be detached from the underlying bones and heal fully. There is poor blood supply to these structures, and that partially explains why it takes so long for the capsule to return to normal, and for full motion to be restored.

Nobody wants to suffer for 18-24 months. So what can you do to help improve your recovery time? The first line approach should include conservative measures to help maintain and improve your range of motion. Shoulder mobilizations, soft tissue therapy and a strong commitment to a rehabilitation plan may help control symptoms and maintain function.

In more persistent cases, surgery may be worth considering. For example, surgeons may opt to enter the shoulder joint arthroscopically, and cut the adhesions between the capsule and underlying bones.

With whatever you chose to do, it is important to keep in mind there is no evidence showing one treatment to be better than the other. What may work for one person may have no impact on another.

Also, with this condition, it is very important to not get discouraged. While it is a long wait, one should keep in mind that most cases of adhesive capsulitis will get better on their own within 24
months.

How do we stop doping in cycling? (Part 1)

Well, everybody must know by now about the downfall of Lance Armstrong.  Rather than being viewed as a hero and as an inspiration, he is now commonly being referred to as a cheat, bully, and fraud.  His sponsors have dropped him, his titles have been stripped, and he has been forced to step down as chairman of Livestrong.

Admittedly, it is sad time for me because he was a childhood hero, as he was for many others.  But unfortunately, he just was not the athlete we were lead to believe.  USADA's reasoned decision paints the true picture of who Amstrong was during those years; an athlete who wins at absolutely any cost.

Who is to blame?

Although Armstong is in the spotlight with regards to his drug use, it is not as though he introduced doping into the sport of cycling.  As early as the late 1800's, athletes were noted to be using cocaine, heroin, morphine among other drugs in the hopes of enhancing performance. 

In the mid 1900's, amphetamines came along.  Italian cyclists referred to them as la bomba, due to the drug's ability to mask fatigue, and help athletes push beyond their normal limits.    

Then in the 1980's, the wonder drug, EPO, came along.  It works by increasing the red blood cell content of your blood.  With a higher red blood cell count, your oxygen carrying capacity increases, and thus performance goes up.  The winner of the 1998 Tour de France, Marco Pantani, was thrown out of the '99 Giro D'Italia for a high hematorict level (to many red blood cells), pointing to EPO use. 

We also cannot forget the entire Festina scandal, in which the entire team was thrown out of the 1998 Tour de France due to EPO use.

So, was Armstrong the inventor of doping in the sport cycling?  Not even close.  Some evidence even points to the fact that he was pressured to dope, at least in part, because of the already rampant use of EPO and other doping methods.

Armstrong racing in 1993

"It's harder to race this year, cycling is harder now. In a year, I tell you, man. I hate to point fingers, and I'm not going to do that. But there are a lot of guys who are a lot better and a lot faster than last year," Armstrong said in a 1994 interview.

He couldn't keep up in 1994 the way he could the year before.  He did not say it was because there was doping, but he was insinuating something was up; what else could he be talking about given the sports' history?

At that point in time, Armstrong was faced with a dilemma.   He could choose to either fall into obscurity within the sport, or start to dope.  What else would an ultra-competitive, aggressive, and dominant personality-type chose?  It is not a stretch to speculate that his unrelenting, and almost unreasonable drive to succeed propelled him not only to start using illegal performance enhancing drugs, but to become the best user the sport has ever seen.

In his book, It's Not About the Bike, Armstrong stated that he, "tackled the problem of the Tour as if [he] were in math class, science class,chemistry class, and nutrition class, all rolled into one. [He] did computer calculations that balanced [his] body weight and [his] equipment weight with the potential velocity of the bike in various stages, trying to find the equation that would get [him] to the finish line faster than anybody else. [He] kept careful computer graphs of [his] training rides, calibrating the distances, wattages, and thresholds."  

In the same way he methodically attacked aerodynamics, equipment, nutrition, and training, USADA's reasoned decision makes it quite evident that he and his accomplices pursued doping with the same intensity.  

What Armstrong could have done

So Armstrong made some morally wrong decisions due to pressure of an existing doping culture.  Does this make him a victim?  The culture of cycling played into Armstrong's decision to dope; there is no doubt.  His unrelenting drive to win also factored in.  

That being said, it is unreasonable to suggest that every professional cyclist with a dominant personality-type had no choice but to use banned substances.  There was a third variable at play here; the fact that there was something in Armstrong's brain that decided winning was more important than playing by the rules.

He could have taken the high road and chosen to be a regular guy who is a good cyclist.  Take Scott Mercier for example; he walked away from cycling when confronted with drugs for the first time.  While it must have been impossibly hard to walk away form the sport, Mercier admits he feels better about it these days.

With regards to Armstrong being stripped of his accolades, along with his teammates also admitting to drug use, Mercier states, "It certainly gives me some validation for the decision I made.  It wasn't that I wasn't good enough, it was just that I made different choices. They talk about winning at all costs, but are you willing to push well beyond the limits?  I'm not, I think there's more to life than that. Sport should be a level playing field and it wasn't. It was who had the best team and resources and the best medicine and that wasn't the game I wanted to play."

Former pro-cyclist, Scott Mercier

Mercier did not want to leave the sport.  He wanted to compete.  It also is obvious that there was part of him that at least considered doping as an option.  

"I would see the likes of Tyler Hamilton and George Hincapie having great success in the Tour and wonder 'where would I have ended up?" Mercier explains.

There is no doubt that Mercier was conflicted.  He had the same drive to succeed that Armstrong possessed.  But, when that drive was confronted with the idea of cheating, he opted to step away from cycling.  Armstrong could have done the same when confronted with the challenges he faced in 1994.

Yes, there were other factors influencing what Armstrong did.  However, it is just plain ignorant  if one fails to acknowledge USADA's reasoned decision and view him as a victim of cycling culture.  At the end of the day, it was Armstrong's fault.

By the same token, I think it is equally ignorant to keep beating up on Armstrong thinking that it will help.  Cycling culture was deeply rooted in doping.  Yes, Armstrong dove head first into that culture and took it to a new level.  But he is not the inventor, and the solution stems much deeper than punishing him unnecessarily.  Heck, even Armstrong's enemies agree.

It is time to move forward to figure out a real solution.  A sport where there is no doping is something I think everybody would be happier with.  Now it is just a matter of how to get there.

So what is the solution?

First of all, it is clear that what we are doing now is not enough.  After all, the UCI claims to have tested Armstrong a total of 218 times.  None of these tests were positive for doping.  There are two explanations for this:

• Somehow, there actually have been no positive tests
• Any positive tests that were found were subsequently covered up

In all likelihood, it is a combination of the two options.  The tests are flawed, there's no doubt there.  For instance, other then measuring the density of your red blood cells, EPO is very difficult to detect directly. So what is preventing athletes from doping up to the legal limit?

That aside, there is good reason to believe that the testers are also corrupt.  The UCI has long been criticized by three time Tour de France winner, Greg LeMond.  The UCI has also pushed to silence LeMond, and have not been successful in doing so. 

In an interesting story, LeMond's wife, Kathy LeMond,  testified under oath that $500,000 was paid to then UCI president, Hein Verbruggen, to get rid of a positive Armstrong test.

Most recently, Tyler Hamilton has called for Pat McQuad to step down as UCI president, claiming  hypocrisy among the union, and describing the sports inability to regulate itself.  

How do we fix this ongoing issue?  That is what I will discuss with my next post.  What are your thoughts on a potential solution?

Also, check out this article published in the British Journal of Sports Medicine, which discusses why doping should be legalized.  Is this a plausible solution in your mind?

Vitamin supplements may not be as useful as we once thought

Sorry for the delay on writing a new article.  It was a busy month with racing in France among a few other things.  This week I wrote an article for the New Hamburg Independent which takes a look at why vitamin supplements may not be as useful as you may think.  As per usual, my space is limited, and the article is more of a basic summary, but it's a good start.  Let me know if you have any other questions!

**EDIT** Keep in mind there is always two sides to the story.  It is pretty ironic that I just published this article, and then this study hits the news: http://jama.jamanetwork.com/article.aspx?articleid=1380451

Thanks to Sweat Science for drawing my attention to this one!

Vitamin supplements may not be as useful as we once thought

It is undisputed that when dealing with a vitamin deficiency, supplementation is an excellent way to speed up the recovery process.  In addition, it has also long been thought that taking a daily multivitamin can go a long way in preventing disease and maintaining health, even in the absence of such a deficiency.  However, a new line of research is showing that the prophylactic use of vitamins may not be as useful as we once thought.

This issue was examined in a large 2011 study which looked at just under 39 000 middle aged women over the course of 20 years.  These women were followed to see what vitamins they were taking on a daily basis in conjunction with how long they lived. 

Throughout the 20-year block that the study took place, just under 16 000 of the subjects deceased.  Among these women, it was to the surprise of the researchers that most vitamins and minerals had little to no impact on the longevity of the subjects.  On top of that, there were a number of vitamins and minerals that were actually associated with a higher risk of death (including iron, copper, folic acid, and B-vitamins). 

This study is not the only one putting these supplements into question;  another 2011 study took a more specific approach, as they followed just under 36 000 men, and looked at the relationship between vitamin E supplementation and the frequency of prostate cancer.

Just to provide some background information, it is well established that free radical damage is associated with an increased risk of cancer.  Free radicals are essentially charged particles that bounce around in your body, create inflammation and cellular damage, and predispose you to cancer.  It is also thought that supplementing with anti-oxidants, which help rid the body of free radicles, reduce the risk of cancer.

Despite vitamin E being a strong anti-oxidant, the researchers of this study did not see what one would expect.  In fact, of 36 000 men who were followed, just over 1 200 developed prostate cancer within 12 years.  Of this 1 200, those who were taking a daily vitamin E supplement were 17% more likely to develop prostate cancer than those who were taking a placebo (a sugar pill they thought was vitamin E).  While it is highly unlikely that these supplements are causing disease, these studies are really starting to cast significant doubt in our daily multi-vitamin regimen. 

So what does this research show us?  It is important to note that these studies are not perfect.  First, they are looking at the correlation of taking supplements with the frequency of a disease, rather than actually trying to see what is causing the disease.   Just because more men who took vitamin E developed prostate cancer does not mean the vitamin E caused the cancer.  In fact, this is highly unlikely.  It is much more probable that there were other factors contributing to the disease frequency that the researchers did not account for. 

That being said, the good news is that when you repeat the same studies mentioned above, except with replacing supplements with a well-balanced diet of fruit and vegetables, we see exactly what one would expect: increased longevity and decreased frequency of cancer.  

Therefore, while we cannot definitely say if multivitamins are good or bad, maintaining a variable and consistently well-balanced diet is your best approach to maintaining optimal vitamin and mineral levels in your body.

Sleep deprivation and running performance

You know what seems to be the cool thing to do these days?  Running events that are way too long (for me).

I remember when I was in elementary school, the 800m was the longest race ever.  4 loops of the 200m track? Impossible.

Then, in grade 8, the 1500m came along; the ultimate test of endurance (or so I thought).

But boy things have changed.  Athletes are now competing in 100-mile trail races, 8 day stage races (like the ENDURrun) among other similar yet equally punishing events.  When did the marathon all of a sudden become a speed-oriented event?

Needless to say, with the popularity of these ultra events rising, the competition is starting to become much more fierce.  As a result, athletes are looking for new ways to tackle the entire host of new challenges that this type of racing introduces.

Nothing like a 24 hour marathon in Namibia!

Among the most significant of these new challenges: sleep deprivation.

The solution to sleep deprivation is an easy one (sleep more).  But just how much does sleep deprivation impact an athlete over a 24-hour period?  That's what I wanted to start looking at with this blog.

Study:

A 2009 study looked at this issue in an interesting way as they took into account both the perceived challenges of being in sleep debt along with some physiological parameters.

Subjects were forced to go 30 hours without sleep and then complete a treadmill stress test.  They first went for 30 minutes at 60% of their V02max, and then went for 30 minutes as hard as they could.  All of the subjects also completed baseline tests when on normal rest.

The subjects were evaluated using the following parameters: core temperature, skin temperature, heart rate, oxygen uptake, carbon dioxide production, some breathing measurements and rating of perceived exertion.

These are the changes the researchers saw:

• Less distance was covered after sleep deprivation (by 2.9% on average)
• Subjects consumed slightly more oxygen during the initial 30 minutes in the sleep deprivation trial
• There was very little difference in the remaining parameters, including perceived exertion

Practical Applications:

So what does this study show us?  Well, first of all, it points toward the conclusion we all would expect: not sleeping over the course of 30 hours makes you slower than if you were well rested.  

The interesting thing, however, is that there was very little difference in the numerous physiological outcomes that were looked at.  There was a hint of sleep deprivation having a negative impact on cardiovascular physiology (which the authors seem to dispel, I'm not sure why?), but all other measures remained constant.  The authors speculate that the reduction in performance, therefore, was likely due to psychological changes involving how the subjects perceived their level of exertion.

Even though the runners THOUGHT they were going just as hard after 30 hours of not sleeping, they were actually going slower.  Perhaps the lack of sleep lowered their threshold for pain?

Clearly more research is needed.  A next logical step would be to investigate WHY the subjects consumed slightly more oxygen after sleep deprivation despite moving at the same pace.  

That being said, if you are an ultra runner, and you plan on working on limited sleep, this study is nothing but good news for you!  It suggests that your body can keep working while the mind starts to fail.  SO, if you just suck it up, there's a good chance you will be good to go!

Ultra runners (or tired runners)- what are your experiences with running while on no sleep?  Is this study consistent with what you went through? 

Silent spinal fractures in Olympic athletes

This month I wrote an article for the New Hamburg Independent looking at one downside to the very strenuous training some Olympic athletes go through.  It's a pretty basic summary of the issue, but a good start nonetheless.  Feel free to e-mail me or comment on the post if you have any questions.  Enjoy!

Silent spinal fractures in Olympic athletes

With the 2012 Olympic Games coming to a close,  it is a great time to be inspired by what the human body can achieve through hard work, discipline and complete dedication.  While this high volume of training helps these athletes perform at an unbelievable level, it also can potentially come with some negative implications.

Believe it or not, some of these athletes may be walking around with training-induced fractures in their spines, and not even know it. 

One of the more impressive events undoubtedly is gymnastics.  The strength and balance put on display by these athletes is astounding.   Yet, have you ever noticed how throughout many of their routines, the athletes rapidly bend backwards throughout their lower back?

While this repeated extension may score them more points, it also increases the odds of developing fractures and forward displacement of bones in their spine.  This condition is called spondolytic spondylolisthesis.

An intact spine showing the area that breaks (LEFT), The initial fracture (MIDDLE), The vertebrae sliding forward (RIGHT)

“A broken back” sounds quite scary, and it is associated with fears of paralysis among other issues.  However, contrary to what you may think, most types of spondylolisthesis are quite common and benign.   In fact, this type of fracture is so stable, many people are completely asymptomatic and have no idea their vertebrae are not intact.

If symptoms do occur, they most commonly include low grade low back pain, a low back that tends to have an accentuated curve into extension, and tight hamstring muscles.  Patients may also experience intermittent electrical shooting pain down the leg relating to pinching the nerve roots as they exit the spinal column. 

So how do gymnasts develop this condition?  It is thought that as these athletes train throughout their younger years, the repeated extension put through their spines causes microscopic stress fractures in a specific part of the vertebrae in their lower back.  These stress fractures, while completely benign individually, start to accumulate, and completely split the vertebrae in half. 

Interestingly, this condition is not exclusive to high-end athletes.   Similar conditions can develop relating to arthritis in older individuals, and even one-time traumatic events such as a bad fall, a tough hit in hockey, or even hitting the bottom of a shallow pool during a dive.  It can even be a congenital issue that you are born with.  So if you suffer from any of the symptoms above, and past treatments for your low back pain have failed, spondylolisthesis may be worth looking into as a possible explanation.

If you do suffer from a spondylolisthesis, and you are one of the individuals who experience associated symptoms, there is plenty you can do to help manage your condition.  In fact, most cases can be managed with some simple manual therapy and specific exercises that will help to target and stabilize the affected vertebrae.

For instance, the gymnasts who induce this injury with their training often have no symptoms at all during their competitive years.  It is only when they retire, and their core musculature starts to detrain that symptoms tend to arise.  Presumably, this is because the stability their muscles once provided is no longer there.

Spondylolisthesis is therefore a condition that more often than not can be managed without surgical interventions.  Like most types of low back pain, core musculature training goes a long way.  So do yourself a favour, use these amazing Olympic athletes as inspiration, and add some back exercises into your daily routine.

Does diet composition have an impact on weight loss?

Hello friends!  Time for another enthralling blog post.  Today's topic may or may not hit close to home.  I've been asked enough about weight loss that I figured it is finally time to write about it.

As much as we like to pursue healthy living to help us feel good, prevent disease, improve quality of life and prolong life, often we simply just want to lose some weight.

And as you all know, there are way too many quick fixes.  While we would like to believe there is some magic weight loss formula, the answer, at the end of the day, comes down to calories in and calories out.

However, an area I often get questions about relates to the composition of those calories coming in.  If we are looking at the issue from a pure weight loss standpoint, does it matter what type of calories we consume?  That's what this blog will explore.

Study

A great 2012 study looked at this issue in a very clear way.  Participants were randomized into 4 groups which followed 4 very distinct weight loss diets.  The caloric content was the same, just the composition varied.

• Two protein amounts were examined (25% of diet vs. 15%)
• Two fat amounts were examined (40% of diet vs. 20%)
• 4 carbohydrate amounts were compared (35% up to 65%)

The study examined the following parameters to monitor the progress of the participants:

• total fat loss
• lean mass loss
• abdominal fat loss
• subcutaneous fat loss (the stuff right under your skin)
• visceral fat loss (the fat that coats your organs)

Results:

This is what they found:

There was NO difference between groups.  

It simply didn't matter what their dietary composition was, it only mattered if they were consuming a calorie-controlled diet.  All participants showed equal fat loss, weight loss and lean mass loss.  All participants lost equal amounts of abdominal fat, subcutaneous fat and visceral fat. 

This study confirms what many others have: weight loss in otherwise healthy individuals comes down to calories in and calories out.

Practical Implication:  

While the answer to weight loss may be as simple as calories in vs. calories out, I am not going to begin to pretend that the issue is that simple in the real world.  When addressing an individual who is trying to pursue weight loss, it is undoubtedly a complex and multifactorial challenge.  Telling someone to eat less and excercise more simply will not work- they already know that!  It's like telling a smoker, "Hey, it's bad for you, so you should quit."

However, what this study does show is that while calories in vs. calories out may not be the answer, it must become the end goal for anybody trying to lose weight.  Whether that means changing social habits, seeking psychological counseling, cutting down on work hours to allow for more exercise; the process will be individualized based on personal needs.  That being said, all of these changes lead to two things: either start burning more calories, or start eating fewer calories.

This study also shows that high protein diets (such as Atkins) really do not have the physiological implications they claim to.  These diets may still work, but most likely because they indirectly result in caloric restriction.  Heck, if you're anything like me, cutting out carbs would result in me consuming about 10 calories/day.  

Also, keep in mind this calorie in vs. calorie out thing does NOT even begin to address the nutritional aspect of what we eat.  For instance, Weight Watchers is actually decently effective in helping people lose weight.  However, the problem I have with it is if you chose to consume empty calories (i.e. 4 beers), then you are going to be forced to skip your nutrient-rich dinner; this is not good!

Conclusion:

Weight loss is a very complicated, but at the same time, a very simple issue.  The end goal: reduce caloric intake and increase exercise.  The complicated part is figuring out how you get yourself there.