exercise

Chronic stress, appetite suppression, control and metabolic inflexibility.

It was the famous stress scientist Hans Selye who suggested that stress can be a positive or negative force. But how do we know whether we are dealing with stress effectively? There’s a common theme among clients both male and female who have got used to feeling in control of their health by suppressing appetite, symptoms and a false sense of health by perhaps feeling in control. Is this control a false economy? A well-known symptom of stress is a loss of appetite and skipping breakfast, it feels better to perpetuate the production of stress hormones like adrenaline and cortisol to liberate energy from stored fats and stride through the day with their endorphin like qualities. A common theme of females suffering from poly cystic ovary syndrome (PCOS) is chronic irregular eating or over eating in the obese. High stress can be chronic and perceived as the norm. I’ve observed the former in my eldest daughter through under eating as a product of emotional stress

‘For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease, evoking boredom and a sense of meaningless. People may have become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed. To such person’s stress feels desirable, while the absence of it feels like something to be avoided.’ Gabor Mate

It should come as no surprise why some studies suggest that short term fasting, and calorific restriction seem to be productive in reversing aspects of inflammation and auto immune disease. When the body is stressed even eating certain foods becomes stressful. Dairy, sugar, fruits, grains all get the blame. I feel better when I don’t eat these some say. I feel better when I don’t eat others say. Is it the food or is it you? Can you be so fragile that eating some fruit for example is enough to send your biology into a tail spin. Eating sugar in excess can be problematic but then so can eating fat or anything in excess.

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A foundation of good health is built upon biological flexibility, potential and far away from equilibrium states.

The inability to utilise carbohydrate is a snapshot of the inflexibility of an individuals’ metabolism and not the carbohydrate. Evolutionary biology has provided efficiency by aerobic metabolism of carbohydrate and fat. The loss of efficient use of carbohydrate/sugar is the hallmark of a loss of function or flexibility and the chronic use of fats as a fuel is problematic due to increased oxidation of these lipids which can damage the aerobic apparatus within the mitochondria. The Randle cycle or glucose fatty acid cycle should allow flexibility between using either fats or carbohydrate as a fuel (Randle, Garland, Hales, & Newsholme, 1963). It’s often the lack of flexibility, decreased oxidation of carbohydrate and perpetual use of fats that damage the energy producing cells. Saturated fats are the preferred fuel of aerobic (oxidative) metabolism but in aggressive metabolism of cancer cells, unsaturated fats are utilised perpetuating the damage, promoting inefficient glycolysis or anaerobic metabolism that creates the acidic state of the cell.

The dogma that persists in nutrition circles is not based on sound reasoning but limited ideas that look at short term studies related to carbohydrate restriction. When a system loses its capacity to regulate sugar, we blame sugar instead of looking at the variety of factors that are responsible for degraded biology, carbohydrate utilisation and insulin responses.

Whether excessive exercise or inadequate nutrition the end result may be similar and its effects are far reaching into metabolism, cardiovascular, sexual and reproductive physiology.

By improving life conditions (in many ways) the hormones of pleasure can have a bigger role in our physiology. I think the experience of pleasure (whatever capacity for pleasure there is) increases the ability to experience pleasure, but I don't offer this with much hope as a therapeutic approach, since I know of people who say that running to exhaustion makes them "feel good" - neither "feeling good" nor "having orgasms" has a clear meaning, at present. Ray Peat

I’m not suggesting that going long periods without eating are necessarily bad, nor if you enjoy running is that bad either. Context is key. If you enjoy running run. If you have the capacity to go long hours without eating, then do that too. However if you have a system that lacks flexibility these actions can be problematic.

Have you ever considered not engaging in intense exercise for a couple of weeks to see how your body really feels?

I think this is a useful test to discover where your biology is really at. It can help determine whether you have been propping up a dysfunctional biology with intense exercise that falsely elevates your body temperature through activation of the sympathetic stress pathway. Slowing down and just focusing on walking and a few stretches shouldn’t feel stressful. Equally an individual who switches to eating regularly every 3 hours or so with the same amount of calories they were previously eating shouldn’t feel stressful. We all have patterns, routines and to the extent that they are effective or not is dictated by the metabolic flexibility that one should have. I’ll also suggest that metabolic flexibility could be analogous to emotional flexibility and mood states. A sign of improvements to metabolic flexibility and flux is return of energy, ability to tolerate exercise, good sleep, libido and emotional responses among other aspects of function. How do you know if it’s working? This diagram suggests what drivers are necessary and how to overcome your unwanted symptoms with the right inputs.

Metabolic inflexibilitY.jpg

Some patience seeking the return of these aspects of function is needed. After all, if you have spent decades constrained by negative symptoms then it may take more than a few weeks or months to fully resolve these patterns. In addition to the foundational work on hormones and chemistry, some people might find a need to address belief systems or require counselling for trauma or emotional grief to help resolve emotional stressors.

 References

Mate, G. (2008). In the realm of hungry ghosts. Close encounters with addiction. Canadian Family Physician.

Randle, P. J., Garland, P. B., Hales, C. N., & Newsholme, E. A. (1963). The glucose fatty-acid cycle its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. The Lancet, 281(7285), 785–789. https://doi.org/10.1016/S0140-6736(63)91500-9

Peat, R. (1997). From PMS to Menopause: Female Hormones in context.

Selye, H. (1987). Stress without distress. In Society, stress, and disease, Vol. 5: Old age. (pp. 257–262). http://doi.org/10.1080/00228958.1983.10517713

 

Is testosterone replacement therapy necessary?

In a world where it is increasingly normal to be convinced that we fall into a risk classification, need a treatment and can convince our doctor accordingly, negating any experience that he or she might have. The marketeers and economists that run pharmaceutical companies are doing a great job of increasing profits. Before we keep looking for the next wonder treatment we should take stock of what food and exercise can do.

Testosterone can be increased by some very simple strategies such as:

  1. Having adequate liver and vitamin A in the diet to assist in the conversion of cholesterol to pregnenolone - the base hormone responsible for production of testosterone and other androgens.

  2. Ensuring that adequate energy and thyroid hormone are available to maintain communication of the hypothalamic- pituitary- (signalling centres for hormone production-brain to testicles) gonadal axis.

  3. Understanding stress, sleep and interactions between excesses of estrogen and their impact on testosterone production.

  4. Less understood but increasingly keeping mobile communication devices out of pockets and bags that are close to reproductive tissue, including females (ovaries, endometrium etc), appears to be a pragmatic approach in the future. Steroid producing tissues have increased production of problematic compounds that may be prone to damage.

Here's some of the technical aspects to the situation that are taken from a recent assignment as part of my masters degree..

Introduction

Testosterone is a hormone found in both males and females but is the major reproductive hormone in men that also has a variety of other beneficial functions for maintaining physical and psychological aspects to health. Testosterone levels may decrease with disease and/or be part of an age related decline of output. The use of testosterone supplementation has increased substantially in recent years counter these states, primarily due to increased marketing as an agent of change for energy, strength, fat loss and sexual function. Whilst its use appears beneficial in some areas, caution has been recommended on the effects of T supplementation use and it’s effects on the cardiovascular system.

 Diagnosis

Testosterone (T) is the most important androgen found in males and produced primarily within the testes, when low it is defined as hypogonadism. Hypogonadism is classified as either primary, derived from the testes or secondary, which involves the hypothalamus, pituitary or derived from illness or disease. A low serum testosterone (<300ng/dL) is suggestive, but not definitive of hypogonadism and measurements of luteinising (LH) and follicle stimulating hormone (FSH) is used to establish a primary or secondary diagnosis (Crawford & Kennedy, 2016). A worry trend is that despite striking increases of testosterone prescription a substantial amount (approximately 29% in this review) of patients often fail to have their levels checked prior to undertaking testosterone replacement therapy (TRT). (Corona G, Rastrelli, Maseroli, Sforza, & Maggi, 2015). Additionally only 45 % had their testosterone levels checked during or post TRT intervention.

Low testosterone and cardiovascular risk

Previous studies have highlighted an increase in all cause mortality associated with low testosterone levels in men (Araujo et al., 2011). Conditions that increase risk of mortality related to low testosterone are increased abdominal obesity, inflammatory biomarkers, dyslipidaemia, diabetes mellitus and metabolic syndrome. However the diagnosis of an isolated low testosterone level should be qualified by ruling out other potential diagnosis such as long-term illness, nutritional deficiencies and other endocrine issues such as subclinical or overt hypothyroidism.

Testosterone supplementation and risks

A number of studies and meta analysis have demonstrated a number of beneficial effects of TRT which extend to increased sexual satisfaction, muscle mass, strength mood and metabolic function (Corona G et al., 2015) (Gagliano-Jucá & Basaria, 2017). However the suggested risk to increased CV adverse events have appeared vague in many studies and previous extrapolations/anecdotes between men having increased levels of testosterone (and therefore increased cardiac risk) and females having less testosterone and more oestrogen were not just problematic but incorrect. Many studies have correlated low testosterone to low biomarkers of health and increased cardiovascular disease (Pastuszak, Kohn, Estis, & Lipshultz, 2017) (Kloner, Carson, Dobs, Kopecky, & Mohler, 2016).

TRT reductionism and treating symptoms

A comprehensive review of the data compiled by Oskui et al (Mesbah Oskui, P., French, W.J., Herring, 2013) described the major CV implications of TRT which can be observed below. The authors draw attention to previously conducted studies, that did not show any relationships between low levels of testosterone and CV risk and suggest that both the subfraction of testosterone (Total T compared to Free T) and method of analysis for CVD were inappropriate and therefore unreliable for inclusion. 

Cardiovascular analysis Studies Major findings Association between T and mortality 8 8/8 studies found relationship between low T and increased all cause and CV mortality. Type 2 DM 6 6/6 studies showed improved insulin sensitivity through HOMA-IR/HgA!c and improved blood glucose Cholesterol 3 2/3 studies found no change to LDL/HDL from TRT Markers of inflammation (primarily C reactive protein CRP) 8 4/8 studies found reduced CRP Intima media thickness 8 8/8 found an inverse relationship between low T and IMT

The above studies reviewed by the authors, established a link between low levels of testosterone and increases in mortality (all cause and CV), insulin sensitivity and increases in intima media thickness that are resolved by TRT. Yet markers for lipids and inflammation markers such as CRP are less convincing. Hypothyroidism is related to low testosterone and hypogonadic states mainly through hypothalamic-pituitary dysfunction. Treatment of hypothyroid and subclinical hypothyroid states also resolves low testosterone and hypogonadic states, decreases intima media thickness, improves insulin sensitivity and decreases lipid levels (Crawford & Kennedy, 2016), (Krassas, Poppe, & Glinoer, 2010),(Donnelly & White, 2000) (Gao, Zhang, Zhang, Yang, & Chen, 2013). Is TRT the correct therapy for many males, given a) the rapid increases in often undiagnosed and prescription and b) when hypogonadic states, that have similar (cardiac) manifestations and are improved beyond the effects of TRT, are resolved with thyroid hormone?

Another factor concerning reliability of the studies used in previous meta analysis is the size to determine true risk between CV adverse events and TRT (Onasanya et al., 2016). The authors suggesting that to achieve a two-sided p value of 0.05 and power of 80% some 17664 participants would need to study to clarify any relationship. Observational data conducted over 5 years suggested that control groups treated with testosterone in short term had a lower mortality (HR 0.88 95 % CI 0:84 - 0.93) than controls (Wallis et al., 2016). From the meta analysis and other studies discussed above both age (>65) and predisposition to existing disease states may indicate the likelihood of adverse CV events when treated with TRT.

Another draw back of meta-analysis is the inclusion of data and bias produced by pharmaceutical companies that may not be adequately reflected or assessed. Much like cardiovascular end point studies being scarce. Testosterone studies that are funded by financial interests are usually in place to validate the benefits of TRT and fail to evaluate CV adverse events as end points. The increased adequate sample size needed to validate the safety and efficacy of this treatment often increase cost and decrease profit margin over time. The many studies that have been conducted so far, show much smaller sample sizes and a wide range of TRT delivery and dosing.

In a recent case crossover analysis that is not included in any current meta analysis, Layton et al (Layton et al., 2018) found a unique association between testosterone injections and short term cardio (and cerebrovascular) events in older men. Increased associations with myocardial infarction and stroke, post testosterone injection showed odds ratio (OR) were increased for all outcomes, OR =1.45 (95%: CI 1.07, 1.98).

Summary

Testosterone replacement does appear to have many positive effects on a number of markers related to cardiovascular health which include sexual performance, increased muscle mass, metabolic health, physical performance and decreasing mortality in a younger population. However, despite the many benefits of TRT the use of this therapy may have significant risk in late onset hypogonadal states, in ages >65 years of age, those susceptible to conditions associated with erythrocytosis and an association with acute cardiac events exists. It remains essential to ensure that not only adequate analysis of hypogonadal states are present but to ascertain if low testosterone levels are merely a symptom of other endocrine disturbances, such as hypothyroidism which has striking similarities to low levels of testosterone.

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References:

1.Araujo, A. B., Dixon, J. M., Suarez, E. a, Murad, M. H., Guey, L. T., & Wittert, G. a. (2011). Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis. The Journal of Clinical Endocrinology and Metabolism, 96(10), 3007–19. http://doi.org/10.1210/jc.2011-1137

2.Basaria, S., Davda, M. N., Travison, T. G., Ulloor, J., Singh, R., & Bhasin, S. (2013). Risk Factors Associated with Cardiovascular Events During Testosterone Administration in Older Men with Mobility Limitation. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 68(2), 153–60. http://doi.org/10.1093/gerona/gls138

  1. Corona G, G., Rastrelli, G., Maseroli, E., Sforza, A., & Maggi, M. (2015). Testosterone Replacement Therapy and Cardiovascular Risk: A Review. The World Journal of Men’s Health, 33(3), 130–42. http://doi.org/10.5534/wjmh.2015.33.3.130

  2. Crawford, M., & Kennedy, L. (2016). Testosterone replacement therapy: role of pituitary and thyroid in diagnosis and treatment. Translational Andrology and Urology, 5(6), 850–858. http://doi.org/10.21037/tau.2016.09.01

  3. Donnelly, P., & White, C. (2000). Testicular dysfunction in men with primary hypothyroidism; Reversal of hypogonadotrophic hypogonadism with replacement thyroxine. Clinical Endocrinology, 52(2), 197–201. http://doi.org/10.1046/j.1365-2265.2000.00918.x

  4. Gagliano-Jucá, T., & Basaria, S. (2017). Trials of testosterone replacement reporting cardiovascular adverse events. Asian Journal of Andrology, 19(May), 1–7. http://doi.org/10.4103/aja.aja

  5. Gao, N., Zhang, W., Zhang, Y., Yang, Q., & Chen, S. (2013). Carotid intima-media thickness in patients with subclinical hypothyroidism: A meta-analysis. Atherosclerosis, 227(1), 18–25. http://doi.org/10.1016/j.atherosclerosis.2012.10.070

  6. Kloner, R. A., Carson, C., Dobs, A., Kopecky, S., & Mohler, E. R. (2016). Testosterone and Cardiovascular Disease. Journal of the American College of Cardiology. http://doi.org/10.1016/j.jacc.2015.12.005

  7. Krassas, G. E., Poppe, K., & Glinoer, D. (2010). Thyroid Function and Human Reproductive Health. Endocrine Reviews, 31(5), 702–755. http://doi.org/10.1210/er.2009-0041

  8. Layton, J. B., Li, D., Meier, C. R., Sharpless, J. L., Stürmer, T., & Brookhart, M. A. (2018). Injection testosterone and adverse cardiovascular events: A case-crossover analysis. Clinical Endocrinology. http://doi.org/10.1111/cen.13574

  9. Mesbah Oskui, P., French, W.J., Herring, M. J. et al. (2013). Testosterone and the Cardiovascular System: A comprehensive Review of the Clinical Literature. Journal of the American Heart Association. http://doi.org/10.1161/JAHA.113.000272

  10. Onasanya, O., Iyer, G., Lucas, E., Lin, D., Singh, S., & Alexander, G. C. (2016). Association between exogenous testosterone and cardiovascular events: an overview of systematic reviews. The Lancet Diabetes and Endocrinology. http://doi.org/10.1016/S2213-8587(16)30215-7

  11. Pastuszak, A. W., Kohn, T. P., Estis, J., & Lipshultz, L. I. (2017). Low Plasma Testosterone Is Associated With Elevated Cardiovascular Disease Biomarkers. The Journal of Sexual Medicine, 14(9), 1095–1103. http://doi.org/10.1016/j.jsxm.2017.06.015

  12. Roos, A., Bakker, S. J. L., Links, T. P., Gans, R. O. B., & Wolffenbuttel, B. H. R. (2007). Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. The Journal of Clinical Endocrinology and Metabolism, 92(2), 491–6. http://doi.org/10.1210/jc.2006-1718

  13. Udovcic, M., Pena, R. H., Patham, B., Tabatabai, L., & Kansara, A. (2017). Hypothyroidism and the Heart. Methodist DeBakey Cardiovascular Journal, 13(2), 55–59. http://doi.org/10.14797/mdcj-13-2-55

  14. Wallis, C. J. D., Lo, K., Lee, Y., Krakowsky, Y., Garbens, A., Satkunasivam, R., … Nam, R. K. (2016). Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. The Lancet. Diabetes & Endocrinology, 4(6), 498–506. http://doi.org/10.1016/S2213-8587(16)00112-1

  15. Xu, L., Freeman, G., Cowling, B. J., & Schooling, C. M. (2013). Testosterone therapy and cardiovascular events among men: A systematic review and meta-analysis of placebo-controlled randomized trials. BMC Medicine, 11(1). http://doi.org/10.1186/1741-7015-11-108

 

Are you using nature to regenerate?

The more clients that I see, I realise that some are very in touch with their bodies and some have no idea what is going on with it. The same rationale can be applied to those who feel the immediate value of being immersed in nature and others who are blissfully unaware of the subject matter. I often remember the change that my body used to experience as I drove out of London towards the Yorkshire Dales; as I edged past the M25 into the countryside and the journey terminated in a swathe of greenery and granite rock, the stress meter had dialled down to a zero. OLYMPUS DIGITAL CAMERA

So why is nature important to human body? The escalation of urbanised environments is ensuring that humans are packed into industrialised, colour lacking, banal developments, that do little to stimulate the eye and increased tension with hustle and close knit streets that people rush to and from work. This dense packing of people also accumulates a large amount of industrial pollutants, be it Benzene from car fuel, Wi-Fi (of which there is an increasing amount of literature to support it’s negative effects to hormone and cellular function) and many other factors that test the body to its limits.

There is increasing research that suggests that urbanisation is a prominent factor in rumination/negative thinking and decreasing mental health. To deal with managing aspects of mental health, exercise is often touted to be helpful as a distraction hypothesis and I don’t dispute the effectiveness of exercise training to help in this situation. A distraction is positive and exercising is essential for good health. However, how many people actually use, quiet appreciation in exercise to regenerate? We often so concerned with pushing ourselves in professional life that exercise often becomes wrapped up in the same goal setting schedules that people religiously stick to. Walking, boating, hiking and taking time to appreciate nature, take in the colours, slowly breathe in the less polluted air, listen to the birds sing, or simply sit on the beach and absorb the endless horizon of water. To often we don’t stop to take in these natural beauties as we are trying to beat those personal bests.

Studies are showing that walking for 90 minutes in a natural environment fares much better than walking in urban settings; The effects showing additional decreases in negative thinking and activity of the brain. I am a firm believer that running and cycling in built up areas may make you fitter but probably less healthier. Increased oxidation of pollutants in urbanised areas, contribute to health issues and mortality rates are on the rise. Training efficiently and smart would warrant that we should aim to exercise less in this manner. Walking in green spaces and utilising the stress decreasing mechanisms of nature, may have more impact to your health than running or cycling on by without appreciating the spaces surrounding you.

Life seems to be whizzing by faster than ever, isn’t it time we slowed down to appreciate it more? Train for strength, walk for health?

References:

Adrenal Fatigue or Reductionist Thinking?

adrenal  

Here is the first part of my article, which published in the May 2014, Womens Health and Fitness Magazine.

Adrenal fatigue or reductionist thinking?

Often, being given a distinct diagnoses that can relate to modern living can   make sense to us, a modern condition that makes sense of the hectic lifestyle and the symptoms that we have been experiencing. Over the last decade there has been much literature on a so  called 'Adrenal fatigue', whose symptoms are wide reaching from fatigue, digestive dysfunction, weight and sleep issues.

Walther Canon and Hans Seyle, probably the most prominent  scientists to study and interpret the mechanics behind, adrenaline, cortisol and the stress response, showed that when  rats were exposed to high levels of stress, they developed issues such as ulcers, intestinal bleeding and then finally death. The common suggested auto immune diseases that are becoming more prevalent, such as intestinal hyper-permeability or leaky gut can therefore be interpreted as symptoms of chronic stressors.

The premise of adrenal fatigue works something along these lines.

  • You are exposed to stress
  • You produce stress hormones (Alarm phase)
  • Your body returns to normal
  • You become stressed again on a regular basis
  • You enter the adaptation phase
  • You constantly maintain the stress response through permanent exposure
  • The adrenal glands become exhausted
  • Suggestion that you have adrenal fatigue or exhaustion phase

There are many problems with this interpretation and deduction of adrenal fatigue, and how many practitioners treat this reductionist diagnosis.  If your adrenals were truly fatigued, you may not actually be with us anymore and ultimately be dead. Cortisol which is produced by the adrenal glands, is the primary hormone that directs immune function, inflammation and is involved in virtually all aspects of body function. Certainly the terms hypocortisolemia, too little cortisol and hyper, too much cortisol make sense, and that is what a typical adrenal stress test tells us. Are we producing too much or not enough cortisol , on that particular day, based around a suggested norm?

Cortisol does go up and down, and probably outside of suggested arbitrary norms especially if you experience or engage in the following:

  • Excessive physiological or structural stress, intense exercise without adequate rest.
  • Psychological stress
  • Diet or fail to eat enough calories, eating too much may also contribute over time
  • Eat a so called healthy diet based upon current guidelines
  • Fail to get adequate sleep.
  • Chronic exposure to environmental pollutants

The longer one stays in a state of chronic stress the more compromised all aspects of body function become. This can ultimately result in hormone, immune and metabolic systems dysfunction.

The positives from treating the aspects of adrenal fatigue are a compliance of those suffering from the suggested condition, to address aspects of why they have got to this current state of affairs. Overworking, too much or too little exercise, not enough sleep and psychological stress recognition can be aspects that can be changed with great effect.

To create effective change, should we not consider other aspects of function that would treat the root cause, rather than plaster over the symptom? Lets take a look at the cross over between symptoms of both adrenal and thyroid dysfunction, which have roots in energy and digestion. You may start to notice that there are many symptoms that you may experience a mixture of both and to highlight adrenal fatigue alone is problematic. The thyroid gland supports energetic process’s and when this becomes compromised we call on the adrenal glands to act in a supporting role. Addressing energy, metabolism and digestion, should be the target of any lifestyle or therapeutic interventions.

Adrenal symptoms Thyroid symptoms
Fatigue

Difficulty sleeping

Low blood pressure

Clenching teeth

Dizzyness

Arthritic issues

Crave salt

Sweats a lot

Allergies

Weakness

Afternoon crash

Need to wear sunglasses

Anxiety

Weight gain or loss

Difficult to lose or gain weight

Nervousness/anxiety

Constipation

Hair loss

Poor energy/fatigue

Feel cold hands and feet

Mentally sluggish

Morning headaches

Seasonal sadness

Poor sleep

 

 

 

 

However treating adrenal fatigue in isolation with adaptogenic herbs, restriction of sugar and other stimulants as is often the case, may be unwarranted and most importantly ineffective in resolving these issues. Treating any system in isolation is reductionist and often gives you at best, reductionist results. The complex interaction of the Hypothalamus-Pituitary-Adrenal-Thyroid-Gonadal axis is a system that helps our body manage many global aspects of our body's function and therefore addressing adrenal balance leaves a gaping hole in your treatment strategy. Consider that the adrenals and in particular cortisol production can be a slave to the your environment, nutrition, exercise and other lifestyle choices. Take stock, address what may be affecting your stress hormone production, If these factors can be changed do so. Stress is a double-edged sword. We need a certain amount of stress to improve our physiological function. Constant exposure to stress decreases our biological state.

Raising biological wholeness such as energy levels, cognition and increasing balance throughout the hormonal system can give much better results than focusing on the adrenals. Remember that the adrenals and ultimately cortisol production elevate in response to, what you eat, or fail to eat, the environment, psychological and physiological stress. All of these aspects are changeable.  In the next article I suggest some strategies that can be used to improve energy and lower adrenal stress.

Shoulder pain...which one?

Shoulder pain is one of the most Image-1common musculoskeletal issues that I see in my practice from week to week. Its easily as common as neck, lower back, hip and knee pain. So why is shoulder joint dysfunction so common? Well from the lay view, most people intepret shoulder pain as a rotator cuff issue, usually stemming from increased medial rotation. Common thoughts are that the use of the computer mouse, impact on this postural problem.

Too much bench press, throwing, ipad playing, racket or club, bat sports or anything that contibutes to excessive internal, external rotation, protraction, retraction, elevation or depressing of the shoulder joint and girdle and other actions will contibute to shoulder pain. Impingement syndrome is probably one of the most common shoulder problems.

Often external rotation exercises are utilised to combat these problems, often ineffectively. Determining whether the issue is one of mobility or stability and motor control should dictate which modality of therapy should be used together and the type of movement should be dictated by the dysfunction of each of the four joints of the shoulder.

Paul CHEK used the term slave joint to decribe any articulation below C2 (2nd cervical vertebrae) as a term to describe the vulnerability afforded to any joint that could be affected by heirachical factors such as breathing, atlas ( 1st cervical), vision, jaw and others that could influence lower joints such as the shoulder. Whilst this is a particularly useful model to bear in mind, both local and global dysfunction often effect the shoulder joint in isolation or together, from the head down or the foot up.

More often than not dysfunction in the opposite ankle can increase the facilitation of shoulder muscles. A lack of dorsi flexion or movement of the ankle which raises the whole foot off the ground whilst keeping the heel on the floor, can be a common feature in shoulder dysfunction. treating the shoulder may be the last thing that needs to be acheived in restoring shoulder function and decreasing pain.

Restoring shoulder mechanics need not be lengthy periods of shoulder rehab. Identify the cullprits involved in over working, rewire the ones that don't work enough, and create a stimulus that holds that pattern.

If you have shoulder pain and all people ever do is look at your shoulder, ask them to take a look at your ankle, breathing pattern, neck just in case they need a nudge in the right direction.

 

 

Is your diet and exercise program working for you?

Health, fitness and well-being are words that are often used interchangeably but more often than not fail to reflect the differences inherent in each person. Exercise, stress and diet are three components of wellbeing that are often grossly misunderstood not only is yourby the general public but by fitness professionals themselves. Companies wanting to sell products that supposedly enhance our well-being have largely driven our concept of health and of what it takes to achieve maximal health. Let’s take diet for example; the current trend is that we should eat foods such as raw green vegetables, drink plenty of water and try to eat less calories than we expend, usually supplemented with a fancy antioxidant that does what no other supplement currently does on the market. Exercise guidelines encourage us to exercise at least every day and in particular cardiovascular exercise is touted as the exercise that will help you lose weight and prevent heart disease. Why is this unhealthy?

This approach may work with a number of people initially, especially with those who have been liberal with eating and drinking and exposure to limited exercise. The long term effect is an increasing number people who have a cold nose, hands and feet, low body temperature (below 36 degrees when the norm should be 37), poor energy, sleep, libido, digestive function, as well as mood swings usually dominated by poor adrenal regulation; and, ultimately, thyroid regulation. In fact one of the many flaws with the current recommendations with exercise guidelines is that it is most likely poor thyroid function that will contribute to elevated cholesterol levels (which is a protective response) and potential cardiovascular events, not a lack of exercise.

 Too much of a good thing?

Excessive exercise and malnutrition can also play havoc with the adrenal glands. Fatigue can also be linked to hypocortisolemia. Under and over production of the stress/anti-inflammatory hormone cortisol is well documented. Ever felt that fatigue early in the morning and inability to get out of bed? ‘But I eat a healthy diet and exercise regularly’ you say? The adrenals are responsible for getting our butt moving and are synergistic with other key glands, such as the thyroid, and have an impact on digestion, healing, blood sugar regulation and many other functions. The common approach to too much or too little cortisol production is adaptogenic herbs, such as Ashwaganda, Rhodiola and many others. However balancing stress responses with appropriate nutrition and a well-designed exercise and rest program can alleviate these issues without rattling as your walk down the street with your daily dose of supplements.

Food for thought

Nutrition and eating to support your own body function was inherently about consuming enough calories to keep us alive throughout history. Our body is geared towards consuming calories and exercise based upon energy being available. Today’s culture is about working more and eating less but it just isn’t working for everyone. If the so-called Paleo approach was right, do you think we would have been scurrying around for a head of broccoli and calorie-poor foods, or looking for food that would have given us more bang for the buck like a wild boar and liberal use of fruits and calorie dense foods? The human genome hasn’t changed that much, so the way we function as organisms will not change radically for some time either.

The big question

So what is the right approach? Well there really is no ideal approach; it’s what works for you. Exercise and nutrition are stressors and have the potential to be positive or negative but how does it affect you? Ask yourself these questions and you should have the answer to either continuing or cessation with your current methodologies.

  1. Do I feel fatigued?
  2.  Do I sleep well?
  3. Good bowel movement once or twice per day?
  4. What’s my libido like?
  5. Is my skin clear
  6. Do I keep getting injured?
  7. Have I lost weight with my plan if that’s what is needed?

You probably already know the answers to these questions; any program that supports energetic processes doesn’t create injury and improves repair processes, such as sleep, is always what we want and you are bound to be doing that right? Unfortunately we mistake the buzz and excitement, release of stress hormones and pumped up music of the group exercise classes, destructive boot camps, cross fit and other over exercise methodologies as healthy. When clients come to me in a state of injury and fatigue they often say to me ‘but I don’t feel like I am doing anything unless I am wringing with sweat and red in the face.’  The fact that their movement is compromised, posture and energy are poor, and re-training the thought process on what is health and balance is the first part of the rehabilitation program. The problem is that we still don’t know what optimal health is; we just work along patterns that appear to be healthy.

Burn baby burn

One of the common misconceptions of health is that you need low levels of body fat and a six-pack to be healthy. This couldn’t be further from the truth. Many people who engage in excessive exercise regimes often take vast amounts of antioxidants in an attempt to combat the wear and tear of these programs.  An observation to be made in the future is will these people live longer than people who engage in a more balanced lifestyle? Many people who lived into their hundreds did not engage in excessive exercise routines and some of these never even drank water on its own, simply drinking tea and juices. The advice that comes from many professionals becomes flawed as we try to apply modern blanket nutrition approaches to the masses. Don’t get me wrong, certain foods can bring about changes to certain conditions and we certainly need water on some level, but for many the modern healthy diet isn’t doing everyone the good it should.

 The environmental factor

One other thing not discussed by many leading health and fitness bodies is the concept of environmental issues on the body. Your environment has the capacity to make or break any fitness or nutrition program. Toxins are ubiquitous and there is not one environment in the world that hasn’t been touched by PCBs, dioxins and PETs amongst hundreds of thousands of other chemicals. Food, water and the air we breathe may have a more significant impact on our ability to stay healthy. Your nutrition and exercise plan may become a sideshow to the inflammatory genes that are expressed when exposed to these estrogenic issues to both male and females.  Obesity and diabetes are now being linked to these issues.

Is more exercise and fewer calories a good idea to those that have less capacity to deal with these toxins than others? Probably not.

A balancing act

That’s not to say that you can’t assist your body towards balance, they key point here is to be aware that your environment may be responsible for many areas that you haven’t achieved with exercise and food. Manage your environment by decreasing infamous chemicals, found in perfumes, GM foods and even wireless technology can lead to great success with less exercise and less calorie restriction.

Ultimately life is about balance and finding your balance may not be the same as another person. Breathing correctly, flexibility, stability and strength may be what your body needs the most. Spending countless hours doing repetitive cardiovascular exercises, restricting calories or pushing your body to get down to low levels of body fat is not how your body perceives balance. Finding your own ideal diet may take time but in the end, time is on your side.