Running on Empty: When Fatigue Stops You in Your Tracks

Are you running on empty? Is your life spiraling into one prolonged episode of fatigue? Are there days when your “gas tank” is so low that you’re sleepy by lunchtime and craving a power nap by mid-afternoon? Ever wonder what’s making you so tired all the time? There are many factors that can contribute to fatigue, including stress, poor eating habits, altered sleeping patterns, poor breathing, lack of exercise, too much exercise, and sometimes an underlying health condition. Most of the time, fatigue can be traced to one or more of your daily habits or routines. More than likely, you already know what’s causing your fatigue; you’re just not doing enough about it. Let’s take a closer look at some of the most powerful changes you can make today to fight fatigue.

Find a Rest Stop

Fatigue rest stop - Copyright – Stock Photo / Register Mark

Whatever happened to getting eight hours of uninterrupted sleep? When was the last time you actually hit that goal? Almost never, right? That’s a shame because adequate sleep is one of the most effective ways to help your body recover and regenerate from the stressors of life. It is paramount to do whatever you can to get eight hours of sleep a night. Inadequate sleep negatively affects your endocrine (hormone) system, altering cellular regeneration and impairing optimum hormone function.

Researchers have found a lack of sleep decreases growth hormone, which may lead to an increase in age-related illnesses. There also may be an alteration in the glucose mechanism, a pathway your body uses for synthesis of sugar and insulin, which could increase your risk of diabetes and metabolic syndromes causing weight gain.

Sleep deprivation also may have a dampening effect on the secretion of thyroid-stimulating hormone and increasing blood levels of cortisol, especially during the afternoon and evening. Elevated cortisol levels are thought to be related to stress-related illness, insulin resistance and memory impairment.

So, what to do? Try going to bed a little sooner than usual. Start slowly at first; if you usually don’t crash until 11:00 at night, don’t shift to a 9:00 bedtime starting tonight or you may end up wide awake at 4:00 tomorrow morning. Transition slowly into the ideal sleep time that will get you those precious eight hours, and aim for that schedule on as many nights as possible.

Also avoid drinking caffeine late at night, since it is a stimulant and will prevent restful sleep. And avoid carbohydrates a few hours before bedtime, to prevent spikes in your insulin and cortisol levels. Finally, develop a relaxing routine that prepares you to fall asleep – and stay asleep. Such a routine can include a bath, reading, soft music, or even a half-hour of silence to process your day; whatever it takes to get you to doze off and sleep soundly.

Rev Your Engine

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Exercise is a fantastic way to combat fatigue and increase energy while becoming healthy. They key is to not exercise so much that you end up sending your body into a state of overtraining and more fatigue. More is not better with exercise; better is better. It is recommended that you exercise 20-45 minutes three to four days per week. You must allow sufficient time for your body to recover from intensive workouts, so adequate rest is crucial if you want to achieve optimal results.

Exercise increases the metabolic hormones growth hormone and testosterone, which help maintain lean muscle and are a key to vitality. The more lean muscle you have, the faster your metabolism works and the less fatigued you feel. Weight training is the best exercise choice for increasing these metabolic hormones. Regular aerobic activity will increase oxygenation to your heart and reduce fatigue. If you are new to exercise, start off slowly and make sure you get a complete physical from your doctor prior to any strenuous activity.

Schedule Maintenance

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Simply put, don’t put off until tomorrow what you can do today, whether it’s changing your car’s oil, going to the grocery store or doing any of the daily tasks that get put off again and again. Get organized and make a plan of action to complete tasks. Procrastination leads to mental stress and anxiety. It’s the dread of anticipation that will take it out of you every time. To minimize the risk of perpetual procrastination, make a list of the “Top 5 Things to Do Before Noon” each day. Whatever task you want to do the least should be at the top of this list. Get these tasks over and done with before midday, and you won’t spend the day worrying and stressing about getting them done. Then start on your To Do List for the remainder of the day.

You can prepare these lists ahead of time and organize your week in advance. After all, it’s easier to avoid stress when you can plan your week of activities. Each night when you are getting ready for bed, create and read over your list for the following day. Buy a pocket organizer or use your smartphone task/calendar settings to store your schedule. Have a list of contacts and resources that are easily accessible. Check off your list after each task is completed; this will give you a sense of accomplishment.

Fuel Up

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Eating frequently helps to maintain normal blood sugar levels, preventing energy crashes during the day. If you wait too long between feedings, your insulin levels spike, causing your body to go on a hormonal roller-coaster ride. You will feel surges of energy followed by sudden crashes with tiredness, fatigue and lethargy. It is very difficult for your body to maintain a normal state of energy with big swings in metabolic hormones.

Try consuming three regular meals and two snacks per day, waiting no longer than three hours between meals. Never skip breakfast. Breakfast sets the tone for the day in terms of your metabolism. Combine macronutrients (protein, carbohydrates and fats) each time you eat. Limit simple carbohydrates such as juice drinks, bread, pasta, crackers, or processed foods, since these are known to cause mood swings from blood sugar changes. Combining macronutrients normalizes the glycemic index effects of foods on your blood sugar levels. This index traces how much blood sugar spikes in relationship to the food you eat. The lower the glycemic index number, the better for your body. Finally, eat more protein and fibrous carbohydrates to reduce digestive fatigue on the body.

Top Off Fluids

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First and foremost, dehydration leads to thirst. This has negative effects on body chemistry, and it takes your system about 24 hours to recover. This additional stress on your body can fatigue your adrenal glands (which control cortisol and adrenaline hormones) and neuromuscular system. There is also a decrease in the absorption of nutrients from food via the lining of your small intestines, since you body is more acidic with dehydration.

Your brain is 83 percent water. Dehydration can cause depression, dementia, anxiety, confusion, delirium and aggravation. Physical problems include fatigue, constipation and headaches. You might also become more susceptible to colds, allergies, and joint pain, since your immune system will weaken. All that can have a profound effect on your energy levels.

So, when it comes to water, how much is the right amount? Multiply your weight in pounds by 0.5 and 0.7. The numbers generated are the range, in ounces, of water you should drink each day. If you’re not close to that range, don’t worry; gradually increase your water intake over the next month or so. And as I’ve said before, keep in mind that caffeine is a natural dehydrator. That means you should drink 2 cups of water for every cup of caffeinated beverage you consume.

Get a Systems Check

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Fatigue may be a sign of an underlying medical issue. If you still have symptoms of fatigue despite improving your lifestyle, it is highly recommended that you get a complete physical from your doctor. In fact, it’s a good idea even if you aren’t fatigued, particularly if you haven’t had one in awhile. Don’t try to self-diagnose your condition. Make an appointment to see a trained health care professional. Conditions that may cause fatigue include hypothyroidism (underactive thyroid), adrenal fatigue, chronic fatigue syndrome, anemia, heart disease, food intolerances (allergies), and other serious illnesses.

So often, we take feeling tired and fatigued for granted as being a normal part of our lives; however, it can be a cry for help from your body. Chronic fatigue is not a normal state for the body. Your body craves homeostasis, a state of normalcy and well-being. It will do whatever it has to in order to maintain that level of function, even sacrificing optimum function.

If you haven’t had one in a while (or ever), it is recommended that you get a complete blood panel screening and have your hormone system evaluated for balance. Hormones are the chemical messengers of your body. A delicate balance exists between hormones; if there is too much of some and not enough of others, your health will be affected.

While these are some great ways to fight fatigue, they’re not the only ones; you also may want to review a few smaller lifestyle issues to see if they are contributing to your fatigue. For example, if you are taking medications, fatigue could be a side effect. If so, ask your doctor if there is an alternative medication (or better yet, a nutritional supplement, herb or even a lifestyle modification) that would be just as helpful. For example, many people take diabetes medication, but diet and exercise are powerful ways to keep diabetes under control – in most cases without requiring medication.

Fatigue running on empty - Copyright – Stock Photo / Register Mark

Also consider the amount of time you are taking for yourself each day. Do you have any “me” time at all? A life of serving and worrying about others without caring for your own needs is extremely draining. Constant stress can also wear you down. This is a common problem for anyone who feels overwhelmed caring for their family, work, friends, and handling all their other responsibilities.

Finally, consider carefully the people you surround yourself with on a daily basis. Is someone dragging you down? Is there a stressful relationship that drains your energy more than restores it? If so, it is in your best interest to change your circumstances, distance yourself from the stress or find ways to make the situation better.

Life today can feel overwhelming, so much so that you may see no end in sight. However, by implementing some simple techniques, you can gain control over your body and mind, and ultimately your fatigue. The secret to gaining more energy and fighting fatigue is to consider every aspect of your current lifestyle and change whatever is necessary to bring a more peaceful, balanced sense to your daily routine. Don’t try to tackle it all at once. Start with small actions and work your way toward a more relaxed lifestyle. An energetic life awaits you – now go get it! You deserve it.


Fundamental Fatigue

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So, what exactly is fatigue? Quite simply, it is physical or mental weariness resulting from exertion. There is a decreased capacity or inability of your body to function normally because of excessive stimulation. Fatigue accumulates from pushing your mental and physical boundaries to the point that they have difficulty recovering. As a result, your body begins to function at a suboptimal level. The first part of recovery is recognizing the factors that may be contributing to your fatigue and then changing habits, circumstances, etc., to get that energy back.

By Dr. Perry Nickelston

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A War You Can Win: 9 Ways to Make Better Food Choices

The average American consumes approximately 60 percent of calories from sugar, flour and refined oils.1 A donut is a good example of a so-called “food” that represents these calorie sources. We also consume a considerable number of calories from French fries and ketchup, each of which began as vegetation, but after refinement represents more sugar, flour and refined oil calories. Generally, Americans consume very little in the way of vegetables and fruit. The result is big business for the refined-food manufacturers and ultimately, Big Pharma. But what about us? Here’s how you can fight back.

Unhealthy Food Is Big Business

The cost of producing foods made with sugar, flour and refined oil is modest when it comes to the price of these commodities. In other words, there is still an acceptable profit margin for “foods” made with these calorie sources. And companies that use these calorie sources are still doing very well financially. To confirm this, all one needs to do is look at the stock prices of companies that use huge amounts of these calories sources. For example, the stock price for Coca-Cola was $11 in 1995, $21 in 2009 and $39 in June 2015. For McDonald’s, the stock price during those years were $15, $55 and $95.

Clearly, if one is involved in the selling of refined calories, there is a financial benefit. Refined calories are a good business. If you would have put all your money in Coca-Cola or McDonald’s in 2009, you might be able to retire right now because you would have doubled your money. Imagine that – your retirement would be based on sugar, flour and refined oil.

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The High Cost to All of Us

What about the people who eat calories from sugar, flour and refined oils? I’ve labeled these folks “dietary crackheads” because these calories are addictive.2 To be fair, even if you eat few calories from dietary crack, you can still be a dietary crackhead. This is because almost everyone loves the taste of dietary crack, and most of us would like to eat a lot of it, which means we are either practicing or non-practicing dietary crackheads. (I have been mostly a non-practicing dietary crackhead for many years.)

But what about those who consume 60 percent of their calories from dietary crack? What happens to them over time? The answer is obvious: most gain weight and eventually develop the metabolic syndrome. Unfortunately, 34 percent of individuals 20 years and older in America have the metabolic syndrome.3 Clearly, the consumers of dietary crack do not benefit unless they simultaneously own stock in companies that distribute “dietary crack.”

The metabolic syndrome is an interesting condition because it is a pro-inflammatory metabolic state that can last for many years before an overt disease develops, which then requires a specific drug or surgical intervention. Here is example of conditions that develop after the metabolic syndrome state is achieved by eating dietary crack: acne, type 2 diabetes, cancer, cardiovascular disease, stroke, hypertension, polycystic ovarian syndrome, non-alcoholic fatty liver disease, gallstones, sleep apnea, myopia, male vertex balding, depression, low testosterone, and erectile dysfunction.4-5

Practically speaking, someone might take acne medication for several years before graduating to metformin for elevated blood glucose and a statin for elevated cholesterol. Eventually, by the time a man is 50 years of age, he may be taking medications for glucose, cholesterol, hypertension, depression and erectile dysfunction. And during this time, he has continued to eat 60 percent of his calories from dietary crack.

How does this man benefit beyond the temporary pleasure he gets from the taste of dietary crack? Clearly, there is no benefit for him – just suffering. And the suffering can continue if he develops vascular disease or cancer that requires surgical intervention.

Big Pharma Continues to Reap the Financial Rewards

In addition to the manufacturers of dietary crack, the pharmaceutical companies and the hospital system are also beneficiaries. While many drug companies had their peak stock price during the tech bubble days (2000), they are certainly not suffering. Their stock prices have a similar upward pattern as the refined food-producing companies. When you get a chance, check out the stock price patterns for Merck, Pfizer and AstraZeneca. Like the refined-calorie producers, drugs companies would have been a good investment over the past several decades.

How to Make Better Food Choices

Refined foods and drugs continue to be growing industries. They obviously have a good business model. Interestingly, people like to blame refined-food companies and drug companies for our bad health. In my opinion, this is completely incorrect and reflects a state of ignorance. If I eat dietary crack and take medications as a result, it is my fault. No one is forcing me to eat their refined calories or take their drugs and support industries that subsequently benefit. This is a voluntary choice made by the majority of Americans. Simply put, we need to make better choices.

The challenge, of course, is to avoid refined calories on a long-term basis. This can be complicated for many people, even if you’re wellness-inclined. So, here is a list of things you can do:

  1. Cultivate a proper eating mindset – this involves finding a reason to truly “care” about avoiding disease-promoting refined foods.
  2. Understand that almost everyone will always like the taste of dietary crack. Do not feel guilty about wanting it or occasionally partaking. Just don’t overdo it on a chronic basis.
  3. Eat more vegetables during meals to create the sensation of fullness. In general, the feeling of gut fullness must be respected in spite of what food-eating thoughts one might have.
  4. Keep dietary crack out of the house so there is no temptation at home.
  5. Drink more water.
  6. Build up to exercising at an aggressive-enough level that appetite suppression occurs.
  7. Get adequate sleep, as less than six hours per night on a chronic basis can promote weight gain by various metabolic mechanisms.
  8. Fight stress with exercise, not by eating excess / unhealthy food.
  9. Mentally accept that steps #1-8 represent a process to utilize throughout life.

By David Seaman, DC, MS, DABCN

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Foods That Fight Inflammation

In recent years, researchers have come to appreciate that our diet can substantially influence the inflammatory state within our body. This view of inflammation is different than the standard view that characterizes inflammation as a response to injury, such as a sprained ankle, which then heals naturally and the inflammation goes away.

The new view of inflammation, developed over the past 10 years, is that it is a generalized state within the circulatory and immune system perpetuated by poor diet. The outcome of this is the dietary promotion of arthritis, osteoporosis, heart disease, cancer, Alzheimer’s disease and most other chronic diseases. We should call this “dietary trauma,” as it leads to the development of biochemical changes similar to physical injury. The difference is that, for most people, dietary trauma occurs every time they eat, three or more times each day, every day.

In most cases, the outcome of dietary trauma is not noticed for years. It takes years to develop arthritis and other chronic diseases, so we don’t usually associate a poor diet with disease expression. This allows us to easily deny such an association between diet, inflammation and disease. Thus, developing an awareness or mindfulness about eating is very important to help influence a behavioral change in our eating habits.

Foods That Promote Inflammation

image - Copyright – Stock Photo / Register Mark

Refined carbohydrates in the form of sugar, sweeteners and flour produce inflammatory responses, as do refined oils and obese (fatty) meat. A surprise to many is that even whole grains and legumes (beans) can promote inflammation.

With the above in mind, consider that the average American consumes about 10 percent of calories from dairy products, 20 percent from refined sugar, 20 percent from refined grains, 20 percent from refined oils and 2 percent from alcohol. The biggest problems clearly are the sugar, grains and oils. Approximately another 20 percent of calories come from obese meat, which is the fatty meat from domestic animals that live a sedentary life in feedlots, where they are fed a tonnage of grains/corn instead of grass/pasture. The remaining 10 percent of calories might be fruits and vegetables.

Foods That Prevent Inflammation

Rather than listing all the foods and snacks that should be avoided, let’s focus on the foods that reduce inflammation. Researchers recently characterized a diet that offers preventive benefits for heart disease, called the “polymeal,” which is consistent with the PaleoDiet, the traditional low-starch Mediterranean diet and the anti-inflammatory diet.

A reasonable recommendation is for 80 percent to 100 percent of our calories to come from vegetables, fruit, raw nuts, potatoes, and either lean or omega-3 protein sources including fish, lean meat, skinless chicken, wild game, grass-fed animals and omega-3 eggs. Spices such as garlic, ginger, turmeric, oregano and the other popular spices are all anti-inflammatory. The best oils/fats to use in moderation are extra-virgin olive oil, coconut oil and butter.

Our focus should be on correcting the 80 percent of calories that come from sugar, refined grains, oils and obese meat. Worrying about yogurt, the occasional bran muffin, a cup of coffee, etc., has little influence compared to the tsunami of inflammation created by the 80 percent of calories derived from inflammatory foods.

Another key to reducing dietary trauma and inflammation is to eat appropriate amounts for your body. In general, overeating leads to an inflammatory response.

Avoid Dietary Extremism

image - Copyright – Stock Photo / Register Mark

If you currently snack on bags of inflammation and regularly do “drive-through self-shootings” at fast-food restaurants, you likely will view a life of eating anti-inflammatory foods as somewhat extreme. In actuality, the anti-inflammatory foods described above are not extreme at all and are completely consistent with our biochemical and physiological needs.

If you’re eating 80 percent or more of your calories from sugar, flour/grains, refined oils and obese meat, you’re a dietary extremist. For many, the mere thought of giving up bread and pasta is too much to bear.

On the other hand, assuming 85 percent to 90 percent of your calories are anti-inflammatory, have fun with the remaining 10 percent to 15 percent of calories borne of foods from the dark side. Don’t become an anti-inflammatory diet extremist and make eating healthy a stressful event.

By David Seaman, DC, MS, DABCN

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Put Down the Gatorade, Pick Up the Chocolate Milk

Since 1969, when Gatorade officially hit the U.S. market, the sports drink industry has been soaring. Stop by any field or gym on any given day and you’ll undoubtedly see participants in various sports using these products. But are sports drinks your best option when it comes to recovery during and following intense exercise?

Not necessarily, suggests a study in the European Journal of Clinical Nutrition. The review study analyzed the results of 12 previous studies in which researchers compared how chocolate milk – yes, chocolate milk – influenced exercise recovery compared to a sports drink or a placebo drink (one without any recovery benefits). In the studies reviewed, participants (athletes) performed exercise tests such as running or cycling, and researchers evaluated various markers to determine how each of the beverages impacted recovery.

Overall, chocolate milk appeared to lengthen the time it took athletes to reach exhaustion and improved other exercise recovery markers equal to sports drinks, and in some cases, proved superior to sports drinks. In fact, while the researchers caution more studies are necessary, they conclude: “[Chocolate milk] provides either similar or superior results when compared to placebo or other recovery drinks.”

chocolate milk - Copyright – Stock Photo / Register Mark

So, what could account for chocolate milk’s recovery potential? Simple: It contains carbohydrates, protein and fat, plus water and electrolytes – all of which are required during exercise, particularly prolonged and/or intense exercise, to maintain energy, prevent dehydration and help muscles recover. Look for a chocolate milk brand that minimizes added sugars – after all, a chocolate milk shake probably won’t help athletic performance or recovery nearly as well! Talk to your doctor to learn more.

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Common Knee Injuries, Uncommon Sense

How to Avoid Surgery and Stay in the Game

The growth of organized amateur sports over the past 30 years has spawned an unexpected and unwanted increase in sports-related injuries. Many young athletes suffer sports-related injuries that can turn into lifelong problems. Here are some basic facts about knee injuries and how they are handled in the world of modern medicine. I am not passing judgment – just pointing out some facts.

The American Academy of Orthopedic Surgeons reported that in 2003, 9.5 million people visited orthopedic surgeons because of knee problems. By now, this staggering number is probably even higher, considering a greater number of children and adults are participating in athletics every year. The most common recommendation regarding knee injuries is to avoid the activities that take place when the knee is injured, such as activities that require stopping and starting or quickly changing directions. It is thought that these extreme forces on the knee can result in torn ligaments; however, they don’t result in torn ligaments in everyone, which means there could be some pre-existing contributing factors.

To learn why our knees are injured so frequently, it’s important to know how the knee works. The knee joint is composed of four bones: the femur, the tibia, the fibula and the patella (see image on facing page). Cartilage covers the joint and provides a smooth, lubricated gliding surface so the knee can move. The shape of the knee joint is stable, but to function properly, the ligaments have to be in good shape, too! Those ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL).

 - Copyright – Stock Photo / Register Mark

While the ACL works as the main stabilizer when the knee is bent, the PCL works as the main stabilizer when the knee is extended. The collateral ligaments are used when you move side to side. The medial and lateral menisci are located within the joint and act as “shock absorbers” and also influence knee stability. The most commonly injured parts of the knee are the ACL and the medial meniscus. Tears of the meniscus usually take place during twisting, pivoting, or decelerating movements, or as a result of direct impact.

When you look for information regarding treatment of knee injuries, you will see two basic categories of medical care: surgical and nonsurgical. Surgical intervention has certainly improved over the past 20 years and typically involves arthroscopic surgery for severely sprained or ruptured ligaments or torn cartilage. The new procedures are far less invasive than techniques used many years ago, resulting in less scar tissue and faster recovery time. Nonsurgical intervention typically involves improving the stability of the knee joint with rehabilitative exercises, focusing on the quadriceps (thigh) muscles and the hamstrings. Bracing is also a common practice to enhance stability by limiting motion in the knee joint.

To summarize, the way knee injuries are handled in today’s world is to stop doing things that tear ligaments, like running, jumping, twisting and stopping quickly. If you do want to continue doing those things, the common recommendation is to get surgery or do rehab and put on a brace to limit motion in the joint. The resulting lack of motion will likely cause degenerative arthritis over the next 20-40 years, which will result in the need for a knee joint replacement.

OK, so where’s the good news? Simply put, a chiropractor has the ability to do a better job than that! Their knowledge of the foot, knee, hip and spine connection, combined with practical experience, affords an alternative to the “shoot the dice and hope for the best” theory. The first thing to understand is that healthy knee function is not possible without healthy foot function. The medical model of health care does not take that into consideration because the foot rarely presents itself as being painful. Even if the foot does hurt, treatment only takes care of the symptom and does not address abnormal joint function.

A vast majority of people, young and old, excessively pronate. This means that when the foot hits the ground, it flattens out or unlocks, rolling inward and creating a twisting stress up the leg and into the knee. These twisting stresses do three things to the knees: stretch the ACL, stretch and twist the medial meniscus, and inhibit contraction of the quadriceps muscle.

Every time we take a step, jump, pivot, stop quickly and run, those three things take place. A torn knee ligament is not a one-injury event; it is a multiple micro-injury event. These abnormal forces take place perhaps thousands of times, creating microtrauma to the support structures of the lower leg until the ligament fails catastrophically.

If thigh muscle weakness is one of the results of excessive pronation, doesn’t it make sense that the muscle loses its tone to a point that it can no longer stabilize the joint efficiently? Remember, muscle is the primary stabilizer; ligaments are secondary. If you weaken the muscle and traumatize the ligament a few thousand times, you have all the ingredients for the classic knee injury.

Common sense tells us to prevent the excessive damaging motions by supporting the foundational structures (your feet) so they function within the functional range of motion.  Many chiropractors now evaluate the quality of the arches of the feet. If the arches aren’t supporting the legs and pelvis sufficiently, it can create stresses that lead to injury or joint wear and tear. It’s just like the foundation of your house; if it settles too much, it creates stress in other parts of the structure. 

Take a proactive step to avoiding injuries and preserving the health of your knees, hips and spine. After all, you know what they say about “an ounce of prevention.” Ask your doctor for a thorough foot evaluation, particularly if you’re experiencing knee pain or participate in activities that put you at risk for a knee injury.

By Brian Jensen, DC

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Nutritional Supplements Instead of Drugs: Natural Pain Relievers

While nonsteroidal anti-inflammatory medications (NSAIDs) have been widely and successfully used to ease back and joint pain and injuries, it is important to be aware of potential drawbacks, including greater risks of serious cardiovascular, gastrointestinal and kidney problems.

Some estimates suggest that each year, more than 100,000 patients are hospitalized for NSAID-related GI complications alone and 16,500 people die annually from these complications.1

NSAID use is also associated with costly adverse events impacting the CV and renal systems. For example, NSAID use has been associated with increased risk for hospitalization due to myocardial infarction and heart failure. Likewise, acute renal failure, also associated with NSAID use, can ultimately lead to expensive dialysis treatment.1 Studies have also shown ibuprofen alters human testicular physiology to produce a state of compensated hypogonadism2 and low testosterone, one of the leading causes of male erectile dysfunction.

Risks and complications are typically greater for those taking the medications for a long period. The FDA recommends that people taking an NSAID for more than 10 days see a doctor, and that NSAIDs be used in the smallest effective dose for the shortest possible time.3

As many people are not aware of the downside of NSAIDS, and abuse is so common, it is important to be informed of the multiple risks and dangers, as well as the multiple natural alternatives, a few of which are briefly presented below. Be sure to talk to your doctor for more information.

Optimal EPA / DHA Status

pain killer - Copyright – Stock Photo / Register Mark

Perhaps the most familiar supplemental approach to reducing a generalized pro-inflammatory state is to cut hydrogenated “fake fats” from the diet, limiting overconsumption of omega-6 fats and increasing omega-3 fatty acid intake, especially EPA and DHA from fish. EPA and DHA are converted by the body into powerful anti-inflammatory chemicals called resolvins which block inflammatory cytokines and prostaglandins.

Fish oil provides a variety of benefits when supplemented, particularly when the ratio of omega-3 and omega-6 fatty acids in the body is almost equal (1:1). The average diet (red meat, eggs, salad oils, chips and baked goods) is high in omega-6 fatty acids, which is why fish oil is recommended (to balance the ratio).

Fish oil supplements at normal doses are safe, but more than 3,000 mg (3 grams of EPA / DHA combined) a day increases bleeding risk. Also avoid taking with blood thinners such as warfarin (Coumadin). However, doses up to 6 grams a day are used in chronic inflammatory conditions or short term to rapidly garner a one-to-one (1:1) ratio in cell membranes and subsequent clinical response.4

It should be noted that some people will have difficulty digesting such large doses of fish oil. (In my practice, this is usually related to liver / gallbladder problems.) Emulsified fish oils allow for easy digestion. (Indeed, for patients without a gallbladder, I always use an emulsified, good-tasting, naturally flavored omega-3 oil.) Many people also find swallowing many large pills daily difficult, which is naturally associated with poor compliance.

Astaxanthin (ASTX)

Another nutrient found in some omega-3 rich fatty, deep cold-water fish like salmon is pertinent to this discussion. It is the phytonutrient salmon ingest in their diet that makes salmon pink: astaxanthin (ASTX), a marine algae. Astaxanthin has been shown in humans to significantly lower important inflammatory and metabolic disease measures. A multitude of published ASTX studies suggest it is also effective in the treatment of OA.5

Tumeric Curcumioids

Of course, there are plant-based phytonutrients that also have powerful anti-inflammatory effects. Perhaps the most popular right now is turmeric.

Tumeric is a spice that comes from the root Curcuma longa, a member of the ginger family, Zingaberaceae. In Ayurveda (Indian traditional medicine), tumeric has been used for its medicinal properties for various indications and through different routes of administration, including topically, orally and by inhalation.

Curcuminoids are the most active components of tumeric; according to PubMed, curcumin has been demonstrated to be safe in six human trials and has demonstrated anti-inflammatory activity. It may exert its anti-inflammatory activity by inhibition of a number of different molecules that play a role in inflammation.6 Dosages from 1,250 to 2,500 mg a day were deemed safe.6

Tumeric is fat soluble and poorly absorbed. However, there are products that provide solutions to improve increased bioavailability. It is best taken with a meal with fat. (In my clinic, I have patients take turmeric containing products with an emulsified fish oil if I have recommended both.)

Ginger Rhizome

Ginger, the “root” or rhizome of the plant Zingiber officinale, has been a popular spice and herbal medicine for thousands of years. It has a long history of use in Asian, Indian, and Arabic herbal traditions. According to the University of Maryland Medical Center website, traditional medicine has used ginger for centuries to reduce inflammation.7

They cite evidence that ginger may help reduce pain from osteoarthritis (OA). In a study of 261 people with OA of the knee, those who took a ginger extract twice daily had less pain and needed fewer pain-killing medications than those who received placebo.8

Boswellia Serrata Extract (BSE)

The resin of the Boswellia species has been used as incense in religious and cultural ceremonies, and in medicines since time immemorial. Gum-resin extracts of Boswellia serrata have been traditionally used in folk medicine for centuries to treat various chronic inflammatory diseases.9

In a study of the potential effectiveness of BSE on rheumatoid arthritis (RA), researchers concluded that BSE was effective in bringing significant changes on all the (enzymatic) parameters studied.10

Oral administration of BSE resulted in significantly reduced levels of inflammatory mediators.10 The protective effects of BSE against RA were also evident from the decrease in arthritis scoring and bone histology. “The abilities to inhibit proinflammatory cytokines and modulation of antioxidant status suggest … the protective effect of Boswellia serrata extract on arthritis,”10

Key Points to Discuss With Your Doctor

The above research suggests a combination of large, adequate dosages of EPA / DHA along with oral ingestion and/or topical cream application of these herbs, combined with the “hands-on” care provided by your chiropractor, may offer relief equal to or greater than oft-abused NSAIDs – without nearly the potential for serious side effects, not to mention the many other significant health benefits these nutrients and phytonutrients provide beyond the scope of this article.

By John Maher, DC, DCBCN, BCIM

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Back Falls & Pain: How To Get Back on Your Feet

Gravity-(noun) the force of attraction by which terrestrial bodies tend to fall toward the center of the earth.

This textbook dictionary definition eloquently explains what falling means. Gravity is constantly pulling us towards the ground with profound effect on posture and overall health. Throw the likelihood of traumatic falls and you have unlimited potential to cause bodily harm. It’s safe to assume that each of us will experience some type of fall in our lifetime. Every fall impacts body function, movement, mechanics, and efficiency. Even a minimal fall transfers energy from the ground through the body potentially causing severe injury. Energy is never lost or gained, it is simply transferred. If a body’s ability to absorb that energy is compromised dysfunction, pain, and injury will occur.

Different types of falls injure the body in distinct ways. Once you understand the mechanism behind a fall you can predict what areas of the body will typically be prone to pain. Forward falls onto an outstretched hand can cause injury to your wrist, elbow, and shoulder. However, the impact force travels up the arm and exits in the cervical spine (neck) and thoracic spine (upper back) similar to a whiplash type injury. Residual delayed symptoms may appear, which include headaches, neck pain, muscle spasm, tingling or numbness in the arm, and pain between the shoulder blades. Backward falls on the buttocks cause trauma to the spine, pelvis, hips, and head. Concussions are extremely common in backward types of falls due to the sudden whipping motion of the head. The tailbone portion of the spine is often bruised or fractured from impact velocity of the backwards fall. The energy transfer through the spine exits at the top of the head leading many people to complain of severe headaches and neck pain. Severe symptoms might not appear for several days or weeks following the fall. Falls from a height landing on the feet may injure the ankles, knees, hips, pelvis, and spine. Hairline fractures are often a side effect of foot landing falls, particularly in the shin bone and pelvis. Lower back pain is the most common spinal complaint after a foot landing fall due to the compressive forces of the impact.

Back Falls & Pain - Copyright – Stock Photo / Register Mark

All falls cause mechanical and functional damage to the body leading to inefficient movement and compensations. These neurological compensations are part of your nervous systems hardwired survival mechanism to avoid pain at all cost by taking the path of least resistance. This mechanism involves adaptation of muscles, connective tissue (fascia), bones, joints, ligaments, and nerves. Postural changes are ingrained in your movement patterns to protect and guard you from future injury. Common chronic side effects from traumatic falls include; arthritis, muscle spasm and tightness, soreness, spinal disc degeneration, disc herniations, and visual postural distortions. You may notice one shoulder becomes higher than another, rounded shoulders, neck far out over the shoulders, hips become tight and you walk with a foot flare. These dysfunctional movement patterns manifest into pain and injury years after the trauma. Everything in your health history contributes to the possibility of future injury. Even that fall you had off the swing on the playground when you were a kid. Everything is connected and everything matters.

So what can and should you do after a fall to help minimize injury? First and foremost is to determine the seriousness of the injury. If severe headaches, dizziness, nausea, slurred speech or sleepiness are present immediately seek emergency medical attention for these are common sign of a concussion (impact injury to the brain). Anticipate the onset of symptoms in the next several days following a fall. For swelling, inflammation, and muscle spasm apply ice for the first 72 hours. Heat is best used for chronic injuries and over muscles. Ice tends to be a more effective alternative for joint related pain to reduce swelling. A warm sitz bath is a very effective conservative treatment for post fall related soreness. Consult your primary care health provider if symptoms do not show improvement or worsen after 72-hours. Pain is the warning signal from your body that something is wrong. Do not ignore the pain message and hope things resolve without professional intervention. It is essential to visit a skilled clinician in manual therapy such as a chiropractor to ensure proper alignment of the spine and joint systems of the body. A doctor of chiropractic is an expert in assessment and treatment of acute and chronic musculoskeletal injuries with programs of preventive medicine. They will do a complete evaluation including x-rays to rule out severe trauma to the body and diagnose any underlying problems that may manifest in the future. Chiropractors will work in conjunction with your primary healthcare provider to ensure you receive the most effective care program for your type of injury. Once pain symptoms have improved your chiropractor will put you on a corrective exercise program involving strengthening and stretching for balance. This will train your body with proprioception (balance) to help improve your chances of catching yourself before falling in the future.

Never underestimate the long term deleterious effects of any fall. Every fall leaves its mark on your body. Play it safe and assume the fall had a negative impact on your health. Be proactive and take steps to ensure you have the maximum chance of full recovery. Little things mean a lot when it comes to your health. Make sure to speak to your chiropractor about effective ways to deal with falls that may occur.

By Perry Nickelston, DC, FMS, SFMA

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Let Your Kids Play (as Many Sports as They Want)

We’re thick in an era of sports specialization, and it’s working its way all the way down to the grade-school level. Increasingly, children are specializing in single sports, with parents doing everything in their power to ensure Little Johnny becomes the next Lebron James, Peyton Manning or Landon Donovan.

But at what cost? In terms of their chances of reaching the elite level, research suggests focusing on only one sport too early may not lead to success.

A U.S. Olympic Committee (USOC) report based on a survey of nearly 2,000 Olympic athletes reveals that “multi-sport athleticism” is important, valuable not only to coaches, but also a common characteristic of most Olympians surveyed. In fact, according to the survey, most Olympians did not specialize in their sport until their teens, with many continuing to play multiple sports even after focusing on one sport as the priority.

It’s also important to understand that anyone, be it a child or an adult, has a higher risk of burnout / disenchantment with a sport if that’s the only thing they’re doing – every day, every week, all year round. Pushing too hard toward a single sport, especially too soon, could push your children away, rather than grow their love of the game. The USOC survey supports this premise, with love of the sport listed frequently by athletes.

You may want your child to be the next great soccer player, but as this survey suggests, they might have a better chance if soccer’s not the all-consuming, be-all, end-all of your child’s existence. So teach them to love being active and to dedicate themselves to excellence; those are the traits that will bring them success in whichever sport they eventually choose.

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Treadmills Need Not Apply: How to Stay Fit Outside the Gym

For those of us who are always on the run, finding time to exercise can be a challenge. While work, school and day-to-day stresses are a part of life, it can be tough to climb out of bed early and hit the gym; or prioritize an evening yoga class after a long day.

I often hear patients in my integrative medicine clinic complain about being too tired to work out or unable to squeeze gym time into their hectic schedules.

I always remind my patients that exercise doesn’t just happen in a gym, nor does it require the “right” workout clothes or shoes. Exercise can take place at any time of the day, as long as you’re open to changing up your regular routine and getting creative with it. Even a few extra minutes of movement per day promotes blood flow and will affect your energy levels and mood. Here are five tips on incorporating daily movement into your life in ways that are both practical and enjoyable.

1. Shake It Out: The next time you’re watching TV, challenge yourself to do jumping jacks during a commercial break. Mute your TV and put on your favorite music, do as many push-ups or sit-ups as you can, dance around, or even just jump in place. Worry less about doing the moves wrong and more on enjoying yourself. There is no wrong way to move!

exercise - Copyright – Stock Photo / Register Mark

2. Count Your Steps: Try taking the stairs instead of riding the elevator when you get the chance, especially if you’re only going up or down a few floors. If you work in a building with many floors, hop off the elevator a few floors before your own and walk the rest of the way up/down.

3. Stop and Smell the Roses: Instead of driving somewhere to grab lunch, go green and walk to a nearby café or restaurant. If you bring your lunch with you, don’t settle for sitting inside a cafeteria – briskly walk to the nearest park or green space and enjoy your lunch outdoors. Not only will you get your daily requirement of vitamin D, but you’ll also have the energy to power through the rest of your workday.

4. Change Your Pace: If you’re the type who circles around the shopping mall looking for the closest parking spot, switch up your routine and get in the habit of parking far away. Not only will you find a spot with ease, but you’ll also get a workout, particularly if you’re toting shopping bags.

5. Back to Basics: If getting to the gym is deterring you from working out, remember exercise is literally around the corner. Whether you live in the middle of the city or out in the suburbs, taking a stroll around the block only requires you to put shoes on and walk out the door. Put on your favorite playlist or podcast and set a timer if you’re short on time, and remember: You can be active anywhere as long as you prioritize it in your daily schedule.

By Julie T. Chen, MD

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Waking Up to the Right Way to Treat Lower Back Pain

An important collection of papers published in research journal The Lancet highlight the global impact of low back pain, the ineffectiveness of current medical treatments, and the value of spinal manipulation and other nondrug options before turning to medication is receiving substantial media attention.

One of the brightest spotlights: a “Health Alert” segment on a recent episode of “Good Morning America” titled “New Research on Lower Back Pain: Are Millions of People Getting Ineffective Treatment?”

“GMA” anchor Robin Roberts opened the segment with this statement to the show’s estimated 4.5 million viewers regarding lower back pain: “As many as 540 million people suffer from it. According to new research, many treatments, [including surgery and pain medication] … could be all wrong.”

She then introduced Dr. Jennifer Ashton, chief health and medical editor for the show. Dr. Ashton, who described the papers as the “magnum opus on low back pain” and The Lancet as “very reputable,” said the material “[draws] attention to the massive gap between evidence-based medicine and what’s really going on” when it comes to the treatment of back pain.

According to Dr. Ashton, reporting on the papers, back pain is a “massive global public health burden.” First-line treatments include staying active (“the worst thing you can do is get in bed”) and education: learning “what works and doesn’t from reputable sources.” Second-line treatment options (Dr. Ashton urged viewers, “This is really what I want people to pay attention to”) include superficial heat, spinal manipulation, massage and acupuncture. [Italics ours]

Good Morning America - Copyright – Stock Photo / Register Mark

Dr. Ashton added that NSAID medication (nonsteroidal anti-inflammatory drugs, commonly available as over-the-counter pain meds such as Advil, Aleve, etc.) is also considered a second-line treatment according to The Lancet papers, but should be utilized “only if the other things are not working.”

The Lancet content on lower back pain, published online on March 21, features two “series” papers, a “viewpoint” and a “comment,” all of which are available in full-text format free of charge on the journal’s website:

  • “What Low Back Pain Is and Why We Need to Pay Attention” (Series 1) (Hartvigsen J., et al.)
  • “Prevention and Treatment of Low Back Pain: Evidence, Challenges and Promising Directions” (Series 2) (Foster N.E., et al.)
  • “Low Back Pain: A Call for Action” (Viewpoint) (Buchbinder R., et al.)
  • “Low Back Pain: A Major Global Challenge” (Comment) (Clark S., et al.)
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