Health Quote of the Week

I am starting a new segment on my blog. I do a ton of reading and find myself not writing as much as I feel I should. From now on, when I read something good, either an article, or a quote, or even a book, I am going to do a write up for everyone to read.

Look for my new segment. 'Health quote of the week.'

Steve Tobak, a writer for FOX Business, in an article about reasons not to buy a new 'smart' watch had a priceless and paradigm breaking quote.

When talking about how the new 'smart' watches can be used as health trackers he states...

"Really? I’m a runner. I own a pair of sneakers, shorts, and socks. I don’t need to know how far I run or how many calories I burn. I know I’m fit because my clothes fit. Funny how the more fitness stuff we buy the fatter we become. If everyone would quit trying to be so smart and just go out and do something, there’d be no obesity epidemic."

Why can't we all be as smart as Steve? For what I know I don't think Steve has a medical degree. I don't believe he is a weight loss expert. He is a business writer. From a business stand point he says away with all this fancy crap to help you be healthy. Get out and move. These are words of pure wisdom.

I have patient's that do not want to know their weight, or have had past eating issues in which the number becomes problematic. This is the same advice, or what I refer to, measurement, I instruct them to use. Put your favorite, best fitting "butt" jeans on. See how they fit. Are they too tight? Let those jeans be your measure. When they fit perfectly you know you are where you want to be.

Jeans don't change. People change. Weight is not something that creeps up with age. It is a constant once you reach adulthood. Let's get to ideal and make it the constant!!!

Thank you Steve for your words of wisdom. It is refreshing to read this kind of common sense.

-Dr K

http://www.foxbusiness.com/technology/2013/09/09/10-reasons-not-to-buy-smartwatch/?intcmp=sem_outloud

Shoulder Health and Crossfit

I recently started working out at a Crossfit gym. I have always loved Olympic and multi-joint lifts as a way to work out, so logically moving into Crossfit was the next step. Crossfit offers some of the best and most exhausting workouts I have ever had. The class atmosphere in addition to the intense training is great and unlike any other fitness "class" you can take at a chain gym. One week into doing crossfit I noticed the lack of posterior deltoid work and proper rotator cuff/external rotation exercises. It dawned on me, after seeing a couple of [Crossfit] patients with shoulder issues (AC joint issues related to rear deltoid/anterior deltoid imbalance) that this could be an issue with Crossfit. At the same time a very easy and adaptable fix.

Presses, pull-ups, push-ups, snatch, and all the variations of pushing weight above the head all strengthen the flexors. As in, the pecoralis muscles (specifically the clavicular division), the anterior deltoid, along with the legs, core, and back as stabilizers. Don't get me wrong, Crossfit works the back muscles extensively, but one thing to note;  pull-ups, butterfly pull-ups, and any other variation primarily work the latissimus dorsi group. The latissimus dorsi muscle is an internal rotator of the shoulder. Therefore, external rotation is excluded.

In this article I will be covering the top 4 musculoskeletal injuries to the shoulder that I see in my clinic. I will also cover and talk about ways to strengthen the shoulders and rotator cuff muscles in order to take you to the next level at Crossfit, or any other workout you are doing.

Top 4 Causes of Shoulder Problems (seen in my office)

1. The Neck: If the neck is out of alignment this can have a devastating effect on the shoulder. If you look up the maps of the cervical plexus (and while your there look up the brachial plexus) you will see the cervical nerve roots. It is these very nerves that innervate the arm muscles. Now the specifics aren't needed for this. What you need to know is if the neck is imbalanced, that can place pressure on the nerves. Proper nerve function is needed for muscles to activate and function properly. If the neck is off, the arm muscles can be off, and this includes any one of the many different muscles acting on the shoulder. Imbalance leads to dysfunction and pain. This is the primary starting point. Any of the following injuries can stem from the neck so ALWAYS CHECK THE NECK.

2. AC Joint (M/C Crossfit imbalance): Before we get into the actual AC joint we need to look at the deltoid. The deltoid is the muscle that covers the whole shoulder. It is also notoriously weak in people. The unique thing about the deltoid is it antagonizes itself. That means when the anterior deltoid is firing the posterior deltoid is not and vice versa. Another example of muscles that antagonize each other are the biceps and triceps. When you flex your bicep you can't flex your triceps. It is turned off. Now the deltoid is unique in that it does this with itself. When using Applied Kinesiolgy (neurologic testing) I find that when a muscle is spasmed or chronically tightened (muscle fibers shortened) it can inhibit the muscle opposing/antagonizing it. The 2 most common are the anterior deltoid being over tight and shutting off the rear deltoid, and the psoas muscle being over tight and shutting off the glut max. (Interestingly both are ball and socket joints.)

What does this have to do with the AC joint? Everything! The rear deltoid muscle stabilizes the AC joint. So think about it. The anterior deltoid is chronically tight, there is a strength imbalance in the deltoid due to presses and internal shoulder rotation exercises. The rear deltoid is weak and inhibited. Where does that stress from the imbalances go? The AC joint. If this problem persists for too long the stress can become too great and a diagnosable AC injury or separation occurs.

3. Biceps Tendon Injuries: This is a fairly complex condition, often called biceps tendonitis among other things by medical doctors, that can affect a number of different joints from the neck to the wrist and can be hard to find if you don't see someone who uses Applied Kinesiology. Applied Kinesiology is neurologic testing. It test muscles and how well the brain turns them on. If a muscle is turned off, or not firing at full potential, it leads to imbalance. Imbalance leads to pain and dysfunction and eventually serious injury. In terms of the biceps tendon, I am talking specifically about the long head biceps tendon.

Some anatomy about this injury you need to know to fully understand the injury includes the bicipital groove of the humerus, the subscapularis, the long head of the biceps, and surrounding musculature. If you don't know these structures please look them up. The long head of the biceps moves up the arm and attaches to the glenoid labrum. The problem mostly arrises in the area of the the bicipital groove. This is a valley in the humerus which houses the biceps tendon. Simply stated, irritation happens to this area and the tendon moves medially. The subscapularis is an internal rotator of the shoulder. It attaches to the transverse ligament, which is the ligament that houses the bicipital groove holding the biceps tendon in place.

The problem: As we slouch, have too much focus on internal rotation of the shoulder, weak extensors, etc. the subscapularis will tighten and create a lot of strain on the transverse ligament of the bicipital groove. This is turn puts strain on the biceps tendon and the biceps function as a whole. This leads to major imbalances in the shoulder and elbow. The shoulder, being a more mobile and vulnerable joint, bares most of the stress and becomes injured.

Sounds complicated, but treatment is usually pretty straight forward (at least in my office). Identify what is happening with the muscles. Which are inhibited, which aren't. Work on the joint specifically, the subscapularis, the bicipital groove area, and long head of the biceps (specific treatments) and things generally get better almost immediately. It isn't rocket science!!! (As in, your doctor should know how to treat this. If they don't, FIND A NEW DOCTOR!)

4. Infraspinatus injury: The infraspinatus muscle is one of the main external rotators of the shoulder. This muscle is notorious for becoming injured, and I believe it is because of the heavy amount of internal rotation today's life and workouts require. This muscle has to be addressed in all shoulder injuries for the shoulder to become function. That usually entails muscle work, muscle lengthening, and neck adjustments. If you don't address an infraspinatus injury, the shoulder will NOT get better.

You may be thinking what about the supraspinatus tendon. This is a common shoulder injury. This is the result of years of wear and tear (really major imbalance and dysfunction) culminating in the tendon tearing. I am not a surgeon and don't see supraspinatus tears in my office. I do have patients with them and miraculously some of them have skipped surgery and have better shoulder function after seeing me. This is because when the shoulder is balanced, there is no added stress on the ligaments and joints, and things heal.

Now, to the good stuff. What can you do to work out the shoulder to take your Crossfit workout to the next level (or any workout for that matter)?

The posture stretch: Take a 3 foot foam roller. Lay on it so your whole spine is on top of the roller. Pelvis to head. Lay your arms on the ground, thumbs pointed toward your head, at a 45 degree angle. Feel the stretch and inch your hands up over the course of 15 minutes. Do this everyday until you no longer feel an intense stretch with your hands at 90 degrees or greater. (hint: should look like a cross position.)

Rotator cuff workout:
Can be done as a workout by itself or after a workout.

A1: 30 degree incline prone trap raise 3 x 10-12 (3 second eccentric phase) 10 sec rest
A2: Elbow on knee DB external rotation 3 x 10-12 (3 second eccentric phase) 10 sec rest
A3: Low pulley external rotation at 30 degress 3 x 10-12 (second eccentric phase) 60 sec rest

This is a super set workout. For more info on what this means, eccentric phase, timing and any lifting questions I encourage you to visit charlespoliquin.com for more info. Below is the link to the article I took this workout from.

http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/984/How_to_Square_Round_Shoulders.aspx

Posterior Deltoid workout:
The rear delts should be worked on a minimum of once a week. I like to to the same as the rotator cuff and follow with some super sets after a workout. It should be noted that shoulders can be a whole day at the gym themselves, and I personally have been working shoulders out extensively for years. So you may have to have separate shoulder days for a while in order to do this.

A1: Bent over rows 3 x 6-8 (2 second eccentric phase) 10 sec rest
A2: Standing cable rows 3 x 8-10 (2 second eccentric phase) 10 sec rest
A3: Face Pulls with rope 3 x 10-12 (4 sec eccentric phase) 60 sec rest

It should be noted that I have adapted these workouts from the shoulder workouts of Charles Poliquin. That guy knows his stuff and for more reading check out his site.

This article has been fun for me to write and I hope very informative for you all. With the tips here, all you Crossfitters out there looking to take your lifts to the next level think about shoulder health and strength. Some added effort can make huge gains and even break some PRs along the way.

Cheers,

Dr. Kurt

References:

Netter FH. Atlas of Human Anatomy. 4th Ed. 2006. (Textbook)

Rakowski Bob. Kinesiology Applied to Functional Medicine. Seminar Series 2010-2012. Minneapolis MN. (itsdrbob.com is his website) (favorite teacher/seminar instructor/mentor/doctor check his seminars and info out!)

Charles Poliquin. www.charlespoliquin.com (too many articles to list. One of the best sources of info I have ever come across. Check out his website.)

http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article/962/Building_3D_Shoulders.aspx

Low Back Pain and Bacteria. What's the gut have to do about it?

Recently, as I have been studying about brain based chiropractic treatments I realized everything keeps coming back to nutrition. I've always believed that nutrition is the best way to stay and be healthy, but this revelation really clicked. Over the past couple of days, while studying Andy Barlow material, a brilliant neuro-based chiropractor, he stated that when the brain has conflicting tests look to metabolic treatments. What that means is the more messed up the brain is, the more you should look to the gut health.

Now a couple days later I stumbled upon a new study linking bacterial infections and chronic low back pain. After reading through the article and a couple of reviews of the article is dawned on me that this all comes back to gut health.

The study found that around 50% of chronic low back pain cases are the result of invading bacteria. The bacteria invades the disc and moves into the surrounding bone causing irritation and pain. More interestingly, when the patients in the study were given a course of antibiotics 80% of them improved drastically. Some of them were even called 'cured' in the article. By far the most interesting part of the article was the invading bacteria. It was the same bacteria present in common acne.

As any natural medicine practitioner will tell you and knows from clinical experience the most common reason people have regular acne is diet. Improper diet, foods you are intolerant or allergic too, GMOs, conventional foods, dairy, gluten, and corn all cause acne. Another thing a crappy diet causes is leaky gut. Dairy causes excessive mucus production clogging the pores inducing acne. Gluten has skin conditions associated like atopic dermatitis. GMOs and toxins all have the ability to cause acne. What I tell patients who ask about acne is this. 'Acne is toxins trying to get out of the body. They want out so fast they are breaking through the skin. Imagine what your intestines look like.'

A common 4 R gut healing program usually always clears up the common acne. Now what does this mean for low back pain cases. Well since the invading bacteria in chronic low back pain seems to be the same as with common acne, wouldn't it make sense that this is a gut issue? How does conventional medicine clean up a bad gut? Antibiotics. How does a natural medicine practitioner do it? With soothing nutrients. With nutrients that kill bad bacteria, yeast, and fungus, while at the same time increasing the good bacteria and nourishing the gut. By reestablishing proper digestion with HCl, enzymes and gallbladder support, healing the gut lining and providing the right probiotics, and most importantly improving the diet. 'Leans, greens, nuts and seeds' is a great easy way to look at food. Michael Pollan stated, "Eat food. Real food. Mostly plants."

So combine what we already know works for low back pain, chiropractic, and now add a gut healing program and we will be eliminating chronic low back pain for millions. All at the same time helping people get healthier!

In good health,

Dr. Kurt

Sources:
Eur Spine J. 2013 Apr; 22(4): 697-707. PMID: 23404353

Ask Dr. Kurt: Do you have metabolic syndrome?

Ask Dr. Kurt: Do you have metabolic syndrome?: Many people hear this term all the time and know that it is part of the diabetes spectrum. First you get metabolic syndrome then you get dia...

Do you have metabolic syndrome?

Many people hear this term all the time and know that it is part of the diabetes spectrum. First you get metabolic syndrome then you get diabetes. How many people really know that they have metabolic syndrome, let alone are full fledged diabetics?

Metabolic syndrome is not just one symptom but a combination of a bunch. High blood pressure, abdominal obesity, increased blood sugar, increased cholesterol levels, high triglycerides, ect. A lot of these markers are pretty easy to see (obesity) or test for. So why is metabolic syndrome and diabetes running rampant?

The reasons for metabolic syndrome and diabetes being so prevalent are the topic for another blog, or weekend seminar (for that matter). But a glaring fact at the time of diagnosis for type II diabetes is the pancreas is at 50% function. This corresponds to a problem 10-12 years in the making to reduce pancreatic function to 50% before type II diabetes is diagnosed.

There is an even drearier outlook for type I diabetes is at the time of diagnosis the beta cell mass of the pancreas is 10%. Type I diabetes also has a huge autoimmune component, as well as a glutamate link. This is all discussion for another time. For this blog is it simply stating the pancreas has to have extensive damage in order for diabetes to be diagnosed.

The positive side of this is that the pancreas is an organ that can withstand a lot of abuse and still work. If the pancreas has to lose 90% of the beta cell mass for DM1 and 50% of function in DM2 to show overt diabetes than that gives us lots of room to improve.

The easiest way to assess and see if you are at risk for metabolic syndrome, or DM2 is the measure your waist and make sure it is equal to or less than your height. This is called the waist to height ratio. It has been extensively studied and proves better than other measurements including the famed waist to hip ratio. One simple reason, 'a big butt cancels a bit waist'.

A study done in 2009 found that for men with a waist greater than 1/2 their height had a 92% increased risk of getting metabolic syndrome. Women were found to have a 87.4% increased risk.

A new study gave the exact ratio that implies metabolic syndrome. 0.59. So if your waist is 60% of your height than you probably have metabolic syndrome, and in the next decade will probably have diabetes.

This is a lot of science to simply say, keep your waist 1/2 your height and have a really good chance of avoiding diabetes and metabolic syndrome. Now for those of you who do have metabolic syndrome, or at worst have diabetes, than it is time to find a natural medicine practitioner and make an appointment. The time was 10 years ago to get this problem in check and start living healthier.

Leans, greens, nuts and seeds is a great way to view food. Avoiding excessive carbohydrates, exercising hard (burst exercises, heavy weight training, sprints, total exhaustion exercises), eating organic foods (especially meats and fats), avoiding all dairy and gluten, and most importantly supporting the pancreas with proper nutrients will help fight diabetes. The side effect is a healthy fulfilling life.

To beat a lifestyle disease we must positively change lifestyle. We can through drugs at diabetes all we want. We are doing that in this country and what effect is it having?

In health,

Dr. Kurt

References:
Metab Syndr Relat Disord. 2009 Oct;7(5):477-84. PMID: 19492953;

Nutr Res Rev. 2010 Dec;23(2):247-69.  PMID: 20819243

Metab Syndr Relat Disord. 2011 Jun;9(3):183-90. PMID: 21226621

Nature. 2010 Apr 22;464(7292):1149-54.

Endocr Rev. 2007 Apr;28(2):187-218. Epub 2007 Mar 12. PMID: 17353295 

Basic Nutrition is LOST Today!

The nutrition industry is starting to lean toward the same marketing strategies as big pharma companies. At the gym I work out at, they have an TV advertisement about Vitamin C. It has an ex-Olympian talking about how she would never leave her house without Vitamin C. Vitamin C alone has single-handedly changed her life and allowed her to be a professional athlete. This is just one example of a single nutrition supplement changing the life of the user. Sounds like a miracle. Why doesn't everyone taking Vitamin C become an elite athlete? Don't get me wrong, I do love some Vitamin C, but I don't think I could say it changed my life. No one nutrient can change someone's life.

No wonder people don't feel the effects of vitamins and minerals. Taking one supplement will not change the body like the claims maintain. Although one MAJOR difference between nutrients and pharmaceuticals is the side-effects and death rates. No one has ever died directly from taking vitamins. Nutrients and vitamins simply do not kill people. It is acceptable for over 100,000 people a year to die from pharmaceuticals being used correctly. Discrepancy? I think yes.

Single nutrients or supplements can have powerful effects when the body is near perfect balance. That means baseline nutrition has been established. Now, what is baseline nutrition?

-Adequate minerals. No single mineral should be given without some form of comprehensive multi-mineral supplement. I love extra magnesium and zinc, but I also give them in conjunction with a comprehensive multi-mineral supplements. A Zn Tally taste test is not only a subjective Zn test, but a total mineral balance test.

-Proper intake of omega 3s. This might take a while to establish, like months of high dose fish oil, more than 10 g per day. As the fat intake becomes more balanced some might decrease the intake, but most people feel so good they continue to take a higher dose of fish oil.

-Plant nutrients including anti-inflammatory nutrients. A plant nutrient powder is a great way to alkalize the body and promote an anti-inflammatory environment. The body works best at a pH of around 7.35. Living creates acid and we need to buffer that acid. Eating lots of plants does this. In today's toxic world we need an even more powerful boost than simply eating plants. This is where a solid and comprehensive plant nutrient supplement comes in. If someone is horrendously inflamed the addition of curcumin and ginger inflavonoids will also help.

-Vitamin D. Vitamin D, yes is one vitamin, but one thing that is unique about Vitamin D is the receptor. Every  cell in the body has Vitamin D receptors, making it very important. I don't need to preach the importance of D, just do a google search and see.

-Digestion. Proper stomach acid, gallbladder function, and enzymes are important. Making stomach acid is one of the most energy dependent processes in the body. People don't make too much stomach acid, they make to little. The LES (lower esophogeal sphictor) is pH dependent meaning the more HCl one has, the tighter the esophagus closes. No acid reflux. Acid reflux is not too much stomach acid, it is too little. Stomach acid is needed to digest food and protect the body from outside infections. The HCl challenge is a simple way to assess if one needs to supplement it. Now HCl by itself might be a supplement that can change someones life.

Once someone's baseline nutrition has been established and continually maintained for a while, this includes lifestyle, organic eating, working out and being active, and most of all a continual source of love, then and only then will single supplement really have great effect on the body.

Next time you are sick and want to reach for the Vitamin C, don't get mad when it doesn't live up to label claims. Take the next week to do an Intense Detox, and start living baseline nutrition. That way the next time sickness happens, the Vitamin C might have a great effect. It might live up to label claims.

-Dr. Kurt

Global Warming... More Like Humans Living

We have all watched, or at least heard of Al Gore's, "Inconvenient Truth" documentary about global warming. One problem I have with the whole global warming movement is that it has become a political movement. Democrats and republicans, liberals and conservatives, all have views on global warming with the left leaning for it and the right leaning against it. This has done a great disservice to all humans. It has created great anger and hostility for both sides when the whole issue should be a human issue.

Yes, I said global warming is not a global issue in the sense that we are saving the Earth. It is a human issue, that we should all be part of. Global warming promotes green cleaning, less non recyclable trash, better products that lower our carbon foot print, etc. Now that is all great, but what the global warming movement does not talk about is how all these products help humans. Yes, they help clean the Earth by not contributing to greater toxification, but what they also do is decrease toxicity to humans.

Humans are exposed to over 80,000 registered chemicals, not counting all the ones not registered. BPA is one of the most talked about toxins, which we know causes cancer, as well as a myriad of other symptoms and problems, most of which are associated with estrogen toxicity. Much of the toxins humans are exposed to are what we call endocrine disruptors. This simply means toxins mess with hormones, usually increasing estrogen in some way, and decreasing or suppressing testosterone by a whole number of mechanisms. We now know that toxins are contributing to type II diabetes and metabolic syndrome. There are reports that toxins are a major contributing factor in austism. High estrogen is associated with infertility, autoimmunity, cancer risk, etc. High estrogens are also associated with toxic exposure.

We as humans should all unite under one cause, a human cause to clean up the Earth. Not only should we detoxify our bodies, but we need to detoxify the Earth. Global warming is a great movement in that it promotes detoxification of the Earth, but the problem is that it is also a political movement. The political movement is killing the effectiveness of the movement.

It is my call to unite the people and join the human movement of living cleaner and creating a clean environment to live. Global warming is an Earth movement. Let's make it a human movement. Healthier humans are the key to a healthy Earth. If we do not promote health in humans, a clean Earth does not matter.

-Dr. Kurt