Tuesday, April 27, 2010

I Never "Exercise"

As a chiropractor, I am always encouraging people to take control of their health, especially with food and exercise.  But I have a confession.  Rarely do I "exercise".  For me and for many people, there is a deep emotional reaction to the word "exercise" which causes some to shudder as they are flooded with thoughts of dragging themselves to the gym or locking themselves in the basement with the latest home exercise machine.  Sure, I lift weights, ride a spin bike, do yoga, usually all at a gym and often ride 150+ miles a week on my bicycle, but I never consider it "exercise", that's probably why I enjoy every minute of it.

Let me clarify: there is a big difference between dragging myself out to do something I dread ("exercise"), and riding my bike or doing the things to make me a faster bike rider.  That's all fun and games.  You see, I am extremely fortunate that early in life I found something that I love to do that will also give me all the benefits of exercise, without having to call it that.  So I tell people that I rarely "exercise" and instead look forward each bike ride or trip to the gym because it makes me better at doing one other thing that I do love: ride bikes!  That's the "trick" I play on myself, and you should too.

When I mention the "E" word, (which is usually in the same category as other words that we refer to with only their first letter, and capitalized nonetheless), most people glaze over and say "oh yes, exercise is good for me".  And then they go right on for days or months or years without ever breaking a sweat.  Of course all the reasons apply like no time, it's too hot, it's too cold, it's too boring, gyms are too expensive, etc.  Well of course exercise is boring and inconvenient!  If it wasn't we wouldn't be having this conversation.  But here is the point that I want to make: instead of forcing yourself to "exercise", find something that you enjoy and DO IT and all the things that will help you do it better.  For me, it all revolves around cycling, for you it might involve golfing, chasing grandkids, gardening, or just moving throughout your day without aches, pains, or immobility.  But in the back of my mind I know that as I age, this game I play revolving around riding bikes is paying huge dividends towards my overall health, wealth, and happiness that I will benefit from in every area of my life, for the rest of my life.

No matter what you like to do, you can look at your "exercise" activities as ways that will make you better at what you love, and they will help you continue to do it better as you age than had you done nothing at all.  A good program would consist of basic strength training with weights and aerobic exercise with stretching as great filler for days you simply can't make it to the gym or get outside.  But don't mistake the fact that you should be doing something on a regular basis.  Switching it up from day to day not only keeps you from getting bored or burned out, it also helps round out your program so that your fitness isn't just one dimensional.

In case you need a few factoids today about how critical exercise is for your health and longevity, here they are:

  • Obvious reasons include: lower blood pressure, decreased resting heart rate, lower body fat, etc.
  • According to a recent study, men can live 14 years longer if they exercise, keep their waste down, and don't smoke.
  • Those men who make those changes also lower their risk of heart disease events by 59%, risk of cardiovascular disease mortality by 77%, and risk of all-cause mortality by 69% compared to those who didn't exercise. 
Those are some pretty awesome "side effects" to just riding bicycles and the doing the other things that help me ride longer and stronger!  So the next time someone asks you about "exercise", just smile and tell them that you gave it up long ago and tell them what you do instead!

Dr. D

Tuesday, April 20, 2010

Blaming Cholesterol is Like Blaming the Police

Statin drugs are often prescribed to lower cholesterol levels and we frequently see patients who are currently taking them.  What people might not know is that one of the common effects of taking statins, among other things is myopathy, or muscle injury.  The FDA recently issued a warning about Zocor stating that patients with myopathy "generally have muscle pain, tenderness of weakness, and an elevation of a muscle enzyme in the blood (creatine kinase)".  They also state that the higher the dose, the greater the risk of developing myopathy.

I don't prescribe drugs, but I often see patients who come in complaining of muscle pain, tenderness of weakness, for which chiropractic, rehab, and some basic nutrition are often very effective at correcting.  But I've learned to comb through the patient's history and through their prescription drug history so that we don't end up chasing side effects from medication when they are not responding like they should.

For those whose concern is lowering cholesterol and improving their LDL and HDL levels, there are safer ways to do so, and when the focus is improving health through food choices and exercise, benefits go far beyond lowering a number on one's lab work.  Blaming cholesterol for heart disease is a lot like showing up to a crime scene and blaming the police for committing the crime because they are always on the scene.  

Cholesterol has been demonized but consider this: your liver makes 80-90% of the cholesterol in your body, and dietary consumption only accounts for 10-20%. So while one might ask "how can we lower cholesterol levels?", a better question would be "why is the body keeping cholesterol levels so high?".  To answer that question, consider this:

  • Cholesterol is a vital component of the cell wall of every cell in your body and helps modulate cell membrane fluidity in the proper range, among other things
  • It is the precursor (gotta have it) steroid hormone production (like testosterone, estrogen, etc., which means that if levels are too low, you are never going to grow, repair, or heal anything)
  • It is converted to Vitamin D in the skin by UV light

The real culprit robbing health is not cholesterol, but inflammation.  Remember?

And although statin drugs may alter the numbers on your blood work, they do not decrease inflammation, and in fact place a tremendous burden on your body's systems, including the liver.  That's why many times doctors want to monitor liver enzymes when they prescribe them.  They want to make sure the liver isn't shutting down!  That's also why every ad for lowering cholesterol with statin drugs has a statement like "dietary modifications and exercise, along with (the drug) can decrease your risk for heart disease..."  Well the truth is, you could do the same with diet and exercise alone, it's just going to take a little more determination.  And if that's not enough, in the Lipitor insert, it says that it "has NOT been shown to prevent heart disease or heart attacks" (emphasis added).  For more reading check out:

Cholesterol does NOT cause heart disease

Understand that the debate over cholesterol is not over, but to be fair you've probably never heard the other side so thoroughly articulated:

Cholesterol Myths

And the author of the above page is far from alone.

I have some good print and video resources as well.  This issue is definitely one of the biggest misconceptions about health today.

-Dr. D

Friday, April 16, 2010

Fishy Business, Part II

Continuing on with our topic, here are the list of questions that I frequently encounter about taking fish oil:

"Why do I burp it up?"
Two points need to be made here.  First, smell inside your fish oil bottle.  Does it smell fishy?  It shouldn't.  People usually burp up their fish oil because it has already gone rancid before they've taken it.  Rancid doesn't mean that it's spoiled, but it does mean that the chemical composition of the fats have been altered (oxidized) and no longer offer a nutritional benefit.  Actually, ingesting oxidized (rancid) fats will do exactly the opposite: they will place a chemical burden on your system and accelerate inflammation.  That's one of the primary reasons to avoid commercially deep fried foods, the oil they are using is most likely days old and virtually completely oxidized and loaded with trans fats, which are completely incompatible with human life.  (California has even attempted to ban trans fats for that reason.)

The other issue that may be at hand is poor digestion of fats, so that it is not broken down and digested properly, due to a gallbladder that might not be producing enough bile to emulsify the ingested fat, allowing it to putrify in the GI tract.  If you've had your gallbladder removed, then you definitely have fat digestion issues, of which you are probably well aware.  There is a quick and easy way that we check in the office to determine if your gallbladder is a contributing factor. and there are products we use with great success to improve the digestion and assimilation of fats for those with and without gallbladders. 

"What brand is the best?"
There are many, many brands out there, but if you couldn't tell by the price tags, they are not all equal in quality.  As you might imagine, fish oil is pretty delicate and process by which the fish are caught and the oil is processed and bottled is of utmost importance.  Look for brands that have valid third party purity and quality certification.  You want to see that not only are the fats packaged to preserve freshness, but that they are also purified and relatively free of harmful toxins like dioxins, mercury, PCBs, etc.  This is not usually the time to get the cheapest product on the shelf because you will more than likely get what you pay for.  So do you homework before you buy or you can contact our office for more information.

"I already take flax seed oil, do I still need to take fish oil?"
The two fats in fish oil that we are concerned about are EPA and DHA.  EPA is the powerful anti-inflammatory component and DHA is critical for our brains and nervous system.  Flax seed provides the fat ALA (alpha-linolenic acid) which can be converted to EPA and DHA in the body.  However, this conversion is not guaranteed because not everyone possesses the enzyme for the conversion.  Even those that possess the enzymatic machinery necessary only make a 10-20% conversion rate at best.  So the best results are often seen by putting people on fish oil, which already have EPA and DHA in it.

"Aren't we over fishing our waters due to the increased demand for fish oil?"
This topic I have more to learn about, but I do know that not all fish oil comes from Norwegian waters, as so many companies would lead you to believe.  Many use fish that are caught in the deep waters off the coast of Peru and Chile, with a small amount coming from African, European, and North American waters.  If you are still concerned about over fishing, some have suggested krill oil as a viable alternative to fish for Omega 3 fatty acids.  At this time I'm sticking to what has worked so well in the past, fish. 

"What is the difference between fish oil and cod liver oil?"
Cod liver oil is specifically made from the liver of cod, and has a slightly different composition than regular fish oil.  There is some concern that one could overdose on the Vitamin A or D in large doses of cod liver oil.  I think these concerns are a bit over-extended, but to be fair, it's NOT recommended for pregnant or lactating women, or women who are pregnant or may become pregnant.  Check with your doctor first, or you can call me and we can decide what the best option is for you.

On the flip side, I might reach for cod liver oil in the winter months when it is impossible to get Vitamin D from the sun and where the extra Vitamin A can go a long way towards strengthening my immune system during the flu season.  If in doubt, go with regular fish oil.

"How much should I take?"
According to patient literature from Nordic Naturals:
  • 1 gram (EPA+DHA) to support healthy joints/muscles
  • 2-3 grams (EPA+DHA) to support the body's natural anti-inflammatory response.
The only word of caution is if you are taking a blood thinner because Omega 3 fats work to thin the blood as well.  Talk to you doctor.

One last thing, if you're going to take fish oil, you might as well go the extra mile and do it right.  Look for an EPA:DHA ratio of 2:1 for long term support.

Next post I'm going to cover an interesting research article from one of the most respected journals in the world, Spine and what it has to say about the relationship between posture and "all cause mortality rates". 

Dr. Darin

Thursday, April 15, 2010

Fish Oil? Living to 150? Might as Well Enjoy It! - Part I

Take a look at this information lifted straight from the CDC website:

Chronic Diseases and Health Promotion
Chronic diseases - such as heart disease, stroke, cancer, diabetes, and arthritis - are among the most common, costly, and preventable of all health problems in the US.

 Chronic Diseases are the Leading cause of Death and Disability in the US
  • 7 out of 10 deaths among Americans each year are from chronic diseases.  Heart disease, cancer and stroke account for more than 50% of all deaths each year.
  • In 2005, 133 million Americans - almost 1 out of every 2 adults - had at least one chronic illness
  • Obesity has become a major health concern.  1 in every 3 adults is obese and almost 1 in 5 youth between the ages of 6 and 19 is obese
  • About 1/4 of people with chronic conditions have one or more daily activity limitations
  • Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations
  • Diabetes continues to be the leading cause of kidney failure, non-traumatic lower extremity amputations, and blindness amount adults, aged 20-74.
 They then go on to say:

Four Common Causes of Chronic Disease
Four modifiable health risk behaviors - lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption - are responsible for much of the illness, suffering, and early death related to chronic disease.
  • More than 1/3 of all adults do not meet recommendations for aerobic physical ativity based on the 2008 PHysical Activity Guidelines for Americans, and 23% report no leisure-time physical activity at all in the preceding month.
  • In 2007, less than 22% of high school students and only 24% of adults reported eating 5 or more servings of fruits and vegetables per day.
  • More than 43 million American adults (approximately 1 in 5) smoke.
  • In 2007, 20% of high school students in the US were current cigarette smokers.
  •  About 30% of adult current drinkers report binge drinking (consuming 4 or more drinks on an occasion for women, 5 or more drinks on an occasion for men) in the past 30 days.
  • Nearly 45% of high school students report consuming alcohol in the past 30 days, and over 60% of those who drink report binge drinking (consuming 5 or more dinks on an occasion) within the past 30 days.
According to a University of Texas report on the Today Show (4/11/2006) the average lifespan in 1900 was 49 years old, and when the show aired the average was 77.6 years old and rising.  in fact, they estimate that by 2050, 800,000 Americans will be over 100 years old and many more will live to be 150!  Keep in mind that many of the chronic diseases outlined above don't manifest clinically until later in life, and they tend to accelerate the older one becomes.  For example, Alzheimer's doesn't usually set in until the 7th or 8th decade; not really an issue when the average person only lived to 49, but very relevant today and even more relevant for tomorrow.

Now go back and read the first sentence of the CDC excerpt again, and notice that THE MOST COMMON AND MOST COSTLY DISEASES WE FACE IN THE US ARE THE MOST PREVENTABLE.  If that doesn't empower you, check your pulse!  Unfortunately the CDC page doesn't get into how to prevent the laundry list of life robbing illnesses.

The common denominator to all chronic disease process is "inflammation", which even made the cover of Time a while back.

What we're talking about is subclinical, chronic inflammation that may not manifest itself as an outright medical emergency, but works steadily and slowly over the years, eroding your health, accelerating the aging process, and ultimately decreasing the quality and quantity of your life.

If that means nothing to you at this point, don't worry, I'll go into more detail in a moment.  But allow me to clarify at the outset: incorporating life style changes that limit chronic, subclinical inflammation (in addition to a little purposeful exercise) will so dramatically limit your risk for degenerative and chronic diseases that to not conciously put this information into practice is simply crazy and self destructive.  That is where Omega 3 fatty acids come into play.  They are arguably the most important nutritional supplement that one can incorporate into their daily routine to increase health in the broadest sense of the word.

You see, whether it's plaquing on arterial walls leading to hypertension or heart disease, or the plaquing in the brain cortex evident in Alzheimer's patients, an allergic reaction to pollen, or even rheumatoid or osteoarthritis, inflammation is the mechanism at hand.  The typical lifestyle (poor food choices while sedentary) push the body's biochemistry overwhelmingly towards inflammatory processes.  Translation: YOU AGE FASTER!

You get the point.  Now, Omega 3 fatty acids are commonly found in fish as well as other sources, although fish oil is usually the most effective for all but strict vegans (for moral/psychological reasons, not biochemical).  What roledto they play in our health?  They are literally the body's precursors for anti-inflammatory messengers.  What do I mean by that?  Well let's look at the relationship between Omega 6 fatty acids, like arachidonic acid, and Omega 3s like EPA.

It's been estimated that the ratio of Omega 6 to Omega 3 fatty acids in the Paleolithic man's diet, one that our genomes have been optimized for through the ages, was roughly 1:1.  It's interesting to note that in people where a ratio of 4 or 5:1 is measured, changes can be seen on the cellular level and those people report vague symptoms like poor memory, depressed moods, etc.  The standard American diet (made primarily of processed food) clocks in at around 20:1, where people experience aches and pains, are more susceptible to allergies, asthma attacks, altered moods, and where signs of gross inflammation are visible in the tissue, but may take years to manifest as a diagnosable disease or medical emergency.  It's interesting to note that the people that are at a 50 or 70:1 ratio have already been diagnosed with schizophrenia, bipolar disorder, etc.  All of these cases typically respond well to supplementation.

Omega 6s produce their effects via COX and LOX enzymes, but the same enzymes are what activate the Omega 3 acid EPA for it's anti-inflammatory effects.  Unfortunately, NSAIDS like Aspirin block both enzymes, inhibiting the inflammatory cascade possible with Omega 6s, but also inhibit the anti-inflammotory potential of Omega 3s.  COX-2 inhibitors specifically target the inflammatory pathways but come with tremendous risks (remember Vioxx?).  On a cost/risk/benefit analysis, Omega3s are a no brainer for long term support of your body's natural anti-inflammatory, anti-aging process.

If you get one thing from all this I hope that it is this: We stand to live longer than our parents and grand parents, but if you do not take the simple, basic, day to day steps to care for your body with regards to what you eat, how you exercise, and how you manage stress, you will seriously limit your ability to enjoy the latter half of your life due to health issues.  There is loads of evidence showing us what will happen if we "let nature take its course" and turn a blind eye to lifestyle factors that rob us of our health.  Incorporating Omega3 fatty acid supplementation into your routine will give you arguably the biggest bang for your buck in preserving your health as you age. 

Next post I'll discuss some of the issues one faces when choosing a fish oil and answer some common questions I get like "Why do I burp it up?" and "Is my generic brand fish oil good enough?".

Dr. D