Archive for June, 2010

You are What You Eat….But Careful Who Says So

Monday, June 28th, 2010

I EAT THEREFORE I AM….A NUTRITIONIST! If it were really that simple, we’d all be experts by now! It seems like every time we turn on the television or open a health magazine, there’s some self-proclaimed health guru telling us what we should and shouldn’t eat; try this diet, take that supplement. But how can we know who to listen to?

Sifting Through the Science
The sheer volume of information available is overwhelming, and it’s no easy task sifting through the claims and determining which have merit and which are nothing more than hollow marketing promises. As health and fitness professionals, our clients look up to us as the real experts, so we must base our recommendations on something more than conjecture and opinion. The following list is a valuable tool for evaluating the science behind nutrition claims. Keep a copy close at hand and refer to it when considering new research findings.

Checklist for scrutinizing scientific research

    Number of studies
    Consider how many studies were conducted. A single study might suggest efficacy, but numerous studies conducted by a variety of researchers from independent labs without vested interests would hold more weight.

    Number of subjects
    The higher the number of subjects in the study, the better. More subjects give a greater degree of statistical power. That is, we can say with reasonable confidence that the results were due to the intervention and not to random chance.

    Look for consistency in the dosages employed in the studies and what is found in commercially available diets/products. If large dosages were used in the studies, say 1000mg, then how does this compare to the comparatively small dosages (i.e. 10mg) used in commercial products? We need to compare “apples to apples” and “oranges to oranges.”

    In the case of dietary supplements, many nutrition products are cocktails comprised of a number of ingredients. If a study was conducted on just one ingredient, then it’s difficult to confirm that a mixed commercial product would yield the same results. Cross-ingredient interactions might potentiate the effect and pose safety issues as was the case with combined herbal preparations containing ma huang (ephedra) and guarana (caffeine).

    Population group
    One size does not fit all. Look at the population group upon which the research was conducted and consider how it applies to real life situations. For example, it is difficult to apply results from a study on young, university-level female athletes to bed-ridden morbidly obese, middle aged diabetic women since their metabolisms would be markedly different. Experimental conditions Consider how “life-like” the experimental conditions were. For example, a diet study conducted on elderly cardiac patients living in a metabolic ward for a month would reflect very different conditions to a young, free-living adult subject to a variety of real-life factors.

    Appropriate methodological controls help to ensure that the results are due to the intervention and not to random chance. Ideally, a study should be randomized, controlled, and, when appropriate, double blind—neither the subjects nor investigators know who received the experimental or control intervention.

    Confirm that the studies were published in reputable peer-reviewed journals. While even this is not a 100% guarantee, it at least confers a higher level of academic scrutiny to minimize bias and ensure the integrity of the research.

    If You Can’t Convince ‘Em Confuse ‘Em
    While claims based on science are always preferred, many diet book authors and product manufacturers are determined not to let the truth get in the way of a good marketing campaign. Clearly not everyone’s a research scientist, but we all have a built-in baloney detector that can help keep us from getting taken for a ride. Cut out and give the following quick reference checklist to your clients.

    Quick reference guide for evaluating popular health claims

    Too good to be true
    Infomercial watchers beware! The age old adage “if it sounds too good to be true, then it probably is” rings true in most cases. Often the repeating of lofty, seemingly unrealistic claims will cause you to lower your guard just long enough to make you lift the phone and surrender your credit card details. Always do your homework and thoroughly investigate all health products.

    While a heart-wrenching testimonial makes for great late-night infomercial viewing, this is not a guarantee of efficacy. Testimonials do not separate cause and effect from coincidence. For example, if someone begins taking a “fat-burning” supplement while exercising every day for 3 hours per day, then it’s difficult to conclusively ascribe those results to the pill or the radical change in exercise levels.

    The use of trendy buzz words is not an accident. Marketing research focus groups are explicitly conducted to determine which terms resonate with consumers and will likely translate to greater sales. For example, the term “natural” has been associated with safe and effective in the eyes of most consumers, yet even natural remedies may carry potential health risks. After all, even arsenic and cobra venom are also naturally occurring substances.

    No effort required
    Humans are pleasure seekers and pain avoiders and will avoid logging the hard yards if at all possible.
    Beware of any diet, supplement, or health product that claims quick, easy results. It took us nearly a century to reach these epidemic levels of obesity and disease and it certainly won’t go away overnight. Diet books have claimed to have the “secret” to health for over 50 years, yet if they worked in the first place, we’d all be skinny by now.

    Strictly business
    Advertising is meant to do one thing: sell product. Altered, airbrushed images, changes in lighting, body positioning, and body angle all give the appearance of a miracle transformation. Again, marketing materials are meant to sell, not inform.

    Confusing jargon
    Sometimes advertising is littered with science-sounding jargon. Glossy images of confusing biochemical pathways mean nothing to most people, yet it seemingly confers a level of scientific scrutiny. For example, because a substance is part of a fat burning metabolic pathway does not mean that taking it as a supplement will enhance the process.

    Out of context claims
    Sometimes it’s not what you’re told, rather it’s what you’re not told. You must be certain to evaluate the original research from which marketing claims are extracted. For example, “statistically significant” fat loss in the context of a research article may, in fact, be scientifically valid, but in the real world might only translate to a half kilo difference. Not quite the 50 kilos you were expecting to lose.

    Persecuted guru
    Beware of self-proclaimed health gurus who trumpet the notion that the “establishment” is trying to persecute them. If their theories are valid, then in time they will stand up to scientific scrutiny and eventually be vindicated. However, in the case of the vast majority, there is a reason why you’ve never heard of them and a reason why next year they’ll be off the health radar.

    Final Thoughts
    As health professionals, we are the ultimate gate keepers between our clients and the multitude of new diets and nutrition products entering the market. We are bombarded by an incessant mélange of both fact and fiction, and it is our responsibility to view each through the lens of science in order to discern the difference. We should never maintain a dismissive attitude because science is always changing. What we
    believe to be false today may eventually be proven true tomorrow—or vice-versa. Clearly we need to keep an open mind, but not so open that our brains fall out!

    About the author
    William R. Sukala, MSc. is a Clinical Exercise Physiologist with two decades of experience in both clinical cardiac rehabilitation and preventive health care settings. He holds a master’s degree in Exercise Physiology and a bachelor’s degree in Nutrition, and is currently completing his PhD with a research focus on type 2 diabetes, obesity, and associated metabolic syndrome risk factors. William is a popular international presenter on medical exercise topics and has authored articles in major publications both domestically and internationally. He is frequently cited as an expert in his field by magazines, newspapers, and television news media. For more information, please visit his website at:

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Wednesday, June 9th, 2010



Does being overweight cause osteoarthritis?

Wednesday, June 9th, 2010

Lower back pain is only second to the common cold for missed works days in the United States. Eighty-five percent of people in the industrialized world will have an episode of debilitating back pain in their life. Many of these sufferers have symptoms related to osteoarthritis of the spine. According to the Arthritis Foundation, forty six million people in the United States are affected by osteoarthritis (OA).

The Arthritis Foundation defines OA as:

The hips, knees and shoulders are also common areas of OA along with the spine. When these joints are painful they will interfere with many exercise programs. Since the hips and knees are load bearing joints for walking, standing, etc., they assume a larger percentage of the impact forces during any upright activity. Reviewing any of the literature on osteoarthritis (OA), you will inevitably see being overweight and obesity commonly listed as “causes” of OA.

From a biomechanical standpoint, I do not believe that excess body weight causes OA. I do believe additional body weight can magnify other mechanical factors leading to OA. If we think about the cartilage as wearing out on the bones, the misconception is that it is the entire bone. Instead it is often an area on the bone that is subject to excessive friction relative to the other parts. I often describe this to my clients as a “hot spot” in the joint. If you apply more pressure to that spot (i.e. more body weight), it will certainly be more sensitive than if less weight were applied. Reducing a person’s body weight does reduce the pressure on the hot spot, but it does not reduce the hot spot itself.

The overweight person often says “I can’t exercise because it hurts”. We say, “It hurts because you don’t exercise”. The caveat here is first defining the type of exercise we are referring to. Far too many people who don’t exercise lump all forms of exercise into one big category. And if you speak to any fitness professional, we can break exercise into multiple categories. These can include but are not limited to:

• Corrective exercise
• Flexibility exercise
• Mobility exercise
• Restorative exercise
• Strength training
• Aerobic conditioning
• Metabolic conditioning
• Sport specific exercise
• Mind/body exercise

For us, proper exercise would refer to a program that first influenced how the body moves. This would incorporate a corrective exercise program that improved joint mechanics to better distribute the forces in the joint. This also does not take away the hot spot but it does reduce the pressure on it and improves the overall function of the joint. This in turn reduces the pain and slows the progression of further degeneration.

Let’s use the knees for example. In our example the person has genu valgum (“knocked knees”). This may in part be congenital. But it is also a result of muscle and soft issue influences on the knee joints. The valgus position of the knee increases the pressure on the outer knee and decreases pressure on the inner knee. Therefore, the forces that should be shared on the inner and outer knee are much greater on the outer knee. This often results in accelerated degeneration to the inner aspect of the knee while the outer aspect remains normal or closer to normal.
valgus knee stress
(Illustration credit: Ajit Chaudhari, PhD, Assistant Professor, Dept. of Orthopaedics Ohio State University)

Common imbalances associated with genu valgum are tightness of the hip ADDuctors and iliotibial band. In addition, the hip ABductors are weak relative to the adductors and do not resist the pull of the femur toward the midline of the body which leads to the valgus position of the knee. In many cases the foot and ankle are involved as well.

Addressing the body’s movement patterns through the muscles and connective tissue you improve the joint mechanics and decrease the stresses that precede and/or perpetuate the degeneration. Both sides of the knee joint now “share” the forces a little more thus removing some pressure from the “hot spot”.

This will allow the overweight individual to get all the other benefits associated with the exercise experience including:

• strength
• increasing energy
• improving sleep
• controlling weight
• decreasing depression
• improving self-esteem.
• combating osteoporosis
• reducing the risk of heart disease

Osteoarthritis is a degenerative process and the result of long term wear and tear. A strategy of ice and medications only douses the fire but never touches the fuel. And as long as you are moving the way you have always moved, the fuel will continue to build up. Changing the way you move through corrective exercises can cut off the fuel line to that fire.

See how Function First’s corrective exercise program can help you by clicking here.