Emergency Treatment for Calf Cramps

August 18, 2015 by Dr. Steve Chaney

To Stretch or Not To Stretch

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

A calf cramp is caused by several different conditions, such as dehydration and mineral deficiency. These each need to be addressed to prevent future calf cramps, but when your calf spasms wake you with a jolt at night or send you crashing to the ground in agony, you need a solution NOW!

And, stretching is definitely NOT the first thing to do.

Emergency Treatment for Calf Cramps

A muscle always contracts 100% before releasing. Once started, a calf cramp will not partially contract and then reverse because you stretch, as it may cause the muscle fibers to tear, which will cause pain to be felt for days afterward.

As a result, it is most beneficial to help your muscle complete the painful contraction before you try to stretch it. It sounds counter-intuitive, but it cuts the time of the calf cramp down, and enables you to start flushing out the toxins that formed during the sudden spasm.

Your muscle will be all knotted up, screaming in pain, so it’s good to practice this self-treatment when you are not having a calf cramp.

Grab your calf muscles as shown in this picture. Hold it tightly, and then as hard as you can, push your two hands together.

The intention is to help the muscle complete the contraction as quickly as possible. During an actual calf cramp it won’t be as “neat” as the picture shows, but anything you can do to shorten the muscle fibers will hasten the completion of the spasm.

Follow These Steps To Release Your Calf Cramps

Hold your hands and continue pushing the muscle together until you can begin to breathe normally again. Continue holding it another 30 seconds, bringing in as much oxygen as possible with slow, deep, breathing.
Release your hands and keep breathing deeply.
Repeat #1. This time it won’t hurt, but you are helping any last muscle fibers to complete the contraction before you move to release the spasm.
Begin to squeeze your entire calf as if you were squeezing water out of a thick towel. Move from the top of your calf and go down toward your ankle. This will feel good, so do it for as long as you can.
It is now safe to stretch your calf muscle because the cramp has completed and you have flushed out the toxins. Stretch slowly, and don’t go past the point of “feels so good”. You don’t want to overstretch.

This calf cramps emergency treatment has been proven successful by endurance athletes who have written to me saying how they could continue their race (or training) without any further pain.

This is a very important tip to share with all athletes. Please tell your friends on Facebook and Twitter, it helps athletes prevent injury and pain.

Wishing you well,

Julie Donnelly

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

Hamstring Stretches

July 21, 2015 by Dr. Steve Chaney

What To Do For Tight Hamstrings

Author: Julie Donnelly, LMT –The Pain Relief Expert

Editor: Dr. Steve Chaney

You are about to begin your run, or maybe you have just finished running. Your hamstring feels really tight. Maybe it is even painful. It seems obvious that you need to stretch it, but that could be exactly the wrong thing to do!

You Need To Release Muscle Fiber Knots Before You Do Hamstring Stretches!

Stretching can be dangerous if the muscle is shortened by spasms. A spasm (also called a muscle knot or trigger point) is like tying a knot in the center of the muscle. And while each spasm may only involve a few fibers; there can be multiple spasms throughout the muscle.

Each spasm feels like a bump when you slide your fingers deeply down the length of the muscle. These spasms normally form over an extended period of time, often from repetitive strain on the muscle fibers.

Muscle Spasms Are At The Heart of the Stretching Misconception

It is important that you think of a spasm as a knot in the muscle fibers in order to understand why it can hurt to stretch.

A muscle begins on a stationary bone, crosses over a joint, and then inserts into a moveable bone. When the muscle pulls on the moveable bone, the joint moves, however, if the muscle has a “knot” in it you can cause micro-tears to the fibers as you stretch.

As you stretch, knots within the muscle get tighter, this also causes the fibers on either side of the spasm to overstretch. Overstretching can cause fiber tears either along the length of the muscle or where the fibers attach to the bone. In most cases this can be avoided by simply applying pressure to the muscle to release the spasm before you stretch.

What Do Hamstrings Do?

Your hamstrings are responsible for bending your knee. Every time you take a step, sit down, or climb stairs, you contract your hamstrings.

The only time your hamstrings aren’t contracting is when you are standing up straight. This means they are frequently repetitively strained and contain multiple spasms along the muscle fibers. These tight muscles put a strain on the back of your knee and at the origination point (the bottom of your posterior pelvis).

What Causes Tight Hamstrings?

The hamstrings are a bit unique from other muscles because while they can certainly have spasms in the fibers from repetitive strain injuries, they are also overstretched because of two major muscles that rotate the pelvis down in the front.

The two muscles that cause tight muscles to be overstretched are the iliopsoas (a muscle on the front side of the lumbar vertebrae) and the quadriceps (front of the thigh).

As these muscles get tight, primarily from sitting, they cause the pelvis to rotate forward and down. As your pelvis rotates down in the front, it rotates up in the back.

Since your hamstrings originate on the bottom of the posterior pelvis, as it is moving up, the muscle fibers are already overstretched – so you don’t need to stretch them further. In fact, if you stretch them they could potentially tear.

What Should You Do Before Your Hamstring Stretches?

It’s actually a 3-step process. The key is to release tension in the front of the body before you can safely stretch the hamstrings.

First you need to release the tension in your quadriceps, this will take the tension off the front of the pelvis. You do this by rolling out your quadriceps muscles which releases trigger points (muscle spasms).

Next, stretch your iliopsoas. A low lunge is a great way to stretch the iliopsoas. This causes the pelvis to rotate up in the front and down in the back. As that happens tension is removed from the hamstrings.

Now you can release the spasms in the hamstrings. You do this by sitting on a trigger point therapy ball, ironing out your hamstrings. Stay on specific points of pain; these are the knots in the muscle fibers you need to release. The direct pressure forces out the toxins, draws in blood and causes muscle fibers to lengthen.

Releasing muscle knots in your quadriceps, stretching your iliopsoas and releasing muscle knots in your hamstrings MUST be done before you can safely perform your hamstring stretches.

Do yourself a big favor and take these short steps; you will notice a difference!

Wishing you well,

Julie Donnelly

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

About The Author

Do Omega-3s Prevent Age-Related Muscle Loss?

June 23, 2015 by Dr. Steve Chaney

Does Fish Oil Build Muscle?

Author: Dr. Stephen Chaney

Omega-3-rich fish oil supplements have attracted their share of controversy in recent years, but there appear to be lots of reasons to make sure that you get enough omega-3s from your diet.

There is actually pretty good evidence that omega-3s offer a natural approach for people who wish to lower their blood pressure (https://chaneyhealth.com/healthtips/do-omega-3s-lower-blood-pressure/) or heart attack risk (https://chaneyhealth.com/healthtips/fish-oil-really-snake-oil/). There is also some evidence that omega-3s may be important for brain development in infants (J Protzko et al, Perspectives on Psychological Science, 8: 25-40, 2013), for mental performance in children (https://chaneyhealth.com/healthtips/omega-3s-improve-reading-skills/) and for preventing cognitive decline in the elderly (https://chaneyhealth.com/healthtips/omega-3s-slow-cognitive-decline/).

If the latest headlines are to be believed, we can add preventing age-related muscle loss to the benefits of an omega-3-rich diet.

Why Is Age-Related Loss of Muscle Mass a Problem?

The term for age-related muscle loss is sarcopenia, and it is a big problem for older adults. After age 50 we lose 1-2% of our muscle mass each year. As you might expect, our strength declines as well. Each 1% loss of muscle mass translates into about 1.5% loss in strength. That means after age 50 we lose 1.5% of our muscle strength each year, and once we hit 60 the rate of loss increases to around 3% per year.

That may not sound like much on an annual basis, but it adds up over time. With a little bit of higher math you can calculate that you could easily have lost 45% of your muscle strength by the age of 70 and a whopping 75% by the age of 80. At that point even the simplest physical activities – lifting a grandchild or a bag of groceries – can become challenging. That loss of strength also contributes to a loss of balance that can lead to debilitating falls.

The most effective way of preventing age-related muscle loss is regular resistance training, especially when coupled with adequate intake of protein and leucine (https://chaneyhealth.com/healthtips/protein-needs-for-older-adults/). However, resistance training is hard work, so many older adults gravitate to quick fixes like testosterone, growth hormone, or DHEA – even though each of those treatment regimens have significant side effects and risks.

That’s why the recent headlines suggesting that a risk-free approach like omega-3 supplementation might increase muscle mass and strength in older adults is so enticing.

Do Omega-3s Prevent Age-Related Muscle Loss?

A previous study had suggested that omega-3 supplementation enhanced the effect of strength training in elderly women (Rodacki et al, AJCN, 95: 428-436, 2012). Although the mechanism of that effect is unclear, the authors of this study decided to go one step further. They asked if omega-3 fatty acids might prevent loss of muscle mass even in the elderly in the absence of a structured exercise program (Smith et al, AJCN, doi: 10.3945/ajcn.114.105833, 2015).

The study consisted of 44 men and women age 60-85 (average age 69) who were not exercising on a regular basis. They were given either 4 gm of fish oil (containing 1.86 gm of EPA and 1.5 gm of DHA) or a placebo containing corn oil each day for 6 months. Muscle mass and four measures of muscle strength were performed at the beginning of the study and again at 6 months. The measures used were thigh muscle volume (a measure of muscle mass), hand grip strength, overall muscle strength (the maximum weight that the subject could lift in a single repetition for leg press, chest press, knee extension, and knee flexion) and isokinetic power (the power attained in knee extension and flexion exercises). The results were pretty impressive for the omega-3 group compared with the control group:

Thigh muscle volume (muscle mass) increased by 3.6%

Handgrip strength increased by 6%.

Overall muscle strength increased by 4%.

Isokinetic power increased by 5.6%.

Other than complaints about fishy breath, there were no adverse effects in the omega-3 group.

The authors calculated that the increase in muscle mass and strength during 6 months of omega-3 supplementation was sufficient to offset 2-3 years of normal age-related muscle loss and strength loss.

The increase in muscle mass and strength associated with omega-3 supplementation was less than can be attained from regular resistance exercise coupled with adequate protein intake. However, it was the same or greater than could be obtained from testosterone, growth hormone or DHEA – and didn’t have the risks associated with those treatments.

For example, a recent study has concluded that testosterone injections are associated with a significant risk of stroke, acute coronary syndromes, hospitalization and death (Layton et al, JAMA Internal Medicine, doi: 10.1001/jamainternmed.2015.1573).

The authors concluded ”Fish oil-derived omega-3 therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.”

Limitations of the Study

Before you all run out and stock up on fish oil supplements, I should point out that this study has several limitations.

It is a very small study. It needs to be replicated by future studies.

It used a very high dose of fish oil (4 gm/day). High doses are often used in an initial study like this one just to establish whether there is an effect worth further study. However, this study needs to be repeated at lower doses to see if this benefit of omega-3 supplementation is also seen at more physiological doses (500 – 1,000 mg) of omega-3s.

Because of these limitations, I am not yet ready to agree with the authors that omega-3 supplementation “…should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults.” This is an interesting finding that holds the promise of an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.

There are many reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength.

However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives.

The Bottom Line

A recent study has suggested that omega-3 supplementation may prevent age-related loss of muscle mass and strength. The study was performed in both men and women age 60-85 who were not exercising on a regular basis.

Omega-3 supplementation was less effective than regular resistance exercise coupled with adequate protein intake, but equal to or greater in effectiveness than testosterone, growth hormone, or DHEA treatment.

This was a very small study and it used a very high dose of omega-3s. It is a promising finding because it represents an inexpensive, risk-free, natural approach for maintaining muscle mass in older adults, but it needs to be verified by future studies before it can be widely recommended.

There are many good reasons to supplement with omega-3s, but at this point in time I would definitely not recommend fish oil supplementation as an alternative to resistance exercise and adequate protein intake for older adults who wish to prevent age-related loss of muscle mass and strength. Resistance training combined with adequate protein is a proven intervention. Omega-3 supplementation is not.

However, the health risks of testosterone, growth hormone, and DHEA supplementation are significant. For someone who is absolutely set on pursuing an exercise-free solution to maintaining muscle mass and strength as they age, I would recommend omega-3 supplementation first rather one of the riskier alternatives. It might just work, and it is a lot less risky.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Protein Needs For Older Adults

February 10, 2015 by Dr. Steve Chaney

How Much Protein Do We Need?

Author: Dr. Stephen Chaney

What are the protein needs for older adults? In previous “Health Tips From the Professor” I have covered the optimal amount of protein for weight loss diets in high protein diets and weight loss and following workouts . In this issue of “Health Tips From the Professor” I will review the latest information about protein needs as we age.

To put this in perspective, many Americans suffer from sarcopenia (loss of muscle mass) as they age.

Some of you may be saying “So what? I wasn’t planning on being a champion weight lifter in my golden years.” The “So what” is that loss of muscle mass leads to loss of mobility, a tendency to fall (which often leads to debilitating bone fractures) and a lower metabolic rate – which leads to obesity and all of the illnesses that go along with obesity.

How Can We Prevent Loss of Muscle Mass As We Age?

Fortunately, sarcopenia is not an inevitable consequence of aging. There are things that we can do to prevent it. The most important thing that we can do to prevent muscle loss as we age is to exercise – and I’m talking about resistance (weight) training, not just aerobic exercise.

But we also need to look at our protein intake and our leucine intake. Protein is important because our muscle fibers are made of protein.

Leucine is an essential amino acid. It is important because it stimulates the muscle’s ability to make new protein. Leucine and insulin act synergistically to stimulate muscle protein synthesis after exercise. I have covered the evidence behind leucine’s importance in maintaining and building muscle mass in a previous “Health Tips From the Professor”, Leucine Triggers Muscle Mass.

Do Our Protein Needs Increase As We Age?

Interestingly, our protein needs actually increase as we age. Campbell et al (Journal of Gerontolgy: Medical Sciences 56A: M373-M380, 2001) showed several years ago that RDA levels of protein were not sufficient to maintain muscle mass in both men & women aged 55 to 77 years old.

Many experts recommend that those of us in our golden years should consume the amount of protein in grams that is equivalent to half our body weight in pounds every day.

When Should We Eat Our Protein?

When we consume the protein is also important. Forget that continental breakfast, salad for lunch and protein-rich dinner. As we age we increasingly need high quality protein at every meal.

In one study, young adults (average age = 31), experienced increased muscle protein synthesis when they consumed as little as 15 grams of protein at a meal, but older adults (average age = 68) experienced no increase in muscle protein synthesis in response to the same low protein meal (Katsanos et al, Am J Clin Nutr 82: 1065-1073).

However, when the amount of protein in a meal was increased to 30 grams (equivalent to a 4 oz piece of chicken or beef) both younger and older adults were able to use that protein to build muscle (Symons et al,Am J Clin Nutr 86: 451-456, 2007).

But, 30 grams seems to be about optimal. Protein intakes above 30 grams in a single meal resulted in no further increase in muscle protein synthesis (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009), which means you can’t hope to get all of the muscle building benefits of protein in a single meal.

As a consequence of these studies most experts recommend that we “golden agers” aim for 20 to 30 grams of high quality protein with every meal.

How Much Leucine Do We Need?

The story with leucine is similar. 1.7 grams of leucine was not sufficient to increase muscle protein synthesis following exercise in older adults, while 2.7 grams was sufficient (Katsanos et al, Am J Physiol Endocrinol Metab 291: E381-E387, 2006). So the experts recommend that older adults get 3 grams of leucine in our diet following workouts to maximize the effect of the workout.

And, of course, if we want to maximize the effects of resistance training, both the protein and leucine need to be consumed after we exercise, not before (Fujita et al, J Appl Physiol 106: 1730-1736, 2009).

Where Do We Get the Protein and Leucine We Need?

So, where do we get the amount of protein and leucine that we are looking for?

If you want to get them from food alone, 4 oz servings of meat are a good starting place – with chicken being the best (35 grams of protein and 2.7 grams of leucine). Dairy, eggs and vegetable foods are much lower in leucine, protein or both.

Unfortunately, I keep running into seniors who are fully convinced that broccoli and tofu will meet their protein needs. I fully understand the rationale for choosing vegetarian protein sources, but you need a bit more than broccoli and tofu if you are going to meet your protein needs in your golden years.

For example, a 4 ounce serving of tofu provides only 10 grams of protein and 0.8 grams of leucine, and a 1.5 cup serving of broccoli provides only 4.2 grams of protein and a miserly 0.36 grams of leucine. That makes it very difficult to meet your target of 20-30 grams of protein and around 2.7 grams of leucine with each meal.

I’m not saying that you can’t get enough protein and leucine to maintain muscle mass on a vegetarian diet. However, you will need to plan that diet very carefully.

So, if you want to know what the old professor does, here it is:

I work out almost every day. On the days when I work out in the morning I rely on a protein shake immediately after the workout to meet my protein and leucine goals. On the days when I train at the gym in the late afternoon, I rely on 4 oz of chicken or fish with dinner to meet those goals.

Those of you who know me know that I will never be featured in muscle magazine, but at least I’m gaining muscle mass – not losing it.

The Bottom Line

As we age many Americans suffer from sarcopenia (loss of muscle mass). The loss of muscle mass leads to loss of mobility, a tendency to fall (and break things) and a lower metabolic rate – which leads to obesity and all of the illnesses that go along with obesity.

The most important thing that we can do to prevent muscle loss as we age is to exercise – especially resistance (weight) training exercise – at least 30 minutes every day. It is also important to make sure that we are getting adequate intake of protein and the essential amino acid leucine.

Our protein needs increase as we age. Recent studies suggest that the RDA levels of protein are not sufficient to maintain muscle mass in people over the age of 55. Many experts recommend that those of us in our golden years consume the amount of protein in grams that is equivalent to half our body weight in pounds every day.

Recent studies show that it is important to spread that protein out through the day rather than consume one protein rich meal at the end of the day. If we are over 50 we should be aiming at 20-30 grams of protein per meal. However, more than 30 grams of protein at a single serving appears to provide no additional benefit.

Seniors also appear to need more leucine in each meal than younger adults if they wish to preserve muscle mass. Young adults need only around 1.7 grams of leucine per serving to stimulate muscle protein synthesis, while mature adults may need as much as 2.7 grams per serving.

Well-designed protein shakes and 4 ounces of lean meats are the easiest way for seniors to meet their protein and leucine needs. Vegetarian diets can provide the protein and leucine needed to maintain muscle mass in seniors, but those diets need to be very well planned. Broccoli and tofu just don’t make the grade if you are serious about preserving muscle mass.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Exercise Make You Live Longer?

January 27, 2015 by Dr. Steve Chaney

Run Long and Prosper

Author: Dr. Stephen Chaney

Does exercise make you live longer? If you are a fan of the original Star Trek series, you may remember the phrase “Live Long and Prosper”. That sounded great, but it was just a wish – a platitude. It said nothing about how you might accomplish the feat of living longer and prospering.

What if something as simple as increasing your exercise levels might help you live a longer, healthier life? A recent study provides pretty convincing evidence that exercise can increase longevity. If that is really true, maybe the proper phase should be “Run Long and Prosper”.

In my past “Health Tips From the Professor” I have talked about how hard it is to prove the value of any individual lifestyle change on improving our longevity – whether we are talking about more exercise, lower fat diets or individual nutritional supplements.

Most studies have too few subjects and last too short a time to show any significant effect. That’s why the study I’m featuring this week (Byberg et al, British Journal of Sports Medicine, 43: 482-489, 2009) is so remarkable.

How Was The Clinical Study Designed?

The study was designed to answer the question of whether exercise can actually help people live longer.

But what was remarkable about the study was the number of people enrolled in the study and how long the study lasted. The study enrolled 2,204 men aged 50 from the city of Uppsala Sweden in 1970-1973 and followed the men for 35 years!

At the beginning of the study the participants completed a survey on leisure time physical activity and were categorized into low, medium or high activity groups. Participants were re-examined at ages 55, 60, 70, 77, and 82 years and changes in physical activity were recorded.

Other information, such as body mass index, blood pressure, cholesterol levels, smoking status and alcohol use, was also collected at each survey. And, of course, the researches recorded how many of the initial participants were still living at each of those ages.

Is Living Longer One of the Benefits of Exercise?

After adjusting for other risk factors (obesity, smoking, excess alcohol consumption, elevated cholesterol or blood pressure), the researchers found that men who reported high levels of physical activity from age 50 lived 2.3 years longer than sedentary men and 1.1 years longer than men who reported medium levels of physical activity.

They also looked at what happened to men who started at low or medium levels of activity and increased their exercise level during the study. After 5 years of increased activity there was no apparent benefit. But after 10 years of increased activity the risk of dying had been reduced just as much as if they had always been exercising at that level!

I find that last finding particularly significant because most studies of this type last 5 years or less. If this study had been concluded at the end of 5 years, you might be tempted to say: “Why bother. If I haven’t exercised before, there’s no point in starting now.” But, this study did last more than five years – so the conclusion was completely different.

The Bottom Line

We’ve known for years that exercise reduces the risks of several types of diseases and improves the quality of life. This study clearly answers “Does exercise make you live longer?” with a yes.

If you haven’t exercised before, it’s never too late to start. Just don’t expect instantaneous results.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Are There Health Benefits of Beetroot Juice for Athletes?

October 28, 2014 by Dr. Steve Chaney

Should You Add Beetroot Juice To Your Training Diet?

Author: Dr. Stephen Chaney

When I saw the headline “Beetroot Juice May Boost Aerobic Fitness For Swimmers” I did a double take. Could something as simple as eating more beets actually improve exercise performance? Are there real health benefits of beetroot juice for athletes? So I looked up recent papers on the topic. But, before I review those I should give you a little science behind the idea that beetroot juice might affect performance.

The Science Behind Beetroot Juice And Exercise

Nitric oxide is a colorless, odorless gas that serves as an important signaling molecule in the human body. Among its many beneficial effects is increased blood flow to muscle. This increased blood flow appears to be preferentially distributed to the type 2 muscle fibers which support moderate to high intensity exercise. Thus, nutrients that enhance nitric oxide levels might be expected to improve moderate to high intensity exercise.

There are two naturally occurring pathways for producing nitric oxide in the body. The first pathway utilizes arginine, an amino acid found in dietary protein. The second pathway utilizes nitrates, which are found in fruits and vegetables. The best dietary sources of nitrates are beetroot, spinach and other leafy green vegetables.

Arginine has been widely used in sports supplements for some time to enhance performance. However, clinical studies on arginine have been mixed, with some showing small enhancements in performance and others showing no significant effect. Most experts now think that the benefits of arginine are primarily seen with untrained or moderately trained athletes (people like you and me) – not for highly trained or elite athletes.

It is logical that natural sources of nitrates, such as beetroot juice, would have a similar beneficial effect on exercise, but it is only in the last couple of years that scientists have started to evaluate that possibility. I looked up six recent publications for this review.

Does Beetroot Juice Improve Exercise Performance?

Study # 1: In this study (Bailey et al, J. Appl. Physiol., 107: 1144-1155, 2009) untrained men (aged 19-38) were given beetroot juice or a placebo for 6 days and then put through a series moderate-intensity and severe-intensity step exercise tests on days 4-6. The amount of oxygen required to support the moderate intensity exercise was decreased by 19% in the beetroot juice group. For severe intensity exercise, the amount of oxygen needed to support the exercise was decreased by 23% and the time to exhaustion was increased by 16% in the beetroot juice group. Those effects were statistically significant.

Study # 2: In this study (Kelly et al, Am. J. Physiol. Regul. Integr. Comp. Physiol., 304: R73-83, 2013) untrained older adults (aged 60-70) were given beetroot juice or a placebo for 3 days and then put through a treadmill exercise test. Resting blood pressure and oxygen uptake kinetics during exercise were significantly improved in the beetroot group.

Study # 3: In this study (Breese et al, Am. J. Physiol. Regul. Integr. Comp. Physiol., 305: R1441-14505, 2013) physically active subjects were given beetroot juice or a placebo for 6 days and then put through a double step exercise protocol involving a transition from stationary to moderate intensity exercise followed immediately by a transition from moderate intensity to severe intensity exercise. No significant differences were observed between the beetroot juice group and the placebo group during the transition from stationary to moderate intensity exercise. However, for the transition from moderate intensity to high intensity exercise both efficiency of oxygen utilization and endurance were increased by 22% in the beetroot juice group.

Study # 4: In this study (Pinna et al, Nutrients, 6: 605-615, 2014) moderately trained male master swimmers were given beetroot juice for 6 days. Swimming tests were conducted at the beginning and end of the 6 day period. After 6 days of beetroot juice supplementation, the workload was increased by 6% and the energy cost was decreased by 12% when the swimmers were performing at their maximal capacity.

Studies # 5 & 6: These studies (Lanceley et al, British Journal of Sports Medicine, 47: doi: 10.1136/bjsports-2013-093073.8; Hoon et al, Int. J. Sports Physiol. Perform., 9: 615-620, 2014) were both done with highly trained athletes and no significant improvement in performance was observed. This is fully consistent with previous studies utilizing arginine supplements.

In short, these studies suggest that beetroot juice is similar to arginine supplements in that:

It improves exercise performance at moderate to severe exercise levels, but not at low exercise levels.

It improves exercise performance for untrained or moderately trained athletes, but not for highly trained athletes.

The effects are modest. However, you should keep in mind that even a 20% increase in endurance during high intensity exercise can result in a significant incremental increase in muscle mass if the exercise is repeated on a regular basis.

What Are The Strengths & Weaknesses Of These Studies?

Strengths: The strengths of these studies are:

Most of the studies were double-blind, placebo controlled studies

The studies were internally consistent and were consistent with previous studies done with arginine supplements.

Weaknesses: The weaknesses of these studies are:

The studies were all very small and were of short duration. Larger, longer term studies are needed to validate the results of these studies.

So, are there health benefits of beetroot juice for athletes?

The Bottom Line:

Nitrates and arginine are both converted to nitric oxide in the body, so it is plausible that they will have similar effects.

Arginine supplements have been around for years and appear to have a modest affect on exercise performance with untrained and moderately trained athletes, but not with highly trained athletes. This is most likely because one of the effects of training is to increase blood supply to the muscles. Thus, highly trained athletes already have enhanced blood flow to the muscles, and the effect of arginine supplementation on blood flow is less noticeable.

Nitrate supplements are just starting to be evaluated for their effects on exercise performance. Most of the research so far has been with beetroot juice, but the results should be similar for any naturally sourced nitrate supplement.

The clinical studies published so far suggest that nitrate supplements are similar to arginine supplements in that they have a modest effect on high intensity exercise in untrained and moderate trained athletes (people like most of us). They appear to have little or no effect for highly trained athletes. Thus, the effect of nitrate supplements on exercise appears to be very similar to the effect of arginine supplements on exercise.

Most of the studies performed to date have been small, short duration studies. They need to be validated by larger, longer term studies.

If the effects of nitrate supplementation published to date are accurate they should be most beneficial for weight training and high intensity exercise because even modest increases in exercise endurance can result in an incremental increase in muscle mass and strength over time.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

The Fundamentals of Stretching

January 30, 2014 by Dr. Steve Chaney

When, Why & How To Stretch

Author: Kai Fusser, MS

Everybody knows (even non-athletes) that stretching can be beneficial for physical performance.

But there is a lot of misinformation and confusion on why, when, what and how to stretch. Also, many confuse stretching with a warm up and vice versa.

A warm up is exactly what it says, warming up your body, the muscles, through dynamic movements. It is the increased blood flow that warms up your muscle. Stretching on the other hand is either static or performed very slowly, which is just the opposite of a warm up.

When Should You Stretch?

One issue is that the muscles don’t like to be stretched when they are cold. They will hardly be able to be “stretched” or lengthened as they are not supple and don’t like to “let go”. Therefore, the stretch is being transferred to the ligaments and tendons, and that’s not what we want.

So I recommend only stretching if your muscles are really warmed up, ideally after a workout or some physical activity. By the way, there is no evidence that stretching will prevent injury before physical activity, yet plenty of evidence that a warm up will.

Why Should You Stretch?

So why should we stretch? It’s to prevent your muscles from tightening after hard physical activity and giving the muscles the signal to let go which is controlled by your nervous system.

I do not recommend to use stretching alone to improve flexibility or range of motion. Stretching alone will not strengthen the muscles as there is no stabilizing of the joints required. This is better achieved through full range of motion exercises that involve a load on the muscles by using weight or resistance.

The Fundamentals Of Stretching

There are many different ways to stretch – from completely static (holding) to PNF (short term tension then letting go). I suggest you try different ways and see what feels best.

I prefer stretching against a rubber band, i.e. attached to a solid object and leaning against it or pulling the extended leg towards the chest with a rubber band. Rubber bands will “dampen” the pull on the muscles and can help with a more progressive and controlled stretch.

So stretch! Just know when and why.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Does Leucine Trigger Muscle Growth?

January 28, 2014 by Dr. Steve Chaney

What Does The Perfect Post-Workout Protein Shake Look Like?

Author: Dr. Stephen Chaney

If you work out on a regular basis and read any of the “muscle magazines”, you’ve seen the ads. “Explode Your Muscles.” “Double Your Gains.” They all claim to have the perfect post-workout protein shake, backed by science. They all sound so tempting, but you know that some of them have to be scams.

I told you about some of the sports supplements to avoid in a previous “Health Tips From the Professor”. In this issue, I’m going to ask “What does the perfect post-workout protein shake look like?”

For years athletes have been using protein beverages containing branched chain amino acids after their workouts to maximize muscle gain and recovery. There was some science behind that practice, but the major questions were unanswered. Nobody really knew:

How much protein is optimal?

What kind of protein is optimal?

What amount of branched chain amino acids is optimal?

Are some branched chain amino acids more important than others?

Does the optimal amount of branched chain amino acids depend on the amount of protein?

As a consequence, after workout protein supplements were all over the map in terms of protein source, protein amount, branched amino acid amount and type of branched chain amino acids. Fortunately, recent research has clarified many of these questions.

How Much And What Kind Of Protein Do You Need?

Recent research has shown that the optimal protein intake for maximizing muscle gain post workout is 15-20 gm for young adults (Katsanos et al, Am J Clin Nutr 82: 1065-1073, 2005; Moore et al, Am J Clin Nutr, 89: 161-168, 2009) and 20-25 gm for older adults (Symons et al, Am J Clin Nutr 86: 451-456, 2007).

More protein isn’t necessarily better. The effect of protein intake on post workout muscle gain maxes out at around 25 gm for young adults and 30 gm for older adults (Symons et al, J Am Diet Assoc 109: 1582-1586, 2009).

Whey protein is the best choice for enhancing muscle gain immediately after a workout. Other protein sources (soy, casein, chicken) are better choices for sustaining muscle gain over the next few hours.

Does Leucine Trigger Muscle Growth?

It turns out that leucine is the only branched chain amino acid that actually stimulates muscle protein synthesis (Am J Physiol Endocrinol Metab 291: E381-E387, 2006). And protein is what gives muscles their strength and their bulk.

Recent research has shown that 2-3 gm of leucine (2 gm for young adults; 3 gm for older adults) is sufficient to maximize post workout muscle gain if protein levels are adequate (Am J Physiol Endocrinol Metab 291: E381-E387, 2006).

Unanswered Questions About Optimizing Muscle Gain Post-Workout

Do the other branched chain amino acids play a supporting role, or is leucine alone sufficient to drive post-workout muscle gain?

Can leucine still help maximize post-workout muscle gain if protein intake is inadequate? If so, how much leucine is needed?

Does Leucine Enhancement Improve Low Protein Shakes?

A recent study (Churchward-Venne et al, Am J Clin Nutr, 99: 276-286, 2014) seems to answer those two questions. The authors compared the effect of 5 protein-amino acid combinations on muscle protein synthesis in 40 young men (~21 years old) following unilateral knee-extensor resistance exercise. The protein shakes contained:

25 gm of whey protein, which naturally contains 3 gm of leucine (high protein)

6.25 gm of whey protein, which naturally contains 0.76 gm of leucine (low protein)

6.25 gm of whey protein with 3 gm of leucine (low protein, low leucine)

6.25 gm of whey protein with 5 gm of leucine (low protein, high leucine)

6.25 gm of whey protein with 5 gm of leucine + added isoleucine and valine (the other branched chain amino acids). (low protein, branched chain amino acids).

The results were clear cut:

The high protein shake (25 gm of protein) was far superior to the low protein shake (6.25 gm of protein) at enhancing post workout protein synthesis. This is consistent with numerous other published clinical reports.

Adding 3 gm of leucine to the low protein shake had no effect on post-workout protein synthesis, but 5 gm of added leucine made the low protein shake just as effective as the high protein shake at supporting post-workout protein synthesis.

In short, leucine can improve the effectiveness of a low protein shake, but you need more leucine than if you chose the high protein shake to begin with.

Adding extra branched chain amino acids actually suppressed the effectiveness of leucine at enhancing post-workout protein synthesis. These data suggest:

Leucine probably is the major amino acid responsible for the muscle gain reported in many of the previous studies with branched chain amino acids.

If the other branched chain amino acids play a supporting role in the muscle gain, the quantities that occur naturally in the protein are probably enough. Adding more may actually reduce the effectiveness of leucine at stimulating muscle gain.

While this is a single study, it is consist with numerous other recent clinical studies. It simply helps clarify whether leucine can increase the effectiveness of a low protein supplement. It also clarifies the role of branched chain amino acids.

Also, while this study focused on protein synthesis, numerous other studies have shown that optimizing post-workout protein and leucine intake results in greater muscle gain (for example, Westcott et al., Fitness Management, May 2008)

The Bottom Line

Research on post-workout nutrition to optimize muscle gain from the workouts has come a long way in recent years. It is now actually possible to make rational choices about the best protein supplements and foods to support your workouts.

If you are a young adult (17-30), you should aim for 15-20 gm of protein and about 2 gm of leucine after your workout.

If you are an older adult (50+), you should aim for 20-25 gm of protein and 3 gm of leucine after your workout.

If you are in between you are on your own. Studies haven’t yet been done in your age group, but it’s reasonable to assume that you should aim for somewhere between the extremes.

If you are getting the recommended amounts of whey protein, the leucine level will also be optimal. If you are using other protein sources you may want to choose ones with added leucine.

The research cited above shows that you can make a low protein supplement effective by adding lots of leucine, but that’s going to require artificial flavors and sweeteners to cover up the taste of that much leucine. I would recommend choosing one that provided adequate protein to begin with.

While the research in this area is still somewhat fluid, I would avoid protein supplements with added branched chain amino acids other than leucine. If the paper I cited above is correct you probably get all of the other branched chain amino acids you need from your protein and adding more may actually interfere with the effect of leucine on muscle gain.

I’d pretty much forget all the other “magic ingredients” in post-workout supplements. If you’re a novice there is some evidence that arginine and HMB may be of benefit, but if you have been working out for more than 6 months, the evidence is mixed at best. As for the rest, the clinical studies are all over the map. There’s no convincing evidence that they work.

Whey protein is the best choice for enhancing muscle gain immediately after your workout. Soy and casein are better choices for sustaining muscle gain over the next few hours. If you’re looking at meat protein, chicken is a particularly good choice. Four ounces of chicken will provide the protein and leucine you need to sustain muscle gain for several hours.

Even if you are not working out, recent research on dietary protein and leucine has important implications for your health. In a recent “Health Tips From the Professor” I shared research showing that optimizing protein and leucine intake helps to increase muscle retention and maximize fat loss when you are losing weight.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

How Flexible Should I Be?

January 16, 2014 by Dr. Steve Chaney

How Can I Measure My Flexibility?

Author: Dr. Pierre DuBois

Watching a dancer her leg to her nose is an impressive sight, and many of us can perform similar feats when we’re children. But we begin to lose flexibility we age if we do not make a conscious effort to remain limber.

Inactivity causes muscles to shorten and stiffen, and muscle mass is lost with increasing years as well. However, maintaining flexibility as we get older is of great importance, since it allows us to retain our mobility and reduces the likelihood of aches, sprains and falls as we age.

How Flexible Should I Be?

Optimal flexibility means the ability of each of your joints to move fully through their natural range of motion. Simple activities such as walking or bending over to tie your shoes can become major difficulties if your flexibility is limited. Unfortunately, sitting for hours at a desk, as so many are forced to do on a daily basis, eventually leads to a reduction in flexibility as the muscles shorten and tighten.

A Simple Test For Measuring Flexibity

There are a number of different tests used to measure flexibility, but the one test that has been used as a standard for years is the sit and reach test. It measures the flexibility of your hamstrings and lower back. The simple home version of the test requires only a step (or a small box) and a ruler.

Before the test, warm up for about 10 minutes with some light aerobic activity and do a few stretches. Then place the ruler on the step, letting the end of it extend out a few inches over your toes, and note where the edge of the step comes to on the ruler.

Sit on the floor with your feet extended in front of you, flat against the bottom step (or box). With your arms extended straight out in front of you and one hand on top of the other, gradually bend forward from the hips, keeping your back straight. (Rounding the back will give you a false result).

Measure where your fingertips reach on the ruler. They should ideally be able to reach at least as far as the front of the step. Any measurement past the edge of the step is a bonus. No matter how far you can reach on the first measurement, do the test periodically and try to improve your score every few weeks.

Increasing Your Flexibility

If you find that you are less flexible than you should be, some regular stretching exercises combined with visits to your chiropractor can help to restore flexibility and improve range of motion, helping to ensure that you remain limber into older age.

The Bottom Line

Optimal flexibility means a full range of motion for all of our joints.

Age, inactivity and desk-bound work environments all can cause loss of flexibility.

The sit and reach test is a good measure of flexibility.

If your flexibility isn’t what it should be, do stretching exercises every day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

The Benefits of Sprint Interval Training

November 14, 2013 by Dr. Steve Chaney

Are You Still Doing Cardio?

Author: Kai Fusser, MS

Last month I told you about functional fitness training and why I think it is superior to workouts on the machines that fill most gyms and sports clubs. This month my topic is sprint interval training, and why it beats the traditional cardiovascular or aerobic exercises.

Walk into any gym and the first thing you see is people straddling treadmills, ellipticals or bikes for 45 minutes or more trying to burn calories and improving their aerobic fitness.

It is not an easy task for me to explain in a short fitness tip why we should stay away from the typical low to moderate-intensity continuous training (“CARDIO”) and instead do sprint interval training (SIT, or burst training), but here are the key points.

The Problem With Cardio Exercise

Slow cardio:

is very time intensive (the number one reason people skip their workouts)

only works on your aerobic fitness (and that fairly inefficient)

burns some calories during the activity but has no impact on your overall metabolism

stresses your joints due to repetitive impact (especially if you are running for your cardio)

increases inflammation

The Benefits of Sprint Interval Training

Now here is a solution for you. SIT (sprint interval training) training:

will only take about 4-8 minutes 3 days a week

works your aerobic and anaerobic system at the same time

will raise your metabolism for several hours after you have completed the exercise

is very effective for fat loss

will build “fast muscles”

reduces impact on your joints and helps reduce inflammation

Sprint training can burn the same calories as slow cardio in 1/15^th of the time! In addition, slow cardio exercise produces a lot of stress hormones (cortisol) while sprint training stimulates growth hormone (have you ever compared the physique of a sprinter to a marathon runner? It’s your choice).

It is the intensity, not duration that effects the adaptation to exercise.

Making Sprint Interval Training Work For You

There are different ways to implement SIT training:

It can be done on equipment like a:

treadmill (using a steep incline rather than high speed)
stationary bike
upper body ergo meter
or a X-iser

Or it can be done with no equipment at all, like

sprinting (athletes only)
running up a flight of stairs
running up a hill
or with full body calisthenics like a Turkish Getup.

I recommend that you start with 4 min workouts (add 2-3 min of warm up before) with a sprint to rest ratio of 1-3, say 10 sec sprint with 30 sec rest (slow pace). As you feel more comfortable you should work your way down to a ratio of 1-1 like 20 sec sprint with 20 sec rest. The maximum total time you would want to do is 8 min. (more is not better in this case).

Please remember that the sprints should be “high intensity” which is of course relative to your fitness level. The intensity will be different for a fully trained athlete than for a de-conditioned couch hugger.

The Bottom Line:

Sprint interval training (SIT) is a quick and efficient way to burn calories and get the cardiovascular exercise your body needs.

You will be surprised how quickly your:

body will adapt to the new and positive exercise stress
energy level will increase
performance will improve,
metabolism will pick up

You will save time and wear on your joints. Most of all, it can be fun !

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.