Where to look if your health is stuck
It’s not unusual for one’s perspective on their personal health to change at different points in his or her life. For some there is indifference, frustration, and reactivity. For others there is clarity, deep involvement, proactivity, and even identity.
Each person has their own “health documentary.” Typically it’s a blend of factors that include your health history, family’s eating habits, psychological health, environmental factors, financial pressures, value systems, and other lifestyle habits.
I want you to pause and think about how you engage with your own health and possibly your family’s health. Do you think about the future of your health? Is it your responsibility or is it a transaction to be had with a doctor at a perfunctory check up? Are you competent enough to embrace your own inner doctor barring some critical situations?
You may be familiar with the term functional medicine. Functional medicine was born out of necessity. It is a systems-based approach that looks to reverse disease by identifying the drivers and causes. This form of personalized medicine is practiced by M.D.’s, D.C’s, D.O’s, Naturopathic doctors and a host of adjunct practitioners. Allopathic or conventional healthcare accels in acute situations and provides disease management. Where it is lacking is disease prevention and health optimization. If you only treat symptoms, people want pills. Show people the root cause and they will demand a fix.
For the most part you do not catch disease. You build it through life exposure, sometimes referred to as the exposome. The exposome is a collection of environmental factors, such as stress and diet, to which an individual is exposed and which can have an effect on health.
Let’s get back to your health. Imagine that you just landed in your body. Time for an appraisal. Can you move well? How do you feel? What’s your emotional and mental state? Is it a fixer-upper or does it require just some basic maintenance?
Perhaps you want to take a closer look at your physiology and chemistry by running predictive lab work. But before you even seek out a doctor, what is in your immediate control? Your lifestyle choices! Let’s touch on a few.
I. Manage stress wisely
Stress is a ubiquitous part of life that affects us all. Stress can have a profound effect on your gut. There is ample evidence that many chronic metabolic diseases start in the gut. Exposure to prolonged stress alters brain-gut interactions, ultimately leading to the development of a broad array of psychological and GI disorders.
II. Focus on nutrition
Food is one of the most effective tools for bringing balance to your body. When we optimize our diets we see improvements in detoxification, energy and metabolic health. We are a society in a chronically fed state. Too much processed foods derail our metabolism. Eating low-carb and the occasional keto cycle can retrain your metabolism and provide a necessary reboot.
III. Intermittent fasting
Our high school biology teachers failed to mention that fasting is not only a evolutionary skill , but also the best way to activate your body’s own “house cleaning” systems. It’s referred to as autophagy and it promotes healthy cell cycles and deep cellular detoxification. When paired with a proper diet it can help balance blood sugar, prune the microbiome, and build metabolic flexibility. Metabolic flexibility means your body can use protein, fats and carbohydrates efficiently.
VI. Exercise
Physical activity has endless possibilities. Research shows that we get the best results when we mix up our routines and change how we stress our bodies.
Fasted- cardio in the morning can help support healthy blood sugar and utilize body fat for fuel. (2-3 times per week)
Post-meal activity can put circulating blood sugar to work. This is 20-40 minute walks a few times a week after lunch or dinner.
High intensity interval training (HIIT) is a great way to work your metabolic machinery and increase insulin sensitivity (2 hours per week total)
Strength training you can’t go wrong having a higher proportion of muscle to fat mass ratio. Free weights, body weight, resistance bands all work well. (3 X per week 20-30 mins)
This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment.
Behavior Change - Rocket Powered Healing
It’s time to move away from the old “ diagnose and adiós” mentality.
Providing information alone or education is not a good recipe to change a behavioral or a pattern. Changing a person’s mind with information is tough whereas changing someone’s behavior with information is a true test.
We live in a fast-paced demanding world. It’s not unusual for us to create habits and even routines that help with the decision fatigue and a constant barrage of responsibilities. Some of these habits are by design and others just a default pattern. In some ways we are in “self preservation” mode.
Let me ask you – How many minutes per year do you spend on “habit change,” or “decision making.” It’s not really something we ponder, but maybe we should. Why? I’d argue that if we don’t we are more likely to go on cruise control and allow subconscious programming to guide our current behaviors. That inner pilot light that’s helping us close the gap on our goals, assess our progress, and change our behaviors grows silent.
So what do we have to do to enhance that inner voice and position ourselves to choose better behaviors? Dan Ariely, is a psychologist that uses a rocket analogy. It’s simple yet profound. Dan’s point is that we must change our environment in a way that reduces friction to make a desired behavior more attainable. Just as a rocket is designed with aerodynamics in mind people can minimize different types of resistance. Once friction has been reduced the rocket needs as much fuel as possible. Fuel in behavioral change is the motivation/energy or incentivizing factors.
How do we apply this analogy to actually making better choices. Providing information alone or education is not a good recipe to change a behavioral or a pattern. Changing a person’s mind with information is tough whereas changing someone’s behavior with information is a true test.
Instead we need to take it a step further and reduce friction by changing our internal environment and external environment. If that's true we already have a leg up on the rocket because we have more control over our external environment. Last I checked gravity does not fluctuate therefore it's a constant variable for the rocket scientists to overcome.
However, we have control over the people we choose to be with, the food that we eat, the relationships we foster, our attitudes, the dreams we pursue, and how we respond to our circumstances. And because our behaviors are often irrational it’s imperative we attempt to harness health related irrationality.
Similar to the mind our physical body responds to friction and fuel (here fuel is food, sleep, stress, social determinants, and mental attitudes).
Let’s look at 3 conditions people struggle with and then engineer ways to reduce the friction and fuel a sustained change.
LEAKY GUT
What creates friction?
Processed foods
Industrial seed oils
Multiple courses of antibiotics
Extended use of Antacids, histamine blockers and PPI’s
Unknown food intolerances
Bacterial overgrowth
Overtraining
Lack of sleep
How to reduce friction?
Create weekly meal plans
Allocate time to create a recipe list
Limit eating out
Test your gut
Look to natural remedies
Try an elimination diet
Intermittent fasting
Utilize a prebiotics and probiotic
Fatty Liver
What creates friction?
Overeating Leaky gut
Food intolerance
Poor bile production
Poor food choice
Endotoxins from GI tract
Alcohol in excess
Nutrient deficiencies
High blood sugar Medications
Bad Oils (seeds oils)
How to reduce friction?
Portion control
Eat for gut health
Liver support
Eat protein fats and some carbs
Liver blood work
Use time-restricted eating Intermittent fasting
Check thyroid health
Blood sugar and cholesterol problems
What creates friction?
Processed food consumption
Calorie surplus and high carb diet
Excess body weight
Insulin resistance
Elevated inflammatory markers
Genetic predisposition
Lack of activity
Emotional eating
Nutrient deficiencies
How to reduce friction?
Increase insulin sensitivity
Liver support
Eat protein fats and some carbs (Nutritional balance)
Use time-restricted eating
Check blood glucose with a glucometer after food (1hr & 2hr)
Check thyroid health
Get adequate sleep
What fuels these examples of friction?
Eating out (especially fast food)
Lack basic cooking skills
Poor time management
Not enough social connection
Poor sleep hygiene
Inability to cope with stress
Inadequate amount of downtime
Fuel to minimize friction?
An unhealthy gut creates problems elsewhere in the body
Gut problems may weaken your immune tolerance (autoimmune)
Gut problems may shift hormonal balance (i.e. PCOS, Cancer)
A dysfunctional gut suppresses our detox pathways
Leaky gut may interfere with your metabolism
What fuels these example of friction?
Disconnection from food choice and disease
Hyper-palatable foods (i.e. potato chips, pizza)
Ignoring constipation
Alcohol addiction
Not enough social connection
Lack of plants and animal products
Pill for every ill mentality
Oblivious to your lipid levels
Fuel to minimize friction?
We tend underestimate our dietary calories
Comprised liver leads to inflammation in the joints as well as the brain
Inflammation is linked to poor liver function
Liver health is directly connected to disease risk
A dysfunctional liver impairs our detox pathways
Liver can be compromised by 90% without a warning signs
What fuels these examples of friction?
Hyper-palatable foods (i.e. potato chips, pizza)
Giving in to cravings
Disregarding weight gain
Sugary drinks
Excessive snacking
Limited information from your doctor
Relying on basic lipid panels and subpar labs from a annual physical
Fuel to minimize friction?
Diseases associated with insulin resistance includes obesity, cardiovascular disease, nonalcoholic fatty liver disease, metabolic syndrome, and polycystic ovary syndrome(PCOS)
Gradual increase of physical activity and energy expenditure
Liver can be compromised by 90% without a warning signs
A dysfunctional liver impairs our detox pathways.
Sleep is necessary appropriate metabolic function
You may have noticed some of the overlap and redundancies, but that’s because there is an interplay going on in all these conditions. What’s going on in the gut directly affects the liver and both organs affect the cardiovascular system all the way down to each individual cell.
Leaky gut, fatty liver and blood sugar/cholesterol problems put a tremendous burden on the healthcare system and can subtract years of good health from just about anyone. Don’t fret because lifestyle modification should be the primary focus for treating any of these conditions.
The body is interconnected, complex, but also self healing. For example the The Diabetes Prevention Program and its Outcomes Study (DPP & DPPOS) demonstrated A 7% weight loss reduced the onset of type 2 diabetes (T2DM) by 58%. The best treatment for non-alcoholic fatty liver is weight reduction and correcting leaky gut and restoring immune tolerance can be done through shifts in diet, diagnostic testing, and targeted supplement protocols.
Given the importance of patient participation in healthcare decisions you deserve sufficient time and treatment solutions that require some self-management other than guzzling down a pill. It’s time to move away from the old “ diagnose and adiós” mentality. Never underestimate the changes you can make by learning about your health and assessing your habits. This exciting shift puts you in the driver’s seat of your life.
I’ll leave you with this, we don’t always do what’s in our own best long-term interest. With that in mind what will you do differently? Can you identify areas of friction and find your source of fuel?
Soft Tissue Work and Healing
If you have spent any time in a gym or physical therapy office you have probably seen an increase in foam rollers, massage guns like the Hyperice, “The stick”, Thera Cane,
Sometimes people’s muscles hurt. Research estimates that massage therapy was a $16 billion dollar industry in 2017. If you have spent any time in a gym or physical therapy office you have probably seen an increase in foam rollers, massage guns like the Hyperice, “The stick”, Thera Cane, fascia blaster, PSO-RITE Psoas Release Tool and Personal Massager and the list goes on. Muscles hurt for a number of reasons such as joint misalignment, tension, stress, overuse, minor injuries, and nerve dysfunction.
Your body is made up of cells. Together those cells make tissues. Tissues make up organs and organs make up entire systems such as the digestive system or musculoskeletal system. Some cells are specifically programmed to help the body heal from trauma. These are known as stem cells. You have probably heard about stem cell injections as they continue gain more attention.
Trauma leads to:
1. Structural damage (disc herniation or muscle sprain/strain)
2. Inhibits normal circulation to that area
3. Triggers inflammation
Stem cells may respond to trauma and come out of an inactive state. They have the ability to move towards sites of injury and differentiate (change in order to carry out a specific function) into cells required for healing. This means they can become bone cells (osteocytes), chondrocytes (connective tissue), muscle cells (myelocytes) and fat cells (adipocytes).
So where do stem cells live? To name a few sites, they reside throughout the body in brain tissue, muscle tissue, fat tissue, and in a baby’s umbilical cord.
There are 4 main approaches to healing a musculoskeletal injury.
1. Eat nutrient dense foods and remove toxins (processed carbs and medications)
2. Adequate rest to avoid further injury followed by gradual exposure to activity aka “corrective care,” and other stress that create positive adaptations (i.e. sauna, fasting, and supplementation)
3. Correct structural misalignments with specific adjustments and rewire poor movement patterns. This will restore balance to the nervous system that plays a key role in healing through control of the neuroimmune system.
4. Help accelerate the body’s ability to heal by working on the soft tissue (muscles, ligaments, fascia)
I’m not going to expand on number 1 & 2 in this article. However, number 3 should be in a chiropractor’s wheelhouse. To correct a misalignment a specific adjustment should be used. Gross manipulation and a cookie cutter approach fall short in my opinion. Let me give you an example of a specific patient. We’ll call him Mike. Mike plays collegiate baseball. In the last few years he’s torn his quadriceps and his opposite leg’s hamstring. He has worked with the team PT, massage therapist and even a practitioner specializing in myofascial release.
Mike continues to play and his schedule is rigorous. The pain is becoming more frequent and increasing in intensity especially with throwing and hitting.
After evaluating Mike it became pretty obvious what was wrong. He presented with muscle asymmetries in his low back, significant pelvic distortion (rotated and un-level), specific areas tender to palpation, and his non-painful side was severely restricted. His painful side was picking up the slack and overworked. Had Mike decided to continue to play, rely solely on physical therapy and soft tissue treatments without specifically correcting the joint issue - my sense is that he would continue to play injured and below his potential.
Instrument assisted soft tissue mobilization (IAST).
Let’s dive a little deeper into number 4. Using the ceramic spoon is known as instrument assisted soft tissue mobilization (IAST). The instrument is run along the skin, subcutaneous tissue, fascia, muscles and ligaments. This is essentially trauma indicated by bruising (e.g. petechiae) that initiates a cellular inflammatory response.
I’d theorize that the “scraping” may be manipulating the local native stem cells populations at the site of treatment. That said, the literature does not support the theory that you are breaking up scar tissue and I agree with the evidence. This reminds me of a quote:
“If you’re not prepared to be wrong you will never come up with anything original.”
The treatment rationale varies as does the type of tool, force, and application used by the practitioner.
Despite the variations in treatment the general premise is to
decrease pain,
enhance myofascial mobility aka connective tissue
stimulate tissue resorption,
induce regeneration and repair.
New studies are being published to assess the efficacy and how stem cells work in a clinical setting both in the body and in vitro (outside a living organism)
While we don’t always have perfect information scientists have made great strides understanding how the body works.
How to Avoid Spine Pain: Lessons From a Plane Crash
Upon review the National Transportation Safety board cited the cause of the crash as “pilot error.” The crew was distracted by the landing gear light and failed to monitor critical instruments tracking their altitude.
In 1972 an airplane carrying 163 passengers crashed into the everglades. This was a scheduled flight from NYC to Miami. The flight was routine until it began its approach into Miami. Shortly after lowering its landing gear the entire crew in the cockpit became preoccupied on an indicator light.
Normally this light lit up green signaling that the nose landing gear was locked down. It turns out that tiny indicator light only appeared to be off as the bulb was burnt-out. This created a diversion and the crew failed to notice that the autopilot had been inadvertently disconnected, resulting in a loss of altitude and a deadly crash.
Upon review the National Transportation Safety board cited the cause of the crash as “pilot error.” The crew was distracted by the landing gear light and failed to monitor critical instruments tracking their altitude.
By no means am I attempting to make light of this particular story. Instead, the story provides an essential lesson. This was a situation where the big picture was eclipsed by the hyper focus on the indicator light.
Patients will ask what causes joint misalignments, muscle pain and loss of range of motion.
Sometimes there is a simple answer, but most of the time it’s hard to boil it down to one specific cause. Unlike flight 401, the underlying cause of musculoskeletal pain is due to the inverse mistake:
relying on autopilot and not responding to the distress signals.
The demands we put on the musculoskeletal system are unbelievable. From the moment we wake up we are bombarding the system with information and postural requests. We begin to create movement habits to conserve the drain on cognitive energy.
The day begins
Negotiate a safe departure from the bed, shower, cook breakfast, dress the kids, empty the dishwasher, commute to work, sit for 6- 8 hours, back in the car, stop at the gym, take out the recycling, load laundry/fold laundry. I’ll leave out the most of the minutia. Whether you’re standing cock-eyed brushing your teeth or flexing over to tidy up some toys off the floor your muscle and joints are at work. Together the joint, muscles and connective tissue function as kinetic architecture. These movement patterns exist as kinetic images in the brain and make up an individual’s “autopilot coding.”
Eventually, through thousand of iterations, we establish a fixed set of movement patterns. We don’t think much about these patterns and in many ways we rely on this internal autopilot.
Over time a constellation of signs and symptoms emerge. Some examples include:
Flexing from the torso,
Slouching while driving
Loss of trunk rotation
Lack of hip mobility and independent movement from lumbar spine
Preference towards forward head posture
Rocking your pelvis back (posterior tilt) while sitting
Rock your pelvis forward when standing
Decrease in sacral flexion and extension
Prolonged static positions where hips and shoulders are not squared up
Walking using the lower legs as the primary movers
Disengaging the core
When looking at the big picture we need take into account load and capacity. Capacity is the ability to do work and the load is the work you do. In all living organisms there is a relationship between structures. The postural problems mentioned above leave you susceptible to tissue damage. The paradox is that pain does not move in lockstep with tissue damage. By the time you are experiencing pain, (absent acute trauma such as rolling your ankle) injury has set in and your body is struggling to meet hose demands
What’s happening from a physiologic standpoint is a cycle of damage, inflammation, and compensation. Diet, sleep, gut health, weight, and immune function add complexity to the cycle of pain and healing, but we’ll save that for another post.
Overuse results from cumulative stress on the muscle, bone, tendon or bursa. This may lead to partial tears, joint instability, and promote non-anatomic joint position.
Periodically it’s beneficial to manually restore awareness and filter out poor mechanical patterns. In an effort to keep the muscles limber and joints healthy we have to rewrite some of the automatic patterns and inadequate muscle coordination.
If left unchecked these postural distortions will become harder to reverse and escalate through every day activities. I would encourage you to cultivate better sensory awareness and connect back to deliberate bodily movement.
This can be done through training conscious movement, adopting spine care, integrating breath and movement, and exercises that activate, strengthen, and balance.
SATURATED FAT & CHOLESTEROL: THE HEART DISEASE SCAPE GOAT ( Part 3)
At the core of any diet there are two fundamental truths when it comes to eating for your health.
Number 1: Avoid processed and refined food
Number 2: Choose nutrient dense foods and incorporate healthy/traditional fats
What does PUMP mean?
Welcome Back! Continuing from part 2. Now we are going to build on the basic info and screening tools. We’ll touch on the more advanced markers to help stratify an individual’s risk for cardiovascular disease. Remember these tests are not bulletproof data points. It’s not a black and white process. A thorough history, review of systems and specific health assessment measures can provide a great blueprint.
Plates not Pills
Armed with that information patients may take the necessary dietary and lifestyle changes to improve how they feel, decrease negative symptoms and see blood markers normalize. You would be hard pressed to find doctors that would deny lifestyle modification as the primary form of intervention. It’s always a good idea to consult with your physician to discuss medication and track your overall heart health.
Useful markers/tests for determining cardiovascular risk
* Included in an Iron panel: serum iron, TIBC, UIBC iron saturation aka transferrin saturation
Two Additional tests that some physicians utilize.
Without a needle or Imaging
If you’re inclined you may want to use one of these two online calculators to give you a basic sense of your risk for heart disease.
If you are over twenty years of age and do not have heart disease or diabetes you can calculate your risk using the Framingham 10-year Risk Calculator. The inputs include: age, gender, total and HDL cholesterol, smoking status, and blood pressure. The Reynolds Risk score might be a better option. It includes family history and C-reactive protein.
If you are ready to minimize your risk, limit your medications and learn what makes up a heart-healthy action plan read on.
In the spirit of heart health
I’ve come up with a mnemonic to help you understand the right approach. PUMP
P - purposeful eating
U - understand your risk
M - measure to be sure
P – participation and lifestyle modification
Over the course of these 3 articles we’ve brushed up on the 3-legged stool of heart disease: (1) why it happens, (2) what causes it, and (3) what’s your risk. Let’s talk about the seat of the stool as it holds all of the legs together and acts as the cornerstone. In this analogy the seat can be divided into 3 parts: Diet, weight management, and exercise.
If you are overweight and want to reduce your risk of heart disease without the side effects of medication eating with purpose will help you lose the weight. Improving one’s relationship with food must be tailored to the individual.
At the core of any diet there are two fundamental truths when it comes to eating for your health.
Number 1: Avoid processed and refined food
Number 2: Choose nutrient dense foods and incorporate healthy/traditional fats
Why? Eating this way curbs inflammation, hunger, weight gain, and metabolic syndrome (recall 1/3 Americans are estimated to have MetS).
From a bird’s-eye view the majority of food should come in the form of meat, poultry, fish and shellfish, non-starchy vegetables, starchy tubers, fruit, nuts, and seeds. Sorry guys please don't try and find these items at Olive Garden or Taco bell.
If you are currently floundering on the standard American diet (SAD) this may feel a bit like an elimination diet. How many daily grams of carbs does the average American eat? Take a guess. It’s around 300 to 400 grams of carbs per day! Delicious, I know. However, the lion’s share comes from refined carbohydrates such as breads, cereals, chips, pasta and crackers. A more sensible target, utilizing whole foods, puts one at 50 - 250 grams of carbs per day. So you’re wondering — Is he suggesting that I go on a plant-based, keto, paleo, or an atkins-like diet? Can I drink milk and eat pizza and pasta?
I am suggesting some form of a modified paleo-ish diet. As for dairy it’s best to eliminate for one month and add it back in to see how it’s tolerated. Eliminating grains entirely may be a hard sell, but you won’t know how you feel or how you’re body will change if you don't give it shot. It doesn’t get much attention, but grains contain certain anti-nutrients that can cause digestive problems and other stealth health issues.
Let’s talk turkey (of the sea)
The average American eats a ratio of anywhere from 12:1 to 25:1 Omega 6 to omega 3 fatty acids. This creates a highly inflammatory state. Usher in some cold-water fish. Some studies suggest that eating 8 oz of fish / week (we’re not talking tilapia; it’s farmed and high in omega 6) would equate to 20,000 few deaths from CVD and 4,000 fewer nonfatal strokes. It’s been speculated that regular fish consumption may reduce total mortality at a higher rate then statins (statins garner 40 billion dollars a year and is a article in itself).
So if not tilapia? We want fish high in omega 3 such as salmon, mackerel, herring, sardines, anchovies, and bass, as well as shellfish like oysters and mussels. The single highest seafood source of EPA and DHA is caviar or fish eggs. I could not eat fish eggs if my life depended on, but if you like them more power to you.
If you want to hit a clinically relevant range of omega 3’s you want to eat 3.5 EPA plus DHA per week. This may reduce heart disease by as much as 25%. A good goal would be to eat between 10-16 oz of fatty fish/shellfish per week. Make up any short fall with a high quality fish oil supplement.
When it comes to other healthy fats olives, olive oil avocados, and macadamia nuts provide healthy monounsaturated fats. Remember monounsaturated fats have been shown to reduce LDL and Triglycerides, decrease oxidized LDL, lower blood pressure, decrease thrombosis, and reduce incidence of heart disease.
You might be familiar with the term antioxidants. If you recall shortages in antioxidants may contribute to an increase in oxidized LDL, which is associated with arterial plaque build up. Food companies do an excellent job with their packaging to seduce the consumer. The supplement and nutraceutical industry is vying for you to seek out their pills. While supplements may be beneficial in some situations, it’s preferable to get these nutrients we need from whole foods, Mother Nature, and not isolated synthetic sources like ascorbic acid.
There is mixed support in the medical literature on antioxidant supplementation. You may have heard that treatment with beta-carotene, vitamin A and vitamin E may increase mortality. For reasons we that have not been fully discovered whole foods appear to be more effective than supplements in meeting nutrient requirements.
Foods high in antioxidants (lower oxidative stress and inflammation) include leafy greens and berries, but there is more to the story. Red meat and organ meats are also rich in antioxidants that are not found in significant amounts in plant sources.
I don’t want to go any deeper into the nutritional weeds. Remember there is no one-size fits all approach. Ultimately, a heart healthy diet requires some attention. It starts by eliminating processed foods and switching to nutrient dense whole foods. There should be an emphasis on cold-water fatty fish and shellfish, healthy fats, antioxidants rich foods, polyphenol-rich foods, soluble fiber, nuts, fermented foods and occasional alcohol. If you decide to supplement be selective. For example, it’s better to take folate then the synthetic folic acid. Much of folic acid is never converted to folate.
Back to the stool analogy
Earlier I broke the stool seat into 3 parts, diet, weight management, and exercise. For most people combining diet and exercise will help you reclaim a healthy weight. The evidence is pretty straightforward and suggests that regular moderate exercise prevents the build up of arterial plaque, improves lipids and reduces vascular symptoms in people with heart disease. Exercise is a great way to reduce stress, and you may have heard me cite stats on the interplay of stress and risk of cardiovascular disease. I’m not proposing everyone flock to the nearest HIIT gym or LA fitness. Make small changes based on your current activity level and attempt to log 10,000 steps a day.
Questions
If you have any specific questions regarding this 3-part educational series (testing, supplementation, lowering high blood pressure, or statin drugs) please contact me at nick @spineandjointoc.com