Naturopathic Medicine

Does Fitness Need to be so Complicated?

I wrote this comment in response to a CBC radio interview with a journalist Daniel Duane. http://www.cbc.ca/q/blog/2014/06/02/daniel-duane-beach-body-secret/

This interview was embarrassing - Daniel Duane has some reasonable arguments and grievances with the fitness industry, but unfortunately his reasonable statements are intertwined with many unreasonable ones.

The large body of science that supports the health benefits of exercise, refers to the types of exercise that get your heart rate up, and keep it up for extended periods. Lifting heavy weights with high risk exercises like deadlifts, bench press and overhead squats, not only puts people's joints at risk but also doesn't emphasize the component of fitness that matters the most - Cardiorespiratory fitness. And yes, you don't need a trainer to go for run and experience these benefits, fair enough. You do however need a good physio/ doctor/ trainer to make sure you are ready for exercise to begin with - someone to make sure your heart isn't at risk, and to help uncover limitations in flexibility, balance, joint stability and posture that also make a difference for your overall physical health.

Perhaps Duane chose poor advisors, or perhaps Duane just didn't 'get it'. Either way, I thought his arguments were weak and I didn't understand why the CBC aired him. My feeling was that he used his notoriety (NYT and Men's Journal Contributor) to simply complain about a bad fitness experience he had.

After thinking on it, I understand why Duane's ideas are popular - he is right that fitness professionals are often trying to be too fancy, and they are failing to keep their clients best interests in perspective.  However, his ideas that doing overhead presses and deadlifts in your basement is a better way to go is ludicrous, and his assessment of current scientific evidence for exercise was irresponsible and not at all helpful for promoting public health.

CON Mental Health and Obesity Conference

CON_OMH_program_2014_4 cover I just attended another great event put on the CON on mental heath and obesity.  Its great to see there is more study being done in this important area.  Rates of obesity and its related comorbidities are higher in people with mental illness, and yet many weight management programs deselect against people with mental health problems, for fear of destabilizing their mental illness or having poor outcomes in the program.  It looks like this worry is unjustified, and may even be discriminatory.

Dr. Oughtred Joins Stein Medical Clinic

Dr. Oughtred is pleased announce that he has joined the team at Stein Medical clinic, in Downtown Vancouver BC.  Stein Medical Clinic is an integrative, walk in medical clinic that not only offers medical care, but also offers in-house physical therapy, massage therapy, and now with the addition of Dr. Oughtred, Naturopathic Medicine.  With this new addition, Stein Medical patients can benefit from a team approach, resulting in more efficient and comprehensive primary care.  Lets say for instance that have chronic fatigue; you can book an appointment with Dr. Oughtred, and if required you could also see an MD after your visit for further work up.  This saves you time as well as allows for a 'two heads are better than one' approach to your concerns.  If you have extended health care as well as MSP coverage, your 1-hour of services could cost you nothing and you will be well on your way to better health and well being. Both Dr. Ryan Oughtred and Stein Medical Clinic believe that a pro-active, multidisciplinary approach to patient care is the way of the future.  Dr. Oughtred hopes his presence at Stein Medical will be a step toward making the future a reality.

Ryan Oughtred

Naturopathic Doctor, Vancouver BC.

Enhancing Muscle Recovery

Enhancing the ability of your muscles to recover better is a popular topic these days.  Here is my advice for anyone wanting to ensure they are recovering properly:  

Sleep

 - Sleep is quite possibly the most effective tool for recovery from any stress.  Sleep is the only time that your muscles totally relax, which I believe is essential in order for blood to properly circulate and for your connective tissues to heal and get stronger for the next day.  Your body instigates many anabolic (tissue healing and growth promoting) processes once you are asleep, and your hormones shift to reflect this process.  After falling asleep, your body produces Growth Hormone, a hormone essential for growth and repair as well as combating normal processes of aging and degeneration.  Some athletes try to nap several times per day in order to increase their growth hormone secretion and promote a state of increased healing and repair.  The position of sleep – lying down – is also healing in itself.

- Improving sleep is simple for some people and not so simple for others.  Ensuring someone has proper sleep hygiene is essential: keep constant wake times, take an hour to relax before bed, avoid stimulants such as caffeine, a noise free environment, temperature that is not too hot or cold, etc.  Some people may have underlying medical causes of their

 

Muscle Tension Prevents Healing

- If your muscles have excess tension, they aren’t healing as well as they could if they were relaxed.  Causes of muscle tension include poor posture, repetitive activities (like running or biking), stress, inflammation, or general overuse.

- Regular massage therapy and other self massage therapy techniques likely increase circulation and decrease the amount of ‘strain’ that is happening through your muscles and joints.  The key point is regular here

- Stretching works to reduce muscle tension, the problem is that people often don’t know how to stretch properly on their own, and often put their body out of balance with poor selection of the types of stretches they perform.

- Heat (hot tubs, saunas, contrast therapy, etc) is an effective way to promote muscle relaxation, this is an evidence based method of enhancing recovery that is underutilized and sometimes forgotten because of its simplicity.

 

Stop Stressing and Take breaks in your day

- Our nervous system and hormones are probably designed to deal with stress in short bouts, after which we would experience a period of time to allow for rest from that stress.  The classic example of having to escape a predator applies here; 1- get scared, 2- run away from the animal for an hour or so, 3- Lick your wounds and have a nap in a safe place.  Our bodies are well adapted for this type of stress, but not the ‘all-day-long’ type of stress that many people put themselves through.  Chronic stress prevents your body from going into a rest and repair mode and your muscles and other tissues will slowly break down.

- Not working too much or taking on too much responsibility at one time is the most obvious measure you can take to prevent chronic stress.  Build breaks into your day in which you do relaxing things like taking a quick walk, exercising, talking to friends or family, laying down, listening to music or meditating.  Try to make these breaks every 90 minutes or less in frequency.

- Some people can’t seem to relax no matter how hard they try.  Addressing the underlying cause of this inability to relax is very important for proper recovery; sometimes this might involve changing how someone things through self help or cognitive behavior therapy is often helpful, or perhaps an underlying medical condition needs to be addressed and supplements or medications might help.

 

Change your body positions

- Standing around for long periods during the day, and generally staying in the same position for long periods of time is also hard on the body’s tissues; the more you can vary your positions while at work or even during exercise, the better.  For instance, while you are resting during an exercise session – sit down with a good posture, or even lay on your back to rest your tissues that always have to work while you are standing.

 

Periodize your exercise

 

- Taking a scientific approach that systematically overloads your tissues and them provides a proper rest period is the best way to train and avoid injury.  For instance, in our group exercise sessions, we progressively increasing the volume and/ or intensity of exercises throughout the month, and then provide a week at the end of the month or start of the following month for rest.   Different components of exercise require different amounts of rest, and following a well planned exercise plan allows you to make the most of your time and get the most ‘bang for your buck’ when exercising.

 

Active Recover

- Your muscles will heal better, and will also develop a better ability to recover long term if you incorporate low intensity movement into your rest time.

 

Pay attention – you can tell if you are recovering well:

- Measuring how well you are recovering is difficult – you might want to experiment by using a journal to track your body for signs of overtraining:

- Morning heart rate elevations

- Grip strength

- Resting Lactate elevations

- Monitor sleep quality, body pain, moods, skin health, and other signs that the body is becoming taxed.

 

Supplements:

- The way you eat can certainly affect how you recover.  The first step is ensuring you have adequate nutrients.  Because most people are omnivores that typically eat too much food in general, true nutrient deficiencies are quite rare.  However, conditional deficiencies are probably more common; these are nutrients that are considered non-essential, but when under stress they can become depleted.  Examples include amino acids like arginine or glutamine and supplementing with these when ‘the going gets tough’ probably makes sense.   Glutamine is also essential for making the hormone GABA, which is an essential neurotransmitter in the brain for relaxation.

- Many of the body’s water soluble vitamins can become taxed with high stress, including ascorbic acid, folic acid, B12, pantothenic acid, or pyridoxine.  Fat-soluble vitamins like the carotenoids and minerals like magnesium or calcium are probably important to add.  If you prefer to stick with food for your essential nutrients, then doing things to enhance your body’s digestion with the use of bitter herbs or digestive enzymes should be helpful when you are having to eat high amounts of calories and your digestive capabilities are being overloaded.

 

Tweak your hormones

- Your hormones are your body’s chemical signals to repair and recover.  Stress, medications, certain diseases, toxins, and normal aging can throw them out of balance.  Combining a good medical history along with some blood work can help shed light on possible excesses or deficiencies that might help your body recover better.  Salivary cortisol testing is cheap and easy to do, and it can often shed light on why people are not sleeping or recovering very well, and can help give people another encouragement to follow through more rigorously with their exercise routine.

- Anabolic hormones like testosterone or growth hormone can be modulated with the types of exercises used, certain supplements (albeit very slightly), and of course with the use of exogenous hormones themselves when medically required.

 

Summary

 

Here is a summary of the various recommendations you could try to enhance your ability to recover:

 

Sleep

- >7 hours for the average adult

- >8 hours/ night for adults that exercise >250 minutes/ week.

- >9 hours/night for active adolescents

 

Stress Reduction

- Time management

- Breaks in your day – every 90 minutes.

- Relaxation – meditation, yoga, walking, progressive relaxation exercises, social time, etc.

- Cognitive, “change how you think” exercises. (CBT)

 

Self Monitoring for Burnout/ Overtraining

- Morning heart rate elevations

- Grip strength

- Resting Lactate elevations

- Monitor sleep quality, body pain, moods, skin health, and other signs that the body is becoming taxed

 

Adequate Nutrition/ Supplements

- Omnivorous diet, high vegetable content.

- Possible supplements:

- B-Vitamins, Carotenoids, Magnesium, Amino acids, Essential Fatty Acids, digestive enzymes, anti-inflammatory herbs, digestive and relaxing herbs.

 

Balance Hormones

- Stress hormones

- Anabolic hormones

 

Periodized Exercise:  Scientific approach to progressing your exercise program.

 

Other Regeneration activities (to be done 3-5 times/ week):

 - Active Recovery – 30 minutes or more

- This is any rhythmic exercise like spinning on a bike, swimming, hiking, or any other continuous type of activity that keeps your heart rate around 50-60% of max (100-120 bpm) for a sustained period.

- This type of exercise is best if performed immediately after strenuous exercise.

- Massage – 30 minutes or more

- This can be self-massage or massage from a professional.  Professional massage is almost always better, but it has cost limitations and you can’t always have your massage therapist with you when you are traveling the world skiing!

- Self-massage can be performed with various types of small balls or rolling devices.

- Thermotherapy (Heat) – 15-30 minutes

- Warm therapies should not be used in excess!  Start with small amounts of time (10 minutes) and work up (30 minutes max).  Too much heat can also be stressful to the body.

- Hot therapies are not recommended prior to exercise.  Always be sure not to burn yourself.

- Examples

- Saunas

- Regular doses of 30 minutes in a humid sauna at 90 degrees Celsius can aid recovery after hard workouts.

- Warm or Hot Water Baths

- 15 minutes at roughly 38 degrees is a typical recommendation.

- Too much time in the hot tub can cause the body to be too relaxed.  Contrast hydrotherapy is probably better than warm baths alone.

- Steam Rooms

- Cryotherapy (Cold) – 30 minutes

- Cold therapies can be used after exercise to limit inflammation and enhance recovery.  Usually, cold therapies are used on specific body parts to help injuries heal or prevent old injuries from coming back.

- Do not use cold therapies prior to exercise.  Do not lie on cold applications and be careful not to put ice directly on skin because it can cause frostbite.

- Apply Cold to the desired body parts for 10 minutes, then remove for 10 minutes, then place back on for another 10 minutes.

- Body parts – Legs only, knees only, arms only, etc.

- Cold packs, bags of ice, cold water baths

- Whole body immersion for 10-20 minutes after exercise can be done (12-18 degrees), but it must be used with caution, as it causes stress to your heart and has caused fainting in some individuals.  Start with warmer temperatures and go colder with each session.

- Contrast Therapy (Hot/ Cold) – 20-30 minutes

- Hot therapies relax muscles and increase blood flow.  Cold therapies contract muscles, decrease blood flow, and limit inflammation.  The combination to the two probably leads to a ‘pumping’ effect of fluids, thus enhancing the rate of circulation and enhancing recovery from exercise and injury.

- Any combination of hot and cold is reasonable:

- Hot therapies – 37-44 degrees

- Cold therapies – 7-20 degrees

-A common recommendation is 4 minutes hot and 1 minute cold X 5 (20 minutes).

- Examples

- Hot bath: Cold Shower

- Sauna: cold bath (legs only)

- Hot Tub: Ice knees (5 minutes: 5 minutes X 3)

- Hot bath: Cold Bath (advanced – start slow!)

- Hot shower: Cold water hose (outside?)

 

60 Minutes on Depression

60 minutes last week aired a segment that featured the work of Dr. Kirsch from Harvard University. His work compares the effect of placebo against that of antidepressant medications. The results if his studies and many other studies is that antidepressants are no better than placebo in the treatment of most types if depression, except for the small group of patients that have severe depression. This is not new to Canadian and British physicians who no longer recommend the use of antidepressant medications for moderate to severe depression. It was good to see this topic making news, but it's unfortunate that the message is arriving so late. What is also unfortunate is the amount of patients that I still see that have been prescribed antidepressant medications for short term and mild types of depression. Obviously we need more media messages to drive the point home, thank you 60 minutes. Ryan Oughtred Naturopathic Doctor Vancouver, BC

Dr Oughtred's Adjunctive Exercise for Mike Janyk

httpvh://www.youtube.com/watch?v=E5MoSCrm-lI&feature=player_embedded Take a look at this clip which highlights some of the exercises that Mike did during his recent visit with Dr Oughtred, in Vancouver, BC.

Dr Oughtred offers Biophysical 250

In the December 2007 issue of Scientific American, Body, there was an article titled, "The Ultimate Blood Test".  The article was a review of a new blood test called the Biophysical 250, the most comprehensive blood test available to date.  I was intrigued, and eventually I decided to call Biophysical Corp to learn more about the test.  After a few conversations, I was convinced that this was a test that I would be comfortable offering to my patients. It's called the Biophysical 250, because it measures 250 things in your blood, all at once.  For those afraid of having blood drawn, you can rest assured that the test requires only 2 tablespoons of blood.  The test covers blood markers for cancer, heart disease, autoimmune disease, infectious disease, nutritional status, hormonal status, inflammation, blood diseases, osteoarthitis, and organ dysfunction.  Biophysical Corp does not advocate testing anything that there is no treatment for, so they don't test markers for alzheimers for instance.  Biophysical reports that in a trial of 120 clients who received the Biophysical, 27 clients had a moderate health risk, and another 15 had a major health risk.  The Biophysical 250 can help discover problems before they become problems, and there are many markers that wouldn't normally be tested for until the disease was already apparent.   Some examples are:

  • H-pylori (a bacteria associated with stomach ulcers)
  • Autoimmune markers (For lupus, scleroderma, or rheumatoid arthritis)
  • Insulin (high insulin levels are thought to precede type 2 diabetes)
  • Cancer markers (Breast, Prostate, Colon, Pancreas, Liver, Testicular)
  • Ferritin (high ferretin can be assymptomatic, and represents high iron stores, which can be harmful to the body over time)
  • Thyroid Markers (thyroid disease is common, and can go a long time before being diagnosed)
  • Hepatitis markers

The trouble with waiting until you get a disease, is that you stand the risk of not being able to reverse the disease process once it is diagnosed.  Cancer and autoimmune diseases are classic examples of diseases that have much better outcomes if treated earlier.

The Biophysical 250 does not replace a comprehensive annual health screen with your physician, but for those who can afford it, it can be a great, low risk adjuct to a comprehensive medical assessement for the patient that wants to know more about their existing state of health.

To learn more about the test, visit: http://www.biophysicalcorp.com/ .  The company has also come up with an abreviated version of the test that is priced more competitively, and still screens for several of the same markers.

Breakfast Restaurant Recommendations for Weight Loss

Because meats and vegetables are not normally consumed at breakfasts, it can be difficult to stick to your diet at breakfast.

• Foods to avoid at breakfast:

• Breads

• Hash browns and other Potatoes

• Cereals (especially ones with sugars added)

• Muffins & Croissants

• Jams & Butter

• Yoghurt (especially ones with sugar added)

• Milk & Fruit Juices

The following are examples of typical breakfast foods that are allowable

Omelettes

• Ask for greens or sliced tomatoes instead of potatoes or toast

• Add vegetables: Onions, zucchini, and other green veggies are best

• Hold the cheese, or use cheese sparingly

• Egg white omelettes are not necessary, but they are certainly lower calorie choices

• Frittata

• Eggs and Style

• Cottage Cheese

• Natural, unsweetened soy milk

• Tofu

• Sliced Tomato or mixed greens can be an easy side to your eggs

• Nuts and seeds (whole or spread versions)

• No sweetened peanut butter

If you have no other alternatives:

• Unsweetened oatmeal

• You can flavour with nuts, seeds or spices

• If you need milk, then try natural soy milk or non-fat natural yoghurt

• Apples, pears, or grapefruits are okay

• Protein smoothies are okay, but most restaurant made smoothies are too sweet

An Integrative Approach to Chronic Pain: Headaches

During my 7 years of competition with the Canadian alpine ski team, I experienced several injuries, the most frustrating of which were the insidious injuries that seemed to appear out of nowhere. These injuries could last for months to years, and usually required multiple treatments to heal. Because one treatment alone was rarely effective, I began to think that there was more than one cause for these problems. It was for this reason that I decided to become an integrated health care professional, utilizing expertise from several different areas to help people experience better health.

Many chronic problems have more than one cause: type 2 diabetes, heart disease, autoimmune disease, asthma, headaches, overuse injuries, back and neck pain, irritable bowel, PMS, and psoriasis, are all examples of problems that have more than one cause or contributing factor. Common sense dictates that the assessment and treatment of such problems should be multifactoral. For example, an integrative assessment of the patient with chronic headaches would consider the following factors:

• Inactivity or obesity

• Overweight individuals that don't exercise experience more health problems, including headaches

• Blood pressure

• High blood pressure or sudden changes in blood pressure can increase your likelihood of head pain

• Hormonal imbalance

• Migraines occur more in women, and they will often notice their pain fluctuates with menses

• Blood sugar imbalance

• Fluctuations in blood sugar can lead to the vascular constriction or dilation that is often associated with headaches

• Stress and cognitive influences

• Those who experience anxiety or depression, experience more headaches

• Neck problems

• The upper two vertebrae in your neck can cause an increase in head pain when they are dysfunctional

• TMJ problems or dental problems

• Food sensitivities

• Environmental sensitivities

• Poor posture and work position

• Poor vision or eye problems

• Infection or cancer

• Drug interactions

• Inflammatory disease

• Past trauma/ accidents

A multifactoral assessment allows the health provider to look at your health from a ‘bird's eye view', and focus treatments on the areas of your health that might contribute to your pain. Treatments could include physical therapies, supplements, therapeutic exercise, specific herbs, a special diet, or cognitive behaviour therapies. However, without an integrated assessment of your health, your treatment may be one sided, and may fail to address weaknesses in your complete health picture. It is for this reason that I recommend an integrated approach for your chronic problems, the prevention of disease, and for the pursuit of your optimum health status.

Ryan Oughtred

5 Ways to Prevent Low Back Problems in the Alpine Skier

Injury to the lower back is one of the more common injuries incurred by the alpine skier. Waiting for back problems to happen before doing anything about them is probably a bad idea; the discs and bones of the spine generally only have nerves on their outermost portions, which means that damage to the inner portions of the vertebrae and discs can occur without experiencing any pain at all. The spine can degenerate ‘from the inside out' for many years without any warning signals, and by the time an athlete is 26 years old-in the peak of a career-the spine can have significant amounts of permanent wear-and-tear. Here are the 5 most important preventive measures I think athletes and support staff can take to prevent back problems:

Build progressions in training schedules:

1. The risky forces for the spine are flexion, rotation, compression, and sheer; all of which are involved in skiing. Because avoidance of these risky forces is not possible, the athlete must be exposed to them gradually over time. Both on-snow and dry-land training should gradually involve progressions in both volume and intensity of activities that involve bending forward, twisting, weight lifting, and eccentric loading.

2. The adolescent spine may be especially vulnerable because the growth plates of the vertebrae are softer than in an adult, making them more prone to injury from compression and sheer forces.

Sit less, and never lift heavy after sitting:

1. Any time the spine is flexed forward for a period of time, such as with sitting, a phenomenon called ‘creep' occurs in the tissues. The tissues are melded toward a shape that is different than normal. Heavy lifting or other compressive activity (such as ski racing) should be avoided immediately following a prolonged period of sitting or forward bending.

2. To combat the effects of creep from sitting on planes, in cars, or on chairlifts, athletes can perform extension exercises like McKenzie press-ups or other extension movements any time they have been prolonged to excess flexion.

3. When traveling - I would never allow athletes to lift heavy bags immediately after riding in a van or on a plane for hours. Stand up, walk around, and maybe bend the spine back a couple of times before lifting anything heavy.

4. When riding the chair lift - athletes should take time after every chair lift ride to stand up, bend back a little, and warm up before diving into another race run. While riding the chair, a relaxed upright posture is probably best.

Compress and twist the spine judiciously:

1. Twisting while you lift heavy weight doubles the load through the back. Athletes should be taught to never twist while they are lifting, unless it is an exercise specifically designed to prepare them for skiing.

2. Discourage athletes from packing heavy bags, and encourage them to share the work of lifting with other people.

Keep your spine neutral and stable:

We know that stability of the spine will prevent injury, but applying that to practice is not a simple task.

1. Maintain a neutral spine as much as possible when training, especially when lifting heavy weights or twisting.

2. Focus on endurance of the spinal related muscles, not just strength.

3. Integrate components of instability, unpredictability and precision into dry land training.

4. Full body exercises are probably better than isolated muscular activities. Even if the athlete feels like the exercise is too easy, it is still doing something for them.

5. Make sure athletes can breathe evenly throughout entire exercises.

6. Encouraging the athlete to lightly draw in their tummy, or ‘feel like they are stopping a pee' while working out, might add to their spinal stability. Train everything. All the muscles of the core probably contribute to injury prevention in some way, as does the lower body and upper body. Search for balance, find weaknesses and eliminate them.

Proper biomechanics-the earlier better:

1. Taking the time to consult with someone who understands normal spinal mechanics and how to assess it could be a valuable investment.

2. If one area of the spine is not moving well, other spinal regions may be forced to work too hard, or in an unbalanced fashion. Detecting these kinds of imbalances early in a career may prevent future injury or even enhance athletic performance.

The field of low back problems is a difficult area. I have done my best to consider some of the evidence so far, and apply it to the ski racing athlete. I hope it was helpful!

Ryan Oughtred

More to read:

• Panjabi MM. The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement. J Spinal Disord 1992; 5(4):383-9

• Richardson CA, Jull GA, Hodges PW, Hides JA. Therapeutic exercise for spinal segmental stabilization in LBP: scientific basis and clinical approach, Edinburgh: Churchill Livingstone; 1999

• McGill S. Low back disorders: evidence based prevention and rehabilitation, Champaign, IL: Human Kinetics Publishers, Inc.; 2002

• N. Bogduk, B. McGuirk. Medical Management of Acute and Chronic Low Back Pain. An Evidence Based Approach. Elsevier Science. 2002