Self-talk is the endless stream of thoughts that run through your head every day. These thoughts can be positive. However, too often they are negative, critical commentary on the everyday events that make up your day.
Tips On How To Have a Sunnier Outlook On Life:
Learn to recognize when your self-talk is negative and irrational. Ask yourself the following questions: Do you magnify the negative aspects of a situation and not pay attention to the positive ones? When something bad happens, do you blame yourself? Do you anticipate the worst in any situation? Do you feel that you have to be perfect, or you’ll fail? These are all common forms of irrational thinking.
Throughout your day, stop and evaluate what you’re thinking. If you find that your thoughts are negative, try to find a way to put a positive and realistic spin on them. If you are thinking “I can’t do this.” You should try, “I’ll try another approach.” This sounds simple, but it takes time and practice to master.
Treat yourself with the same respect you give to others. Don’t say anything to yourself that you wouldn’t say to someone else.
Source: “Silencing Your Inner Critic.” Mayo Clinic Health Quest. September 2006.
http://www.nwhealth.edu/healthyU/stayHealthy/shhh.html
Friday, February 27, 2009
Tuesday, February 24, 2009
Laugh More for Better Health
Laughter: Rx for Better Health
Laughter is powerful “emotional” medicine. It has been shown to lift ailing spirits, foster instant relaxation, reduce stress and burnout, and improve health and healing by bolstering the immune system.
“Hearty laughter is a good way to jog internally,” according to Norman Cousins, author of Anatomy of an Illness. In his book, Cousins credits daily belly laughs and a positive attitude as important to his recovery from a life-threatening illness. His book, published in 1979, launched widespread interest in the role and power of the mind in health and healing that continues today.
Here are some tips to add more laughter to your life:
Lighten up. Laugh at yourself.
Look for the humor in everyday activities that are silly or absurd.
Keep a book of cartoons or jokes handy for comic relief when you are faced with a stressful situation.
Start your own humor file and collect cartoons, jokes, videos, books, and pictures that lighten up your spirit and bring you laughter.
Bookmark humorous websites.
Wear humorous accessories.
Watch a funny movie or TV sitcom.
Take a humor break every day and read something funny, add to a humor notebook, or listen to a funny tape or CD.
Share a funny story with a friend.
Hang around with funny friends.
Look for the humor in awkward or difficult situations.
Source: Wellness News You Can Use, National Wellness Institute, March 2004.
http://www.nwhealth.edu/healthyU/findBalance/laughter.html
Laughter is powerful “emotional” medicine. It has been shown to lift ailing spirits, foster instant relaxation, reduce stress and burnout, and improve health and healing by bolstering the immune system.
“Hearty laughter is a good way to jog internally,” according to Norman Cousins, author of Anatomy of an Illness. In his book, Cousins credits daily belly laughs and a positive attitude as important to his recovery from a life-threatening illness. His book, published in 1979, launched widespread interest in the role and power of the mind in health and healing that continues today.
Here are some tips to add more laughter to your life:
Lighten up. Laugh at yourself.
Look for the humor in everyday activities that are silly or absurd.
Keep a book of cartoons or jokes handy for comic relief when you are faced with a stressful situation.
Start your own humor file and collect cartoons, jokes, videos, books, and pictures that lighten up your spirit and bring you laughter.
Bookmark humorous websites.
Wear humorous accessories.
Watch a funny movie or TV sitcom.
Take a humor break every day and read something funny, add to a humor notebook, or listen to a funny tape or CD.
Share a funny story with a friend.
Hang around with funny friends.
Look for the humor in awkward or difficult situations.
Source: Wellness News You Can Use, National Wellness Institute, March 2004.
http://www.nwhealth.edu/healthyU/findBalance/laughter.html
Saturday, February 21, 2009
Body Mass Index(BMI) vs Body Fat
Body Mass Index (BMI)
Body Mass Index (BMI) is an assessment of body weight relative to height. Evidence has shown that an elevated BMI increases risk for such diseases as cancer, diabetes mellitus, hypertension, hypercholesterolemia, and atherosclerosis. Research has proven that the higher your BMI, the greater the risk for a premature death. A healthy BMI is 20.0 – 24.9 kg/m 2. A BMI of at least 27 kg/m 2 indicates obesity and increased health risk. A BMI of 30.0 kg/m 2 indicates grade II obesity, while 40.0 kg/m 2 and greater is morbid obesity.
To calculate your BMI, click here.
BMI is the preferred body composition assessment for the obese population because calipers lose their accuracy with large skin folds and variance in fat density. Bio-impedance and near-infrared typically underestimate body fat percentage in this population. Although BMIs don’t account for body fat percentage, excess body fat is already known in the obese.
Important Limitations of BMI:
BMI does not distinguish between fat mass and fat free mass. This is important because ACSM defines obesity as a percent of body fat at which disease increases. People with large amounts of lean tissue may have a high BMI while having their body fat percentage in a healthy range. In addition, a healthy BMI does not necessarily mean that body fat is within a healthy range.
BMI does not give any information on the location of the body fat which is important in determining obesity-related risk for disease.
General Interpretation Guidelines:Underweight: BMI <18.5normal: bmi =" 18.5-24.9Overweight:" bmi =" 25.0-29.9Obese:">30
*see grades of obesity classification
Obesity Categories
A BMI score of 20 to 25 is associated with the lowest risk of excessive or deficient adipose tissue. Obesity is divided into three grades:
Grade I = 25.0-29.9
Grade II = 30-40
Grade III = 40+
A BMI of at least 27 indicates obesity and increased health risk. Body mass index increases with age; therefore, age-specific guidelines for interpreting the BMI in the elderly have been recommended.
Body Fat
Body fat, not weight, is a better measure of your health and fitness. Increased body fat is associated with obesity-related health conditions. Because the scale does not distinguish between lean weight and fat weight, a person could be “over-weight” but not be “over-fat”. However, body fat analysis is not appropriate for people who are obviously obese and tests may not provide an accurate result.
Body fat can be measured in many ways. The most common methods are skinfold calipers and Bioelectrical Impedance (BEI). Both of these tests should not be done after exercising; BEI results will be greatly affected if you are not properly hydrated. Each method has a margin of error of approximately 3-5%. For skinfold calipers, the more sites that are assessed, and the greater the skill of the person doing the measurement, the more accurate the result will be.
The gold standard for body fat is underwater weighing; however, most people do not have easy access to an exercise physiology lab to have this test performed. As you age, the acceptable level of body fat increases. The guidelines listed below are not age-adjusted but can give you a general framework to use.
Body Type
Female
Male
Athlete
<17%
<10%
Lean
17-22%
10-15%
Normal
22-25%
15-18%
Above Average
25-29%
18-20%
Over-fat
29-35%
20-25%
Obese
35+%
25+%
Sources: ACSM’s Guidelines for Exercise Testing and Prescription, 6th Ed., 2000 and ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 4th Ed., 2001
Body Mass Index (BMI) is an assessment of body weight relative to height. Evidence has shown that an elevated BMI increases risk for such diseases as cancer, diabetes mellitus, hypertension, hypercholesterolemia, and atherosclerosis. Research has proven that the higher your BMI, the greater the risk for a premature death. A healthy BMI is 20.0 – 24.9 kg/m 2. A BMI of at least 27 kg/m 2 indicates obesity and increased health risk. A BMI of 30.0 kg/m 2 indicates grade II obesity, while 40.0 kg/m 2 and greater is morbid obesity.
To calculate your BMI, click here.
BMI is the preferred body composition assessment for the obese population because calipers lose their accuracy with large skin folds and variance in fat density. Bio-impedance and near-infrared typically underestimate body fat percentage in this population. Although BMIs don’t account for body fat percentage, excess body fat is already known in the obese.
Important Limitations of BMI:
BMI does not distinguish between fat mass and fat free mass. This is important because ACSM defines obesity as a percent of body fat at which disease increases. People with large amounts of lean tissue may have a high BMI while having their body fat percentage in a healthy range. In addition, a healthy BMI does not necessarily mean that body fat is within a healthy range.
BMI does not give any information on the location of the body fat which is important in determining obesity-related risk for disease.
General Interpretation Guidelines:Underweight: BMI <18.5normal: bmi =" 18.5-24.9Overweight:" bmi =" 25.0-29.9Obese:">30
*see grades of obesity classification
Obesity Categories
A BMI score of 20 to 25 is associated with the lowest risk of excessive or deficient adipose tissue. Obesity is divided into three grades:
Grade I = 25.0-29.9
Grade II = 30-40
Grade III = 40+
A BMI of at least 27 indicates obesity and increased health risk. Body mass index increases with age; therefore, age-specific guidelines for interpreting the BMI in the elderly have been recommended.
Body Fat
Body fat, not weight, is a better measure of your health and fitness. Increased body fat is associated with obesity-related health conditions. Because the scale does not distinguish between lean weight and fat weight, a person could be “over-weight” but not be “over-fat”. However, body fat analysis is not appropriate for people who are obviously obese and tests may not provide an accurate result.
Body fat can be measured in many ways. The most common methods are skinfold calipers and Bioelectrical Impedance (BEI). Both of these tests should not be done after exercising; BEI results will be greatly affected if you are not properly hydrated. Each method has a margin of error of approximately 3-5%. For skinfold calipers, the more sites that are assessed, and the greater the skill of the person doing the measurement, the more accurate the result will be.
The gold standard for body fat is underwater weighing; however, most people do not have easy access to an exercise physiology lab to have this test performed. As you age, the acceptable level of body fat increases. The guidelines listed below are not age-adjusted but can give you a general framework to use.
Body Type
Female
Male
Athlete
<17%
<10%
Lean
17-22%
10-15%
Normal
22-25%
15-18%
Above Average
25-29%
18-20%
Over-fat
29-35%
20-25%
Obese
35+%
25+%
Sources: ACSM’s Guidelines for Exercise Testing and Prescription, 6th Ed., 2000 and ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 4th Ed., 2001
Wednesday, February 18, 2009
Dietary Fiber and Heart Health
An additional marker for heart disease risk is being used more frequently by the medical community. C-reactive protein, or CRP, is a marker for acute inflammation in the arteries. This inflammation is a primary reason for heart attacks and strokes due to the rupture of artery plaques. It is believed that anything that lowers CRP can reduce the risk of a serious cardiovascular episode.
The University of Massachusetts studied the diets of 524 people on a quarterly basis for 5 quarters and checked their blood CRP levels. They wanted to see if certain dietary factors could reduce CRP levels and inflammation.
The Results
The researchers found dietary fiber to have a protective effect. When examining the participants based on both a longitudinal and a cross-sectional analysis, it was determined that people who ate higher amounts of fiber in their diet were 63% less likely to have elevated CRP levels.
Both soluble and insoluble fibers were linked to lower CRP levels. Foods that reduce CRP levels or inflammation may have an immediate risk lowering effect on heart health.
What it Means
The researches concluded that dietary fiber is protective against high CRP and therefore support the current recommendations for a high fiber diet. People with the lowest CRP levels were eating at least 22 grams of fiber per day; however, the Institute of Medicine recommends consuming 25-36 grams of fiber per day for both men and women. Therefore, if these individuals had a higher fiber intake, their cardiovascular risk would have had a greater decrease.
Dietary fiber has an anti-inflammatory effect and helps explains why whole grains, fruits, vegetables and other high fiber foods help prevent heart attacks.
Source: Ma Y., et al (April 2006). Association between dietary fiber and serum C-reactive protein. American Journal of Clinical Nutrition,83:760-6.
The University of Massachusetts studied the diets of 524 people on a quarterly basis for 5 quarters and checked their blood CRP levels. They wanted to see if certain dietary factors could reduce CRP levels and inflammation.
The Results
The researchers found dietary fiber to have a protective effect. When examining the participants based on both a longitudinal and a cross-sectional analysis, it was determined that people who ate higher amounts of fiber in their diet were 63% less likely to have elevated CRP levels.
Both soluble and insoluble fibers were linked to lower CRP levels. Foods that reduce CRP levels or inflammation may have an immediate risk lowering effect on heart health.
What it Means
The researches concluded that dietary fiber is protective against high CRP and therefore support the current recommendations for a high fiber diet. People with the lowest CRP levels were eating at least 22 grams of fiber per day; however, the Institute of Medicine recommends consuming 25-36 grams of fiber per day for both men and women. Therefore, if these individuals had a higher fiber intake, their cardiovascular risk would have had a greater decrease.
Dietary fiber has an anti-inflammatory effect and helps explains why whole grains, fruits, vegetables and other high fiber foods help prevent heart attacks.
Source: Ma Y., et al (April 2006). Association between dietary fiber and serum C-reactive protein. American Journal of Clinical Nutrition,83:760-6.
Saturday, February 7, 2009
Fiber Tips
And Foods
Fiber is good for us, it lowers cholesterol, and it keeps us trim and feeling full. Here are a few ways to work in 25 grams of fiber a day for someone eating 2,000 calories a day. Remember when you increase fiber, you should increase your water intake along with it. And gradually add fiber, so your body can adapt to the change.
Eat whole grains whenever possible. Whole Grain should be the first of second ingredient on the list. Products that say “100% wheat” or “multigrain” are usually not whole grain.
2 slices of whole-wheat bread = 4 grams of fiber
1 cup of cooked brown rice = 4 grams
Reduced-Fat Triscuits = 3 grams
Choose the right breakfast cereals.
1 cup Fiber One = 14 grams of fiber
1 cup Raisin Bran = 7.5 grams
1 cup Frosted Shredded Wheat Spoon Size = 5 grams
1 cup Quaker Squares Baked in Cinnamon = 5 grams
1 cup cooked oatmeal = 3 grams
Eat beans a few times per week. Beans offer more fiber than most plant foods
1 cup of canned minestrone = about 5 grams of fiber
½ cup vegetarian or fat-free refried beans, used to make microwave nachos = about 6 grams
¼ cup kidney beans, added to a green salad = 3 grams
Bean burrito at Taco Bell (or at home) = 8 grams
Add more fruit to your daily diet.
1 large apple = 4 grams of fiber
1 banana = 3 grams
1 pear = 4 grams
1 cup of strawberries = 4 grams
Stir in a tablespoon of ground flaxseed into your smoothie, soup, or casserole. This will boost your fiber by 3 grams.
Add more veggies to your daily diet.
1 cup carrot slices, cooked = 5 grams of fiber
1 cup cooked broccoli = 4.5 grams
1 cup raw carrots = 4 grams
1 sweet potato = 4 grams
1 cup cauliflower, cooked = 3 grams
2 cups raw spinach leaves = 3 grams
Source: “Digestive Relief! Your First Line of Defense.” www.webmd.com/solutions/sc/digestive-relief/six-fiber-foods
Fiber is good for us, it lowers cholesterol, and it keeps us trim and feeling full. Here are a few ways to work in 25 grams of fiber a day for someone eating 2,000 calories a day. Remember when you increase fiber, you should increase your water intake along with it. And gradually add fiber, so your body can adapt to the change.
Eat whole grains whenever possible. Whole Grain should be the first of second ingredient on the list. Products that say “100% wheat” or “multigrain” are usually not whole grain.
2 slices of whole-wheat bread = 4 grams of fiber
1 cup of cooked brown rice = 4 grams
Reduced-Fat Triscuits = 3 grams
Choose the right breakfast cereals.
1 cup Fiber One = 14 grams of fiber
1 cup Raisin Bran = 7.5 grams
1 cup Frosted Shredded Wheat Spoon Size = 5 grams
1 cup Quaker Squares Baked in Cinnamon = 5 grams
1 cup cooked oatmeal = 3 grams
Eat beans a few times per week. Beans offer more fiber than most plant foods
1 cup of canned minestrone = about 5 grams of fiber
½ cup vegetarian or fat-free refried beans, used to make microwave nachos = about 6 grams
¼ cup kidney beans, added to a green salad = 3 grams
Bean burrito at Taco Bell (or at home) = 8 grams
Add more fruit to your daily diet.
1 large apple = 4 grams of fiber
1 banana = 3 grams
1 pear = 4 grams
1 cup of strawberries = 4 grams
Stir in a tablespoon of ground flaxseed into your smoothie, soup, or casserole. This will boost your fiber by 3 grams.
Add more veggies to your daily diet.
1 cup carrot slices, cooked = 5 grams of fiber
1 cup cooked broccoli = 4.5 grams
1 cup raw carrots = 4 grams
1 sweet potato = 4 grams
1 cup cauliflower, cooked = 3 grams
2 cups raw spinach leaves = 3 grams
Source: “Digestive Relief! Your First Line of Defense.” www.webmd.com/solutions/sc/digestive-relief/six-fiber-foods
Wednesday, February 4, 2009
On-the-go Weight Loss: Nutritional Considerations
On-the-Go Weight Loss: Nutritional Considerations
By John Maher, DC, DCCN, FAIIM
“There is an urgent need for effective tools to prevent weight gain in the population at large and weight regain in overweight persons after weight loss. In theory the solution is simple, but implementation will continue to be difficult and ineffective as long as we maintain the view that just telling people that they should eat less and exercise more does the job.”3
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The spreading “obesity epidemic,” even among our children, is well known to all chiropractors.1,2 There is also an increasing list of weight-loss diets. In any diet, there are varying degrees in difficulty and in compliance. Let’s discuss some ideas on how to support compliance.
Specifically, I want to encourage the use of nutrient-dense foods and ingredients to make quick and easy weight loss on-the-go meals that will fit into almost any diet scheme. The recipes need to be nutrient dense, including phytonutrients, zoonutrients and omega-3 EFAs; be enjoyable, filling and satisfying; provide long-lasting energy and satiation; be quick and easy to make; and fit into most any dietary approach.
Satiating Power of Protein
“Many popular diets recommend 30% to 40% protein content, at the expense of carbohydrate, over and above the usual 10-20% protein recommendation. Newer research indicates that the high-protein content of these diets may actually be the reason for their partial success in inducing weight loss, despite no restrictions in total calories.”3
Scientists have stated that research subjects felt more satiated with an isocaloric high-protein diet thanwith a weight-maintenance diet.4 Of note in relation to metabolic syndrome (Syndrome X), high-protein diets,independent of the loss of total body fat, resulted in a significantloss of visceral fat.5
We do not yet have consensus agreement on how protein increases satiety. This effect could not be explained bychanges in the hunger hormone ghrelin or the satiety hormoneleptin.6 However, that does not prevent us from using that knowledge. The guidelines from the Institute of Medicine allow for theinclusion of higher amounts of protein than previously recommended.7 The institute concluded that there isno clear evidence that a high protein intake increases the riskof renal stones, osteoporosis, cancer or cardiovascular disease.
Perhaps the protein with the best features is whey protein. First, whey has an excellent value, efficiency, utilization and digestibility profile.8 Whey is a complete and balanced protein and, as such, is a good source of the amino acid tryptophan, supplying about 2.4 g/100 g. Low-calorie, low-protein diets may not supply enough of this essential amino acid. Tryptophan is the precursor to serotonin, an important neurotransmitter that helps regulate mood, sleep and appetite, especially as relates to carbohydrates. Also, if niacin intake is insufficient, the body will convert tryptophan to niacin, needing 60 mg of the former to make 1 mg of the latter. Typically, most people consume 1,000 to 1,500 mg of tryptophan a day.9 Diets low in tryptophan are not likely to succeed in the long term.
Comparison of Protein Sources
BV
PER
NPU
PDCAAS
BV
PER
NPU
PDCAAS
Whole Egg
100
3.8
94
1.18
Beef
80
2.9
73
.92
Whey Protein
104
3.2
92
1.15
Casein
77
2.5
76
1.23
Cow’s milk
91
3.1
82
1.21
Soy Protein
61
2.1
61
.91
Biological Value (BV), Protein Efficiency Ratio (PER), Net Protein Utilization (NPU), and Protein Digestibility Corrected Amino-Acid Score (PDCAAS)
Whey protein provides more branched-chain amino acids (L-isoleucine, L-leucine and L-valine) than any other protein source. Branched-chain amino acids (BCAAs) are unique in that they are metabolized for energy by muscle, rather than by the liver. BCAAs thereby both spare lean muscle mass in weight-management programs and reduce the role of insulin in blood glucose control.10
Another component of whey, glycomacropeptide (GMP), appears to have a role in appetite suppression. GMP has been shown to stimulate the intestinal hormone cholecystokinin (CCK), which inhibits gastric emptying and secretions, and also induces satiety. Admittedly, human trials have been limited, but studies have demonstrated that consumption of whey protein enriched with GMP reduced hunger and subsequent meal intake.11,12
Whey protein also confers significant angiotensin-converting enzyme (ACE) activity. Recent data demonstrate adipocyte lipogenesis is regulated in part by angiotensin II. Perhaps most importantly, as it relates to comorbidity in obesity and the oft-related diabetes and metabolic syndrome, ACE appears to have significant hypotensive effects.13,14
Carbohydrates
The most popular weight-loss diets today tend to de-emphasize carbohydrates, especially those that have a high glycemic index (GI). High-GI foods tend to promote large insulin fluctuations, perhaps eventually leading to insulin resistance, metabolic syndrome and diabetes. Dysglycemias are usually associated with weight gain, increased deep belly fat and resultant central adiposity.
High-protein foods tend to be low in carbohydrates and therefore have a low GI index. Whey protein isolates (>90 percent protein) have a glycemic index of less than one.15 Whey protein isolate is also extremely lean, being low in fat and cholesterol. Unlike meats or eggs, whey protein is never fried, broiled or barbecued, and therefore does not promote the formation of advanced glycation endproducts, a major contributor to the development of the common diseases of aging.
Low-carbohydrate vegetables are strongly recommended in most dietary strategies. They provide fiber, vitamins, minerals, phytonutrients and lots of chewing. In the more restricted carbohydrate routines, many fruits are severely limited because of their sugar content. As the unique nutrients in fruits and vegetables are so beneficial to health, high-phytonutrient fruit and vegetable liquid concentrates and drink mix powders are often recommended for those who do not consume optimal amounts, or desire the nutrients without the carbohydrates.
Fats
Even though fats have over twice the calories per gram as protein or carbohydrates, the highest satiating power is found with high levels of protein, dietary fiber and water. Low satiating power is related to higher fat foods.16,17 Still, it is most important to have sufficient essential fatty acid intake, both omega-3 and omega-6.18,19 Omega 3 is usually the most limited. Fatty fish and flax seed are the richest, most common sources, though high-omega chia seeds and foods fortified with DHA have recently become more available.
Fiber
According to a report in the Journal of Nutrition, “Dietary fiber has many functions in diet, one of which may be to aid in energy intake control and reduced risk for development of obesity. The role of dietary fiber in energy intake regulation and obesity development is related to its unique physical and chemical properties that aid in early signals of satiation and enhanced or prolonged signals of satiety. Early signals of satiation may be induced through cephalic- and gastric-phase responses related to the bulking effects of dietary fiber on energy density and palatability, whereas the viscosity-producing effects of certain fibers may enhance satiety through intestinal-phase events related to modified gastrointestinal function and subsequent delay in fat absorption.”20 Clearly, sufficient soluble and insoluble fiber are important factors in weight-loss diets.
Stevia, Lecithin, Green Tea and Water
Stevia (Stevia rebaudiana) extracts are used as natural sweeteners or dietary supplements for their stevioside or rebaudioside A compounds. These compounds possess up to 250 times the sweetness of sucrose. They are noncaloric and noncariogenic.21 In addition, stevia has the ability to lower high blood sugar and blood pressure.22 High-quality stevia, without the bitter aftertaste, is available.
Lecithin is a common component of drink powders that makes them mix better. It also appears to have a satiating effect, in part likely related to CCK stimulation.23
Green tea may enhance fat burning due to its caffeine and catechin polyphenol content.24 It is likely that several tea bags would be needed to optimize potential effects. The theanine has a calming effect, which tends to tone down some of the jitters experienced from other forms of caffeine.25
According to German research, water consumption increases the rate at which people burn calories. The impact is modest and the findings are preliminary, but the findings could have important implications for weight-control programs.26
Weight Loss on the Go
The basic building blocks of a weight-loss recipe are protein, fiber and essential fatty acids. If fruits and/or vegetables are limited, add a fruit/vegetable concentrate liquid or powder. An example might be 15 g of vanilla-flavored whey powder with fiber (sweetened with stevia), ground flax seed (10 g) and one scoop (8 g) of a fruit phytonutrient liquid concentrate with fiber, added to 10 to 12 ounces of strong green tea, followed by an extra glass of water if not full. This hypothetical recipe would provide about 17 g protein, 4 g fiber, 5 net carbs, 3 g fat (mostly omega-3) in just 150 calories. Some diet plans less restricted in carbohydrates or calories might allow half the water or green tea to be replaced by orange juice or dairy, soy, rice or almond milk. One-quarter cup berries may be added. Diets of 1,200 calories or less need usually require multivitamin/mineral supplementation.
When to Take?
Although most Americans agree in the importance of consuming breakfast, the majority of consumers say they do not have the time for it, according to a survey conducted by Impulse Research Service.27 Busy schedules and an increasingly fast-paced lifestyle have meant that Americans increasingly miss out on this meal.
A study in the Journal of the American Dietetic Association found that breakfast consumption may be associated with healthier body weights in children and adolescents. Skipping breakfast is common in overweight or obese children. The review authors wrote, “To maximize the potential benefits of breakfast consumption, it is important to distinguish between simply promoting breakfast versus the consumption of a healthful breakfast … Breakfast should include a variety of healthful foods that are high in nutritive value yet do not provide excess energy.”28
For most patients, breakfast is the best time to use these weight loss on-the-go meals as they are easy to prepare and consume. If it is helpful, a second meal either in mid-afternoon, an hour before dinner or as a late-night snack are also good.
I presume that most of you reading this article are not heavily involved in providing detailed weight-loss programs for your patients. Nonetheless, it is likely many are on a weight-loss diet of some kind. Sharing with them some version of this meal plan may assist their compliance while providing many potential health benefits.
The best business promotion for those of us who are overweight is to use this weight-loss solution to lose those extra pounds ourselves. Trust me, your patients will notice. They will ask, “How did you do it?”
References
www.cdc.gov/nccdphp/dnpa/obesity/trend/maps.
Cox ER, Halloran DR, Homan SM, et al. Trends in the prevalence of chronic medication use in children: 2002-2005. Pediatrics 2008;122(5):e1053.
Astrup A, Meinert Larsen T, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?Lancet 2004;364:897-9.
Weigle DS, Breen PA, Matthys CC, et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin andghrelin concentrations. Am J Clin Nutr 2005;82:41-8.
Due A, Toubro S, Skov AR, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord 2004;28:1283-90.
Weigle DS, op cit.
Dietary Reference iIntakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Institute of Medicine, Food and Nutrition Board. Washington, DC: National Academy Press, 2002.
Gerds SK. Whey Ingredients and Weight Management. Applications Monograph. U.S. Dairy Export Council.
Hartmann E, Spinweber CL. Sleep induced L-tryptophan. Effect of dosages within the normal dietary intake. J Nerv Ment Dis 1979 Aug;167(8):497-9
Weigle DS, op cit.
Corring, et al. Release of cystokinin in humans after ingestion of glycomacropeptide (GMP). International Whey conference, Rosemont, Ill. 1997.
Weight management and satiety effects of whey proteins. Carbery Food Ingredients, Ballineen, Co. Cork, Ireland.
Preuss HG, Bagchi D. Obesity: Epidemiology, Pathophysiology, and Prevention. CRC Press 2007, p. 481.
FitzGerald RJ, Meisel H. Milk protein-derived peptide inhibitors of angiotensin-I-converting enzyme. Br J Nutr 2000;84:S33-7.
Gerds SK, op cit, p. 5
Green SM, Delargy HJ, Joanes D, Blundell JE. A satiety quotient: a formulation to assess the satiating effect of food. Appetite 1997;29:91-304.
Holt SHA, Brand Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr 1995;49:675-90.
Omega-3 Fatty Acids. University of Maryland Medical Center.
Omega-6 Fatty Acids. University of Maryland Medical Center.
Burton B, Freeman J. Dietary fiber and energy regulation. J Nutr 2000;130:272S-5.
Gardana C, Simonetti P, Canzi E, et al. Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora. J Agric Food Chem 2003;51(22):6618-22.
Stevia (Stevia rebaudiana bertoni). Natural Standard Monograph.
Nishimukai M, Hara H, Aoyama Y. The addition of soybean phosphatidylcholine to triglyceride increases suppressive effects on food intake and gastric emptying in rats. J Nutr 2003;133:1255-1258.
Cronin JR. Green tea extract stokes thermogenesis. Altern Complement Therapies 2000:296-300.
Mason R. 200 mg of Zen; L-theanine boosts alpha waves, promotes alert relaxation. Altern Complement Therapies 2001:91-5.
Boschmann M. J Clin Endocrinol Metabol December 2003;88:6015-9.
Heller L. Americans recognize but ignore importance of breakfast. Oct. 11, 2006.
Rampersaud GC, Pereira MA, Girard BL, et al. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005 May;105(5):743-60.
Dr. John Maher is a past postgraduate faculty member of the New York Chiropractic College Academy of Anti-Aging Medicine, a diplomate of the College of Clinical Nutrition and a fellow of the American Academy of Integrative Medicine. He is the founder of BioPharma Scientifica and oversees research and education. He can be contacted at jmaher@biopharmasci.com.
By John Maher, DC, DCCN, FAIIM
“There is an urgent need for effective tools to prevent weight gain in the population at large and weight regain in overweight persons after weight loss. In theory the solution is simple, but implementation will continue to be difficult and ineffective as long as we maintain the view that just telling people that they should eat less and exercise more does the job.”3
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The spreading “obesity epidemic,” even among our children, is well known to all chiropractors.1,2 There is also an increasing list of weight-loss diets. In any diet, there are varying degrees in difficulty and in compliance. Let’s discuss some ideas on how to support compliance.
Specifically, I want to encourage the use of nutrient-dense foods and ingredients to make quick and easy weight loss on-the-go meals that will fit into almost any diet scheme. The recipes need to be nutrient dense, including phytonutrients, zoonutrients and omega-3 EFAs; be enjoyable, filling and satisfying; provide long-lasting energy and satiation; be quick and easy to make; and fit into most any dietary approach.
Satiating Power of Protein
“Many popular diets recommend 30% to 40% protein content, at the expense of carbohydrate, over and above the usual 10-20% protein recommendation. Newer research indicates that the high-protein content of these diets may actually be the reason for their partial success in inducing weight loss, despite no restrictions in total calories.”3
Scientists have stated that research subjects felt more satiated with an isocaloric high-protein diet thanwith a weight-maintenance diet.4 Of note in relation to metabolic syndrome (Syndrome X), high-protein diets,independent of the loss of total body fat, resulted in a significantloss of visceral fat.5
We do not yet have consensus agreement on how protein increases satiety. This effect could not be explained bychanges in the hunger hormone ghrelin or the satiety hormoneleptin.6 However, that does not prevent us from using that knowledge. The guidelines from the Institute of Medicine allow for theinclusion of higher amounts of protein than previously recommended.7 The institute concluded that there isno clear evidence that a high protein intake increases the riskof renal stones, osteoporosis, cancer or cardiovascular disease.
Perhaps the protein with the best features is whey protein. First, whey has an excellent value, efficiency, utilization and digestibility profile.8 Whey is a complete and balanced protein and, as such, is a good source of the amino acid tryptophan, supplying about 2.4 g/100 g. Low-calorie, low-protein diets may not supply enough of this essential amino acid. Tryptophan is the precursor to serotonin, an important neurotransmitter that helps regulate mood, sleep and appetite, especially as relates to carbohydrates. Also, if niacin intake is insufficient, the body will convert tryptophan to niacin, needing 60 mg of the former to make 1 mg of the latter. Typically, most people consume 1,000 to 1,500 mg of tryptophan a day.9 Diets low in tryptophan are not likely to succeed in the long term.
Comparison of Protein Sources
BV
PER
NPU
PDCAAS
BV
PER
NPU
PDCAAS
Whole Egg
100
3.8
94
1.18
Beef
80
2.9
73
.92
Whey Protein
104
3.2
92
1.15
Casein
77
2.5
76
1.23
Cow’s milk
91
3.1
82
1.21
Soy Protein
61
2.1
61
.91
Biological Value (BV), Protein Efficiency Ratio (PER), Net Protein Utilization (NPU), and Protein Digestibility Corrected Amino-Acid Score (PDCAAS)
Whey protein provides more branched-chain amino acids (L-isoleucine, L-leucine and L-valine) than any other protein source. Branched-chain amino acids (BCAAs) are unique in that they are metabolized for energy by muscle, rather than by the liver. BCAAs thereby both spare lean muscle mass in weight-management programs and reduce the role of insulin in blood glucose control.10
Another component of whey, glycomacropeptide (GMP), appears to have a role in appetite suppression. GMP has been shown to stimulate the intestinal hormone cholecystokinin (CCK), which inhibits gastric emptying and secretions, and also induces satiety. Admittedly, human trials have been limited, but studies have demonstrated that consumption of whey protein enriched with GMP reduced hunger and subsequent meal intake.11,12
Whey protein also confers significant angiotensin-converting enzyme (ACE) activity. Recent data demonstrate adipocyte lipogenesis is regulated in part by angiotensin II. Perhaps most importantly, as it relates to comorbidity in obesity and the oft-related diabetes and metabolic syndrome, ACE appears to have significant hypotensive effects.13,14
Carbohydrates
The most popular weight-loss diets today tend to de-emphasize carbohydrates, especially those that have a high glycemic index (GI). High-GI foods tend to promote large insulin fluctuations, perhaps eventually leading to insulin resistance, metabolic syndrome and diabetes. Dysglycemias are usually associated with weight gain, increased deep belly fat and resultant central adiposity.
High-protein foods tend to be low in carbohydrates and therefore have a low GI index. Whey protein isolates (>90 percent protein) have a glycemic index of less than one.15 Whey protein isolate is also extremely lean, being low in fat and cholesterol. Unlike meats or eggs, whey protein is never fried, broiled or barbecued, and therefore does not promote the formation of advanced glycation endproducts, a major contributor to the development of the common diseases of aging.
Low-carbohydrate vegetables are strongly recommended in most dietary strategies. They provide fiber, vitamins, minerals, phytonutrients and lots of chewing. In the more restricted carbohydrate routines, many fruits are severely limited because of their sugar content. As the unique nutrients in fruits and vegetables are so beneficial to health, high-phytonutrient fruit and vegetable liquid concentrates and drink mix powders are often recommended for those who do not consume optimal amounts, or desire the nutrients without the carbohydrates.
Fats
Even though fats have over twice the calories per gram as protein or carbohydrates, the highest satiating power is found with high levels of protein, dietary fiber and water. Low satiating power is related to higher fat foods.16,17 Still, it is most important to have sufficient essential fatty acid intake, both omega-3 and omega-6.18,19 Omega 3 is usually the most limited. Fatty fish and flax seed are the richest, most common sources, though high-omega chia seeds and foods fortified with DHA have recently become more available.
Fiber
According to a report in the Journal of Nutrition, “Dietary fiber has many functions in diet, one of which may be to aid in energy intake control and reduced risk for development of obesity. The role of dietary fiber in energy intake regulation and obesity development is related to its unique physical and chemical properties that aid in early signals of satiation and enhanced or prolonged signals of satiety. Early signals of satiation may be induced through cephalic- and gastric-phase responses related to the bulking effects of dietary fiber on energy density and palatability, whereas the viscosity-producing effects of certain fibers may enhance satiety through intestinal-phase events related to modified gastrointestinal function and subsequent delay in fat absorption.”20 Clearly, sufficient soluble and insoluble fiber are important factors in weight-loss diets.
Stevia, Lecithin, Green Tea and Water
Stevia (Stevia rebaudiana) extracts are used as natural sweeteners or dietary supplements for their stevioside or rebaudioside A compounds. These compounds possess up to 250 times the sweetness of sucrose. They are noncaloric and noncariogenic.21 In addition, stevia has the ability to lower high blood sugar and blood pressure.22 High-quality stevia, without the bitter aftertaste, is available.
Lecithin is a common component of drink powders that makes them mix better. It also appears to have a satiating effect, in part likely related to CCK stimulation.23
Green tea may enhance fat burning due to its caffeine and catechin polyphenol content.24 It is likely that several tea bags would be needed to optimize potential effects. The theanine has a calming effect, which tends to tone down some of the jitters experienced from other forms of caffeine.25
According to German research, water consumption increases the rate at which people burn calories. The impact is modest and the findings are preliminary, but the findings could have important implications for weight-control programs.26
Weight Loss on the Go
The basic building blocks of a weight-loss recipe are protein, fiber and essential fatty acids. If fruits and/or vegetables are limited, add a fruit/vegetable concentrate liquid or powder. An example might be 15 g of vanilla-flavored whey powder with fiber (sweetened with stevia), ground flax seed (10 g) and one scoop (8 g) of a fruit phytonutrient liquid concentrate with fiber, added to 10 to 12 ounces of strong green tea, followed by an extra glass of water if not full. This hypothetical recipe would provide about 17 g protein, 4 g fiber, 5 net carbs, 3 g fat (mostly omega-3) in just 150 calories. Some diet plans less restricted in carbohydrates or calories might allow half the water or green tea to be replaced by orange juice or dairy, soy, rice or almond milk. One-quarter cup berries may be added. Diets of 1,200 calories or less need usually require multivitamin/mineral supplementation.
When to Take?
Although most Americans agree in the importance of consuming breakfast, the majority of consumers say they do not have the time for it, according to a survey conducted by Impulse Research Service.27 Busy schedules and an increasingly fast-paced lifestyle have meant that Americans increasingly miss out on this meal.
A study in the Journal of the American Dietetic Association found that breakfast consumption may be associated with healthier body weights in children and adolescents. Skipping breakfast is common in overweight or obese children. The review authors wrote, “To maximize the potential benefits of breakfast consumption, it is important to distinguish between simply promoting breakfast versus the consumption of a healthful breakfast … Breakfast should include a variety of healthful foods that are high in nutritive value yet do not provide excess energy.”28
For most patients, breakfast is the best time to use these weight loss on-the-go meals as they are easy to prepare and consume. If it is helpful, a second meal either in mid-afternoon, an hour before dinner or as a late-night snack are also good.
I presume that most of you reading this article are not heavily involved in providing detailed weight-loss programs for your patients. Nonetheless, it is likely many are on a weight-loss diet of some kind. Sharing with them some version of this meal plan may assist their compliance while providing many potential health benefits.
The best business promotion for those of us who are overweight is to use this weight-loss solution to lose those extra pounds ourselves. Trust me, your patients will notice. They will ask, “How did you do it?”
References
www.cdc.gov/nccdphp/dnpa/obesity/trend/maps.
Cox ER, Halloran DR, Homan SM, et al. Trends in the prevalence of chronic medication use in children: 2002-2005. Pediatrics 2008;122(5):e1053.
Astrup A, Meinert Larsen T, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?Lancet 2004;364:897-9.
Weigle DS, Breen PA, Matthys CC, et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin andghrelin concentrations. Am J Clin Nutr 2005;82:41-8.
Due A, Toubro S, Skov AR, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord 2004;28:1283-90.
Weigle DS, op cit.
Dietary Reference iIntakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Institute of Medicine, Food and Nutrition Board. Washington, DC: National Academy Press, 2002.
Gerds SK. Whey Ingredients and Weight Management. Applications Monograph. U.S. Dairy Export Council.
Hartmann E, Spinweber CL. Sleep induced L-tryptophan. Effect of dosages within the normal dietary intake. J Nerv Ment Dis 1979 Aug;167(8):497-9
Weigle DS, op cit.
Corring, et al. Release of cystokinin in humans after ingestion of glycomacropeptide (GMP). International Whey conference, Rosemont, Ill. 1997.
Weight management and satiety effects of whey proteins. Carbery Food Ingredients, Ballineen, Co. Cork, Ireland.
Preuss HG, Bagchi D. Obesity: Epidemiology, Pathophysiology, and Prevention. CRC Press 2007, p. 481.
FitzGerald RJ, Meisel H. Milk protein-derived peptide inhibitors of angiotensin-I-converting enzyme. Br J Nutr 2000;84:S33-7.
Gerds SK, op cit, p. 5
Green SM, Delargy HJ, Joanes D, Blundell JE. A satiety quotient: a formulation to assess the satiating effect of food. Appetite 1997;29:91-304.
Holt SHA, Brand Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods. Eur J Clin Nutr 1995;49:675-90.
Omega-3 Fatty Acids. University of Maryland Medical Center.
Omega-6 Fatty Acids. University of Maryland Medical Center.
Burton B, Freeman J. Dietary fiber and energy regulation. J Nutr 2000;130:272S-5.
Gardana C, Simonetti P, Canzi E, et al. Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora. J Agric Food Chem 2003;51(22):6618-22.
Stevia (Stevia rebaudiana bertoni). Natural Standard Monograph.
Nishimukai M, Hara H, Aoyama Y. The addition of soybean phosphatidylcholine to triglyceride increases suppressive effects on food intake and gastric emptying in rats. J Nutr 2003;133:1255-1258.
Cronin JR. Green tea extract stokes thermogenesis. Altern Complement Therapies 2000:296-300.
Mason R. 200 mg of Zen; L-theanine boosts alpha waves, promotes alert relaxation. Altern Complement Therapies 2001:91-5.
Boschmann M. J Clin Endocrinol Metabol December 2003;88:6015-9.
Heller L. Americans recognize but ignore importance of breakfast. Oct. 11, 2006.
Rampersaud GC, Pereira MA, Girard BL, et al. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005 May;105(5):743-60.
Dr. John Maher is a past postgraduate faculty member of the New York Chiropractic College Academy of Anti-Aging Medicine, a diplomate of the College of Clinical Nutrition and a fellow of the American Academy of Integrative Medicine. He is the founder of BioPharma Scientifica and oversees research and education. He can be contacted at jmaher@biopharmasci.com.
Esterfied Fatty Acids fpr Arthritic Pain
Esterified Fatty Acids for Arthritis Pain
By Kim Vanderlinden, ND, DTCM
Esterified fatty-acid complex (EFAC), which is not to be confused with essential fatty acids, may indeed be our most potent natural anti-inflammatory. Clinical trial results using EFAC, both as a topical agent and as an oral supplement, have been nothing short of spectacular. The results have been so dramatic that it appears to be a major breakthrough in arthritis and pain management. And as we know, genuine advancements are few and far between.
Esterified Fatty Acids vs. Essential Fatty Acids
Esterified fatty acids and essential fatty acids are very similar in the fact that they are both derived from oils. However, esterified oils are not essential oils, such as omega-3 and omega-6. Oils are considered to be healthy when they have anti-inflammatory properties. Omega-3 and fish oils are currently popular for this very reason. Esterified fatty acids are derived from beef tallow and appear to have far greater anti-inflammatory properties than current healthy oils, as shown in promising trial results.
Esterified fatty acids have another unique property: They are very well-absorbed topically, thereby reaching target tissues. This has major implications for chiropractic care. The active agent itself is the penetrating agent, versus trying to mix active ingredients and carriers in the same formula and hoping that some of the active agent passes through the skin along with the carrier.
EFAC for Knee Osteoarthritis
In 2007, researchers using EFAC as an oral supplement were awarded the best paper out of the 90 papers presented at the prestigious Scripps Integrated Medical Conference in San Diego.1 The researchers were investigating knee osteoarthritis (OA). In this trial, as in previous trials using EFAC, pain scores dropped quickly and significantly. However, since pain is largely subjective, the researchers wanted objective measurements as well. The researchers decided to measure how far patients could go in a timed six-minute walk. Presumably patients with knee OA would walk slower due to pain and/or stiffness. The patients were tested prior to supplementation to establish a baseline and then again after two, four and eight weeks. In addition to less pain, the treated patients improved in just two weeks, as they were able walk an extra 233 feet. After four weeks they could travel an additional 330 feet. After eight weeks, they were able to walk a remarkable 537 feet farther than from baseline. Most importantly, the placebo patients did not improve, which makes the results that much more significant.
Two clinical trials using EFAC to treat osteoarthritis of the knees have been published in the very highly regarded Journal of Rheumatology. Once study tested an oral capsule, and the other tested a topical cream.2,3 Osteoarthritic knees are often the subject of anti-inflammatory and joint health research because knee OA is prevalent and it provides a functional benchmark with which to compare previous research on other treatments.
In the topical cream trial, patients were tested at baseline, 30 minutes after the first application to the knees and after 30 days of applying the cream twice daily.3 Range of motion of their knees, ability to ascend and descend stairs, ease of getting up from a sitting position and balance while stepping down was tested. After only 30 minutes, the EFAC cream improved the ability of patients to perform the above tasks. There were also long-term benefits. After 30 days, the patients improved significantly.
What About Glucosamine and Chondroitin?
The NIH conducted the GAIT trial, which is the largest (1,583 patients) and most rigorous trial ever conducted on glucosamine and chondroitin.4 In 2006, the initial results of the trial were released: After six months of treatment, there was not a statistically significant reduction of knee pain compared to placebo. However, many physicians continued to recommend glucosamine and chondroitin despite the negative results in the NIH trial because even if they did not relieve pain, they still provided benefit for the cartilage.
GAIT trial patients were given the option to continue for an additional 18 months for a total treatment period of two years to determine whether glucosamine and/or chondroitin would benefit cartilage. The results: Glucosamine and/or chondroitin came up short again, as they did not prevent a statistically significant loss of cartilage.5
First, Do No Harm
Should we continue to recommend glucosamine and chondroitin to patients? Chiropractors need to be leaders, not followers, in the field of pain management. Taking the position that glucosamine and chondroitin likely won’t help, but won’t hurt, either, is simply not serving the best interests of our patients, especially if an safe, effective alternative is available.
As physicians primarily seeing patients presenting with pain, success largely depends on the reduction of that pain. It is generally acknowledged that a majority of pain is due to inflammation. Therefore, to effectively combat pain, we often need to address that inflammation. EFAC, both topically and orally, provides us with a clinically proven tool to do just that.
References
Udani JK, Singh B, Torreliza M, et al. Oral cetylated fatty acids for the improvement of functional ability and pain in patients with knee osteoarthritis. Presented at the Scripps Integrated Medical Conference, 2007
Hesslink R Jr, Armstrong D 3rd, Nagendran MV, et al. Cetylated fatty acids improve knee function in patients with osteoarthritis. J Rheumatol Aug 2002;29(8):1708-12.
Kraemer WJ, Ratamess NA, Anderson JM, et al. Effect of a cetylated fatty acid topical cream on functional mobility and quality of life of patients with osteoarthritis. J Rheumatol Apr 2004;31(4):767-74.
Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med, Feb. 23, 2006;354(8):795-808.
Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheumatism 2008;58(10):3181-91.
Dr. Kim Vanderlinden graduated from Bastyr University and maintains a private practice in Vancouver, British Columbia, Canada. He is the president of Nutra Naturals (www.nutranaturals.com).
By Kim Vanderlinden, ND, DTCM
Esterified fatty-acid complex (EFAC), which is not to be confused with essential fatty acids, may indeed be our most potent natural anti-inflammatory. Clinical trial results using EFAC, both as a topical agent and as an oral supplement, have been nothing short of spectacular. The results have been so dramatic that it appears to be a major breakthrough in arthritis and pain management. And as we know, genuine advancements are few and far between.
Esterified Fatty Acids vs. Essential Fatty Acids
Esterified fatty acids and essential fatty acids are very similar in the fact that they are both derived from oils. However, esterified oils are not essential oils, such as omega-3 and omega-6. Oils are considered to be healthy when they have anti-inflammatory properties. Omega-3 and fish oils are currently popular for this very reason. Esterified fatty acids are derived from beef tallow and appear to have far greater anti-inflammatory properties than current healthy oils, as shown in promising trial results.
Esterified fatty acids have another unique property: They are very well-absorbed topically, thereby reaching target tissues. This has major implications for chiropractic care. The active agent itself is the penetrating agent, versus trying to mix active ingredients and carriers in the same formula and hoping that some of the active agent passes through the skin along with the carrier.
EFAC for Knee Osteoarthritis
In 2007, researchers using EFAC as an oral supplement were awarded the best paper out of the 90 papers presented at the prestigious Scripps Integrated Medical Conference in San Diego.1 The researchers were investigating knee osteoarthritis (OA). In this trial, as in previous trials using EFAC, pain scores dropped quickly and significantly. However, since pain is largely subjective, the researchers wanted objective measurements as well. The researchers decided to measure how far patients could go in a timed six-minute walk. Presumably patients with knee OA would walk slower due to pain and/or stiffness. The patients were tested prior to supplementation to establish a baseline and then again after two, four and eight weeks. In addition to less pain, the treated patients improved in just two weeks, as they were able walk an extra 233 feet. After four weeks they could travel an additional 330 feet. After eight weeks, they were able to walk a remarkable 537 feet farther than from baseline. Most importantly, the placebo patients did not improve, which makes the results that much more significant.
Two clinical trials using EFAC to treat osteoarthritis of the knees have been published in the very highly regarded Journal of Rheumatology. Once study tested an oral capsule, and the other tested a topical cream.2,3 Osteoarthritic knees are often the subject of anti-inflammatory and joint health research because knee OA is prevalent and it provides a functional benchmark with which to compare previous research on other treatments.
In the topical cream trial, patients were tested at baseline, 30 minutes after the first application to the knees and after 30 days of applying the cream twice daily.3 Range of motion of their knees, ability to ascend and descend stairs, ease of getting up from a sitting position and balance while stepping down was tested. After only 30 minutes, the EFAC cream improved the ability of patients to perform the above tasks. There were also long-term benefits. After 30 days, the patients improved significantly.
What About Glucosamine and Chondroitin?
The NIH conducted the GAIT trial, which is the largest (1,583 patients) and most rigorous trial ever conducted on glucosamine and chondroitin.4 In 2006, the initial results of the trial were released: After six months of treatment, there was not a statistically significant reduction of knee pain compared to placebo. However, many physicians continued to recommend glucosamine and chondroitin despite the negative results in the NIH trial because even if they did not relieve pain, they still provided benefit for the cartilage.
GAIT trial patients were given the option to continue for an additional 18 months for a total treatment period of two years to determine whether glucosamine and/or chondroitin would benefit cartilage. The results: Glucosamine and/or chondroitin came up short again, as they did not prevent a statistically significant loss of cartilage.5
First, Do No Harm
Should we continue to recommend glucosamine and chondroitin to patients? Chiropractors need to be leaders, not followers, in the field of pain management. Taking the position that glucosamine and chondroitin likely won’t help, but won’t hurt, either, is simply not serving the best interests of our patients, especially if an safe, effective alternative is available.
As physicians primarily seeing patients presenting with pain, success largely depends on the reduction of that pain. It is generally acknowledged that a majority of pain is due to inflammation. Therefore, to effectively combat pain, we often need to address that inflammation. EFAC, both topically and orally, provides us with a clinically proven tool to do just that.
References
Udani JK, Singh B, Torreliza M, et al. Oral cetylated fatty acids for the improvement of functional ability and pain in patients with knee osteoarthritis. Presented at the Scripps Integrated Medical Conference, 2007
Hesslink R Jr, Armstrong D 3rd, Nagendran MV, et al. Cetylated fatty acids improve knee function in patients with osteoarthritis. J Rheumatol Aug 2002;29(8):1708-12.
Kraemer WJ, Ratamess NA, Anderson JM, et al. Effect of a cetylated fatty acid topical cream on functional mobility and quality of life of patients with osteoarthritis. J Rheumatol Apr 2004;31(4):767-74.
Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med, Feb. 23, 2006;354(8):795-808.
Sawitzke AD, Shi H, Finco MF, et al. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial. Arthritis Rheumatism 2008;58(10):3181-91.
Dr. Kim Vanderlinden graduated from Bastyr University and maintains a private practice in Vancouver, British Columbia, Canada. He is the president of Nutra Naturals (www.nutranaturals.com).
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