Endurance exercise, heat tolerance, and gut health

GI disturbances are a frequent complaint in those competing in endurance and ultra-endurance competitions.  In addition to GI disturbances, many athletes must cope with heat tolerance issues as well as heat stroke.  While many researchers focus on the detrimental effects of endurance exercise on the heart, heat stroke is a much more common occurrence, especially in warmer climates(1).  While most endurance athletes probably attribute an intolerance to heat or heat stroke to other mechanisms within the body, the research to date points to immune disturbances caused by increased intestinal permeability as a casuative and/or major contributive factor.  In other words, the body's inability to cool down isn't because heat isn't being dissipated properly through sweating, it's because the immune system is being activated.  In this blog I will go over the science of what causes this and other factors that can contribute to the problem.

Heat as an inducer of heat stroke

The classic model of heat stroke was centered on the notion that once a critical core temperature is reached that is damaging to cells, the hypothalamus decreases the neural drive to muscles.  This decreases heat production and, therefore, core temperature.  So, in essence, there is a safety mechanism built within the hypothalamus that prevents core temperature from exceeding a certain point that could be detrimental to the cells of the body.  While this is true, there are a couple of issues that contradict this model.  First, people often experience heat stroke at workloads they have previously tolerated, both in terms of performance and heat stress.  Second, core temperature doesn't seem to share a relationship with the severity of symptoms experienced once heat stroke is triggered, but there is a strong relationship between symptom severity and circulating inflammatory cytokines(2).

The immune system as an inducer of heat stroke

These factors have caused researchers to propose a dual model of heat stroke that has a heat induced pathway and an immune system induced pathway.  There doesn't appear to be a specific core temperature at which heat stroke is induced between individuals or within the same individual, and many of the clinical manifestations of heat stroke are identical to those found in sepsis, a whole body inflammatory response to infection.  It is believed that endotoxemia, the leakage of lipopolysaccharide(LPS) from the gut in to the circulation due to increased intestinal permeability, drives this inflammatory process.  This has led scientists to develop an endotoxemia model of heat stroke where hyperthermia initiates heat stroke by increasing intestinal permeability, but endotoxemia drives the clinical progression.  It is believed that this model of heat stroke is the primary cause as the vast majority of people who experience heat stroke are not reaching the critical core temperature that is damaging to cells(2).

When an endurance athlete competes or performs an intense training run, blood is diverted from the gastrointestinal tract and toward the muscles to power the activity and toward the skin to dissipate heat via sweat.  In addition to these changes in circulation, the immune system is also suppressed.  This combination of physiological changes, in addition to mechanical jarring of the area, increases intestinal permeability and causes LPS to leak in to the circulation(2, 3, 4, 5).  These issues are exacerbated when runs are prolonged, in the heat, and under conditions of dehydration(3).  Since LPS drives the immune system nuts, and the immune system is suppressed, it is believed that pushing through causes LPS levels to increase further, and sepsis occurs.

The immune system and chronic endurance exercise

This may sound like a whole bunch of doom and gloom for people undertaking endurance exercise, but the body adapts.  A chronic adaptation to long term endurance training is an increase in anti-LPS antibodies(2, 4).  This means training at or above the threshold that causes LPS to leak from the GI tract in to the circulation causes the body to deal with LPS better.  However, this brings up a couple of interesting questions.  Why would a well trained, experienced runner experience heat stroke during a run of tolerable intensity?  Also, how can some trained athletes tolerate levels of heat that induce heat stroke in others?

Internal vs. external environmental conditions

Obviously external environmental conditions, especially in extremely hot environments, could be at play, but what about internal environmental conditions?  In other words, maybe it isn't the state of the environment that is causing the problem, maybe it's the physiological state of the athlete.  One potential contributing factor is obvious; training during an infection.  The trio of an existing infection, an acutely depressed immune system, and LPS leaking from the gut in to the circulation could negatively impact heat tolerance causing once manageable workloads to cause unmanageable levels of LPS.  There is data to support the evidence that immune disturbances can lead to transient heat intolerance(2).  Furthermore, many animal studies show that heat tolerance is improved and heat stroke can be averted up to a point when animals are given therapies to help deal with LPS.  Animals given therapy to bolster LPS clearance are better able to tolerate heat and do not succumb to heat stroke until temperatures exceed 43.8C, which is considered the critical temperature for cell damage(2).  In a small study, all monkeys who were given anti-LPS antibodies were able to survive at 43.5C but only 16% of control monkeys lived as the rest succumbed to heat stroke(6).  When core temperature was raised to 43.8C, all of the monkeys died but the treated monkeys lived 5 times longer than the controls.

Gut health as a contributing factor

Another avenue worth exploring is the health of the gut.  Many factors affect intestinal permeability under what would be considered resting conditions including the use of anti-inflammatory drugs, antibiotic use, and diet.  A recent study looking at the use of ibuprofen found that intestinal permeability after exercise was greater when an athlete took ibuprofen than when they did not(7).  This is important because many athletes use anti-inflammatories as a training tool to help reduce inflammation, and this study shows that there may be drawbacks to using this approach.

Antibiotic use is known to change the ecology of the gut by modulating gut bacteria.  Changes in gut bacteria can lead to alterations in intestinal permeability as many of the byproducts of bacterial fermentation are known to help maintain intestinal barrier integrity.  Elimination of a keystone species may impair an athlete's ability to maintain intestinal barrier integrity and lead to greater levels of LPS during exercise and, thus, decreased heat tolerance.  This is not to say you shouldn't take antibiotics, but you should only take them when needed and maintain a diet high in fiber when doing so because it will support the bacteria that are responsible for maintaining intestinal barrier integrity.

Diet as a preventative therapy

This brings us to diet, one of the most important "therapies" a person can use to maintain optimal intestinal barrier integrity.  A proper diet helps maintain intestinal barrier integrity by optimizing gut bacteria, providing nutrients that gut bacteria can use to uphold the intestinal barrier, and limiting the types of food that can increase intestinal permeability.  Under optimal conditions, the intestinal barrier is maintained by tight junctions, areas between cells that don't allow contents of the intestine, including LPS, in to the bloodstream.  These tight junctions can be dissolved under certain conditions, and the fermentation of soluble fiber and resistant starches by resident bacteria generate short-chain fatty acids that reseal these tight junctions.

Certain foods can increase intestinal permeability, particularly ones that contain gluten.  Gluten causes the release of zonulin, a protein that causes the tight junctions between cells of the intestine to dissolve.  All humans secrete zonulin in response to gluten, but most people reseal the tight junctions rapidly, before significant levels of LPS enter the circulation.  People with Celiac disease or a sensitivity to gluten have a delayed response which allows more LPS to enter the circulation and increase inflammation.  Researchers believe that this delayed ability to reseal the tight junctions is due to local changes in gut bacteria.

Despite the mass hysteria surrounding gluten, I don't feel that everyone should avoid gluten.  In limited quantities in an otherwise vegetable/fiber heavy diet, gluten is likely harmless for most people.  However, there is nothing nutritionally novel about gluten that makes it a necessary part of your diet, and most people are likely overeating it while undereating higher quality foods like vegetables. 

Chronic alcohol intake is another thing that can increase intestinal permeability and cause damage to the cells of the intestine both directly and as a result of bacterial fermentation(8). The concern here isn't that people are getting loaded before their runs and this impacts their ability to regulate core temperature.  The primary concern is that people who chronically ingest alcoholic beverages, particularly beer, may be changing their gut ecology over time in a way that may reduce their ability to reseal tight junctions after distance runs.

Conclusion

As research on the topic of gut health progresses, we find more and more physiological processes that gut health affects.  This blog presents compelling evidence that gut health can directly impact performance in endurance competitions through modification in heat tolerance.  If you take one thing from this blog, it should be that it is in your best interest to pay attention to the quality of your diet.  While research on gut bacteria and gut health is in it's infancy, the one common thread in all of the data is that a diverse microbiome is best for gut health, and a diverse diet is what's best for a diverse microbiome.  Including as many different fruits and vegetables as possible will help build a diverse microbiome and provide enough fiber to help maintain intestinal barrier integrity as you train throughout the year.  In addition, the use of anti-inflammatories should be used with caution and diet quality should be tightened up during an infection that requires the use of antibiotics.

Combining endurance exercise with resistance training

Over the course of the last 2 blogs, I've gone over the evidence that endurance exercise is something humans are uniquely adapted to and the science behind how we adapt to both forms of exercise.  In this blog I will go over the intricacies of combining both forms of exercise in a total fitness plan.  At the end, I'll go over why my personal program is laid out the way it is.

For the most part, combining resistance training with endurance training is fairly easy.  The first thing you need to do is determine your priorities.  Are you more interested in gaining muscle mass or are you interested in shedding some fat or participating in distance running competitions?  Making this determination will help you decide how much you should do of each and the order you should perform each in.  If you are trying to maintain strength, get stronger, or increase your muscle mass, you should place resistance training first during days you perform both. If you are trying to improve your performance in an endurance event you should perform your endurance exercise first.  From a fat loss perspective there really doesn't appear to be much of a difference, so if fat loss is your goal you should perform the one you like doing least first so you are less likely to skip it.

Keep in mind you don't have to perform both forms of exercise on the same day.  Assuming you plan on exercising Monday-Friday, you can perform each on alternating days.  If you are trying to get stronger or build muscle, you should perform resistance training on Mondays, Wednesdays, and Fridays and endurance training on Tuesdays and Thursdays.  Endurance exercise, when performed at a lower intensity, has the added benefit of promoting recovery from resistance training so this type of layout tends to work well for most.

If your goal is to become good at an endurance sport, chances are you will be performing that type of activity at least 5-6 times a week at varying levels of intensity.  This is because the adaptations that occur from endurance training are much more sensitive to taking long breaks and, therefore, require more training to attain and maintain.  In this case you will likely throw in 2 resistance training days on the days you are using lower intensity for your endurance training.

Another important concept to grasp is that adaptations to any mode of exercise are muscle specific.  In other words, endurance exercise that only uses the upper body leads to adaptations in the heart as well as the muscles of the upper body but no adaptation to the muscles of the lower body.  In the same way, resistance training of the upper body tends to only affect the muscles of the upper body unless the lower body is somehow involved in stabilizing the body moreso than it normally would by standing.  Taken further with regard to endurance training, while there will be some carryover between things like cycling and running, if you are trying to run a 10k you should stick to running and if you are trying to compete in cycling you should stick to that.

Finally, how hard you push yourself at each workout determines how much you adapt.  For the most part, if you don't push yourself further each time you train, you won't adapt further.  In other words, if you run 2 miles in 18 minutes and you never improve on that pace, don't expect to see a significant amount of adaptation over time.  It's actually a little more complex than that, and every now and again you have to throw in a lower intensity session or string of sessions to prevent overtraining, but the important part to note is that over time you should see improvements in the amount of time it takes you to complete endurance training and in the amount of weight you can lift for a given set of reps, or the amount of reps you can lift on a given amount of weight in resistance training.  Depending on how you structure your program, you may see more improvements from one form of training over the other, and you can adjust your program accordingly.

So what do I do for a program?  I do full body resistance training on Mondays, Wednesdays, and Fridays.  I do full body workouts because missing workouts is not that big of a deal and won't lead to me skipping out on body parts I don't want to do or on body parts that just happen to fall on Friday.  It also allows me to compress more work in to a given time by performing a leg exercise followed by an upper body exercise followed by a core exercise followed by a rest.  Each day I do an upper body pushing exercise, an upper body pulling exercise, a lower body hip dominant exercise, and a lower body knee dominant exercise and vary the reps of each from session to session and week to week.  I also perform core exercises to give myself a break between exercises.  After each resistance training session, I perform 15 minutes of rowing on a Concept 2 rower and keep track of how many meters I go each time.  The reason I chose rowing is because I want the beneficial effects of endurance training on the heart, but I want to maintain my leg strength and power.  Since I am not using my lower body as much during the endurance training, I'm using it just not as much as if I were running, I don't have to worry about an interference effect between distance running and resistance training of my legs.  Every now and again I will throw in some running on Tuesdays and Thursdays, I just keep the intensity of the runs low so that I am not forcing an adaptation that will conflict with my leg strength.  That's basically it, not too complex.

Author's note: My primary goals are longevity and to mitigate the trends associated with aging.  My goals are to remain lean, to maintain lean body mass, and to maintain cardiovascular function.

Complementary adaptations to resistance and endurance training

In my previous blog I introduced some of the anthropological evidence that humans are evolved for endurance running.  Many in the Paleo and Primal communities believe that most of what our ancestors did was sprint and lift heavy things and very little endurance activities were employed so they tend to avoid endurance exercise.  However, when you look at the adaptations that occur as a part of each exercise modality, there is the potential that combining the 2 is very beneficial through complementary adaptations.

Multiple systems are affected by resistance and endurance training.  While most people only think of the adaptations that occur within the musculoskeletal system, adaptations within the cardiovascular and nervous systems are also important.  Let's begin by taking a look at the adaptations to the musculoskeletal system.

As you can see, each exercise modality has differing effects on muscle cells within the body.  Each tends to improve the predominant energy system it uses, phosphagen and anaerobic systems in resistance training and the aerobic system in endurance training, by improving enzymatic activities in these systems.  This improves the capacity to use fat for endurance training while improving the capacity to use glucose in resistance training.  A couple of the adaptations found in endurance training, increased blood flow to the muscles and increased mitochondrial density, actually see a decrease in resistance training.

This is important because increased blood flow enhances oxygen delivery to the muscles and increased mitochondrial density provides more of the organelles responsible for the use of fat as energy in the cells.  Since fat requires oxygen to be burned, both are prerequisites for efficient fat burning and a decrease in either tends to hamper fat loss.  Of course, since some of these adaptations work against each other from a performance perspective, a person who is training for a sport that is heavily reliant on either modality will have to fine tune the proportion of each that they do for optimal results.

From within the cardiovascular system, many of the positive adaptations attributed to exercise come from endurance training.  One of these positive adaptations is a decrease in arterial stiffness which is one of the potential mechanisms that causes a decrease in blood pressure in people who regularly partake in endurance exercise(1).  In resistance training, studies have shown an increase in arterial stiffness which should result in an increase in blood pressure.  Interestingly enough, resistance training has also been shown to decrease blood pressure by amounts similar to endurance training, indicating that resistance training causes a decrease in blood pressure through a different mechanisms than endurance training(2).  This indicates combining the two could provide better results on blood pressure than one or the other.

Another aspect of health that improves with exercise and is worth noting is the effect of exercise on the brain.  Both resistance and endurance exercise have been shown to improve brain function, and studies have shown that these enhancements may be due to separate adaptations.  While endurance exercise tends to increase brain-derived neurotrophic factor(BDNF) and insulin-like growth factor-1(IGF-1) in the hippocampus, resistance exercise tends to increase brain levels of IGF-1 and cause increased expression of IGF-1 receptors in the hippocampus(3).  The hippocampus is a part of the brain integral to memory function and both BDNF and IGF-1 enhance it's function.  For more on how this works, the book Spark by Dr. John J. Ratey covers many of the positive adaptations of exercise on brain function.

Outside of these adaptations, the general consensus in medicine is that endurance exercise helps to maintain lung and heart function throughout life while resistance training tends to help maintain muscle mass and strength(4).  VO2max, a measure of cardiac output that increases with endurance training, has been shown to be a strong predictor of all-cause mortality.  In other words, people with a low VO2max have an increased risk of dying from any cause compared to people with a higher VO2max(5).  Muscle mass is also a strong predictor of all cause mortality; people with a higher muscle mass have a lower risk of dying from any cause than people with low muscle mass(5). 

Overall, both resistance training and endurance training have benefits that are separate from and potentially complementary to one another.  Adaptations to both, while sometimes conflicting, may prove to be either additive or synergistic when you combine both forms of exercise in your wellness program.  Studies show combining the 2 to be superior to one or the other as a therapeutic approach to both cardiovascular disease(6) and Type 2 Diabetes(7). Whether this holds true for healthy people looking to maintain their quality of life remains to be seen, but the mechanisms for at least an additive effect are there.

In my next blog we will go over how you can apply this information to your wellness program.

Paleo and Endurance Exercise: The Pendulum hath swung back

One of the more "interesting" things I find with most hardcore advocates of the Paleo or Primal diets is that they love to use the evolutionary template when it suits them and discard parts of it that don't jibe with their preconceived notions of what they believe to be optimal.  I have been guilty of this at times myself.  A couple of great examples are the use of starches in the diet and the predominantly meat-heavy diet they believe our ancestors ate.  There are a couple of great examples of hunter gatherer tribes that eat tons of starches with no ill effects, the Hadza being the most well known.  As far as meat being a huge part of the diet, this is debateable.  What is not debateable is that large fatty cuts of meat were not the norm.  Just because a hunter gatherer didn't discard the fat from a lean animal doesn't mean they ate fat ad libitum in the same vein as bulletproof coffee.  What is also not debateable is that even if they ate a more animal-based diet, they were doing so while also consuming 100-150g of plant-based fiber, something you are unlikely to get with today's vegetables without high doses of supplemental fiber.  This would be highly protective of the microbiome that our ancestors had and makes your bacon and nut butter-based diet not applicable to theirs.

Another great example of ignoring the data comes in the form of eschewing exercise in the aerobic energy pathway.  There are numerous traits that humans have evolved that set us apart from our primate ancestors and make us incredibly adept at endurance running.  You can see this anatomically in the way that we are built as well as physiologically in the way our energy systems operate.  These adaptations include adaptations to the tendons and ligaments that allow for greater forces, enhanced thermoregulation through sweating, glutes that can generate large forces and help stabilize the leg, a pelvis and spine that can absorb and stabilize against greater forces, larger joints surfaces in the lower body to improve shock absorption, and a foot well adapted to generating large forces(1).

A body that can absorb large forces like this, from a walking perspective, is unnecessary.  It's also unlikely that animals that were once our prey were being sprinted down by a much slower animal.  Since some of these adaptations predate modern humans, and weapons used at the time were not sharp enough to pierce the flesh of animals when thrown from a distance, it seems likely that endurance running may have been something that drove the evolution of modern humans.  (For a more thorough rundown of this, I recommend the book The Story of the Human Body by Dr. Dan Lieberman).  In addition, many of the adaptations to endurance exercise that we see in modern research imply that endurance running is indeed important to human health.

There are other benefits of endurance exercise that show great promise in human health, and many of these are separate and sometimes diametrically opposed to resistance/sprint training.  Quite a few of these adaptations are complementary to the adaptations of resistance exercise and affect the brain as well as the cardiovascular and immune systems.  Over the course of the next 2 blogs, I will take a look at the adaptations to both strength training and endurance exercise and how you can practically apply this information to enhance your health.

In the first blog, we will go over what the research shows us to be the beneficial adaptations from strength training and endurance exercise.  Do you eat MCTs or coconut oil for the ketones?  Are you looking to improve your ability to burn fat efficiently?  Is brain performance important to you?  Will a robust immune system improve your quality of life?  We'll take a look at how resistance and endurance training each affect these systems and why ignoring endurance exercise is a mistake.

In the second blog we will go over how we can apply this information to your exercise program.  How much?  How often?  How intense?  What kind?  All of these questions are important and we will cover them all.

Hopefully this series gives you a new appreciation for an exercise modality you have likely been ignoring while following a Paleo or Primal lifestyle.  While strength training and sprinting are both excellent forms of exercise, they do not provide you with all of the benefits you could be getting from a program that includes both of these modalities with endurance training.

Introductory Stretching Video

In my last video blog I illustrated how I foam roll at the beginning of my workouts or when I feel my muscles feel like they are getting tight.  In this second video, I go over my stretching routine that follows the foam rolling routine.  For someone who hasn't exercised in a long time, or someone who has lived a sedentary life where they haven't exercised before, this 3 part program is likely where you will start.  The purpose of the entire program is to physically prepare your body for a more active lifestyle and to prevent some of the injuries that often occur in people who have never exercised before that begin an exercise program.

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Next Thursday I will go over the activation and mobility portion of my program.

Introductory foam rolling video

In this video, I go over my introductory foam rolling program.  I also go over why one would want to foam roll and the benefits you can expect from regular foam rolling. 

Note: In this video I roll one side of my body to show you how you can determine how restricted your fascia is.  Obviously you should do the other side once you've determined done this.  Next week Thursday I will go over my stretching/activation/mobility program.  For best results, you want to foam roll and stretch at least 3x per week initially and then continue at least 2 more times per week.  I like to do it prior to workouts as a part of my warm up, but you can also just have a foam rolling/stretching program if you get exercise through methods other than lifting weights.

Why Paleo? Endurance athlete edition

Call it Paleo, call it Primal, for the most part you see many in either lifestyle poo-pooing endurance activities as unnecessary.  Personally, I don't do endurance type activities because I really don't like doing them.  Perhaps if I was better suited to doing them I would, but I am not.  I also don't recommend clients do them unless they like to do them.  More than any other criteria, your physical activity should be something you like to do, that way you do it often.  However, I feel the Paleo and Primal crowds aren't using very good logic when they say endurance exercise is unnecessary.  Is slamming in to a 300lbs lineman necessary?  Is lifting weights at an explosive pace with terrible form necessary?  For the most part, any sort of physical activity that doesn't involve you trying to attain food or procreate is unnecessary, so why try to exclude a group just because their mode of exercise isn't your cup of tea?  Let's take a look at how the benefits of a Paleo diet translate in to performance benefits for endurance athletes.

Many people are confused with what a Paleo diet is and what it can do for them.  Part of this can be blamed on the original message insinuating that if a food wasn't consumed regularly by your ancestors then it wasn't good for you and part of it can be blamed on people currently pushing Paleo that don't really know why it works.  Paleo does not mean that any food or environmental factor that has come in the last X number of years is necessarily harmful, there are many examples to the contrary.  Olive oil and broccoli are relatively new and are great for health as evidenced by the ample clinical research supporting both.

One of the biggest examples occurred millions of years ago when some of our herbivorous ancestors climbed out of the trees and began scavenging on the DHA rich carcasses left by carnivorous land animals.  Organ meats rich in DHA provided a nutrient that is vital for human brain development, and is potentially one of the primary reasons we branched away from other primates and developed a much better brain.  If this had never happened, certainly it would be seen as missing out on something that was a complete game changer for life on the planet.

However, on the flip side, many critics also create a logical fallacy.  The fallacy on the other side of the fence is that since we have been eating something for the last 30,000 or so years that it is a healthy food.  Look at the diseases killing humans today: Diabetes, heart disease, cancer, and Alzheimer's disease to name a few.  Few of these diseases affect younger people, they are called chronic diseases of aging because you get them in your 40s, 50s, and beyond.  Since these diseases don't typically affect your ability to reproduce and don't kill you before you can reproduce, you can't logically assume they are healthy unless your goal in life is to live to the age of 30, have 3 kids, and then die.

So then why should you be eating a Paleo diet?  Let's take a look at the primary reasons, the proteins in grains, legumes, and dairy.  The proteins in grains(1), legumes and dairy are immunogenic, meaning they elicit an immune response.  In a healthy person without celiac disease this doesn't mean they are necessarily toxic.  Look at hay fever.  Pollen isn't toxic, it just elicits an immune response that gives you itchy eyes, causes you to sneeze and cough, and gives a headache.  Does that mean not being able to see or constantly sneezing is something you want to do all day long?  It would certainly affect your performance.  Ironically, seasonal allergies as well as most other autoimmune diseases are linked to intestinal permeability(2) and many resolve on a Paleo diet.

However, therein lies the problem with the immune response to the proteins in grains, legumes, and dairy; the symptoms can range from headaches to gastrointestinal flares to metabolic dysfunction and can affect any system in the body.  In fact, a lot of people have no idea they have this response until they completely remove them from the diet for a couple of months because their body has become adapted to the constant firing of the immune system and the low grade inflammation accompanying it.  However, there are quantifiable things going on in your body that you may not be aware of.

When these proteins interact with the intestinal wall, they can cause intestinal permeability.  Intestinal permeability is a fancy way of saying that your gut is leaking it's contents in to your bloodstream.  By releasing a protein called zonulin, proteins found in grains, legumes, and dairy(Especially gluten) may dissolve the tight junctions between the cells that separate the contents of your digestive tract from your blood.  This process is well known in people with celiac disease, but studies on intestinal tissue taken from healthy people indicates that it may happen in everyone who consumes gluten, it just takes longer to repair in people with celiac disease(3).  In addition, zonulin is known to regulate the tight junctions in the lungs(4, ) and blood brain barrier(5).  Since zonulin from the gut enters the circulation, this means it is free to interact with the tight junctions in these areas, potentially compromising brain and lung function by increasing their permeability to toxins.

This can lead to some pretty serious performance consequences.  Obviously poor brain or lung function will have a big impact on performance in endurance sports.  An increase in airway infections will also negatively impact training.  However, one of the bigger impacts has to do with glucose utilization and insulin sensitivity.

Lipopolysaccharide(LPS) is a component of the cell membranes of bacteria found in your gut.  When it enters your bloodstream, your body sense it is under attack.  As a result, your immune system fires off and produces inflammation that signals your muscle and fat tissue to become insulin resistant.  This spares glucose for the immune system to fight off the attacker, which isn't even really there.  In addition, your immune system signals your liver to start dumping glucose in to the blood to help provide more glucose to the immune system.  This is one of the reasons fasting blood glucose is high in diabetics, even if they haven't been eating carbohydrates.

Now think about that from an endurance performance perspective.  You train hard which empties out your glycogen stores and burns some fat, but when you recover and eat some carbohydrate from grains you fire off the immune system.  This causes your immune system to consume some of the carbohydrate you take in to fight off the infection caused by what you are eating.  In addition, your muscles and fat tissue become insulin resistant so they aren't getting the energy they need to get ready for your next training session until the immune system clears the mess you created with what you chose to eat.  Maybe performance isn't affected immediately because you consume so many carbohydrates, but over time you are causing progressively more damage to your digestive tract and metabolism by consuming more grains.  Couple that with the fact that you are training hard which will compromise your immune system further.  Also, if your liver is constantly called upon to pump glucose in to your bloodstream, cortisol may increase due to gluconeogenesis.  I think all of these issues warrant some attention from the endurance sport crowd given how hard they train and how many events they participate in annually.

Before I go, let me preface what I say with a caveat.  We are all different, each and every one of us.  Some of us may be able to eat dairy, some may not.  Some of us may be able to eat a lot of grains, some of us a few, some of us none at all.  Unless there has been a 2-3 month period in your life where you've completely abstained from grains, legumes, and dairy you have no idea whether or not they are affecting your health and/or performance.  That's why you should just give it a try, replace grains with dextrose, potatoes, or other tubers.  If you or anyone in your family has Type 2 diabetes, heart disease, get frequent respiratory infections, or experience any form of autoimmunity I would strongly suggest you look in to the Paleo diet, not only from a performance perspective but also for general health as these conditions are associated with intestinal permeability.

Six habits of a good personal trainer

In my last article I discussed how the "Crossfit's Dirty Little Secret" article is actually a rebuke of the fitness industry's dirty little secret, that anyone can easily become certified to become a personal trainer or group exercise instructor.  In this article, I will discuss things to look out for to determine if a trainer is good or not.  The following habits are common for good personal trainers:

1. Their primary focus is the client
2. They are a reflection of their program
3. Their exercises are rarely machine based
4. Their sessions are comprehensive
5. They are upfront about their place in your fitness journey
6. They are constantly collecting data and adjusting workouts accordingly

Let's go over each one of these one by one.

Their primary focus is the client

This one should seem straightforward, but I see so many trainers break this rule.  I cannot tell you how many times I have seen a trainer talk on their cell phone or carry on a full conversation with someone else while training a client.  You don't need to ignore someone who says hi, but to turn away from the person who is paying you for the hour is ridiculous.  For the entirety of a training session, a good trainer will be reinforcing good technique, walking around you to make sure your form and posture are good, and gathering information that will help them determine if you are on the right track.  If they just sit on a medicine ball and count then you should reconsider.

They are a reflection of their program

I have always been a believer in the notion that a person's outward appearance isn't an accurate reflection of the knowledge they possess.  However, I feel that a person who is going to guide you toward the goal of being fit and healthy should be fit and healthy themselves.  It's not that I don't believe an unfit person can have the knowledge to get you where you want to be, they may have that knowledge.  The problem is that whether or not they understand it or not, they are an example for their client.  There is also something inherently wrong with someone telling you something is doable when they themselves cannot do it.  The final piece of this puzzle is that these people should have some health or training philosophy that should get a client from point A to point B.  It's not just about having the knowledge of how to get from point A to point B, it's about knowing how to get people to do the work.  If the trainer can't do the work themselves, they are an example of how effective that philosophy is, and the answer is "not very".

Their exercises are rarely machine based

On the surface, most people will say that this is a debatable topic.  The problem is that it's not.  I'm not saying a trainer shouldn't use machines at all, there are a few instances where a machine is necessary.  Machines dictate the path of resistance so the muscles that would normally stabilize a load get ignored.  Even if you don't buy in to this notion(You would be wrong, btw), most people sit for 95% of their day, do they really need to sit for the only 5% where they are supposed to be getting physical activity? If I may be so bold, most trainers who program an entirely machine based workout are lazy and are not worthy of your time or money.

Their sessions are comprehensive

A good training philosophy will cover the gamut of health and fitness from strength to balance to flexibility.  I require all of my clients to foam roll, stretch, strength train, do balance work, and so on because all of that stuff is necessary for good health.  In fact, I think it's so necessary that I do all of that stuff myself as well which goes back to being a reflection of your program.

They are upfront about their place in your fitness journey

A good trainer knows that most of the work in a fitness journey is outside of the gym.  This includes avoiding prolonged sitting, getting regular physical activity outside of the gym, getting a full 8 hours of quality sleep, managing stress, and formulating an eating plan that involves quality food.  This is the main course of your health and fitness plan.  Your 2-3 training sessions per week should be looked at as just a side dish unless you have imbalances and weaknesses that are compromising your ability to move properly.

They are constantly collecting data and adjusting workouts accordingly

Every training session, your trainer should be collecting information about how you are feeling, how you have been sleeping, and anything that could affect your workout.  If you have an injury or a part of you hasn't been feeling great, your workout should be adjusted to prevent an injury to the area.  In the same way, if you haven't been sleeping well or have been under a lot of stress, your session should be dialed back.  You don't want your side dish to affect your main course, but it does in so many ways.  It can affect your appetite, your sleep, your willingness to move, and even your ability to move.  A good trainer will save you from yourself by explaining why this isn't a good idea.

"Crossfit's dirty little secret": My take on the new anti-crossfit article

An article recently posted on the website Medium.com entitled, "Crossfit's dirty little secret" made the rounds on many news websites last week and created a firestorm on the internet.  Most people see it as the beginning of the end for Crossfit, but that's not how I see it.  If you haven't read the article, you can find it here.

Before I get in to the article, I must first point out that I am by no means a Crossfit apologist.  I can think of about 10 other more pertinent reasons why you shouldn't do Crossfit that are far more likely to happen than Rhabdomyolosis.  However, what this article actually points out isn't that Crossfit is bad. What it points out is that it is far too easy for any schmuck off the street to start training people and most people like lying to themselves about what it takes to be healthy.

Do you have any idea what it takes to become a Crossfit certified trainer?  It takes $1000 and 1 free weekend to attend a workshop on "programming" crossfit workouts.  That's it.  No formal education on exercise programming, no anatomy or physiology, no apprenticeship, no internship.  You probably think that is pretty shocking and outrageous that Crossfit is allowed to exist.  After all, most trainers have to do far more work to become certified, right?  Nope.

My first "certification" as a trainer was a 20 question test at a gym that any high school student who took a gym class could pass.  The first actual certification I took was online, by myself, with the materials they gave me.  I didn't use their materials and still finished it within 30 minutes and it included 50 multiple choice questions and 4 essays.  My final certification is considered one of the more prestigious certifications and qualifies me to work with athletes, the NSCA-CSCS.  It was a much more difficult test, was proctored, and required a college degree to sit for the test.  It gave me the knowledge about exercise, but it didn't make me qualified to train people.

Another problem is that the people who are looking for personal trainers have a skewed view of what they are looking for.  They are constantly bombarded on TV by trainers who are hacks.  I wouldn't let most of those trainers train my father's dog.  Anyone who would take a person who is 150lbs overweight and have them jump is as negligent as the Crossfit gym that promotes that "Go 'til you puke" mentality.  Why people venture in to fitness without researching it is beyond me, do you buy a house without researching it first?  I think part of it is that they don't respect the occupation, another one is that they are under the mistaken impression that they can continue what they are doing in every day life and just exercise 5 days a week to counteract that.  Newsflash: You can't and your trainer should tell you that.  I see clients 2-3 hours per week tops, and most of the hard work is during the other 165 hours in the week.  This isn't even taking in to consideration the fact that if you feel like crap during a workout you should stop and that's ultimately your responsibility.

The real problems addressed by the Crossfit article is that it is basically like the wild wild west out there when it comes to who you get as a personal trainer and most people are looking for something that doesn't exist.  Some personal trainers are very good and work hard to become better.  Some are terrible and really don't care about you.  Whether or not they are affiliated with a Crossfit is irrelevant.  If you don't care to put the time in outside of the gym, who's at fault?  In my state of NJ, there was a push a few years ago for required licensure of personal trainers that was voted down.  I didn't support that law because the organization that was going to do the licensing is terrible.  I fully support requiring personal trainers to get a license just as I believe massage therapists should get a license.  The problem is, what makes a good trainer?  We'll take a look at this topic in the next blog.

Six habits of a good personal trainer

5 mistakes most people make in their exercise program

Let's face it, when it comes to exercise, there are a million ways to skin a cat.  In fact, the best thing about exercise is that there are no hard rules as to what constitutes it.  You can run, you can swim, you can dance, you can ride a horse, there are literally hundreds of possibilities.  However, just because there are so many options doesn't mean that you should go about exercise haphazardly.  In fact, most people do just that and it ends up doing the exact opposite of their intent, it makes them less healthy and causes them to gain weight.  When I get a new client, the assessment doesn't begin by looking at the state they are in now, it begins by looking at what they have been doing and identifying things that may be working against them.  More often than not, a lot of the problems they are having can be fixed by changing their approach to fitness.  Below are the top five problems I see with the exercise program of new clients.

5)Their exercise time is spent in the same position as the rest of their day...On their ass

There is probably nothing worse for a humans than prolonged sitting.  Most of us spend the vast majority of our day in a seated position. Our exercise program should do the opposite, you should be on your feet as much as possible.  This is a problem that runs the gambit, too.  I know some people who spin 4 days a week as their primary mode of exercise.  I also know people who warm up for their workout for 5 minutes on a bike and then go sit on different benches for 10 minutes at a time with 15 second intervals of bench press or leg curls interspersed between their sitting time. I'm not saying the bench press is not a good exercise, I'm saying that when 95% of your time is spent sitting and 5% of your time is spent bench pressing, why would you call that sets of bench pressing and not sets of sitting.  Get up and move around, explore the space.

4)Focusing on quantity and not quality

This is a big one.  When people think of exercise, they tend to think of quantity and not quality.  This can mean a couple of things.  This can mean they are using terrible form to get a high number of reps which is a stupid thing to do.  If you need momentum to move a weight for a prescribed number of reps you need to decrease the weight so your muscles can do the job.  This can also mean they are using a partial range of motion.  If you can't move a weight through the entire range of motion, lower the weight and use the full range so you can recruit all of your muscle fibers.  Finally, this can mean that they are just training too much.  If you beat yourself up in the gym day in and day out and your technique suffers you are only asking for trouble.  This scenario typically leads to injury which leads to prolonged breaks from exercise.

3)Sticking to one activity

Most of the time, people pick one exercise modality and just stick with it and ignore the others.  Endurance athletes stick to endurance exercise, meatheads stick to meathead exercises, people who do yoga just stick with yoga, pilates people only do pilates, and the aerobics crowd sticks with aerobic exercise.  This typically leads to burn out as people get bored, and it also tend to lead to overuse injurie.  Specializing in one form of exercise will typically build up some attributes of fitness while neglecting others.  To become a better rounded person as well as a more fit and healthy person, it's important to improve all facets of your body.  This includes getting some conditioning in to work your heart, some flexibility training to maintain range of motion, some strength training to maintain bone and muscle health, some yoga and meditation to give your brain a break, and some balance and core work to help maintain good movement.  When I first meet with clients, we come up with a plan to address all of these things either directly in our workouts or over the course of the week in a combination of workouts with myself and other fitness professionals.

2)Overdoing it

Oddly enough, most of the people I assess need to dial back the number of workouts they do in a week.  Unless you are an athlete, most people only need to lift weights twice a week.  I often get clients who come in already exercising 4-5 times a week with no real rhyme or reason behind what they are doing.  We have been programmed to believe that with something like exercise, more is better.  This is not really the case.  Most people need to exercise less and move more in their everyday life.  The most common lifestyle I find coming to me frustrated for lack of results is a lifestyle that is spent sitting behind a desk for 8 hours and that exercises for 5 or more hours a week.  These people need to get up and move more throughout the day while exercising 2-3 hours a week.  There is a lot that goes on with sitting for long periods of time from a genetic expression level that cannot be reversed with any amount of exercise.  Moving more throughout your day and exercising 2x per week is more than enough for people to drastically improve their health and drop excess pounds.

1)Not balancing your stress account

Most people don't realize the benefit of balancing stress.  More importantly, if you don't balance stress you can negatively impact your health as well as your ability to lose weight.  This is ironic to me because I've heard many people talk about a mythical stress mode their body enters when they don't eat every 3 hours.  While that stress mode is a figment of people's imagination, beating yourself in to the ground 5 days a week with exercise and then getting drunk on the weekends leading to poor sleep will certainly put your body in to stress mode.  When this happens, many things can go wrong.  You will not properly digest your food so you will not absorb the nutrients you eat which will lead to increased appetite.  Your sleep will become negatively impacted which will cause your blood sugars to run high.  Your immunity will be negatively impacted because your body will always be in fight or flight mode and will become incapable of both resting and digesting.  As a result, you will not adequately recover from your overexercising and will push yourself further push your self in to stress mode until you break.

It's best to look at your exercise program like a bank account.  On the one hand you have stress debits such as strength training, conditioning, boot camps, crossfit, and aerobics classes and on the other hand you have stress credits such as yoga, meditation, tai chi, foam rolling/stretching, recovery days, and solid sleep.  If you don't balance all of your debits with credits you will be on the fast track to stress bankruptcy, and that is certainly not a good state to be in.  One of the best ways to monitor this is with heart rate variability.  Heart rate variability can tell you if you are overdoing it and need to dial it back, or if you are underdoing it and need to dial it up.  Fortunately for the technically savvy, there are many apps for that.  The best idiot proof apps are Bioforce HRV and Ithlete, but there are free apps you can tinker with that require a learning curve.

Conquering Type 2 diabetes: Exercise and Supplements

Over the last 2 blogs we have discussed how you can manipulate diet and lifestyle to help prevent or reverse Type 2 diabetes.  The reason hose two blogs came first is because that is where most of your efforts should lie.  Unfortunately, mot people first look to supplements and exercise to beat Type 2 diabetes and this is a mistake.  It is simply not possible to reverse the damage from an inappropriate diet and lifestyle with exercise and supplements no matter what your condition is, especially Type 2 diabetes.  The sooner people realize this, the sooner they can attain optimal health, wellbeing, and an ideal physique.  However, this does not mean exercise and supplements are of no value.  In fact, once you get the other two factors in line, exercise and supplements can be a good way to have a little more flexibility in your diet and help mitigate the damage you can cause if you go nuts on the weekend.  Let's take a look at the research.

Exercise for Type 2 diabetes

I have written extensively on this blog about the different muscle types and how they help ictate what a person with Type 2 diabetes should do for exercise.  Rather than hash out all of the research again, you can find the article that cite all of the references here and here.  Now, let's just get the crib notes version of all of that.

You have two major types of muscle fibers, Type I and Type II.  Type II fibers can be further broken down in to Type IIa and Type IIx fibers.  See the chart below of the characteristics of each fiber type.  Please note that IIx and IIb are used interchangeably to denote the fastest twitch muscle fibers so on this chart the IIx fibers are referred to as IIb fibers.

 .

Taken from http://general.utpb.edu/fac/eldridge_j/kine3350/chapte19n.jpg

The important thing to realize about these muscle fiber types is that the IIa and IIx fibers can more or less convert to one another depending on training status.  When a person begins exercising, over time the IIx fibers convert to IIa fibers while Type I fibers just increase their fat storing ability.  When a person stops exercising, eventually the IIa fibers convert back to IIx fibers.  This is important for Type 2 diabetes because people prone to Type 2 diabetes have a higher proportion of Type II muscle fibers.  People with Type 2 diabetes have a very high percentage of IIx fibers.  It is easy to see that the higher proportion of IIx fibers is obviously a result of not partaking in regular exercise.

As a long term adaptation to exercise, muscle fibers begin to store more energy in the form of glucose and fat.  Type I fibers use primarily fat to recharge their energy stores while the Type II fiber types tend to store more glucose, or glycogen.  Type IIx fibers store less glycogen than IIa fibers and as an adaptation to continued exercise, they begin to increase glycogen stores and convert to IIa fibers.  This has a couple of positive benefits with regard to blood glucose control.  First, by actively using the glycogen stored within the muscle, the muscle is able to take in more glucose when you eat carbohydrates and store it as glycogen.  In addition, this increases the amount of glycogen the muscle fiber can store, giving you more leeway when you decide to consume excessive carbohydrates before they begin turning to fat or accumulating in your bloodstream.

In order to get the Type IIx fibers to convert to IIa fibers, you need to activate them.  Type II fiber types are activated during high force movements such as lifting weights or performing the explosive movements common in most sports.  They are not typically activated by activities that are long and slow in duration, these activities recruit primarily Type I muscle fibers.  In addition, you want to use a full range of motion in whatever activity you are doing or you won't activate all of the muscle fibers from the muscle group you are using.  Unfortunately, most people begin jogging or biking in an attempt to help combat Type 2 diabetes.  This is a mistake because most people do not do them at an intensity sufficient to activate the Type II muscle fiber types, few people use a full range of motion when they run, and running and biking do little for the upper body.

The best bang for your buck to beat Type 2 diabetes exercise-wise is to either play a sport or strength train.  Any sport will do provided it is not an endurance event such as high mileage running or biking,  You could even do short sprints which I highly recommend provided you are doing something for your upper body as well.  My personal preference is strength training because you can do it in 30 minutes and you can get away with only doing it twice a week if you lift heavy enough weights.  You will want to work mostly compound movements such as lunges, pull ups, push ups/bench press, shoulder press, rows, and deadlifts.  Technique is important so using an experienced strength coach or personal trainer is a good idea.  In my experience, sticking to 3 sets of 12 reps for the first month to break yourself in and gradually working towards 3 sets or 4-8 reps per exercise is the best exercise option for fighting Type 2 diabetes.

Supplements for Type 2 diabetes

There are a few supplements that are beneficial for people with Type 2 diabetes.  These include:

Magnesium

Magnesium is critically important for proper blood glucose control.  Not only is it necessary for insulin secretion, it's also necessary for glucose to move from your blood in to cells once insulin has attached to the cell to let glucose in.  For a thorough discussion on magnesium, click here.  The problem with supplementing magnesium is that you want a type of magnesium that is time released so that it doesn't cause loose stool.  Magnesium oxide, the form of magnesium most typically found in supplements is poorly absorbed and normally causes loose stool.  I personally use Jigsaw Magnesium w/SRT but you can also use any brand of magnesium glycinate or citrate.

You want approximately 420mg or elemental magnesium a day as a maintenance dose.  If you are deficient in magnesium, as most people are(Especially people with Type 2 diabetes), you may need much more to become sufficient in magnesium.  You can request an RBC magnesium test from an integrative medicine doctor to determine if you have adequate magnesium levels.  In addition, if you have low stomach acid, gut dysbiosis, or leaky gut you may want to try transdermal magnesium in the form of magnesium oil or epsom salt baths as you will have problems absorbing it.  Since magnesium is water soluble, excess magnesium is simply excreted in the urine.  If you have kidney issues you should speak with your doctor before beginning magnesium supplementation.  I do not have kidney problems and have gone as high as 1500mg per day between oral (800mg) and transdermal(700mg) for a month with no issue.  However, the oil burns and you may need to dilute it with distilled water before applying.  If you have problems sleeping, this is your go to supplement.

Iodine

There is some epidemiological evidence that Type 2 diabetics take in too little iodine(1) and people with Type 2 diabetes are at an increased risk for hypothyroidism(2).  This data is certainly not a scorching endorsement for iodine in Type 2 diabetes, but in my opinion most people who don't eat sea vegetables, or ample amounts of fish are probably deficient in iodine.  In addition, high consumption of goitrogenic foods such as the cruciferous vegetables(Broccoli, spinach, cauliflower, kale) and using refined sea salt instead of iodized salt also make you more likely to be deficient in iodine.  In the body, iodine is used to make thyroid hormones which regulate metabolism in every cell.  If you are not sure if you are deficient in iodine, there is a test called the 24 hour iodine loading test which can show you whether or not you need to supplement with iodine.  For more information on supplementing with iodine, click here.

Resistant starch

Resistant starch is a hot topic in the Paleo community.  Like soluble fiber, resistant starch is fermented in to short chain fatty acids in your large intestine which are used to heal gut damage.  Studies have shown resistant starch to lower blood glucose and impove insulin sensitivity in healthy subjects (3,4,5,6) and subjects with Type 2 diabetes(7,8).  The structure of resistant starch prevents it from being digested in the small intestine, allowing it to make it to the large intestine where it can feed good bacteria that help improve blood glucose regulation(For more on how this works click here).  There are supplements that contain resistant starch such as Hi-maize corn starch, but the most readily available form of resistant starch is unmodified potato starch which contains 7.8g of resistant starch per tbsp.  You can use it as a thickener in shakes or put it in water and drink it.  Just be sure not to heat it as heating it changes the starch in to a more digestible form.  Two tbsp per day seems to be a sufficient dose, but once you improve your gut function and blood glucose control you only really need to use it as damage control when you decide to go nuts and eat crazy.  It is best to start with a lower dose and spread it out throughout the day to prevent gas.  I have a future blog post planned on resistant starch that will go in to more detail as there is a ton of research on it.

Conclusion

So there you have it.  Over the last 3 blogs we've gone over everything you need to know about diet, lifestyle, exercise, and supplements to prevent or reverse Type 2 diabetes.  For the vast majority of people with insulin resistance or full blown Type 2 diabetes, this is more than enough to fix blood glucose control and prevent the damage caused by elevated glucose levels.  If you have done sufficient damage to your pancreas you may be dependent on some level of insulin injections for life, but this protocol will allow you to minimize the amount of insulin you need to inject and live a happier, healthier life.

How to lose weight the Synergy Wellness way. Part 7-Exercise

You want to know how to lose weight and use exercise to that end, eh?  Well, I have some bad news for ya, you're barking up the wrong tree.  This may come as a surprise coming from a strength coach, but exercise is very low on the weight loss totem poll.  In fact, I'd put it well behind every other variable we've discussed up until this point.  That is not to say that there are not many health benefits to exercise, just that helping you lose weight isn't one of them, at least not directly.  My intention is not to dissuade you from exercising, everyone should perform some intense physical activity 2-4 times per week.  I'm also not using it as a cop out to not give you the proper direction for exercise, you will leave this blog knowing what you should do for exercise to help you lose weight.  Let's get started by discussing why exercise can impede your ability to lose weight.

Compensation

In 2009, Dr. Timothy Church from Louisiana State University published a research study that looked at the effects of different amounts of exercise on weight loss in postmenopausal women(1).  The women were broken up in to 4 groups.  The control group performed no exercise and were told to maintain their regular activity while the exercise groups worked out for 72, 134, and 196 min/wk.  At the end of the six month study, there was no significant difference between any of the groups in terms of weight loss.  In other words, no amount of exercise helped them to lose any more weight than if they had just maintained their regular physical activity.  In addition, there was no significant difference in fat loss between the groups.  How does this appear to happen?  The answer, is compensation.

When people change one lifestyle factor this change tends to cause a ripple effect in other factors.  One of the more obvious changes is that when people begin to burn more calories, they also tend to eat more calories.  This is why it's so difficult for people to lose weight come January 1st, they decide to substantially increase their energy expenditure while at the same time cutting their caloric intake.  This leads to a situation where they are unable to control their appetite because their brain senses increased stress and decreased resources to deal with stress.  The natural response of a brain under stress is to increase caloric intake, particularly from carbohydrates as one of the primary roles of the stress hormones, particularly cortisol, is to increase blood glucose levels.  It does this by causing the liver to make more glucose and by increasing your appetite for glucose generating substrate, aka carbohydrates.  This is why cortisol is called a glucocorticoid, it's secreted by the adrenal cortex to help mobilize glucose.  In the above study, there was no difference in self-reported food intake between groups, but this type of reporting of data has been shown to be inaccurate in the past.  Increased food intake due to exercise has been identified as an issue in other studies(2, 3) and is a typical issue for most people when they begin an exercise program.  This type of compensation can be minimized by introducing exercise stress slowly and not implementing severe lifestyle changes in a sudden, poorly thought out manner.

Compensation from exercise also comes in the form of reduced physical activity throughout the rest of the day.  Anybody who has jumped head first in to a program on January 1st can tell you that they will typically be sore the next day.  When moving around hurts, it's not too big of a stretch to think that people will do it less.  This is a way that we subconsciously compensate for exercise.  If the intensity and duration of a workout is going to negatively impact your ability to move the next day, it's definitely not going to help you lose weight. 

Many people use large amounts of soreness as an indicator of a good workout, it's not.  Pain is one of the ways your body tells you to stop doing something.  If you put your hand on a hot stove burner it is the pain that tells you to stop doing it.  In the same way, overdoing it in the gym will lead to excessive amounts of soreness the next day and this is not a desired state.  It's fine to feel a little tight, but that should be remedied fairly easily with a mild bit of stretching and/or warming up.  The same goes for energy levels.  After a good workout, you should feel energized and alert, if you feel dead and shot you overdid it.

Using exercise to lose weight

When working with clients who are just trying to lose weight, the role of exercise in their wellness program is to keep them moving well, pain-free, and insulin sensitive.  The first step in this process is to help them move properly.  The best way to do this is to utilize the joint by joint approach, which also helps them move pain free.  The joint by joint approach identifies which joints are best suited to mobility or stability, and that gives you direction in developing those qualities in the specific joints.  Below is a diagram of the qualities each joint is best suited:

Joint by joint mobility/stability requirement
Taken from http://agogeblog.files.wordpress.com/2011/11/joint-by-joint-skeleton.jpg

With every one of our clients, we begin the program with a Functional Movement Screen(FMS) that will identify areas where the quality of movement is poor because one or more joints have dysfunction.  When this happens, there may or may not be pain in a separate joint because it is compensating for the other(s).  For example, many people with knee pain actually have ankles that are immobile.  In order for the kinetic chain to move properly, joints should alternate between mobility and stability.  Looking at the diagram, the ankle should be mobile.  When it's not, the knee must become mobile to allow movement which can cause pain because the knee is supposed to be stable.  Many people will work on strengthening their knee in this situation, but since the problem is at the ankle you need to fix the ankle first.  I can't tell you how many times I've had someone come in who has had knee pain from running their whole life that fixes the problem almost immediately by adding ankle mobility work in prior to running.

The FMS is a very easy, yet powerful tool.  I remember one 18 year old client who thought she would never get rid of her back pain have it eliminated in 2 weeks just by performing a proper foam rolling/stretching/activation program that utilizes the joint by joint approach.  She initially thought it was from an injury lifting up a stage, but lifting the stage merely brought her movement dysfunction to her attention.  She had been to chiropractors and physical therapists who couldn't help her, and all she had to do was pay attention to the joint by joint approach and perform a 20-30 minute warm up 2-3 times per week.  Be on the lookout as in the near future, I will be posting a video of the dynamic warm-up I do with all athletes and clients.  This is the general warm-up we start with, if the FMS identifies an area of need we will add something on top of this to fix the issue locally and then work on restoring the movement pattern(s).

Insulin sensitivity

In terms of improving general health and helping you lose weight, exercise is best used to maintain insulin sensitivity.  We have gone over this here and here, so we won't rehash the science on this topic.  Intense physical activity a couple of times a week improves your insulin sensitivity and cleans out your glycogen stores, allowing you to consume more carbohydrate before altering insulin sensitivity.  This is particularly important if you are obese, diabetic, or prone to either condition as these people tend to carry more of the Type II muscle fiber types(IIa and IIx).  To improve insulin sensitivity it is important to activate the Type II muscle fiber types on a regular basis by generating high forces.  Since Force=Mass x Acceleration, you can either move heavy objects or perform fast movements.

I personally choose to lift heavy weights 2 times a week for upper body and hit my legs every 10 days, but you could easily play a sport, sprint, or perform a plyometric program.  My personal program is pretty simple, for upper body I push in a plane of motion and pull in a plane of motion 2 times a week.  One week I'll do 3 sets of 4 reps for each and the next week I'll do 3 sets of 8 reps for each.  One day I will push and pull vertically and the other day I'll push and pull horizontally.  I also do some core exercises in between sets to give myself a rest and prevent my posture from getting bad.  Every 10 days I'll hit my legs pretty hard with plyos, strength training, or sprints.  I keep my leg volume pretty low because I'm always doing something active on the weekends.  That's it, for someone with my goals(Maintain strength and insulin sensitivity while being healthy) that is pretty much all you need to do.  If I enter a stressful week, am not sleeping well, or haven't been getting the proper nutrition I'll dial it back.  Someone with less training experience or whose goals include physique enhancement may want more volume, but for the vast majority of people simpler is better. 

Conclusion

Most people look to exercise as their immediate concern when trying to learn how to lose weight, which is why they fail.  Time and time again I have to get clients to go after the low hanging fruit first (Diet, sleep, stress, daily physical activity).  In the grand scheme of things, you are not going to undo 160 hours of living like a slob each week with 8 hours of exercise, it's not possible.  Most people look at it from a calories in vs. calories out perspective which is the primary hang up.  Yes, calories matter.  However, you cannot accurately predict the number of calories you are burning when you solely focus on exercise.  If you subconsciously reduce your physical activity throughout the rest of the day or eat more calories because exercise makes you hungrier, this is of no benefit to you.  In addition, your metabolism slows down when you reduce the number of calories you consume, and few people take that in to consideration.  As we learn more about epigenetics, we get a greater understanding of why we fail when we try to lose weight.  There are so many variables that you need to look at to figure out energy balance that there is no point in doing it.  Live a healthy life, get regular non-exercise activity time(NEAT), get your sleep, manage your stress, and eat a Paleo diet that is mostly vegetable matter by volume.  Once you have all of that down, perform intense physical activity a couple of times per week after you attend to any movement dysfunction with corrective exercise.

Click Here for part 8

Paleo Diet not working? Part 1-Intense effort

In the 17 years that I have been working with people to help them get healthy and in shape, I have never seen quite what I see with the Paleo diet. No other diet causes so much change so rapidly. I’m not just referring to the weight loss, I am talking about health parameters, energy levels, attitude, systemic pain, and just about anything you would expect is affected by diet. While I think the Paleo diet is the cat’s meow, I think people overstate it’s effectiveness. If you take your average 300 pounder, they will get immediate, dramatic change. However, if you take your average person who only has about 30bs to drop, they may drop 10lbs of fat rapidly, and then they stall. Once they’ve stalled for more than a couple of weeks, they get desperate and feel the diet is failing them. In this respect, the Paleo diet is a victim of it’s own success.  IN this multiple part series, I will go over the important factors that people seem to ignore when following a Paleo diet.

Part 1: Intense Exercise

One thing that I’ve found, whether it is from giving online advice or working with clients, is that these people tend to have little desire to progress their training regimen. Maybe it’s because they don’t want to get bulky, which doesn’t happen unless your diet is terrible, or maybe it’s because they are plain lazy. I don’t know the answer to that but I can tell you one thing, you are not going to get an ideal physique walking and eating the Paleo diet. I’d even argue that you aren’t going to get an ideal physique jogging and doing the Paleo diet. In order to change the way your metabolism runs and lean out effectively, you need to force physiological adaptation at the level of the cell. You need a ton of mitochondria to burn fat, high glycogen storage capacity to give you a cushion when you cheat, and routine activation of muscle fibers you aren’t going to activate doing everyday activities.

When you look at people like Mark Sisson or some of the more ideal physiques in the Paleo community, you need to realize that a lot of work was put in up front to attain that physique. In my opinion the diet takes care of quite a bit, but you need to hold up your end of the bargain. This means putting in low volume high intensity physical activity 2-3 times a week. Whether that activity comes from lifting weights or playing flag football is irrelevant, so long as it is of sufficient intensity. The problem most people run in to is that they have no strength base, so getting in intense activity is difficult to do when playing football because they are slow and ineffective. It’s really difficult for a person like this to get intense activity outside of weight training because how do you increase the amount of force you generate? When you take in to consideration that you are typically losing weight and, therefore, moving less weight, you are actually producing less force. Enter weight training.

Weight training not only provides a way to produce a lot of force, it also gives you a way to measure and progress it. If I do lunges with 20lbs this week and then next week I do them with 25lbs, I am increasing the amount of force I am producing. Even if I lose weight I can account for that by choosing to lift that much more. It has been my experience that most people are going to have to, at the very least, put in some weight training up front so that when they do decide to play football, baseball, or whatever sport they choose they can generate sufficient forces. It really doesn’t require that much effort and time. My clients either do 3 45 minute full body workouts per week or 4 30 minutes sessions alternating between upper and lower body. If you were to calculate how much of that time was spent actually working it’s actually quite low. Doing sets that are 15-20 seconds long followed by 3 minutes of walking around for recovery six times doesn’t really seem that difficult to me. That’s 90 seconds of intense activity and 18 minutes of walking around per day. Seems like an awfully small price to pay for an ideal physique, what do you think?

Three concepts every Crossfit box should incorporate to improve their product.

The strength and conditioning community and Crossfit have had a relationship that could be described as confrontational at best.  On the one side you have people who have been in the industry for years arguing it's negligent at best, and dangerous at wost.  On the other side, you have the box owners serving their clients, giving them that pound your ass in to the ground workout that makes people who are driven to crossfit cream in their pants.  As someone that's been in the training field for 17 years and a former high school wrestler, I see both sides.  I love that feeling after an uber intense workout, and in my past I have pounded away doing crossfit style workouts, what do you think a wrestling practice is?  It's a 2 hour crossfit workout.

While talking with my friend and rolfer to the stars Todd Fluck, I realized that my approach with Crossfit was not constructive.  I don't look at Crossfit as competition, I look at it as a sport that has nothing to do with me.  I don't think it's appropriate as a general fitness tool, but it's a free society and the vast majority of people who go there are looking for Crossfit.  As I was playing disc golf this morning, I posed a question to myself:

What are the 3 things you would do to improve Crossfit?

It took all of 5 seconds to come up with all 3, and here they are:

Adopt the joint by joint approach

The joint by joint approach is the product of a collaboration between strength coach Michael Boyle and physical theparist Gray Cook and has been since expanded by Physical Therapist Charlie Weingroff.  The joint by joint approach, quite simply, explains how we move effectively.  It tells you so much and is what the Functional Movement Screen (FMS) is based on.  The basics of the joint by joint approach is that each joint of your body lends itself to either being more stable or more mobile.  Efficient, pain free movement requires that each component of the system functions as it should, or the entire system suffers.  Movement dysfunction starts when 1 joint functions in the wrong way.  When a joint that is supposed to be stable becomes mobile, the joint above or below it needs to switch and become stable, otherwise movement cannot occur.  This messes up the entire system and can lead to pain, poor movement, and injury.  When I work with any client, I inform them of the joint by joint approach and how it works. When you know what each component of a system is supposed to do, making sure that system functions properly is much easier.  It's also easier to get rid of lower back pain when you know what everything is supposed to do.

Program intelligently, not randomly

When I get any athlete, I find out when they need to be ready, how they need to be ready, and I work backwards.  If I have a tennis player that comes to me in August and needs to be at the top of their game in January, I already know what I'm going to do near the end of December, I then work back.  How can I get them to that point?  What other things do they have going on that I have to work around?  Does the results of their FMS allow them to do what I want or do I need to change my approach.  The random nature of Crossfit is the primary beef most knowledgeable strength coaches have with it.  If I had a box, I would identify the populations I am working with and have 2 tracks.   You have a group of people looking to compete, and those that are just doing it for fun.  Ok, the competitors are easy because you know when they have to be ready.  What needs to get accomplished each week, and how can I lay out WODs pragmatically so that I hit everything that needs to get hit while limiting overuse injuries and burnout?  How often am I going to hit specific tissues and how am I going to give each tissue a break?  What recovery modalities am I going to have them do?  Then you can get in to individualizing the person's program based on their life and career.

For the people doing it for fun, it's even easier.  You can lay out WODs for these people that won't lead to overuse injuries because you're not preparing them for anything.  You could lay out an entire league or season at your box easily.  Even though it's not random, that's not the point.  What makes Crossfit difficult is you don't know what you're preparing for, not that it's random.  If you lay it out how you want in an intelligent way and it's a surprise to your customers, what's the difference?

Stress-Learn it and manage it

Most of us know of the concept that is stress, but few actually understand it.  Understanding stress is critically important for anyone in the fitness industry.  Few things can have as dramatic an effect on our health as stress.  When used properly, stress can allow you to accomplish so much.  When used improperly, it can destroy your performance and make you miserable and sick.  With all of the tools we have available and everything we know about stress, there is no reason not to be measuring it in some way if you train people.  You can measure it objectively with an HRV app, or just use a subjective questionnaire.  Understanding and managing stress has allowed me to get my athletes to peak when they need to, but also allowed me to develop every day people who would probably have quit training had I not.  Looking back I know I have lost clients because I didn't understand stress in my past, I'm glad I do now.  If I were to give someone a place to start, Why Zebras don't get Ulcers by Dr. Robert Sapolsky is the book I'd begin with.  You won't get tons of information you can apply immediately, but to get to a point where you can you need to understand stress on the basic level.

Conclusion

So that's it, those are the 3 things I would change about Crossfit if I were to open a box.  As I look at all 3, they are not problems that are solely Crossfit problems.  Most shitty trainers are guilty of all 3.  I think the reason my stance on Crossfit comes off as negative is because I have no problem telling people my feelings on fitness related things.  If someone asks me if so and so is a good trainer and they're not, I have no problem telling that person that so and so is an asshole.  I know one day I will come across a Crossfit that has their shit together.  When I do I will have absolutely no problem directing people to them.  I actually hope I get to that point, it's not a space in the fitness industry I am interested in and I like being able to refer people to a quality product.    If you're in need of good bodywork in the South Jersey area, schedule an appointment with Todd Fluck.  :)

Stop the Insanity: What’s the deal with Crossfit, P90x and Insanity?

I don’t think I go a week without someone asking me about Crossfit, P90x, or Insanity. My response most of the time is that if it’s something you want to do, do it. Personally, I think all 3 of them are insanity and wouldn’t recommend them to your casual fitness enthusiast or weight loss client, and people often want to know why I think that. Listed below are my primary reasons.

1. For the vast majority of people, they are overkill. You can get the same or better results doing less than half as much total work. Dealing with the general population as much as I do, I can tell you the number of people who have asked me what is the most amount of work they need to do to lose fat is zero. Most, if not all, want to know the quickest, easiest way to lose fat. These 3 methods are none of the above. They require a ton of work and the results you get really aren’t any better than what I’ve seen with my clients who train 3-4 times a week for 30 minutes at a time with tons of rest between sets.

2. Pushing your stress response to the level these people do day in and day out almost always leads to more injuries or illnesses. The last thing someone who is trying to lose weight needs is a reason to quit and both of these reasons are probably the greatest contributors to quitting a fat loss plan.

3. Most people who need to lose fat are coming from sedentary lifestyles. While over time you can certainly prepare them for these types of activities, it would take at least a year just to correct movement dysfunction and learn proper exercise technique, let alone improve their stress response to the point this activity leads to positive adaptation.  If you get sore in very specific areas chronically this is almost always due to either over-stressing that tissue or a movement dysfunction.

4. People who are more prone to obesity and Type 2 Diabetes tend to have higher percentages of Type II muscle fibers. These fibers fatigue more easily than Type I fibers and take longer to recover. In order to activate these fibers they cannot be in a fatigued state, they need full recovery. If organized properly you can do higher intensity exercise in a compressed time window while getting full recovery. None of these modalities do that.

5. I agree that intensity is key, but what these programs do isn’t intense by definition. While they are physically draining, intensity is defined by percentage of max force output. If I sprint as fast as I can for 30 seconds, get full recovery, and then sprint as fast as I can for 2 minutes, the second sprint will be more exhausting but the first will be more intense because it will be at a greater speed which requires more force. Also, if I sprint for 30 seconds, get partial recovery, and then try to sprint for 30 seconds again, the second sprint will not be as intense as the first because I will not be able to produce as much force. This is the primary drawback of these types of exercise; partial recovery means partial muscle recruitment. We want total muscle recruitment, not partial.

6. If you have problems regulating your appetite with no exercise, you are going to have a hell of a time regulating it by doing all of this work.

7. Muscle confusion does not exist.  Don't get me wrong, I'm not about to compare sports science to heart surgery, but I don't intend on going to a heart surgeon who calls my heart the "Blood pumpy thing".  I expect the people I pay to provide a service to know what they are doing and talking about.  A muscle cannot be confused any more than a hammer can.  Muscles are tools your brain uses to accomplish a task, they don't get confused.  If they get used and haven't been used in a while they get sore via inflammation and waste products they are not capable of disposing of.  This can both be a positive adaptation or a negative one depending on the magnitude of the soreness.


Don't get me wrong, if your goal is to become a Crossfit athlete you obviously need to join a Crossfit gym.  Of the 3, Crossfit is obviously superior because you are getting instruction.  I've noticed quite a push in the Crossfit community to develop bridge programs so that sedentary people who want to do crossfit can work their way up to doing it safely.  This is a very good move and is causing me to soften on it, I would endorse a gym that does it properly.  If you are interested in doing a crossfit program I highly recommend going to one that uses a Functional Movement Screen to drive corrective exercise and has a good bridge program.  Realize that most programs that do this are going to be more expensive than ones that don't, but you get what you pay for.  It is well worth it to take care of any movement dysfunction up front rather than deal with it after you have learned the movements and need to re-learn them after fixing the problem.  As for the other 2 programs...fix your diet, go for walks, and foam roll and strength train 2-3 times per week for 45 minutes at a time.  The rest is just overkill.