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Barefoot running and shoes

A friend asked me for my opinion on barefoot running, technique and specific shoes. I think that barefoot running is a big and controversial topic (!) so I thought I would post my response on line and get other’s perspective on it!

Here are some of my thoughts: Yes I agree that modern shoe wear is probably to blame for a lot of the foot problems that we now have. But the real problem starts when we started to wear shoes full-time as kids. You would probably know that we should try to let kids run around barefoot as much as possible and for as long as possible so that their foot musculature develops. As soon as we get into ‘stable’ ‘supportive’ shoes our own muscles are no longer required for the role… so we then design and need more supportive shoes to help the unstable foot, and so on…

In as far as our running style being changed due to modern shoes, I’m not so sure. I have not done a lot of reading on this specific topic so the following is just my opinion: I really don’t think that we are actually designed for long distance running. I think that most of our running – from a historical perspective – would tend to be over shorter distances and at higher speeds, ie: warfare, hunting, etc which would favour a style based on the ball of the foot as sprinting does.

However, we know that at slower speeds we do ‘naturally’ heel strike, such as with walking. Also from an anatomical perspective, the foot arches and shape seem to be designed for this function. And to their credit, good shoe manufacturers base their shoe designs on that structure and shape and their understanding of foot bio-mechanics, and try to work ‘with’ it as much as possible. Furthermore, from a clinical perspective we see a number of musculo-skeletal issues from incorrect foot function, especially when sprinters turn to distance running later in life and don’t change their running style! Without going into too much detail we are naturally equipped with a shock absorbing system called the ‘longitudinal sling’, which is based on a chain of structures (ligament, tendons and muscles) designed to absorb shock on heel strike.

In as far as shoes designed to mimic barefoot function, I’m actually a big fan. I am mostly familiar with the popular Nike ‘Free’ range and to some degree with the Vibram Five Fingers range. I like them because they are a great training tool for our foot musculature, but I would be cautious about their application for long distance running due to their decreased shock absorption and the point I made earlier about our running ‘design’. If you wanted to run in them I would then suggest the Nike Free range as they provide more ‘vertical/axial’ cushioning, and I would start with more supportive ones (higher support numbers, ie 7+) and then progress to less support (yes, expensive process I know!).

A great way to start, and this would apply to both types of shoes mentioned is to treat them as a training tool, which is really what they are. As with any training tool, there needs to be an introductory period and then some progressive overload. I would start with just wearing them around the house or gym training, etc, then progress to more hours/walking, and then do some running in them. While there’s people that do big kilometres with them, I would limit that to about 5kms.

Well I hope this adds to an interesting discussion’! I think its a really interesting and important topic. I would love to get some more educated comments on this!

Exercise and Low Back Pain

Here’s some scary stats for you:

  • 80% of the Australian population has suffered from low back pain at some stage in their life.
  • 25% is suffering from it right NOW!! – there’s a good chance that this may be you as you read this. And one in four people that you walk past tomorrow will be suffering from low back pain… wow… maybe we can understand the serious face!
  • A recent study by the Chiropractors Association of Australia (CAA) recently found that more than a third of Australian retirees suffer from daily low back pain. that is not how I hope to spend my retirement.

Now here’s the really scary part: 45% of Australians will chose to take a painkiller to deal with their pain (knowing that the painkiller will have no long term effect on the condition) over trying to find a sustainable approach to improving their condition. This can be successfully achieved by finding and improving the cause of the problem.

The study indicated that we can reduce the chance of suffering from frequent back pain by 18% by exercising for atleast 30 minutes a day. Also, reducing stress, and dietary changes can have a significant effects on low back pain. For more on this particular factor, please refer to our previous post on Omega 3s (http://informhealth.wordpress.com/2009/06/15/green-vs-brown-carbs-the-omega-argument/)

Here’s some more good news (depending on your perspective!): a study by Hendrickson (2002) indicates that of those people suffering from frequent low back pain, 98% of cases are due to mechanical and functional issues, and not due to true pathologies (such as arthritis, disc damage, muscle/tendon/ligament tears, etc). This is great news because functional issues are relatively easy to address! these issues would include having some muscles that are not working to their correct level, while others are compensating for this and becoming overly tight.

Such dysfunctions are successfully treated on a daily basis by quality Physiotherapists, chiropractors, exercise physiologists and personal trainers.

So please, don’t just pop a pill to deal with the pain!! there’s simple ways to address the causes of low back pain in most cases, which will make you feel better in a number of different ways, beyond just taking your pain away.

‘Green’ vs ‘brown’ carbs. The Omega argument

In our last post we left off with a recommendation to increase vegetable intake as a means of reducing total carbohydrate intake, and to also improve the ratio between 0mega-3s and omega-6s. This is very important as this ratio is totally unbalanced by our common western diets, which, among other things will also increase the level of inflammation that we are under.

Chronic inflammation can occur when your body is constantly fighting a disease or condition that is putting undue stress on a particular area. It is relatively common in people suffering from cancer, arthritis, lower back pain, asthma and depression. In extreme cases this inflammation creates a breakdown of muscle tissue with associated weight loss, which is known as cachexia.

While the exact cause of this chronic inflammation is poorly understood, what is known is that specific messenger cells called cytokines are released which act to amplify the inflammation process in the body. Under most circumstances this is a very important process because this pro-inflammatory mechanism is very important in the healing process when the body’s tissues and organs are damaged and also act to help trigger our white blood cells to action when we have a virus or infection.

However, when this process is unable to be “switched off” this amplification process builds on itself and creates a breakdown of muscle tissue and we get associated loss of strength and a decreased quality of life. In this case it is beneficial for us to break the inflammation cycle as under these chronic inflammation conditions it is very hard for us to build muscle.

We also know that the inflammatory cytokines are mediated through messengers called eicosanoids. Depending on the eicosanoids involved there may be a pro-inflammatory or anti-inflammatory response. The pro-inflammatory eicosanoids are the by products of omega-6 fatty acids while omega-3 fatty acids create anti-inflammatory eicosanoids.

These essential fatty acids (our body cannot produce these), are gained from our diet. A general rule is that the brown things that we eat (grains, bread etc) have a high amount of omega-6 (pro-inflammation) while the green things that we eat have high amounts of omega-3 (anti-inflammation). It is not a wonder then that our western diet has moved from approximately a 3:1 ratio of omega-6 to omega-3’s, to approximately a 15+:1 ratio!

How do we break this chronic inflammation cycle?

Obviously for us to break the inflammation cycle we need to alter our ratio of omega-6 to omega-3 in favour of the anti-inflammatory process. Research has shown that by supplementing with fish oil, which has high concentrations of Omega-3 fatty acids in the form of EPA & DHA, we can decrease the amount of inflammation in the body.

However, the dosage required is quite high (approximately 1kg of oily fish per day!) for someone in a cachexic state and the only safe way to get this amount without the risk of mercury poisoning is with a practitioner grade fish oil supplement.

It should be noted that large dosages of fish oil may cause gastrointestinal problems, and there is also a risk of blood thinning at very high dosages (above 6g of fish oil per day).

Other benefits of fish oil

Omega-3 fatty acids have also been shown to be beneficial for other health conditions including: hypertriglyceridemia, hypertension, rheumatoid arthritis, stroke prevention, atherosclerosis, angina, cancer prevention, brain/eye development in infants, Crohn’s disease, Lupus, psoriasis, eczema, asthma, depression and mental illnesses.

For more information on fish oil or the inflammation process talk to one of our Exercise Physiologists.

Free Lap-Band surgery for the Obese – where is the prevention??

An Australian government parliamentary committee is proposing giving the morbidly obese tax-payer funded lap-band surgery.

Some of the facts are: Obesity cost us $50 billion in 08 (wow, don’t just skim over that number!). 

This surgery can have drastic and rapid effects in terms of reducing weight, disease, financial and personal costs associated with obesity, both to the individual and to tax payers. 

It will only be available to those qualifying under clinical guidelines.

My issue with this is this: our health system is not a health system, its an illness system! where is the prevention??!

How is this for a prevention mindset: Considering the $50billion cost, the government has provided $872million for preventative health programs. Thats 0.02%of the cost being invested!!! and thats for all health programs, that includes obesity, its not even for obesity alone.

Our (SA) federal MP Steve Georganas defended the strategy in ‘Today Tonight’ (tuesday 2nd June09) using the stats above,and said that the program would only be available to those that “have tried everything”. Lets look at that for a second… ‘TRIED’ ‘EVERYTHING‘… when questioned about what may have led individuals to end up in that condition, he mentioned a series of lifestyle behaviours, not surprisingly including poor dietary habits, low levels of physical activity, and high levels of sedentary behaviour, such as prolonged use of TV and computers (its OK, I’m going for a run as soon as I post this!). 

They tried everything??? how about actually doing something?? I have yet to meet an individual who has not had very positive results with weight loss when they have actually committed to it! I hope I don’t sound patronising or inconsiderate. I understand that there’s a vast range of socio-demographic and mental health issues that play a very serious role in this debate, not to mention hormonal imbalances that can make things tougher; I spent a two year-honours degree studying them. 

My point is this: where is the prevention?! where is the focus on education and facilitating healthier choices?? its in the 0.02%!! c’mon, Mr Rudd, lets get serious about a very serious issue!

So what to eat to lose weight, especially body fat?

Now we are getting onto the meaty (pardon the pun!) end of the discussion. What do we do from a dietary perspective to lose weight?? Research seems to be supporting dietary approaches different to the traditional ‘low-fat’ approach so widely publicised. There’s very strong support for the notion that the our ‘trusted’ food pyramid is not the most effective way towards health and leanness. The argument has more to do with insulin responses than with fat intake per se, and points us towards diets aiming for lower insulin releases, and hence lower in carbohydrates.

What the research tells us about low carbohydrate diets

Low carbohydrate (low CHO) diets in the past have been looked upon unfavorably mostly due to the bad press associated with the Atkins Diet which places no limitation on fat consumption. Another allegation made against low CHO diets is that they are not proven long term. There is strong research to indicate that low CHO diets reduce weight more so that low FAT diets over three and six month duration, and until recently only one study that tracked weight loss over 12 months. While in this study weight loss was greater (5.1kg vs 3.1 kg) in the low CHO diet, it didn’t reach statistical significance (Stern et al., 2004). There was also a large dropout rate, and because of this many argue that low CHO diets cannot be adhered to.

However, the same argument could be made for low FAT diets and this has been the mainstream dietary modification suggested by many peak health bodies.

A publication in the New England Journal of Medicine (July 2008), may force mainstream organisations to change their perceptions of low CHO diets. In this publication Shai et al (2008) followed 322 individuals for two years who were either on a low CHO diet, Mediterranean diet (higher in monounsaturated fats) or low FAT diet. It was found that both the low CHO diet and Mediterranean diet  had greater weight loss over the two year period. Furthermore it was found that cholesterol profile improved more so with the low CHO diet and insulin and glucose levels were more favourable with the Mediterranean diet as compared to the low FAT diet.

It seems consistent findings such as these (albeit over shorter study durations) have lead to peak bodies such as the American Diabetic Association (ADA) changing their recommendation from 60-70% CHO to 45-60%.

So what is the explanation behind this? its all about the insulin response to carbohydrate rich foods, which make up the bulk of tradidional low-fat diets, such as the ‘food-pyramid’.

Insulin is responsible for lowering blood sugar levels when they rise as a result of consuming sugar. now, all carbohydrates that we eat, be they in the form of ‘complex’/low glycemic options or simple/sugary/HI GI options, are broken down to glucose to be absorbed by the intestines and enter the blood stream. Insulin regulates the increased blood sugar levels in two ways.

  1. The most commonly known is by ‘driving’ glucose into muscles to be absorbed for energy production.
  2. Insulin also acts on fat cells to decrease their release of fat into the blood stream, and encourages them to uptake/store more fat. The aim of this is to prioritise glucose metabolism (burning)

It is this second mechanism that is of greatest interest to us. If and when you eat carbohydrate dense foods, especially grains-based foods (breads, pasta, rice, etc), your body will enter into a fat storing mode, as it needs to maintain blood sugar/glucose levels constant.

So what is the take home message? aim to balance the amount of carbs and proteins that you eat during th day.

  1. decrease the amount of grains that you consume
  2. increase the amount of vegetables you eat. while most of the energy in vegetables comes from carbs, they contain very small amounts of it.
  3. Vegetables will also provide you with an adequate amount of vitamins and fibre
  4. an increased amount of protein intake will decrease the likelyhood of losing muscle mass as a result of decreasing your energy intake – resistance training (weights will also play a huge role in this).
  5. Eating more ‘green’ and less ‘brown’ will change your ratio of omega-3s to omega-6s in your diet, but more about this next week!

hope this helps. again, if you would like more information, detail, or clarification, please do not heistate to ASK!

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