Paleo Doc

Understanding Common Shoulder Injuries

The most common sports injury that we deal with in our clients is relating to the shoulder.  Here are two videos and an article that help you to diagnose and understand the issues.  Most people are ignoring or trying to "work through" these injuries but you really need to seek some medical advice if you suspect this is happening before making it worse.

This first video takes you through diagnosis of an injury which you can do at home.

 

This next video takes you through the details of labral injuries and evaluation.

 

The below article will help you to differentiate the difference between labral and rotator cuff.

Understanding labrum tear vs rotator cuff

 

 

Positive Thoughts, Positive World

Ever notice how often you use negative idioms in your daily speech without a second thought?  Idioms are expressions that don’t mean what they appear to mean. They are found in most cultures and provide interesting insights into languages and speakers.    Our society is full of these “fun” little well known phrases but when you really listen to many of them, you have to wonder why. 

Take for instance the phrase often used to let one know that continued conversation about a topic is futile….”stop beating a dead horse.”  How about when you accomplish two things instead of one and you say, “I killed two birds with one stone” or when there are several ways to accomplish something….“there’s more than one way to skin a cat.”  Then, when you don’t want to destroy something that is profitable to you…” let’s not kill the goose that lays the golden egg”, or when someone is relaying not so happy news they preface their words with…”don’t shoot the messenger. “

We “throw babies out with bath water,” send good wishes by telling someone to “break a leg,” scold naughtiness by putting “shame on you” and express our dislike of someone by saying she “sucks the life out of me or she is a “pain in the ass.”

These examples are only a few in the sea of thousands of idioms and more are being created each day. They are not all negative but the negative do far outweigh the positive.  Many will read this and say, “what’s the big deal, they are cute.”  Cute to some, but what kind of subconscious effect do these phrases have on our happiness? Research is clear about the fact that positive people are healthier and happier.

The ability to experience true happiness in life comes from the inside out. Are the phrases and words you choose a reflection of your inner world?  Wouldn’t it be wonderful to be more aware of what we say?   Shift away from using negative phrases and instead create positive alternatives?  Could we “feed two birds with one hand,” tell someone “awesome on you” or “reward the goose that laid the golden egg? Perhaps we could even see our glass as always full. It is after all; even if the glass has half water the other half is filled by air.

Words are a reflection of your thoughts.  Positive words come from positive thoughts, negative words from negative thoughts. When you listen to the words and phrases you choose you will find a good indication of where your thoughts and your life are at the present time.  Re-wording negative words and phrases to something positive can help re-train our bio-computers (brains) to see a new perspective. The perspective that life is exactly what you think and say it is.

Mickra Hamilton, AuD

Book Review - "Eating on the Wild Side"

At Synchronicity Wellness, we are constantly working to improve our nutrition knowledge so that we can pass this information on to each of our clients.  We are in an ongoing state of flux as we improve on this knowledge.  Real unprocessed foods have been a constant for us but as we have learned over the years, this guideline has its variables as well.  Years ago, we figured if it were meat or grown from the ground, it was a safe choice.  Many of our clients would ask us about such things as; what is the best type of meat?  What are the better fruits and vegetables? But then we started getting more complex questions such as; pastured vs. industrial meats, organic vs. non-organic, and GMO vs. non-GMO.   It really is great to see that consumers are becoming more conscious about their choices.  Giving them guidance on where to find the information can be difficult because opinions shift like the wind, scientifically “proving” one thing and then debunking that guidance in a few short years.  We are left to wonder “how can we really know what is best to optimize our physiology?” 

 

We are always searching for new resources to assist our clients in optimizing their nutrition and love it when we find one that clearly and concisely educates the consumer on every aspect of a topic.  This is the case with Jo Robinson’s new book “Eating On the Wild Side: The Missing Link to Optimum Health,” released June 4, 2013.  Jo Robinson is a nationally recognized expert in the movement to recapture the nutritional value of our food supply.  She has compiled a remarkable book that covers, in great depth, not only the indigenous history behind our fruits and vegetables but also the way these once highly nutritious foods have been modified down through the course of history to produce the low nutritional foods that the average consumer purchases.  Jo Robinson gives us practical tips on buying, preparing and growing fruits and veggies as well a sources for buying seeds. She neutrally conveys the facts without judgment and leaves us with the good news that all is not lost……that we still have marvelous choices and can easily move back to eating foods with amazing nutritional value.  This is 400 pages of history, nutritional info, and tips on all of the common fruits and vegetables.

 

The health implications of genetically modified foods are becoming clear. We as consumers can change that picture for ourselves and for future generations..  Jo Robinson’s book “Eating on the Wild Side: The Missing Link to Optimum Health” is a must read, we recommend that you move it to the top of your summer reading list and set an intention to be part of the change in our food culture. Thank you Jo Robinson for this amazing new resource.

Buy it at Amazon:

http://www.amazon.com/Eating-Wild-Side-Missing-Optimum/dp/0316227943

Would your Biography be a best seller?

If you were asked to write the story of your life, do you think it would be a real page turner or a sleep inducer?  I think that most people would like to think that their life would make an interesting story but if you step back and look objectively at your stories, would they really be interesting?  Some of you may be wondering if it is all that important to lead an interesting life that would make a good story or whether that should even be a goal.  I will grant you the fact that we do not lead our lives for the entertainment of others nor are we valued based on our adventures but it does come down to vitality.  I have spent many years counseling clients on fitness, nutrition, and health optimization but it has only been in the past few years that I realized the importance of the mind and spirit component which make up about 90% of our vitality.  In these evaluations I find people with many regrets over things they never did or adventures they never took, they are robbed of vitality.  I compare this by talking about those that sit on the sidelines in the game of life, watching or cheering others, to those that are actively participating in the game.  We do see renewed vitality in our client population, whether it be travel, hobbies, or even late life career changes and it truly is a game changer for them.

Nobody would like to classify themselves as a box dweller or Stepford spouse but we see these stereotypes on a regular basis and they are anxious to escape the confines that they have walled themselves into.  Many see escape as an impossible proposition and they resign themselves to their lot in life.

Sit down and think about all of the things that you wanted to do in life, write them down and cross through all that you have accomplished, include things that were your aspirations when you were a child, a teenager, and in your 20's.  How does your list look?  Are there remaining items?  What is stopping you from achieving these remaining items?  Are you setting new goals?  If you knew you only had two more years to live, what would your bucket list look like?  If you died tomorrow, would you have any regrets?

I love to watch the Dos Equis Man commercials, the world's most interesting man - people love this guy, Why? Because he is interesting, why is he interesting? Because he is expressing vitality, a zest for life.  We want to be like that, he is the epitome of what we dreamed of being as children until we became slowly boxed in by the "rules" of society.  You HAVE to get a good education, you HAVE to get a well paying job, you HAVE to save for retirement - you can never have enough money saved!  We have become safe, sterile, and yes....boring.

Think about the consequences if you said tomorrow, "I'm done," and you began really living life, quit your job to go do something that you have always dreamed of doing......climb a mountain, travel to an exotic place, take up a career as an artist, dancer, actor, writer, etc.  People would think you have lost your mind, but many would also envy you for breaking out of the box.  It reminds me of the option Neo had in The Matrix - the blue pill keeps him in his safe "fabricated life" but the red pill and you "stay in wonderland and get to see how deep the rabbit hole goes."

Be interesting my friends and when given the option, always take the RED pill!

Carb Loaded Beef in our Food Chain

I first read the article on Reuters News about 6 weeks ago and thought that it was some sort of joke or conspiracy statement until I saw different versions crop up on different news networks.  I was really astonished by the fact that this did not create major social network buzz or even news headlines.  The story is that the national drought has brought about a shortage of corn and thus price increases.  The beef producers were looking for ways to fatten up the cows on the cheap and guess what they found.....gummy worms, ice cream sprinkles, Froot Loops, and even marshmellows!  Apparently, all of these seem to fatten their cows as well as the corn and at a much cheaper cost.  

Most of us, especially the readers here, would not even consider putting the above items in our body so why do some not see the problem with consuming meat that has been fed these items?   We all know the benefits of consuming healthy fats - it changes the composition of our body fats, changes the way our lipoproteins function, and decreases inflammation.  So, what happens when cows are fed corn, gummy worms or even ice cream sprinkles......It changes the fat.  Lets look at what happens when we feed beef grain:

Some farms will grass feed and then finish the 1-3 months prior to butcher with grain.  In the graph above, you can see that in just 30 days alone the fat undergos dramatic reductions in Omega-3, this is one of the reasons we want our beef grass-fed start to finish.

Buy organic, buy grass-fed, and buy local.

Statins: Poisoning the Population

The pharmaceutical companies like statistics because with statistics, they know you can make convincing arguments for taking their drug.  Statins are a classic example of this problem.  Advertising and even some physicians will tell patients that taking statins will decrease the risk of a major cardiac event by 30%.  Wow, does that mean that it helps about one in three patients?....Nope.  That would be a very convincing statistic if that is what it meant but that is also very deceptive.  It is true about the 30% reduction but lets look at what it really means.  In a meta-analysis of 42,000 patients from 7 separate studies there was a 29% reduction in major cardiac events over a 3-5 year period but the number of major cardiac events in this population was very low.  A more understandable way to look at this study is that 60 patients would need to take statins for 4.3 years in order to protect one person from a single heart attack.  This is what is called Number Needed to Treat or NNT.  

The NNT is the average number of patients who need to be treated to prevent one additional bad outcome (i.e. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial). - Wikipedia

So what about the other 59 patients taking the statin?  Well, nearly all of them experienced some degreee of frailty or mental decline.

Let's look at some other studies on the NNT for statin drug use:

Statins x 5 years - without known heart disease

• 98% saw no benefit
• 0% saved from death
• 1.6% prevented heart attack
• 0.4% stroke prevention
• 1.5% developed diabetes
• 10% developed muscle damage

So,

• None were actually saved
• 1 in 60 had heart attack prevented
• 1 in 67 developed diabetes
• 1 in 10 experienced muscle damage

Other studies for NNT of statins to prevent one heart attack have shown;

• Patients with previous heart attack or known heart disease NNT ranges 16-23
• Patients with no previous heart attack but have risk factors NNT 70-250
• To prevent death with no previous heart attack but with risk factors NNT = 500+

This would not be that big of a deal if it were not for the fact that statins pose a great risk of toxicity.  Adverse outcomes occur more commonly than benefits and these include; rhabdomyolysis (muscle wasting), liver damage, diabetes, ALS (yes, Lou Gehrigs disease us much more common in statin users), heart failure, arthritis, memory problems, Parkinson's disease, neuropathy, and dementia.  The body makes horrible sacrifices for the benefit of the heart when taking statins.  Think about the fact that despite the brain only making up 2% of our body weight, it contains 25% of our total body cholesterol.  Multiple studies have demonstrated the detrimental effects of statins on the brain - depression, confusion, dementia, memory loss, Parkinson's, and ALS.

Statin drugs inhibit an enzyme called HMG CoA reductase which is part of an early step in the 25 step process to create cholesterol.  Unfortunately this enzyme is involved in multiple other very important physiologic processes in our body.  It is a big component of metabolism and energy utilization, especially when it comes to Coenzyme Q10.  When CoQ10 is impaired then muscle energy physiology is drastically altered, this accounts for much of the muscular dysfunction in patients treated with statins.  Also this does not have to be a frankly obvious symptom when one first starts taking the drug, it will work insidiously at gradually destroying your muscle over time.  

We need to develop a new understanding that cholesterol is not the villain that we have made it out to be.  In fact, it is a life essential friend to the body.  Cholesterol is an important structural component to the cell wall of every cell in our body, it is involved in ion transport in cells, it is the precursor to vitamin D3, it makes up our sex hormones (testosterone, estrogen, and progesterone), and cortisol.

Based on statin's mechanism of action we can expect with longer use leading to frailty, mental decline and death.  I also would like to mention one other NNT study;

Prevention of second heart attack in patients following and adhering to the Mediterranean diet after their first heart attack = 18!  

• Side affects = 0
• Prevented cancer NNT 30
• Prevented death NNT 30

I can only imagine what the NNT would be for paleo diet with regard to heart disease, diabetes, and cancer.

SHBG and Testosterone

Have you been noticing that you have symptoms generally associated with testosterone deficiency; loss of sex drive, depressed mood, anxiety, decreased sense of well being, difficulty concentrating, memory issues, fatigue, and even poor sleep?  Then, after being tested you were told that everything was normal?  It may be a problem of the testosterone deficiency being masked and your physician just did not appreciate the flaws in the testing.

The main problem is that we are testing the wrong thing.  Most of the time when testing is requested, we order a total testosterone level but only 1-2.5% of this amount is actually free usable testosterone.  This means that 97-99% of this value is bound to serum proteins and useless.  Very small changes in the percent of free can have a dramatic effect on the usable amount of testosterone.  

The bulk of this binding is because of a protein called sex hormone binding globulin or SHBG and the amount of SHBG that each person has can be affected by many things.  We are seeing more and more issues with excessive binding due to elevated SHBG in clients coming to see us.  Other physicians are also noting this trend in their patients.  

The following can cause increased SHBG levels:

• elevated estrogen (from overweight males)
• liver disease (hepatitis, alcohol)
• low insulin levels (healthy people, especially eating paleo)
• calorie restriction
• green tea
• increased protein/carb ratio (paleo eating)
• certain medications

I need to mention one particularly nasty SHBG elevator and that is contraceptives.  We have seen huge elevations with oral contraceptives and even the vaginal rings.  These levels increase 4-5x over normal range, essentially leaving women with zero free testosterone - talk about birth control...yikes.  Interestingly, the elevation observed in women on birth control, though lower, still persists even one year after stopping.

I have seen clients with total testosterones that were in the mid ranges that actually had free testosterones lower than clients that had pathologically deficient levels of total testosterone due to elevated binding.

So what can we do?  First, if you are experiencing symptoms that are consistent with low levels, get some comprehensive blood work - free and total testosterone, SHBG, estradiol, and liver studies.  Second, talk with aphysician that is knowledgable in testosterone replacement and management.  If you do have elevated SHBG, then discuss ways to overcome this issue.  

Studies have shown benefit with the following treatments:

• estrogen lowering medication in men
• stinging nettle supplementation
• boron supplementation
• Vitamin D supplementation

For women on birth control, the first step is to get off the medicine but this will also be a gradual process for recovery of healthy levels so discuss options with your physicians.  In women with this issue, we have seen dramatic improvements in libido, body composition, mood, and general well being when the SHBG levels normalize.

Unnecessary Medical Testing

A patient called me the other day with suspicion that he had a herniated disc in his back and seemed concerned.  I asked him about his symptoms and how it happened.  He was not debilitated by this but did have a fair amount of pain.  He was wondering if he should have an x-ray to check it out.  Up until the recent year or two, the routine was: order the mandatory back x-ray (which is useless but usually required by insurance prior to CT scan), then CT scan of back  = yes, herniated disc.  This is followed by referral to orthopedics or neurosurgery.  Interesting thing is that the end result was almost always the same - lets just watch this.  The other option is CT negative, so just probably a pulled muscle.  Patient would now feel better that he has a diagnosis either way and gets to avoid surgical treatment.  Would have been much more simple to skip all the intervening steps and say, "let's just watch this and treat it symptomatically and see if it improves," right?  Well, we live in a society where the most advanced tools of medicine are available to us so why not use them.

The answer is that we may be doing more harm than benefit.  When it comes to radiation, we are vulnerable.  Radiation damages our DNA and the effects are cumulative over the years.  We get about 3 millisieverts a year of environmental radiation, a pretty nominal amount but still damaging.  Chest x-rays and mammograms are pretty benign at around 0.5-0.7 millisieverts but a CT scan can give you a dose 100-500 times that dose.  In terms of years of average radiation exposure, consider these numbers:

• coronary calcium scan = 1 year
• angiogram or technetium stress test = 3-5 years
• cardiac CT = 3-7 years
• abdominal CT = 3-4 years
• thallium stress test = 6 years
• angioplasty = 3-18 years

CT scans are responsible for 3/4 of the radiation exposure in our population.  A study in 2010 revealed that 20 CT scans were performed for every 100 adults.  They now estimate that 1.5% of cancers are direct results of CT scans performed in our country, and these are very conservative estimates.  The problem is that it takes 10-20 years before you appreciate the full impact of this radiation.  A study in JAMA looked at CT scans from 1996-2010 and found that the 10-20% of children that received CT scans of the head, the radiation exposure was equivalent to previous studies that showed exposure to this amount of radiation in children was associated with triple the risk of developing brain tumors later.

The point is this, take a pro-active role as a patient.  Ask if the test is necessary, are there risks, and will it change the treatment.  Sometimes it is not worth the risk of having a specific answer.

Do you have enough muscle?

Adequacy of muscle is an important factor in health that many of us underestimate.
 We all know the importance of muscle mass when it comes to strength, exercise, and performance of activities of daily living but what about when it comes to disease risks, immune function, bone density, or recovery from illness?  

It is important to understand that muscle is more than just on organ system that is responsible for movement and function, it is the principal reservoir for our bodies amino acids.  Muscle is very active metabolic factory that supplies the body with amino acids for creation of proteins responsible for growth, immunity, energy, and normal function.  This highly dynamic activity of protein synthesis and breakdown is the largest component of the bodies resting energy expenditure (REE).  The greater the muscle mass the more resting energy expenditure meaning greater metabolic rate.

We understand the fact that muscle mass is important when it comes to preventing disability and injury especially as we age but it is also important in disease risk and recovery from illness.  Stress and illness in the body creates an immediate need for acute phase proteins, recovery as well as health maintenance is highly dependent on the bodies ability to manage these conditions.  The amino acid requirements of the body during these stressors can reach a level of 3-4 grams of protein per kg of body mass per day which will be derived from your muscle (i.e. in a 150# person = 210-280 grams of protein breakdown from muscle per day).  This is why ongoing stress or chronic disease leads to muscle wasting.  Hence, a good reason to have a deep reserve.

Bone density is also affected by the amount of lean body mass.  We know that weight bearing is key to keeping strong bones but evidence now points to the fact that the largest voluntary loads on bone are created by muscle contractions.  Larger muscle mass and greater strength are strongly correlated with higher bone densities.

So, now that we know the importance of lean mass, what is adequate?  The standard definitions of adequate muscle mass are vague and really only addresses the sarcopenic (inadequate) state.  For this reason, we have developed a standard scale based on our patient population over the years where we can actually have objective criteria for the classification of our clients.  Ideally the assessment of the lean body mass needs to be performed using a DEXA body scanner, the gold standard in body composition - these scans are available in most major cities and will cost between $80-120.  DEXA scans will accuately measure your total lean body mass.  We are all familiar with Body Mass Index (BMI), a traditional tool for determining health that is calculated based on height and weight, this measure has significant limitations as I have indicated in previous articles.  We use a similar calculation for determining adequacy of lean mass but it eliminates the body fat mass to get what is a Lean Body Mass Index (LBMI).  This calculation now has only two variables (height and lean mass) vs. BMI which has three (height, lean mass, and fat mass).  You can also get a rough estimate based on other forms of measurement of body fat percentage but most are significantly inaccurate.

Example: Lets take a female that weighs 125# and has a body fat percentage of 35% and she is 5'4".

BMI calculation is [weight(lbs)/height (in)²] x 703 = [125/64²] x 703 = 21.5, a very healthy level based on BMI

LBMI = [weight x (1 - body fat %)/height (in)²] x 703 = [125(1 - .35)/64²] x 703 = 13.9, this would be considered sarcopenic and classify this female as skinny fat.

Female scale for LBMI:

• <14.3 = sarcopenic
• 14.4 - 16.5 = low lean mass - at risk
• 16.6 - 18 = adequate
• 18 - 20 = fit
• > 20 = generally athletic build

Male scale for LBMI:

• <14.9 = sarcopenic
• 15 - 17 = low lean mass, at risk
• 17.1 - 18.5 = adequate
• 18.6 - 20.5 = fit
• > 21.5 = generally athletic build

It is important to remember that these scales are not necessarily meant for diagnostic purposes but are clinical scales based on our years of experience and outcome observations.  Feel free to email me if you have any specific questions or post your questions in the comment section and I will gladly answer them.

Are You Skinny Fat?

Skinny fat is a frequently misunderstood condition but is an increasingly common problem.  Basically skinny fat is a condition where a persons BMI (body mass index) is 25 or less but their body fat percentage classifies them as overweight or obese.  This would be roughly 30% or higher in a female and 25% or higher in a male.  This is not a healthy condition but you may be falsely comforted by falling into the "normal" range based on BMI.  Many of those that fall into this category are sarcopenic, which means that their muscle mass is so low that it is unhealthy.  Most of the time you can look at someone and know that they are skinny fat but those that are skinny fat rarely recognize it in themselves.  They are told that they are in a healthy range for their BMI and they see that their clothing size seems "normal" but despite these deceptions, they generally will not like how they look naked.

BMI has always been a poor judge of health.  It is a measurement developed in the mid-1800's and still used today to define healthy vs. unhealthy.  Interestingly the classification of healthy value is different for different world populations and even here in the US, we have changed the cut-off value over time.  The measurement was really popularized in the early 70's by a well known scientist by the name of Ancel Keys.  He is also famous for his serious flawed study (7 country study) that effectively created an obesity epidemic in America.

 We have this obsession here in the US with being thin when we should be focusing on body composition.  Your weight means very little to anyone but you.  Too little muscle can be just as unhealthy as too much fat.  Few understand that there are serious health consequences to this condition of sarcopenia.  The risk of disability, injury, immune dysfunction, and even heart conditions can develop when muscle mass is too low.  We will discuss more about lean body mass index in our next post.

Lets look at some examples of the above conditions:

This is "skinny fat"

Now sarcopenic:

Now the fit or athletic body type:

Intersetingly the sarcopenic picture is a model and she has approximately the same body fat percentage as the women pictured above as the athletic/fit build.  It is very common for trainers to hear women state that they are worried about getting too bulky......really?  I have been practicing wellness medicine and working with women on body composition for many years and I cannot recall a single one of them asking to lose some muscle mass.