Sunday, August 28, 2011

on gary taubes, author of "why we get fat"

normally i take a more conservative stance on dieting for wt loss. that is, while i know it's important to lose wt for the two-thirds of americans who are overwt or obese, i am sensitive to the wt loss mantra that pervades our society and has been over-used in the minds of some afflicted with body image issues and eating disorders. confusing? well, it is for me too. that is, i am sensitive to the needs and issues of those with ED (eating disorders) but i'm also sensitive to the needs and issues of those with excess wt....and pissed off, if you've read some of my previous blogs. pissed off because excess wt is in many cases avoidable or at least manageable and when i see the millions of unconcerned parents of little kids, and other adults or near adults, who seem not to be taking any actions to avoid wt gain, i know the drain on our medical systems and dollars that seem so selfishly being left open. that said, i keep reading.....

when a formerly obese but currently lean client - a surgeon - came in to consult about his exercise program, he informed me of gary taubes, author of "why we get fat" which was s sequel to "good calories, bad calories". both are catchy titles and both pitch the low carb diet. however, different from other books of this type, he goes thru the world history, literally, of how excess fat consumption may NOT be the source of excess fat DEPOSITION let alone metabolic consequences of obesity. historically speaking, there is a substantial body of accepted evidence from all kinds of trials and meta-analyses that demonstrates that hi insulin resultant from hi carb diets is the source of both obesity and heart disease/diabetes/metabolic syndrome...and maybe many cancers. his review of literature is comprehensive tho he does avoid alternative explanations for some of the supportive studies he uses when debunking the diet- or exercise-only methods of wt loss. more on that later. additionally, his review of biochemistry that anyone can almost make sense of - i write this pen in cheek because, while he does soften it up and masticate it for the common reader, never delude yourself to think you can understand the complexities of our hormonal and metabolic systems by his or anyone else's descriptions - is also compelling. let me summarize and synopsize this for you: simple carbs - anything refined, starchy, white - elevate insulin which causes all kinds of bad things in your body if you persistently run high in your blood stream. his diet advice, however, is more sane sounding than one might otherwise expect from this warning.

now, to his exercise critique, something about which i do know and am sensitive.

taubes contends that studies show exercise is not an effective way to lose wt. he uses two types of studies: clinical, where control groups and supervision/guidance are offered, and epidemiological, where you survey people in large numbers. of the first, often times wt loss, on AVERAGE, does not occur from either cardio or strength training. taken on the face of it, this would make it appear that exercise is only useful for health, not wt loss; and while this is clearly true, don't discount its ability to help with the latter. in fact, many lose wt by exercising for the following reasons: calorie use while exercising, calorie use to restore homeostasis (post exercise oxygen consumption, or what is referred to in the fitness lit as EPOC, exercise post oxygen consumption which to me puts the cart before the horse but never mind....), and body composition changes, esp from resistance training. now, can you lose as much as you might wish via exercise, and is it easy? NO, but it's not ineffective. and it does confer great health benefits even beyond those that are medical - such as increased vigor, function, and emotional stability. taubes acknowledges as much but does not equate these benefits to the ones he touts when he reviews the studies that support his preferred diet, low carbs. so, in one study where subjects lost almost 10# after 6 mos, which is not that impressive really, one could find exercise routines that do the same. but he argues that exercise actually stimulates eating, and he's wrong here, from two angles. first, exercise actually increases leptin sensitivity such that the hormonal signaling that shuts off appetite if fat cells are satisfied does not need the enormity of output necessary to effect eating restraint. much as with increased insulin sensitivity, another benefit of exercise, if the body is better adapted to using hormones, the decreased hormone output not only conserves organic function (think pancreas when you think of insulin) but it also reduces negative effects of too much hormonal output overall (think hyperinsulinemia). furthermore, tho the exercise is hard to induce and maintain in many subjects, it does not stimulate so much as modulate hunger; minimally, it's another hour of the day you DON'T EAT. in fact, studies have shown that athletes, in hard training, lose wt often because they UNDEREAT. granted, the overwt/obese may compensate, and taubes does point that out, but with new studies recommending shorter bursts of higher intensities, i would think this type of compensatory eating - and even compensatory sedentariness, which taubes does not address - would be diminished, too.

now, as for large pop studies, self-reported exercise (over estimated) and diet (underestimated), esp if recalled over large tracts of time - like how many days/wk did you exercise at X% over the past year? - are inherently of nominal value. they may show why some succeed in accomplishing a study's goal - whether of wt loss or blood cholesterol reduction - but do not allow us to categorically state why some fail. we'd have to accuse them of lying, to the researchers and to themselves. no one wants to do that, right? taubes does not really address it when he accuses studies of exercise or low fat diets of failing.

that all said, let me pat him on the back for writing what i believe has not been writ large enough by authors promoting any sort of diet of the sort he promotes: he goes thru the various negatives of the higher protein/fat diets and explains them in ways that make the reader not pause but consider with some forethought the reality of taking on this kind of LIFESTYLE change. i emphasize lifestyle seriously because this is NOT a two week diet - if you have diabetes or have been overwt/obese for a long period of time, it may take months if not years to reverse your metabolism...and still some may not succeed to the degree to which they or their doc may like. and finally he presents the medico-legal problem inherent in his recommendation to docs: it's still outside the mainstream of government-supported recommendations so docs may be reluctant to put folks on this kind of diet. my advice: give patients the book, highlight certain features, and let the patient decide; then refer to a dietitian for specifics. and taubes i think could live with this, too.

so, my recommendation to readers who are interested in wt loss either from a personal or professional perspective: read this book, why we get fat, esp the last two chapters. if you want more of the history and science behind it, read the first 172 pages and/or read his other book, "good calories, bad calories", and decide for yourself.

my one caveat, and my daughter personifies this, is that vegetarians or vegans, or people like myself who don't eat red meat/pork, will have a harder time adapting to this kind of meal plan. hi pro/hi fat diets need to be creatively prepared to avoid mundanity; if you only know so many ways to prepare fish and chicken, good luck. otherwise, learn to cook better or learn to eat meat.

Friday, August 19, 2011

on core exercises - what works, what doesn't, and whether you should at all

there are some things in the fitness world that are accepted entirely on faith. to argue against them is to walk right into the path of someone's whole way of seeing the world. flexibility - whether it helps performance (not necessarily, and may hurt it), reduces risk of injury (maybe increases it), or helps you be stronger (maybe, maybe not) - is one of these on faith principles that has achieved near-idyllic status. only the studies over the past 15 yrs has altered its stature yet to hear all the new found love of pilates and yoga that is touted in the media and among fitness people, you'd think it's the answer to everything. (disclaimer: i stretch, a lot, and always have, esp when i did martial arts 7 d/wk. but stretching is useful for some sports, tae kwon do being one of them; but at the same time, overstretching, which is what i did, likely contributed to my bad knee and hips, and maybe even interfered with my ability to actually be more effective as a fighter. looked great in forms, tho:))

another is the paramount role the core has come to play in fitness circles. the classic 6-pack, those cuts in the anterior abdominal wall that signify leanness and well toned abdominal (not stomach) muscles, has come to suggest that an individual, esp an athlete is somehow more effective, efficient, powerful, capable, and less prone to injuries, esp of the back. but the thinking here may be, and i believe as this article suggests is, way off base. for one thing, the 6 pk is just one set of the musculature of the core which we now understand to be all the muscles around the waist plus the hips, and even the upper thighs. furthermore, despite all the talk about having a strong core, few have distinctively identified any one or even battery of tests that measure it.

in this article, there are references to stuart mcgill, of canada, whose work in this arena is profoundly influential. he argues against sit ups and crunches as valid tests of or exercises for good core strength or function. he even suggests that these may be more dangerous than helpful, but he does suggest a safer way to do them - by placing one hand palm down in the small of your back and only raising up just enough to feel the abs contract. but for core, he recommends planks, front and side ones.

mentioned too is an article in this month's NSCA journal of strength and conditioning by schoenfeld which reads really well. he suggests, in opposition to mcgill, that the crunch may be perfectly safe and may have value for some athletes and body "builders" - those seeking, if lean enough, to have a toned midsection. his review of the literature is well taken. and his guidance at the end of the article is suitable for all levels of fitness participants.

however, as i've written before, all these are isolational exercises: they work one section or one side of the core without reference to how the core works. let's review this functionality.

the core transmits power/force from the lower body to the upper body. studies show tennis serves and baseball throws come primarily from the navel down - anywhere from 55-60% of the power comes from the legs and hips. the waist is a conduit to the upper body. if not strong, and functional, it will dissipate force coming from below. now, how does this force come up?

first, you rotate from the feet, twist thru the legs, and then into the hips. before the spine actually rotates, usually the rear leg hip externally rotates to turn the trunk toward the target be it the opponent or batter or what not. in this manner the spine is put into a twisted position - javelin throwers show this quite well - and then, like a spring, untwists to propel the upper trunk and shoulders into action. thus, the core is really a twister, not a squarer. that is, it does not operate in one plane; it operates in all three, as twisting is a multiplanar movement. so, training it in twist is really more appropos. and what exercise does that? the torso rotation with tube or cable resistance. done properly, whether statically to develop core stability, or on an unstable surface such as on a stability ball or less-than-optimal stance, or in a firm and solid stance or position, such as sitting on a bench, straddling or normally (why? because polo players straddle a horse; race car drivers sit in chairs; and so do you....), the torso rotation exercise most approximates the way the spine has works. let's imagine.....

if you stand with feet shoulder or hips width apart, knees soft, and hands directly out in front of the sternum, you have effectively created a spoke (hands) and wheel (spine/core) system. now, if you have some force - manual from a partner or tubing or cable - that tries to twist your arms over to one side, and you resist, you are isometrically rotating to the opposite side. for example, if a partner pushes the hands to your right, you rotate to the left using your right gluteals, left inner thigh/hip rotators, left erector spinae, left latissimus dorsi, right external oblique and left internal oblique - all the same muscles that actually turn you to the left to throw a ball or punch or serve. in other words, it makes your core work like your core works - in synchrony with all the muscles of the hips, thighs, and midsection. wow!!!

the problem is how to test core strength. and i believe ohio state is testing with a self-designed mechanism at least function if not strength. so maybe someone will come up with a way to standardize the tests for core strength. in the meantime, i use a tubing pull - where i pull the tube while the client faces the mirror and watch for when the core starts to give out. not truly accurate - more qualitative than quantitative - but it allows me to see if someone needs to be trained more to one side than the other. it also allows me to test the muscles of the hips and low back because the client can often identify where the weakness lies.

to conclude, this article is provocative because it touches the sensitivities of many in the fitness world. but read it closely and think about it. and think about what i've said here. i believe you'll find what i've found - sit ups and crunches are just for fun and tone but not function or strength of the core.

on barefoot running

barefoot running, and barefoot shoes, are the newest things in fitness and in fitness gear. i've commented and written before on this topic and more studies keep popping up about it. most are positive - so far as actual running barefoot is concerned; some are negative so far as injury rates while running barefoot are concerned. but some are neutral - discussing the science behind barefoot running while also discussing the spate of injuries that have been reported by those attempting to run barefoot. this then leaves the researcher -not scientific ones, but potential buyers and users of barefoot technology shoes - in a quandary: should i or shouldn't i?

here is an article in the american council on exercise's on line mag for professionals. it does not shed a pleasant light on the subject but i want to point out a few problems with it.

first, recreational runners were subjects, meaning they were less likely to be "soft" or skilled runners, ones most likely to benefit from these shoes for performance sake. two, they were young females. in other words, we don't know if men - generally heavier but also stronger - would be better 'landers' while running in these kinds of shoes. three, the researchers told the subjects to run no more than 20 mins three times a week for the two weeks prior to testing. and four, they were tested after running 20 meters on ground reaction forces.
why these may be problematic i'll discuss below.

first, recreational runners come in all types, but many if not most are heel runners. two weeks is not enough time for a heel runner to adapt her style. second, being female runners, as i said above , they are not likely to be strong enough in the lower extremity to absorb impact via mid foot landings quite so well as a male might be. the fact that we know nothing about their body weight, body composition, or other measures or indicators of fitness suggests that these subjects may not have be representative of more elite, male runners trying out barefoot shoes. third, to make the adjustment to these kinds of shoes, one should probably not go right out and start running, perhaps at all but definitely not for 20 mins. that we do not know about their fitness levels, it's feasible that 20 mins was half of their capacity, in which case they would definitely not be fit runners, tho they would be fit individuals. furthermore, most sales and fitness pros would suggest starting a run/walk program with substantially less run time total than would otherwise be done in the early weeks of adaptation. so, 3 x 20 mins x 2 wks is not enough time to adapt or learn to adapt. finally, the technique of testing is a good one for most running biomechanics studies. but we don't know anything about trials - numbers, cues, etc - and actual forces - vertical, horizontal or shear. so while it's an interesting set of data, i would not bet my shoes on this study.

nonetheless, take from the study my comments - slow and easy introductory period - and the advice of others - learn to land on the forefoot - and then maybe you will be one of the lucky many who've learned that running barefoot is now possible in these funny looking but very comfortable shoes.

Sunday, August 14, 2011

coconut water and other concoctions

the latest, today, because who knows what it will be tomorrow, is coconut water. yes, this natural product from the islands and tropics is capable of damn near anything you athletes would want, from hydration to energy to curing all kinds of aches and pains. but as this article, and many others i've researched, shows, it does not hydrate better than sports drinks. however, if you follow the link to the pubmed article, you will note that the one - i emphasize, ONE - article says it's better tolerated than sports drinks. now, there are three things i want to bring to your attention.

first, the study was done in singapore. not that good research isn't done there, but being a land of milk and coconut, and the abstract does not tell us anything about this, it was possibly funded by the coconut industry itself. in fact, google coconut and you'll see bunches of 'research' all of which is funded by the coconut industry. possibly biased, you think?

second, we don't know, from this abstract, to what extent the study was done in the format we in the west would do it. that is, how much and at what rate were the drinks administered? what sports drink was it - gatorade, a well ressearched product, or some local/national brand? and there are many other questions one could, and should ask.

finally, the results show that coconut with added sodium - that's extra salt, for those who forgot chemistry 101 - works as well as the sports drink at hydration but was better tolerated. that's the question mark, but leave that aside. it works as well as artificially flavored and colored water with sugar and sodium added. more natural? no...because the coconut was also modified, with salt. and who knows what else. it was a coconut drink, not pure coconut. in other words, read the labels, and question the marketing. as you would for a computer, a car, or anything someone's hawking that somehow miraculously without notice from the Nobel Prize distributors have ever noticed, think twice. it may not be bad for you but it also may not be good for you. and if it's only as good, or marginally as good, consider cost, at the checkout and to your body. for the one thing we don't have evidence on is the accumulated cost of consuming products about which we know little other than what the sellers tell us.

Friday, August 5, 2011

HAES it going?

it's intentional: HAES = health at every size, a program to help overwt women come to grips with the lifestyle patterns that have contributed to their heaviness, but NOT by enforcing wt loss. rather, it encourages finding - no, creating -new patterns of thinking, feeling, responding, and acting to stimuli - both external as well as internal - that previously was counter-productive to their well-being. that is, food, eating, and dietary habits, as well as activity habits, which contributed to excessive weight gain are redirected with a loving message that participants can reconfigure into new habits and patterns that lend themselves to improved mental and medical health....even if participants never lose the weight they'd like to lose.

this concept came from the research of Steven Blair when he was at the Cooper Clinic in TX years ago; his writings and lectures on 'fit and fat' changed the way exercise and nutrition professionals started to approach the problem of overweight/obesity: small changes in lifestyle choices reaped large, very large benefits in health, even if the wt never got to the 'healthy' range.

as a trainer, i've been hit up since early in my career for the answer to wt loss. having provided the party lines - dietary and exercise - even as they've changed over time, i've come up with a simple dietary dictum: eat whatever you want, but take ONE THIRD off the plate even before you taste it, and put it in a to-go or tupperware container. i've also come to grips with the exercise rx of so many minutes a day times so many days per wk: do 15 minutes daily, where daily is nearly every day of the week. as for strength training and all that malarkey about building muscle mass to boost metabolic rate, well, old folks and women don't build so easily and really won't build enough to substantially reduce total calories; and the exercises themeselves won't do it, either. so, the exercise advice is more directed toward health, mental, cv, and musculoskeletal, than toward wt loss. why? because you really can't exercise it off. a combination of eating less and moving more may, that is, MAY help some lose wt, but will always, read: ALWAYS, improve wellbeing.

some get frustrated with these guidelines, but i prefer honesty to false and impermanent promises. it's really easy for trainers to brag on successful wt loss with their clients. but let's look down the long corridor to see where these clients end up years later. some will have kept it off; most will have regained it; and many if not most will have gained beyond where they had started from. what's really more important, other than how they feel about themselves, which is a far cry from anything i can offer, what is important and what i can influence is their well-being, their physical fitness, and to some degree their health, even in the long run.

so when i get a client who intransigently struggles in vain to lose wt - and won't because of lifestyle choices that suggest lack of discipline, laziness, or whatever other excuses all of us make to not do what we know needs to be done to accomplish whatever our goals may be, i fall back on my basic mantra of small changes for large results: if they will exercise twice a week with me, and modulate their diets as a function of our relationship, then i'm helping them....until such time as they are ready to help themselves.


because ultimately, that's all the power anyone has to help another: loving support. from there, it's their choice how to use the knowledge, power, strength, endurance, functional capacity, etc. like HAES.......

Wednesday, August 3, 2011

on food and self-regulating industry

this op-ed in the Times - - highlights perhaps one of the strangest elements of american politics that has long gone unencumbered by both parties: the revolving door and closed feedback loop of those who should be regulated by those who were once or will someday soon be working for the very industries that are to be regulated. that is, the classic fox guarding the hen house model of government oversight.

this article takes our government to task over its weak rules and mild constraints against the food, primarily the fast food and kids' oriented food, industry and how they are allowed to both be represented at the table as well as be in control of the writing of the very rules that are supposed to provide guidance to their production and marketing. what if the oil industry were allowed to establish the rules for exploration, environmental management, and supply and demand of our nation's fossil fuel reserves? you think there'd be more holes in the ground any and every where with little regard for the environment during and after they were tapped? you think prices would be higher and their drilling fees lower? you think your cars would be getting any fuel efficiency? heck no. they'd be padding their wallets....oh, wait a minute; they are padding their wallets, and have very little regard and take very little responsibility to the larger issues faced by our people, our nation, and the global environment. fat chance they'd be so kind if there were teeth and guts behind the regs and the regulators themselves. but many if not most of them have worked for or will someday hope to work for the very industry they presumably regulate. furthermore, so long as our politicians are dependent on the largesse of such industrial giants, they will be sure to write the weakest of laws and finance the minimalist of regulators as to ensure the continued profits of these corporations.

the downside of this is highlighted in the food industry. what with crappy and unhealthy foods being produced and sold cheaper than healthy foods esp to kids and the underprivileged, our country is awash in obesity-related disease and lifestyle accommodations. while any one industry is not totally at fault for these circumstances, the depth and width of which are actually, not figuratively, killing people by the millions, without some government regulation, the food industry is getting off pretty light. when you can redefine obviously-unhealthy foods - damn near anything processed - as healthy, and the gov and regs look away, we are destined to stumble down the highway of heart disease, diabetes, and cancers for all.

but what to do about it? therein lies the conundrum. for if we really believe people are in their rights to choose how to live and eat, then putting out there for them foods that feel and taste good even if they offer nothing nutritionally is fulfilling a basic human right. and who'd deny an individual such a right, right?

but if we believe that each individual is entitled to this right, but then must take responsibility for the consequences of that right, then a public health policy is impossible to sustain; and a private-based health initiative should more precisely 'punish' those who have taken advantage of that right at the expense of those of us who have tried to live healthfully. it just does not seem fair to either let folks suffer and die needlessly so others can profit; nor does it seem fair to make those of us who watch what and how much we eat pay for the sins of gluttony and uncontrolled eating and sedentariness. but alas we do.

it's not easy but i do know this: the industry in this case should know the mission - public welfare- and be supported in supporting this mission, or financially penalized for seeking profits over well-being. i know - idealist if not socialist thinking. but isn't that better than just giving up?