Blog about Physical therapy , health and wellness

Consider the Source- how to know whom and what to trust with your health

1/21/2020

You’re faced with a health concern you can’t quite figure out on your own. Maybe you have a bacterial infection, or perhaps a tendon is aching from all the running you’ve been doing. Where do you turn for help? What reasoning do you use to discern what to believe and trust among all the voices vying for your attention?

In the day and age of concepts such as “fake news”, many people are left with the (fortunately erroneous!) impression that there is no consensus in the health sciences either. This article is intended to help you approach taking care of your body, in sickness and health, and finding the help you need to do so, in the most logical and effective way, and in the process help you avoid the many potential pitfalls along the way.

When it comes to the serious infection, most people tend to turn to a medical doctor. They know that by doing this they have chosen a professional that is a graduate of a rigorous program and who will base their recommendation —probably a course of antibiotics — on scientific evidence, not on best guesses or hearsay, or on what some other person told them.

This practice, basing your actions on scientific evidence in addition to the traditionally honored
practices of clinical knowledge and the patient’s desires, is called Evidence Based Practice.

Evidence Based Practice therefore strongly incorporates and emphasizes the scientific method; systematically testing a hypothesis and drawing conclusions based on the findings. Once such as study has been performed, scientists seek to publish their findings in the form of a scientific paper in a peer-reviewed journal. Many different studies then accrue over time, and other scientist authors summarize these many studies into one, and draw conclusions based on these. If 20 studies point to A, and only one, poorly designed, study points to B, we have good reason to conclude that A is correct. We don’t, however, rest on out laurels, and scientific evidence is continuously accumulating, ever refining and enhancing our understanding.

Experts back their claims with scientific references

The above system also leads to a hierarchy of evidence where the opinion of an expert ranks the lowest and systematic reviews the highest. The latter is also what is later used to base practice guidelines on for various types of practitioners, and any “expert” worth listening to also continually refers to the highest levels of evidence to back their claims.

Even lay persons can access many of these scientific papers eg on Pub Med https://www.nlm.nih.gov/bsd/pubmed.html .PubMed is a free resource provided by the NIH for peer-reviewed biomedical and life sciences literature “with the aim of improving health – both globally and personally.”

Unfortunately, the lay press often contributes to the confusion by focusing on individual case control studies and expert opinions, creating among their readers the impression that our scientific consensus is weak and ever changing.

Because.... science

All this means that when you are turning to your medical doctor for help with that serious infection, you can rest assured that her or his recommendation is based on sound scientific evidence, not tradition, guesswork or dogma. You certainly wouldn't have someone with self-proclaimed surgical expertise remove your gallbladder. You'd insist on a professional with a degree proving his or her expertise. This is the rigor with which you arguably should approach all aspects of your healthcare. Scientist have gradually worked to understand physiology, biochemistry etc, other scientists have critiqued and refined their work, and a large body of evidence has accumulated. Your physician has not only received a specific degree based on this, but is also receiving periodic updates to their practice guidelines. All this to make sure that your care is up to date, based on the best of our knowledge today, not on assumptions an not on beliefs that were held 20 years ago.

How about that aching tendon then? When it comes to musculoskeletal issues, there are many, mostly well-intentioned individuals who, thanks to the world-wide web, have found an unprecedented outlet for their creativity. While, in the times before personal computers, only credentialed individuals with formal expertise in any given area were given a platform, usually in the form of publishing a book on any given topic, today anyone with a computer can post videos on Youtube or create entire websites dedicated to their ideas. Any self-proclaimed guru with enough marketing savvy can easily reach an audience large enough to create a course, claiming to certify (usually after a brief course of study), that the certified individual possesses some type of expertise (has become a certified practitioner or expert of this or that).

Convincing as this may sound, a brief course on any given topic doesn’t come anywhere near the knowledge base of a practitioner with a multi-year formal academic degree, based on a rigorous science-based program. Unfortunately this is not always obvious to the unsuspecting audience, which instead may be influenced by a convincing tone or a captivating video. Appearances matter a lot these days, and coming up with a catchy name or slogan goes a long way - just not towards creating good health.

Don’t fall for easy tricks and simple claims - your body is not simple

The greatest enemy of truth, however, tends to be our increasing appetite for simplistic explanations, concepts that can be grasped immediately, without the pre-existing context of a scientific understanding. But the human body is incredibly complex, and any intervention, any concept, any approach that is based on actual scientific evidence is therefore, by definition, going to be complex, not something that is easy to generalize and sell. And at the end of the day, Mother Nature follows her own rules, and only by following those rules can we safely obtain the results we are looking for.

So, with the infection cured by antibiotics, to once again be able to run without pain or injury in that tendon, you need to find out how to proceed. Should you look to various movement practices? Will yoga have the secret sauce? Should you, as your friend recommends, simply rest, because running, she says she's heard, is bad for you anyway? Is there one simple trick you need to find somewhere?

Fortunately, while you may not be sure how to proceed, as your area of expertise may lie elsewhere, science does. While there is a lot left to learn, we do know quite a lot about tendons, and we do not need to waste time, as the saying goes, “throwing some stuff at a wall to see what sticks,” trying various dogmatic approaches that claim that their movement philosophy is the cure-all.

We know that tendons have a certain ability to accept and transmit load (eg the pulling force through it as you’re running). We know that tendons, over time, change according to the load you place on them (inactive people have thinner tendons and ligaments than people who place a great load on their tendons, eg by running or lifting weights). We know that tendons ail (we call this tendinopathy) when the forces we place on them exceed their strength, and their ability to repair overnight. We know that to heal tendinopathy we need to temporarily decrease the load while gently stimulating the tendon to grow stronger.

These basic facts are no less true, but actually more so, in specific cases such as chronic pain, joint hypermobility syndromes, aging etc. Individuals that fit into these categories need to take even greater care to be guided by properly trained healthcare
professionals.

Consider the source

Can those two funny guys you found on youtube guide you through this? Maybe, although unlikely, but how can you tell whether what they are saying is correct or not? You consider the source, and the sources your source uses. If that sounds complicated, here’s what it means. You consider what, if any, credentials the individual has. Have they gone through a long academic program in order to obtain a, preferably terminal, degree specific to the claims they are making? Are you listening to a DPT (Doctor of Physical Therapy), MD (Medical Doctor, preferentially with a specialization in orthopedics of physiatry), DO (Doctor of Osteopathy), DC (Doctor of Chiropractic) or ND (Naturopathic Doctor), or are you listening to someone who never mentions their credentials because they don’t have any?

If the latter is the case, you are most likely placing your health in hands that lack the requisite competence. I have the utmost respect for autodidacts, and to a certain extent we all have to be responsible for broadening our scope of knowledge and understanding in order not to endanger patients through the almost absurd degree of specialization that exists in health care today. Certainly not all knowledge that is worth sharing has to obtained through formal education. But in order to gain your trust, your source should always at least be able to tell you why they are making the claims that they are. “Everyone knows”, “I’ve noticed” or “I learned this from someone I really trust” are not scientifically valid arguments.

So here are some things to think about and look for when you are about to place what is arguably one of your greatest assets, your health, in the hands of someone, trust their claims and follow their advice:

Does this person have actual formal, academic credentials (see above). You simply cannot learn enough from a brief, cursory class or certification program.

Does this person stay up to date? Many degreed professionals unfortunately do not have the time , money or inclination to continuously update their practice with recent knowledge, and continue practicing the way they were taught to, decades ago.

Does this person refer to either accepted practice guidelines, and, preferably, to specific high-quality studies to back their claims?

Is what this person is saying specific to you? Remember, the human body is complex, and no intervention, action or idea is ideal for everyone at all times.

Does the suggested intervention help you understand how you should proceed and progress?
Are you sure that your problem actually is what you think it is? A non-healthcare provider does not necessarily possess the necessary skills to diagnose you.

Nice does not equal knowledgeable. We all want to interact with people we like, that have good intentions. But we need to take care not to conflate these admirable qualities with the possession and dissemination of actual scientifically valid information.

When reading an article, again, look for references. If the author doesn’t offer any scientific references for scientific claims, do not trust the content. At best, it now serves as an inspiration for further learning and research on your part. Unfortunately, even many authors of both articles and books pad their work with false references (references to studies that do not actually substantiate their claims) in order to lend it a false sense of credibility, so proceeding with caution is always prudent. An excellent source for judging the validity of claims in health-related books is Red Pen Reviews.

Once again, the body is complex, and those of us who have devoted years of study and practice to understanding the body are in awe of its complexity and ingenuity. We do not believe that there are easy and quick fixes, nor do we advocate one size fits all approaches. We stay attentive to new research as it emerges and make changes to our clinical practice accordingly. And when our patients ask us for advice, and ask us where our information originated, and why we make the claims we do, we can usually refer to science. We make a clear distinction between our clinical observations and practice guidelines, whether we agree with them or not.

Most of all, we value the knowledgeable patient, and always strive to both educate our patients and help them become a discerning and educated audience for health-related claims, whoever is making them. To this end, our patients have to understand how we arrive at our conclusions, claims and practices. They have to understand the basic structure of the scientific process and it’s clinical application. My hope is that this article has been helpful with that.

To your health, and your knowledge and understanding thereof!

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The four cornerstones of health - #2: FOOD

1/9/2020

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Few topics stir as many emotions and awaken as much fear, hope, confusion and even judgement as our diet. The overabundance of opinions, dogma and conflicting claims repels and confuses us, yet we, justifiably so, feel the need to make sense of it all. We have always known that diet is indeed one of the cornerstones of good health. The founder of western medicine, Hippocrates, well over two thousand years ago strongly emphasized the fundamental role of food and exercise in health. Food is also one of our greatest sensory pleasures, one that brings people together and celebrates our connection to the natural world.

To sort it all out, let’s first consider why we eat, and why we should pay attention to what we eat, in the first place. Food serves several functions: it acts as a source of energy for the body, it serves as a building block for our constantly renewing tissues and it gives us ingredients that facilitate various other processes in the body, among them thinking, hormonal function, reproduction etc. But in a time of relative abundance, we tend to turn our attention from these important roles and focus more on the shadow side of food; the fact that, when eaten in quantities larger than what we need, it can wreak havoc on our bodies and cause negative effects such as obesity, inflammation, and diabetes. This often colors out relationship with food and leads us to think of it not as a life sustaining force but as something of a threat. “Are eggs bad for me?” we ask. “Will carbohydrates harm me?”, “Will eating meat give me a heart attack?”.

As is true for most choices in life, choosing our diet based on fear, without a clear paradigm, can have us running back and forth like a ball boy at a tennis match, vegan this day and keto the next, enthusiastic about the newest food religion one day, fearful that we may still not be getting enough of the latest superfood the next. Choosing a diet based on what it doesn’t contain is arguably not enough. Thinking instead about what our bodies actually need (the “macronutrients” fat, protein and carbohydrate as well as “micronutrients” such as vitamins and minerals), and how to get enough of each type is the only logical and comprehensive approach.

Humans evolved over a very long period of time eating an omnivorous diet, consisting of a wide variety of plant foods and animal foods, sometimes with a bit more to eat, sometimes going for a little while without food. While our genes haven’t had time to change much (read: we still thrive on a very similar diet to the one we evolved with) there have also been some relatively recent changes in our genome, and as opportunistic omnivores we inarguably have much more leeway when choosing what to eat than a single-plant eating panda bear.

While there is no need to buy into the latest egg or lectin scare, there are some things that make their way into our food that we would do better without. These include certain, potentially problematic, (inflammatory, neurotoxic, xenoestrogenic, carcinogenic) non-food aspects of the modern diet. They have less to do with the food items we eat and more to do with how we grow and handle our food. Modern additions to our diet that we did not evolve to tolerate well include things like vegetable seed oils (sunflower-, corn- and safflower oils etc), synthetic trans fats, an abundance of processed acellular carbohydrates, an abundance of refined sugar, pesticides, food coloring, preservatives, pasteurization, and so on. We would do best to view these more recent additions to our lives as science experiments we choose not to participate in. Uniquely nutritious food items no longer ubiquitous in our diet include organ meats and collagen-rich organs like bone, skin and tendons, and making up for this loss may support optimal health.

While science is usually a good starting point for understanding our world, food science is unfortunately not best known for its rigor and quality. Fortunately we do know a great deal about the human body and what it needs, and can most certainly nail down some basic facts. Instead of looking to self-proclaimed gurus espousing complicated diets based on the purported dangers of this or that food item, we might do better to look to our ancestors and our bodies for answers.

Let’s take a big step back and consider a few facts:

We need protein, fat and carbohydrate (fiber is a form of carbohydrate).
Our carbohydrate need isn’t static. More carbs are needed by physically active people, less by sedentary individuals. The best carbs come attached to fiber (vegetables, berries, fruit, legumes, whole grains).
Our protein need isn’t static. We need less protein when we are young (0.8g/kg of bodyweight) and more when we are recovering from injuries or surgeries or dieting, or over 65 years of age (1,2g/kg).
Everyone, but especially people recovering from injuries, surgeries and individuals with joint hypermobility, would probably benefit from adding more collagen to their diets.
If you follow a diet that is based on eliminating certain basic food groups, be consistent with supplementation of nutrients that are missing in your diet. As an example, vegan diets need to be supplemented with fat soluble vitamins like A and D, vitamins such as B12 and riboflavin and minerals such as zinc.
We also need time away from food. A nightly fast of 12-16 hours has been shown to have great health benefits.
Our water supply has also changed. It can be beneficial to remineralize the water we drink, and this is especially important for individuals that sweat a lot during heat or exercise, drink alcohol or suffer from low blood pressure or POTS.

There you have it. Like the author Michael Pollan famously said: “Eat food, not too much, mostly plants.” Get enough protein, including collagen, good, natural fats, plenty of plant foods. Consider who you are (your age, activity level, injuries and recovery, body type etc) and choose your macro- and micronutrients accordingly. Eat fresh, organic, grass fed - you know, whatever your great grandparents would have recognized as food. Avoid unnecessary chemicals such as pesticides, preservatives and food coloring whenever you can, and listen to your body.

Love food, don’t fear it, and it will love you back.

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The four cornerstones of good health - #1: SLEEP

1/6/2020

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In a world where we are swimming in a sea of advice and admonitions, how do you sort through all the information? How do you decide what is relevant to you, and make good use of it?

Seemingly contradictory advice abounds, threatening to confuse the most analytical mind. Should you try the carnivore diet, go vegan, or fast? Should you follow your own daily rhythm and stay productive until the wee hours of the night, or go to sleep when the sun does?

What is often lost in the rush to present a never-ending stream of new, fresh ideas is the fact that there are some unchanging foundational requirements for health. This a basic principle that no new dogma, product, or guru can change.

80 percent of results come from 20 percent of foundational effort

The 80/20 rule, also known as the Pareto Principle, states that 20 percent of the effort you put into any endeavor leads to 80 percent of the results, and conversely, that 80 percent of your effort only leads to an additional 20 percent gain. How does this apply to your search for health and well-being? It means that you get most of the benefits from a few simple things. After these fundamental requirements are met, we benefit relatively little from adding the latest exotic bells and whistles. It therefore stands to reason that we should be paying much more attention to the basics, and much less to the siren song of the new, the expensive, the popular or the latest health fad.

So what are these fundamental principles, our 20 % that will give us 80% of the benefit? The four cornerstones of health are sleep, diet, exercise, and the health of your mind.

Let’s start with sleep, and cover diet, exercise and the mind in subsequent posts.

“There is a time for many words, and there is also a time for sleep.”
― Homer, The Odyssey

Deep sleep is when tissues rebuild and repair themselves. Sleep deprivation therefore impairs your body’s ability to sufficiently regenerate tissue overnight. Accumulating un-repaired tissue damage leads to pain and soreness, and may even over time contribute to a diagnosis of fibromyalgia, or simply looking like, well, you know what. As mentioned in a previous post, sleep is also a time when the brain is cleansed from metabolic waste, making sleep not just one of the best tools for rebuilding the body, but also the brain, protecting us from everything from unhappiness to dementia. Artificial light at night, the light pollution that seeps through our curtains while we sleep, has been found to contribute to breast and prostate cancer, obesity and depression.

Sleep is not only a time for your brain to recover from the events of the day, but also for new information (for example, those new exercises you’ve been doing) to be consolidated into long-term memory. And honestly, the very last thing you need when dealing with the demands of your career, your young children or a surreptitiously aging body, is one of the most reliable outcomes of poor sleep quality, the significant negative effect it has on energy and mood. So here, shortlisted for your convenience are the ingredients of good sleep. These are fundamentals that the night owls among us need to adhere to even more strictly than others, as their circadian rhythm more easily is disrupted by artificial light at night.

The ingredients of a good night’s sleep

Expose your eyes to bright light first thing in the morning and during the day.
Eat during daytime hours, not late at night.
Avoid bright, “blue” light after sundown. Instead, use orange light bulbs in your fixtures and wear orange glasses to shield your eyes from the light of the TV or other backlit screens. They even come as clip-ons for your reading glasses!
Sleep in a completely darkened room. If you can see your hand in front of your face, there is too much light. Blackout curtains are a must!
Keep the bedroom cool and your sleep schedule somewhat predictable.
Use a supportive, not ultra-soft mattress. Turn it around periodically to ensure that it remains supportive and keeps your body from sinking into the mattress during the night.
Use only natural sleep aids, if needed. Good habits, calming herbs, and supplemental glycine (a sweet-tasting amino acid that at a dose of 3-6 grams at bedtime deepens sleep and helps build collagen) are better than pharmaceutical drugs. Sleep researcher Matthew Walker, PhD, at University of California, Berkeley, cautions that drugs do no create true sleep.

If you have been lax with your sleep hygiene, kept late hours or have suffered from insomnia for a while, keep in mind that it does take time for us to change habits and expectations. Make positive choices and give them several weeks to gradually work their magic. Remember, good health is not the result of easy shortcuts but of lifelong, conscious habits.

Now that is something worth sleeping on!

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Consider the Source- how to know whom and what to trust with your health

The four cornerstones of health - #2: FOOD

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