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27 Jan 2016
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All Proteins Are Not Created Equal

All Proteins Are Not Created Equal

January 27, 2016 | 0 Comments | , , , , , , , , , , , , , , , , ,

Yes, it’s true.  All proteins are not created equal. But before we can go further, we need to understand that our diet consists of macronutrients and micronutrients.  Proteins, carbohydrates, and fats are our macronutrients and micronutrients are what we ingest in smaller quantities, like our vitamins and minerals.

When we eat food, it does not declare itself as simply a carbohydrate, protein, or fat.  Most foods have a variety of macronutrient components and our bodies do an amazing job at breaking down each ingredient into particles that can then be utilized.  This is why eating high quality food without lots of chemicals is preferred.  Our body has enough to do without the need of bombarding it with toxins and unnecessary compounds.

There are basic components that make up proteins. They are called amino acids and there are 20 of them. Of these, 9 are considered ‘essential‘, because we cannot create them from other foods we eat. This means you have to consume them in the protein sources you are eating.  By definition, a complete protein is one that contains at minimum, all 9 of the essential amino acids. There are also 3 amino acids  in the essential amino acid family that are called Branch Chain Amino Acids (BCAAs).  These 3, leucine, isoleucine, and valine, are important for muscle function and many medical treatments.  In the fitness community, we want to ingest a lot of foods that contain BCAAs.  Luckily, most animal proteins contain BCAAs and all the other essential amino acids. Vegetarians and vegans can acquire BCAAs and essential amino acids, but many times this involves food combining, and food combining is not the most efficient way to achieve the objective. Continue Reading →

04 Jan 2016
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Sarcopenia is a Killer and You Should Know About It

Sarcopenia is a Killer and You Should Know About It

January 4, 2016 | 0 Comments | , , , , , , , , , , , , ,

Sarcopenia is a condition that we are ALL at risk of getting and it’s really quite scary.  It is defined as a process of reduction in skeletal muscle mass and muscular function that begins after the third decade of life (yeah, by age 40) and progresses as we age.  If we look at the body as having hundreds of thousands of different proteins/enzymes, and each muscle is made up of primarily protein, this problem begins to look really bad.  It’s one thing to have loss of skeletal muscle and be able to see yourself getting softer and weaker as you age, it’s another to not be able to see the decay in our heart and other organs.  Think about it…you are not just losing muscle mass and health on the outside, it’s occurring on the inside as well.   The problem is that this will not be identified usually until you have a significant health problem…and who wants that?  Sarcopenia is a condition of malnutrition yet almost nobody in the US does anything about it until it causes serious health issues.

Healthcare costs in the year 2000 were 18.5 billion dollars for the treatment of Sarcopenia and its related disease processes and that number is far greater now (this amount constituted 1.5% of the total health care cost of the nation in 2000).  Sarcopenia is well studied in the literature and all physicians should be discussing this topic with their adult patients (before they become geriatric patients). Sarcopenia has a direct link to COPD (Chronic Obstructive Pulmonary Disease), contributes to osteoporosis and related fractures, increases hip fracture risk, contributes to mental disorders, increases the risk of postoperative complications, and more.

One of the bigger concerns with Sarcopenia is that it has a link to mitochondrial damage.  This is a big deal as mitochondrial damage is linked to almost all disease processes in the human body. So, listen up…if you are near 40, at 40, or over 40, you need to pay attention if you want to be healthy and maximize your life!  This is nothing to laugh about.  As a society, we are getting softer and weaker as we age and yes, we can do something about it.

For those out there who still think we get enough protein, the easy way to prove this point wrong is by looking at our population as a whole and recognizing that Sarcopenia affects a large amount of our adult population.  Simply put, we are wasting away…yikes!  We have to concede that very little is being done to address this serious problem. The great thing is that with some basic lifestyle improvements, we can get healthier…yes, it’s that simple!

We have to keep in mind that the out of date notion that ‘don’t eat too much protein as it leads to positive nitrogen balance or kidney damage’ is simply that: out of date.  This blog falls on the heels of my last blog that discussed what caloric restricted resistance training athletes need for protein needs.  To many, this amount of protein would seem high, but the research, for some time, has been showing that we are not consuming enough high quality protein.  It’s time for healthcare professionals to update their knowledge on protein and make proper recommendations.  More protein isn’t needed just for those who are lean and active, it’s needed for everyone!

Treatment for sarcopenia involves being active/exercising and eating more protein to offset the age-related loss.  A 2015 double blind randomized study in the American Journal of Clinical Nutrition determined that a Vitamin D and leucine enriched whey (protein) ‘nutritional supplement’ improved muscle mass and lowered the risk of Sarcopenia.  Another study from 2015, this one a review study, suggests at least 25-30gm of ‘high quality’ protein at each meal to prevent Sarcopenia.  Beasley et. al authored a great study in 2013 in Nutrition in Clinical Practice that discussed how whey protein works better than other proteins at muscle protein synthesis (MPS) and his study makes recommendations to consider protein supplementation for those who are Sarcopenic and are not getting in enough protein (this basically means all of them).   

In the next few blogs, I’ll be writing about the best ways to extend your life/reduce diseases as per the literature.  In regards to Sarcopenia, we need to get in more high quality protein.  So this begs the question: what is the best protein to ingest, how do I compare protein sources,  and where do I get the best stuff?  To whet your appetite, I’ll mention that the literature shows that whey is the best protein.  As to where to get it, ask me now or wait until I write about it.

More on its way…stay tuned!

 

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15 Dec 2015
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‘Leaner and Meaner’: How Much Protein Do You Need?

‘Leaner and Meaner’: How Much Protein Do You Need?

December 15, 2015 | 2 Comments | , , , , , , , , , , , , , , , , , , , , ,

There has always been a debate about how much protein an athlete needs.  ‘You need one gram per kilogram of weight’ or you need ‘one gram per pound of weight’ and some other somewhat random numbers are usually used to determine how much protein resistance training athletes need.  As a healthcare provider who works with athletes, I need to make sure my athletes have enough protein to ensure healthy soft tissue function and reduce the likelihood of injury. Without proper protein consumption, an athlete will not achieve his/her fitness goals, and if there’s an injury, the athlete will certainly need extra protein during the recovery phase to get better.  I won’t discuss the subject of sarcopenia in this blog but this topic too is a major crisis in our country.  So, how do we know where to really start?

A literature review study from 2014 in the International Journal of Sports Nutrition and Exercise Metabolism gives us a good formula for determining the range of protein needed for caloric restricted, resistance trained athletes. Before we go any further, we should define who these athletes are…. they are…you and me.  If you work out, want to look good, and want a high level of lean muscle mass (highly desirable for good health), then this formula applies to you.  In fact, if you just work out and wish to have healthy muscle, this formula will help you achieve your goals.  The bottom line is that athletes tend to ingest less protein than they need and this is a major concern.  Not only that, but they also are unlikely getting the best quality protein they can. Oh, this study also mentions that total fat consumption should not go below 20% of total calorie intake.  So what are we looking at?  A sensible caloric restricted diet with adequate micronutrient ingestion and the proper ratio of macronutrients.  So, you want to be ‘lean and mean’?…here’s how to achieve it… Continue Reading →

06 Jul 2015
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Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

Dry Needling Support Models (4 of 4): Central Model and Studies That Prove the Efficacy of Dry Needling

July 6, 2015 | 0 Comments | , , , , , , , , , , , , , , , , , ,

We have covered a lot of information about Dry Needling in our last 3 blogs.  We discussed the Radiculopathy Model, the Trigger Point Model, and the Spinal Segemental Sensitization and Pentad Model.  Already, we can clearly see how Dry Needling can help to break down myofascial trigger points (MTrPs) and reduce pain.  The fourth model will discuss another reason as to why Dry Needling can help you.

Central Model

Our final model, the Central Model, covers information about how Dry Needling and other physical interventions (including manipulation, massage, mobilization, etc…)  affect the spinal cord and brain.  This is a rather basic but powerful model.  The premise is that input stimuli will affect tracks in the spinal cord that will carry that information up to the brain.  The deeper the treatment, the more information that will be conveyed.  The hypothalamus will then take the stimuli and  communicate with the pituitary gland and affect other endocrine functions.

In regards to the hypothalamus, it has three primary functions:  1.  It supplies input to the brainstem, thus affecting autonomic regulation, 2.  It controls endocrine function, and 3.  It exerts influence on posture and locomotion.

With the Central Model, MTrPs along the spine will likely cause more autonomic issues (please click to read more about autonomic issues on the Trigger Point Blog).   Dry Needling causes an anti-inflammatory response that emanates from the hypothalamic-pituitary-adrenal axis.  This is deep stuff!

If we assume that the hypothalamus is directly or indirectly adversely affected by MTrPs, then we can conclude that such MTrPs create autonomic and endocrine problems in addition to postural and movement issues (this means it affects the way you work inside and outside).  Certainly, we would want to rid our bodies of such noxious stimuli, and since Dry Needling can eliminate such MTrPs, then this makes it a great option for restoring proper function of not only the musculoskeletal system, but also the autonomic and endocrine functions that are affected by an improperly functioning musculoskeletal system.

Any way you slice it, Dry Needling can help you to function better.  From simple pain and dysfunction to autonomic concomitants, Dry Needling offers a viable option for the treatment of trigger points and pain due to musculoskeletal causes.

Let’s take a look at some studies supporting the application of Dry Needling…there are a few here but many more in print:

We will start with the grand-daddy of them all…the landmark study performed by Karl Lewit, MD published in 1979.  This study broke down the effects of trigger point injections to determine if the analgesic/steroid that was the agent that helped the patient, or was it the needle alone that contained all the magic!  Please read study, and if you would like the full study (versus just the abstract), please let us know.

The Needle Effect In The Relief of Myofascial Pain

And the other studies…

Dry Needling Having Anti-Nociceptive (anti-pain) Effects

Probable Mechanisms of Needling Therapies for Myofascial Pain Control

The Influence of Dry Needling of The Trapezius Muscle on Muscle Blood Flow and Oxygenation

Dry Needling at Myofascial Trigger Spots of Rabbit Skeletal Muscles Modulates the Biochemicals Associated with Pain, Inflammation, and Hypoxia

The Effect of Dry Needling in the Treatment of Myofascial Pain Syndrome: A Randomized, Double-Blinded Placebo-controlled Trial

Dry Needling and Exercise for Chronic Whiplash – A Randomized Controlled Trial

Management of Shoulder Injuries Using Dry Needling in Elite Volleyball Players

04 Jun 2015
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Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

June 4, 2015 | 1 Comment | , , , , , , , , , , , , , ,

In our last two blogs, we went over models that help explain how Dry Needling works.  These two were the Radiculopathy and the Trigger Point Models.  The topic of this blog will involve the third model, or the Spinal Segmental Sensitization and Pentad Model.  As we have with the last two discussions, we will try to explain any difficult terminology or ideas.

Spinal Segmental Sensitization and Pentad Model

The Spinal Segmental Sensitization (SSS) and Pentad Model was proposed by the late Andrew Fischer, M.D. (Physiatrist…pain management and rehabilitation medical doctor).  This is a good time to discuss this model as it really incorporates both of the first two models.  Dr. Fischer proposed that the SSS is a ‘hyperactive’ state of the dorsal horn of the spinal cord that is caused by damaged tissue sending nociceptive (pain) input into the spinal cord.  This information then causes the over-sensitivity of the associated spinal level dermatome (skin), pain sensitivity of the associated spinal level sclerotome (bone, ligaments, joints), and Myofascial Trigger Points (MTrPs) in the associated spinal level muscles.  All this occurs because the nerve coming from the spine is over sensitized, and by being in this pathological state, it stimulates these changes listed above.  In effect, we have a pretty vicious cycle of pain and dysfunction. Continue Reading →

14 May 2015
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Dry Needling Support Models (2 of 4): The Trigger Point Model

Dry Needling Support Models (2 of 4): The Trigger Point Model

May 14, 2015 | 2 Comments | , , , , , , , , , , , , , , , , , , ,

In the last blog, we discussed the first model (The Radiculopathy Model) that helps explain why Dry Needling works.  Now we will continue with the second of four models.   This one is probably the most well-known one and there is a plethora of medical literature supporting it.  Again, we will try to explain any concepts that are a little difficult to understand.  These models really shed light into how our bodies work and they are great to learn about.

The Trigger Point Model

Myofascial Trigger Points (MTrPs, or TrPs for Trigger Points) are defined as ‘hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’ (Travell and Simons).  The resultant pain/discomfort that one gets due to such points is referred to as myofascial pain syndrome (MPS).  Simply put, MPS is defined as ‘sensory, motor, and autonomic symptoms caused by myofascial trigger points’ (Travell and Simons).  Sensory symptoms refer to what you feel, motor symptoms refer to how the muscles work, and autonomic symptoms refer to the things that you do not realize.  This seems a little odd, but consider what happens when you bang your arm really hard.  You will feel the pain (sensory), the muscle might be painful and not contract properly (motor), and your heart rate goes up as does your respiration due to the ‘adrenaline rush’ (autonomic) of the injury. Continue Reading →

11 May 2015
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Dry Needling Support Models (1 of 4): The Radiculopathy Model

Dry Needling Support Models (1 of 4): The Radiculopathy Model

May 11, 2015 | 4 Comments | , , , ,

We get a lot of questions about Dry Needling and the next few blogs will address several theories that support the treatment.  There is currently a good amount of medical literature supporting Dry Needling and this is great, but the theories behind Dry Needling are fascinating and interesting to discuss.

The 4 models are as following:

1.  The Radiculopathy Model
2.  The Trigger Point Model
3.  The Spinal Segmental Sensitization and Pentad Model
4.  The Central Model

Each of the next 4 blogs (including this one) will discuss one of these theories as it relates to Dry Needling.  We hope this gives you a better understanding as to why Dry Needling works so well.  We are aware that the models tend to use medical terminology and can be a little hard to follow, so we will try to explain things as we go to make the explanations easier to understand. Continue Reading →

21 Apr 2015
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We Are A Sick Society, Literally!

We Are A Sick Society, Literally!

April 21, 2015 | 0 Comments | , , , , , , , , , , , , ,

When we look at what Americans spend on prescription drugs yearly, we see that we are really an unhealthy society.  In fact, last year we spent over $374 billion dollars. Spending on prescription drugs went up 13%..and that is a huge amount of money.

Besides trying to fathom this amazingly huge number of dollars spent on prescriptions, what more-so led me to write this blog was the sick feeling I got in my stomach after reading the statement by Michael Kleinrock, director of research development at IMS Health. Although there was a lot of great news on the treatment/cure of Hepatitis C, the overall dollars are very high.  On the news of the $374 billion, he was quoted as saying “This was an outstanding year, really a once-in-a-lifetime year.  It was the largest dollar growth in a single year we’ve ever measured. This is a huge amount of extra spending.”  Continue Reading →

15 Dec 2014
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Oxidative Stress and Low Back Pain

Oxidative Stress and Low Back Pain

December 15, 2014 | 2 Comments | , , , , , , , , , , , , , ,

A new study in the high impact orthopedic journal Spine discusses what we have seen for some time with patient care but have not been able to validate in the literature: oxidative stress contributes to low back pain.

This is a topic of huge importance.  As our patients know, we use a Raman Spectrometer (Biophotonic Scanner), not unlike the one Yale uses in their studies,  to determine the oxidative stress of our patients through means of a dermal carotenoid scan.  The Raman Spectrometer (RS) has been determined in many studies to offer clinicians the optimal way to analyze oxidative stress as the test is not costly to perform, is not invasive, and it makes it easy to track changes in diet/nutrition/supplementation.  This is important for all healthcare providers.  Being a sports chiropractor, I find the RS to be an absolute necessity for all of us who work in the neuromusculoskeletal fields.  Simply put, if we cannot assess oxidative stress, we have no idea if our patients are healthy and this directly affects clinical outcomes.  This is not only limited to low back pain.  We are not what we eat, but what we absorb. Working with unhealthy patients reduces the effectiveness of our treatments and we should know this before we commence treatment.  This is only fair to the patient. They need to know if they have hindered healing ability or not.

Continue Reading →

11 Nov 2014
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Hyperbaric…This Is What You Want To Breathe!

Hyperbaric…This Is What You Want To Breathe!

November 11, 2014 | 0 Comments | , , , ,

I recently wrote a letter to the Maryland Board of Chiropractic Examiners on the topic of allowing us to use mild Hyperbaric Oxygen Therapy (mHBOT)  in-office. I had been exposed to patients/doctors utilizing it with great results over the years when I worked at various sporting events and I wanted to add this amazing technology to my office to help my patients.  I am happy to say that at the June 2014 meeting, the Board determined that Hyperbaric Oxygen Therapy can be included under the scope of practice for chiropractors in the state of Maryland. I’m so excited my patients can now benefit from it and you should be excited too!

Continue Reading →

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