Steroids for Sciatica: More Trouble Than They’re Worth

Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous).

Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure as it relates to sciatica or pain affecting the sciatic nerve, which extends from the lower back down the back of each leg.

Small Relief, Big Potential Side Effects

In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.

Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, cataracts and increased risk of fracture.

Tainted Steroid Injections: The Framingham Outbreak

In September 2012, the CDC and the FDA began investigating a multistate outbreak of fungal meningitis and other infections among patients who had received contaminated steroid injections. The contaminated vials were tracked back to a New England compounding center in Framingham, Mass. The cases included fungal meningitis; localized spinal or paraspinal infections, including epidural abscess, basilar stroke, vertebral osteomeylitis and arachnoiditis; and infections associated with injection in a peripheral joint space such as the knee, shoulder or ankle. Ultimately, the outbreak resulted in 751 cases and 64 deaths in more than 20 states.

This last complication is certainly not emphasized in clinical circles. Therapeutic steroids may reduce pain, however the use of steroid injections seem to promote deterioration of skeletal quality, which is not surprising since other forms of steroid medication have long been associated with osteoporosis.

A retrospective study published in the Journal of Bone and Joint Surgery looked at lumbar epidural steroid injection (LESI), and the potential impact on bone fragility and vertebral fractures (spinal fractures). Researchers identified a total of 50,345 patients who had medical diagnosis codes involving the spine; within that group, a total of 3,415 patients had received at least one LESI.

Three thousand patients were randomly selected from the 3,415 injected population and 3,000 additional patients were selected from the non-injected group as a control group. There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.

When incidence of vertebral fractures was assessed, researchers discovered that an increasing number of injections was associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent. Based on this evidence, LESIs clearly exacerbate skeletal fragility. They promote deterioration of skeletal quality similar to the use of exogenous steroids, which is the leading cause of secondary osteoporosis. In fact, the rate of vertebral fracture following epidural steroid injections may be underestimated.

Both European and American guidelines, based on systemic reviews, conclude that epidural corticosteroid injections may offer temporary relief of sciatica, but do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates. Facet joint injections with corticosteroids seem no more effective than saline injections.

Rising Costs, Limited Benefits

Despite the limited benefits of epidural injections, Medicare claims show a 271 percent increase during a recent seven-year interval. Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates. For patients with axial back pain without sciatica, there is no evidence of benefit from spinal injections; however, many injections given to patients in the Medicare population seem to be for axial back pain alone.

Charges per injection have risen 100 percent during the past decade (after inflation), and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections. Yet during this time, the Medicare population increased by only 12 percent.

It all begs the question: Why such a huge increase in the use of a procedure that has limited benefit?

Take-Home Points

  • Epidural steroid injections have little clinical benefit (short or long term) and are associated with significant risks.
  • Steroid injections cause deterioration of bone quality, elevating the risk of spinal fracture.
  • Use of epidural steroid injections has increased dramatically despite lack of evidence to justify the procedure.

Talk to your doctor of chiropractic for more information on sciatica and nondrug alternatives to your pain.

By Deborah Pate, DC, DACBR

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Chiropractic Better Than Medication for Neck Pain

A study published in the research journal Annals of Internal Medicine and widely reported by mainstream media suggests chiropractic spinal manipulation is more effective than over-the-counter and prescription medication for relieving acute and subacute neck pain.

Spinal manipulative therapy was more effective than medication in both the short and long term.

The study involved 272 adults ages 18-65 with neck pain of two to 12 weeks’ duration. Participants were recruited from a university research center and a pain management clinic in Minnesota. Spinal manipulation was provided courtesy of a doctor of chiropractic. According to the study, six chiropractors, each with at least five years’ experience, provided treatment, with the specific spinal level to be treated and the number of treatments provided left to the discretion of the individual chiropractor.

Instead of chiropractic care, some patients in the study group received medication as monitored by a licensed medical physician. Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (aspirin), or both served as the first line of pharmacological therapy. With patients who did not respond to or could not tolerate these drugs, narcotic medications and muscle relaxants were prescribed. With each patient, the MD determined the type of medication administered and the number of patient visits.

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Self-reported outcomes, including pain, were measured six times during the 12-week treatment period: at two initial (baseline) appointments; two, four, eight and 12 weeks after treatment began; and on two occasions post-treatment (weeks 26 and 52). Objective measures of cervical spine motion were measured at four and 12 weeks by seven trained examiners who were unaware of which treatment the patients were receiving.

After 12 weeks of treatment, a significantly higher proportion of the SMT group experienced reductions of pain of at least 50% [compared to the medication group]. Specifically, at week 12, more than 82 percent of the SMT group reported a 50 percent or greater reduction in pain; 57 percent reported at least a 75 percent reduction and 32 percent reported a 100 percent reduction. By comparison, the medication group reported reductions of only 69 percent, 33 percent and 13 percent, respectively.

In terms of long-term improvement, 75 percent of the SMT group reported at least a 50 percent reduction in pain after 26 weeks, while nearly 81 percent reported at least a 50 percent reduction at 52 weeks. The medication group’s improvement fluctuated from 59 percent reporting pain reduction of 50 percent or more at 26 weeks to 69 percent reporting the same reduction at 52 weeks.

“Participants who received medication seemed to fare worse, with a consistently higher use of pain medications for neck pain throughout the trial’s observational period,” said the study authors. In other words, chiropractic was a much better choice than medication for neck pain.

Interestingly enough, a third group of patients who received home exercise advice instead of chiropractic care or medication also fared better than the medication group during the study period. That means two forms of conservative, drug-free care – both of which are commonly provided by doctors of chiropractic – were more effective than over-the-counter and/or prescription drugs. The moral of the story? The next time you or someone you know is suffering from neck pain, don’t turn to the medicine cabinet or a medical doctor; turn to your doctor of chiropractic.

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How “The Biggest Losers” Keep the Weight Off (and How You Can, Too)

Anyone who’s followed the popular TV series, “The Biggest Loser,” over the years understands two things instantly: 1) Even people who are significantly overweight / obese can lose dramatic amounts of weight by changing their diet, exercise and other habits.

2) Once they lose the weight (and leave the weight-loss-conductive confines of the show), it can be difficult to maintain the weight loss. That’s why in too many cases, on the show and in “real life,” people end up in a vicious cycle of weight loss, weight gain, weight loss and so on.

A new study may provide an important clue as to how people who lose weight can keep it off. The study actually tracked some of “The Biggest Loser” participants and determined that while many actually regained some or all of their original weight after leaving the show, the ones who were able to maintain their weight loss (or even lose more weight) did so because they modified an important variable: exercise. Specifically, participants who successfully kept the weight off six years after the show (average weight loss: 13 percent compared to pre-show weight) had increased their physical activity by 160 percent compared to 34 percent in weight “regainers,” who were actually 1.1 percent heavier, on average, than their pre-show weight.

weight loss - Copyright – Stock Photo / Register Mark

The moral to the story? Keep exercising! If you’re trying to lose weight, burning calories is key to dropping pounds; if you’re trying to maintain it, a physically active lifestyle not only keeps you fit physically, but also keeps you in the fitness mindset, which is equally as important when it comes to maintaining a healthy weight in the long term.

Note: Experts suggest that when first trying to lose weight, particularly significant amounts, diet may be more important than exercise, since poor eating habits – particularly excessive consumption of high-calorie, nutrition-sparse foods – often cause more weight gain than exercise can burn off. For example, a cheeseburger with fries and a milkshake could account for 1,000 calories or more, depending on the fast-food establishment; whereas burning 1,000 calories could require several hours of physical activity (depending on the exerciser’s weight and activity intensity). It’s also vital to change eating habits because in today’s processed, fast-food world, it’s far too easy to give in to temptation. Your doctor can tell you more about how to combine proper diet and regular exercise to take the weight off and keep it off for good.

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Chiropractic Care for Common Sports Injuries

Have you ever had a sports injury that limited you from playing your favorite sport? If so, you aren’t alone. Whether you are a weekend sports enthusiast or an athlete, getting back to playing again is the most important thing. That’s why an injury can take time to heal and really frustrate us. We want to be back playing yesterday. That’s why chiropractic care is so important. Getting your injury assessed and treatment will not only get you back on your feet faster, but also screen out any bad habits that can lead to further injury. Let’s look at some of the most common sports injuries out there, and review what you can do to get it better.

Injury: Hamstring Strain

Treatment:

  • Follow RICE principle if injury happened within last 48 hours
  • RICE: (Rest, Ice, Compression, Elevation)
  • Electrotherapy, Ultrasound for swelling control
  • Stretching for increasing flexibility
  • Chiropractic adjustments to address joint tightness
  • Muscle tissue work to break up scar tissue
  • Active exercise to get back to full strength and prevent further injury

Key points to remember:

Sports Injuries - Copyright – Stock Photo / Register Mark

Hamstring pulls and strains are most commonly due to lack of flexibility and adequate warm up before beginning your sport. Apart from treating the area of injury, your Chiropractor will examine to see if there’s any muscular imbalances. Having a tight thigh and weak hamstrings will lead to recurring injuries unless you get your muscles and joint motion back to normal.

Injury: Low back strain

Treatment:

  • Chiropractic adjustments to increase range of motion and decrease pain
  • Low back stretching exercises
  • Strengthening and core training

Key points to remember:

Majority of sports injuries to the back involve sudden twisting motions. Core strength is one of the most important goals you need to achieve if you are going to continue playing. Avoid any forward bending movements in sports, since this puts a lot of stresses to the spine and can increase risk of injury, especially if  you are being hit

Injury: Tennis Elbow

Treatment:

  • Ultrasound or laser to help with tissue healing
  • Spinal manipulation around the elbow joint to increase joint motion
  • Muscle tissue work to break up scar tissue around the area of injury
  • Stretching exercises to increase range of motion
  • Strengthening forearm exercises

Key points to remember:

The pain on the outside of the elbow is known either as lateral epicondylitis or tennis elbow. This area has one of the least amounts of blood supply to the body. That’s why it may take longer to heal. It’s important to get back into activity slowly. You may even need to wear a brace to limit stresses on this area in the beginning. It’s best to follow the advice of your chiropractor on your timing of return to sports. Getting back too quickly with this injury can lead to reinjury and further frustration.

Injury: Runner’s Knee

Treatment:

  • Specific stretching of the muscles around the knee
  • Strengthening of inner knee muscles to improve tracking of the knee cap
  • Deep tissue massage techniques to help break up scar tissue
  • Examine the feet for altered gait and improper walking form
  • Address any low back joint problems that alter proper leg movement

Key points to remember:

Runner’s knee is not only something runners get. Any form of sport that involves running or sprinting can lead to Runner’s knee. Apart from stretching and strengthening exercises, its important to get good advice on proper footwear. Think of the feet as the foundation from which everything is built. Improper foot wear and bad form in walking can lead to increased stresses in the knee, hip and low back.

By Jasper Sidhu, BSc, DC

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Take Time to Stretch

Let’s face it, most people do not enjoy stretching. If you think about it, it’s probably close to the bottom of your list of priorities when you work out or do any other type of physical activity. In fact, stretching is probably the most overlooked aspect of physical fitness, and yet it is one of the most important. I continually stress the benefits of stretching to my clients, and the ones who take my advice see a difference in their workouts and everyday lives. By the end of this article, you will have the information and the tools to put together a great stretching program, too.

Why We Need to Stretch

Lady stretching on the floor - Copyright – Stock Photo / Register Mark

As we age, our muscles tighten and range of motion in our joints decreases. This can impact even the most active lifestyle and hinder your normal day-to-day activities. Tasks that used to be simple, like zipping up a dress or reaching for a can off the top shelf, may become extremely difficult. A regular stretching program can help lengthen your muscles and make daily activities routine again.

The word flexible comes from the Latin word flexus, which means “to bend.” Flexibility is the degree to which an individual muscle will lengthen. Stretching increases flexibility, which will help you perform daily activities and reduce the risk of muscle, joint and tendon injuries. Stretching also improves circulation, increasing blood flow to the muscles. Increased blood flow provides more nourishment to the muscles and gets rid of more waste by-products in the muscle tissue itself. Improved circulation can also help speed up recovery time if you suffer a muscle injury.

What’s more, stretching can help eliminate or decrease low back pain, one of the most common kinds of structural pain, affecting a large percentage of the population. Muscle tightness in the quadriceps, hamstrings, hip flexors, and low back muscles is a common cause of low back pain. Stretching these muscles will often eliminate the pain. Keep in mind that every joint is tied to another joint, so if one muscle is tight, it is going to affect another joint or muscle.

Man stretching - Copyright – Stock Photo / Register Mark

One of the greatest benefits of stretching is that you’re able to increase your range of motion, which means your joints can move further before an injury occurs. Stretching after you exercise (at least after you’ve warmed up a bit) has proven to be much more effective than pre-workout stretches, because by the time you’ve completed your workout, the muscles are “warm.” Post-exercise stretching also helps reduce soreness, improves workout recovery, and ensures muscle and tendons are working properly.

Different Ways to Stretch

There are three main types of stretching/flexibility programs: static (corrective) stretching, active stretching and functional stretching. No matter what type of flexibility program you are on, in the end it will help with posture, relieve muscle tightness and imbalances, prevent injury and improve the quality of everyday activities we take for granted from time to time.

Corrective/static stretching addresses your individual muscle imbalances, which increases extendability in muscles that are chronically tight. Typically, you will perform static stretches, meaning you hold the stretch for 20-30 seconds. Each stretch should be performed 2-3 times. The main goal of static stretching is to alleviate muscle imbalances, improve posture and prevent injury.

Active stretching gradually increases joint range of motion by moving into and out of stretches in a more rhythmic fashion. You hold each stretch for only 2-4 seconds, performing between five and 10 repetitions of a particular stretch. One of the added benefits of an active flexibility routine is that it strengthens and stretches at the same time. Active flexibility helps improve posture and your quality of movement.

Functional stretching uses muscles and the body’s momentum to take a joint through its full range of motion in dynamic, multiplanar (all directions) ways. Movement mimics those you do in everyday life or your training program, and make for great warm-up activities. Functional flexibility improves posture and the quality of your everyday life.

Lady stretching in front of window - Copyright – Stock Photo / Register Mark

Static Stretches

Static Calf Stretch

Preparation: Stand facing a wall or sturdy object. Bring one leg forward, using your upper body to lean against the wall and keeping the outstretched rear leg straight.

Movement: Draw the belly button inward and keep the rear foot flat and pointed straight ahead; do not allow the rear foot to cave inward or roll outward. Bend the arms, move chest toward the wall and tilt pelvis forward. Stop the movement when slight tension is felt. Hold for 20-30 seconds, switch sides and repeat.

Static Kneeling Thigh and Hip Stretch

Preparation: Kneel with front leg bent at a 90-degree angle. Rotate the back leg slightly inward.

Movement: Draw belly button inward, keeping the rear foot flat and pointed straight ahead. Do not allow the rear foot to cave inward or roll outward. Bend the arms, move chest toward the wall and tilt pelvis forward. Stop movement when slight tension is felt. Hold for 20-30 seconds, switch sides and repeat.

Static Abdominal Stretch Over Ball

Preparation: Lie supine (on your back) on a stability ball, with arms outstretched.

Movement: Draw belly button inward and slowly allow body to drape over the ball, extending legs and reaching with arms. Hold for 20-30 seconds.

Active Stretches

Active Calf Stretch

Preparation: Stand near a wall  or sturdy object. Bring one leg forward for support; use upper body and lean against wall. The outstretched leg should form a straight line and the feet and ankle should be in a neutral position.

Movement: Draw belly button inward and keep rear foot on the ground, with opposite hip flexed. Slowly move the hips forward, creating controlled movement through the lower extremity. Hold for 2-4 seconds and repeat for 5-10 repetitions. Switch sides and repeat.

Lady stretching - Copyright – Stock Photo / Register Mark

Active Standing Hip Stretch

Preparation: Stand with one leg bent and slightly forward. Turn the back leg slightly inward.

Movement: Draw belly button inward and squeeze the glutes while tucking the hips. Stride forward slowly until a mild tension is achieved in the front of the hip being stretched. Raise and stretch the stride-side arm up and over the opposite side while maintaining pelvic position. Rotate to the back leg in a controlled manner, hold for 2-4 seconds for 5-10 repetitions, then switch sides and repeat.

Tube Walking Side to Side

Preparation: Stand with feet hip width apart, knees slightly bent and feet straight ahead. Place resistance band under feet.

Movement: Draw belly button inward. Keep feet straight ahead and take 10 small side steps without allowing knees to cave inward. Repeat in the opposite direction.

Lady stretching on exercise ball - Copyright – Stock Photo / Register Mark

Functional Stretches

Multi-Planar Lunge

Preparation: Stand in proper alignment with hands on hips and feet straight ahead.

Movement: Draw belly button inward. While maintaining total body alignment, step forward (saggital plane), descending slowly by bending at the hips, knees and ankles. Use the hips and thigh muscles to push up and back to the start position. Perform 10 repetitions, then repeat on opposite leg. Progress to side lunges (coronal/frontal plane), followed by turning lunges (transverse plane).

Russian Twist

Preparation: Lie on a ball with your head and neck supported and both feet straight ahead. Lift hips up until they are in line with knees and shoulders.

Movement: Draw belly button inward. Maintaining core control, slowly rotate trunk to each side. Perform 10 repetitions to each side.

Prisoner Squat

Preparation: Stand in proper alignment with hands behind head.

Movement: Draw belly button inward and lower to a 3/4 squat position (controlled); do not let the knees go forward or cave inward. Extend hips, knees and ankles to return to start position. Raise onto toes and then return to start position. Perform 10 repetitions of the entire move, start to finish.

Exercise ball - Copyright – Stock Photo / Register Mark

Well, there you have it in a nutshell: how to start stretching today and take your first steps down the path to a more flexible, healthier you. These stretches should get you started, but there are a lot more you can add to your flexibility routine as you progress. Which muscles are tight will determine what stretches you should be doing. The benefits of stretching are important, so make sure it’s a regular part of your fitness program. Talk to your doctor for more information.


Lady happy stretching - Copyright – Stock Photo / Register Mark

Safe Stretching: Four Things Not to Do

There are no disadvantages to stretching – unless, of course, you do them improperly, which is actually easy to do if you don’t know what you’re doing. Here are a few tips to keep in mind before starting any stretching program:

DON’T bounce when stretching; hold your position for the specified time.

DON’T stretch cold muscles; always do some type of warm-up for at least five minutes: jogging in place, walking on a treadmill, light jump rope, etc.

DON’T overstretch. There should be a little discomfort, especially if you’re not used to stretching, but it should not be painful.

DON’T stretch a muscle improperly. If you are not sure of the proper stretch or how to perform it, get some assistance from a professional.

By Chelsea Cooper

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You Deserve a (Micro)Break

Microbreaks are short breaks that are taken frequently throughout the workday. Properly used, they can reduce the strain on anatomical structures. They also have been shown to positively affect productivity.1 Obviously, not all jobs or tasks are amenable to the use of microbreaks. But for those that are, they make a great deal of sense.

Microbreak Basics

A microbreak is a break that lasts anywhere from 30 seconds to as long as 5 minutes, and is meant to be taken frequently – as often as every 10 minutes. Evidence suggests microbreaks actually reduce muscle fatigue by as much as 20-50 percent in an eight-hour day.2

It’s important to contrast the microbreak with the traditional break at work. As an example, workers often begin their shift at 8 a.m. Around 10 a.m., they take a scheduled 15-minute break, after which they return to work. At noon or so, they get another break for lunch (also scheduled). They return to their jobs at 12:30 p.m., with another 15-minute break scheduled at some point in the afternoon.

To illustrate the microbreak, I’ll use the following example. When someone uses a manual typewriter (remember those?), regardless of how fast a typist they are, at some point the sheet of paper runs out. The typist must stop the act of typing long enough to put in a new sheet. While this only takes a few seconds, it forces the typist to take a microbreak.

Contrast this to someone using a modern computer, who thus has a never-ending sheet of paper and can type for an indefinite period of time. With that in mind, it’s no real surprise that conditions such as carpal tunnel syndrome are more common in computer users.

microbreak - Copyright – Stock Photo / Register Mark

To offset the effects of constantly striking the computer keys, I’ve long suggested drinking a glass of water every hour. This has significant benefits for the typist. First, it stops the typist long enough to take a microbreak. Second, it forces the typist to stop periodically, leave their computer, walk (to get a new glass of water) and perhaps even go to the bathroom. In other words, it makes them become physically active. Finally and perhaps most importantly, it hydrates the typist, which is always a good thing.

Microbreaks as Prevention

Stanford University provides the following tips to minimize the development of health issues by taking microbreaks and/or changing up your routine3 (I’ve made a few changes):

  • Take microbreaks (approximately 30 seconds to 1 minute in duration) every 10 minutes.
  • Avoid extended periods of continuous tasks (e.g., typing) by taking short breaks or performing other tasks (e.g. filing, talking on the phone, etc.).

It is important to build microbreaks into the daily routine. As such, Stanford also provides the following ideas for making breaks a part of the workday:

  • Move the printer to an area that requires you to stand up and walk to get a printout. (My printer is in another room.)
  • Stand up when talking on the phone (the use of a stand-up desk is also helpful),
  • Go to the restroom or get a cup of coffee / water (frequently; remember the glass of water every hour),
  • Break up continuous computer time with tasks such as checking phone messages, reading reports, etc.

The folks at Stanford also provide the following exercises and stretches as suggestions:

Eyes – Eye strain is particularly problematic for those who stare at computer screens for long periods:

  • Eyes around the clock – Look straight ahead. Without moving the head or straining the eyes, focus on the 1 o’clock position of an imaginary clock placed in front of you. Next, focus on the 2 o’clock and 3 o’clock positions, and so on, until reaching the 12 o’clock position. Repeat the same exercise in a counterclockwise direction.
  • Close both eyes tightly for a second or two and then open them widely (repeat several times).
  • Refocus the eyes momentarily on an object at least 20 feet away.

Neck and Shoulders – We seem to live in an environment that places a constant strain on the neck and shoulders:

  • Shoulder circles – Lift the shoulders toward the head. Pinch the shoulder blades to roll the shoulders back, and let the shoulders drop down to the starting position. Try to move the shoulders in a circular fashion. Repeat.
  • Shoulder shrugs – Lift the shoulders toward the head. Hold for 1-3 seconds and then relax. Repeat.
  • Shoulder pinches – Pinch the shoulder blades together. Hold for 1-3 seconds and then relax. Repeat.
  • Slowly turn the head to the side and hold for 10 seconds. Alternate sides and repeat.
  • Slowly tilt the head to the side and hold for 5-10 seconds. Alternate sides and repeat.

Hands – Problems with the hands and wrists are endemic in the workplace:

  • Catch and release – Clench the fists slowly and hold for a few seconds. Slowly open the hand and spread the fingers. Hold this position for a few seconds and repeat.
  • Flex and extend – Raise the arms out in front with the palms facing down and the fingers flat. Slowly extend the wrists and fingers so they are pointing up. Hold this position for a few seconds. Slowly lower the wrists and fingers so they are pointed toward the ground and hold for a few seconds. Repeat.
  • Place the hands together with the fingers spread apart and fingertips at chin level. Slowly lower the hands, peel them apart and then reverse the process. Repeat.

Low Back – Even though we know more about low back pain than ever, it doesn’t seem to be going away:

  • Stand with hands on the hips and feet about shoulder-width apart.
  • Slowly lean the hips forward while keeping the shoulders slightly back. Hold the stretch for 5-10 seconds.

Chiropractic and Microbreaks

Exercise and other aspects of healthy living have always been a part of the armamentarium of the chiropractic profession. In my classes over the years, I’ve taught that many conditions have multiple causes and multiple solutions. It would appear that the use of microbreaks is one such part of the puzzle. Talk to your chiropractor to learn more.

By Paul Hooper, DC, MPH, MS

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Delayed Muscle Soreness: How to Recover (Without Drugs)

Delayed-onset muscle soreness (DOMS) is a common occurrence. Recovery strategies are designed to reduce pain and recover faster. Let’s explore some of the current research into the most popular and effective recovery strategies, and discuss why you need to balance their use with your overall goals (and after consultation with your doctor, of course).

Massage Therapy

Studies have generally shown massage to be effective for DOMS, reducing pain and in some cases improving function. However, the studies differ in the treatment duration and whether the treatment was performed before, immediately after or 48 hours after DOMS.

One study1 evaluated massage performed for 10 minutes approximately 30 minutes after eccentric exercise. Massage was shown to reduce DOMS by approximately 30 percent, but had no effect on muscle function. A comprehensive review2 asserted that massage may reduce DOMS, but questions whether force recovers more quickly.

A recent study, however, found massage did in fact help with function in the form of gait performance.3 Massage was provided for 15 minutes on the same day DOMS was introduced via isotonic exercises (going up and down stairs). Not only was there a reduction in pain, but also an improvement in gait on the same day DOMS and massage were applied. (It would be have been interesting if the study also had looked at the effects after 48 hours.)

exercise - Copyright – Stock Photo / Register Mark

What about applying massage prior to an intense exercise session? Shagufta, et al. (2014) compared vibration to massage therapy in terms of DOMS recovery.4 Fifteen minutes of massage, applied prior to the performance of an eccentric exercise, was effective in the prevention of DOMS, in addition to restoration of concentric strength (1 RM). However, it had no effect on maximal isometric force.

Massage therapy also was assessed for its impact on relieving muscle soreness 48 hours post-exercise. Andersen L.L., et al. (2013) examined whether massage therapy had any acute effects on muscle soreness, comparing massage to active recovery.5 Massage was provided to the upper trapezius muscle for 10 minutes. Perceived soreness significantly decreased 20 minutes after treatment. However, the effects diminished within the hour. Findings suggest massage is just as effective as active exercise in reducing muscle soreness.

With respect to massage and DOMS, timing of massage sessions need to be taken into consideration. Massage can be applied before, immediately after and over the next 48 hours. In the studies referenced above, the massage sessions provided also were short in nature. Experimenting with longer massage sessions may impact results differently.

A study by Kargarfard M., et. al. (2015) found body-builders who received a 30-minute massage after an exercise session demonstrated a better recovery rate.6 Working with athletes in the field can allow you to perform short massage sessions and have a positive effect on DOMS. In the clinical setting, experimenting with 30- to 60-minute massage sessions may provide better results.

Stretching

Stretching, static stretching in particular, has been used as a “warm-up” prior to exercise, and as a strategy to prevent DOMS. Does it work? The research overwhelmingly points to the answer being no. A Cochrane Review in 2007 included 10 studies and found no evidence that muscle stretching reduced delayed-onset muscle soreness in young, healthy adults.7 The study was updated in 2011 with two additional studies and reached the same conclusion.8

A study by Torres R., et al. (2013) noted favorable effects on muscle stiffness following repeated bouts of stretching days following exercise.9 However, there was no change with respect to DOMS. If the goal is to recover faster from DOMS, stretching may not be the best strategy to use. In recent years, there has been a shift in focus from static stretching to dynamic exercises in reducing DOMS. Again, timing may be the ultimate factor in its effectiveness.

Cryotherapy

Various cryotherapy strategies, such as ice packs, cold-water immersion and recently, whole-body cryotherapy, are quite common practices in rehabilitation and sports performance recovery. Their effects on DOMS are well-known. A recent systematic review by Hohenauer E., et al. (2015) confirmed that cryotherapy reduced DOMS up to 96 hours post-exercise and RPE (ratings of perceived exertion) up to 24 hours compared to passive controls.10 However, the use of cryotherapy may need to be assessed depending on what the ultimate goal is.

A recent study by Roberts L.A., et al. (2015) looked at the effects of cold-water immersion on long-term adaptations in muscle to strength training.11 Results showed that cold-water immersion attenuated long-term gains in muscle mass and strength. Although you may get better recovery, you could be sacrificing long-term strength and muscle gains. If this is the case, what other strategies can we utilize to maintain muscle and strength?

Active Exercises

Lower-intensity exercises prior to a maximal eccentric contraction may provide benefit against muscle damage. Lin M.J., et al. (2015) evaluated whether low-intensity eccentric contractions (performed with a load of 10 percent of maximal voluntary isometric contraction strength with reps in the 30 to 60 range) could protect against muscle damage.12 Results showed a 30-66 percent protection against muscle damage induced by maximal eccentric exercises. The protective effect lasted one week.

What about maximal isometric contractions? A study by Lima L.C., et al. (2015) found maximum isometric contractions performed 2-4 days prior to a demanding eccentric exercise provided a protective effect from post-exercise soreness.13 The authors recommended putting patients through these non-damaging isometric exercises prior to putting patients through unaccustomed exercises.

Chen H.L., et al. (2012) reached similar conclusions, finding two maximum isometric contractions performed two days before eccentric training could be an effective strategy to minimize muscle damage.14

Take-Home Points to Discuss With Your Doctor

Various recovery strategies can help your athletes recover faster. Massage therapy, cryotherapy, stretching and active exercise all appear to provide some form of relief from DOMS. However, while some may improve DOMS, they also may stunt muscle strength, power or growth. Timing of these strategies is also important. A certain strategy may work best after an exercise session or two days prior. As you can see, there are no straight answers to what works and what doesn’t.

In some cases, such as when using cryotherapy, new research is showing the benefits of recovery need to be weighed against long-term impact on muscle strength, power and hypertrophy. Applying massage therapy is practical before, during and after a training session, since the 15-minute time frame has been shown to be effective. Static stretching by itself may not be the best use of a patient’s or athlete’s time when other strategies are more effective. Finally, the use of isometrics is an important strategy to prepare you for the stresses of a more intense exercise program.

By Jasper Sidhu, BSc, DC

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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

Fatigue schedule maintenance - Copyright – Stock Photo / Register Mark

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

Fatigue fuel up - Copyright – Stock Photo / Register Mark

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

Fatigue top off fluids - Copyright – Stock Photo / Register Mark

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

Fatigue systems check - Copyright – Stock Photo / Register Mark

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

fatigue - Copyright – Stock Photo / Register Mark

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.

junk food - Copyright – Stock Photo / Register Mark

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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