April 27, 2011

Podcast #143 https://bengreenfieldfitness.com/2011/04/episode-143-can-prolotherapy-make-your-injuries-vanish/

Introduction:                                                                                                                         In this podcast, can prolotherapy make your injuries vanish, eating algae oil, increasing testosterone, frankenfoods, how to raise HDL, recognizing if your nervous system is overtrained, making a home gym, does the brand of fish oil matter, training for a marathon on a low carb diet, does stevia and artificial sweeteners elevate insulin, how to get off a weight loss plateau, compression gear, rotator cuff exercises, is bottled water healthy and is Ironman training bad for you?

Ben Greenfield:  Hey, Ben Greenfield here.  As you may have just heard, we do have a jam-packed podcast today, and our special guest is Dr. David Minkoff and David has been on the podcast a few times, the guy is amazing; he’s a complementary and alternative medicine physician down in Clearwater, Florida.  He’s done almost 40 Ironman triathlons.  He’s been on the show before talking about the 3 main causes of illness and poor performance and also did the show called “The Peek into the Life of an Ironman Physician”.  I’ll put a link to both of those previous shows that he’s done in the show notes to this episode, Episode # 143, and he’s always just a wealth of interesting content, so you don’t want to miss his interview today which is on something called Prolotherapy and as I mentioned last week, over the next couple weeks, I am responding to more questions during the Q & A sessions to kind of catch up to the many questions that we have in the question database, so let’s go ahead and jump right in to this week’s content.

Special Announcements:   Well, you may have heard last week, if you listen to the special announcements, that I am accepting designs now for the new BenGreenfieldFitness t-shirt.  And several people emailed me this week and all I do is respond to that email and just give you a big collection of different logos and graphics that you can use to make your designs so if you want to be involved in the BenGreenfieldFitness t-shirt design contest, all you need to do is submit your design to [email protected].  If your design wins, we’re going to do a special blog post and podcast talking about how you put it together and why you designed your t-shirt the way that you did.   So a couple of other announcements: still sending out free copies of KC Craichy’s book: “Super Health: The Last Diet That You’ll Ever Need”.  All you need to do to be eligible to get that book is post a video telling me why that book would help you over at Facebook.com/BGFitness , and if you have no clue what that book is, listen to Episode #139 and 140.  And then finally, if you happen to have an extra dollar lying around, I’ve got a couple things you can do with it.  First of all, you can donate 1 dollar to keep the BenGreenfieldFitness podcast going, and all you need to do is go to BenGreenfieldFitness.com and there’s a button there that you can push to donate 1 dollar to keep this podcast going.  You can also, if you have a dollar to spare, go check out the BenGreenfieldFitness Inner Circle. It costs one dollar to get a 14-day sneak peak at the tons of videos, seminars and forum Q & A’s that my wife and I are running on teaching you how to re-invent your life and put together a healthy life style for you and your family, that’s the Ben Greenfield Fitness Inner Circle.  I’ll put a link to that $1 sneak peak in the show notes as well.  Well let’s go ahead and move on to this week’s listener Q and A.

Well remember, if you have a question for the podcast, you can use the handy-dandy “Ask Ben Form” over at BenGreenfieldFitness.com.  click Ask a Podcast Question at the bottom of this page; you can ask your question via Twitter too, at BenGreenfield, or if you happen to be one of the 8000 people going down to the Wildflower Triathlon this weekend, I’ll be down there in the athlete’s lounge, from 2-3 o’clock in the afternoon.  Both days, answering your questions.  Friday and Saturday, so there you go.

Armi says:     I had a question about algae derived DHA and its benefits.  One of your podcast guests talked about how fish oil is best, but what about something like Udo’s choice DHA?  Also, have you heard of Astaxanthin?

Ben answers: Well, DHA is something that we’ve talked about on the show before, it is one of the Omega 3 fatty acids which not only has anti-inflammatory properties but is super rich in terms of its brain- building capabilities and its ability to lower your risk of degenerative diseases of the nervous system like multiple sclerosis and it’s fantastic for your joints, for your brain, for your body, for your immune system, ton of different things that DHA has going on in it or for it and it is part of fish oil.  However, you can also get a DHA from algae that produce this DHA and you can get in like a pill form.  So the big problem though is basically the idea of the dosing with DHA, so if you go out, you get one of these algae oils, the problem is that, it typically comes in somewhere around like 200 milligrams of DHA in a capsule, and the issue is that if your essential fatty acid levels, like most people’s are, are way off base and your Omega 6 fatty acids are way up and your Omega 3 fatty acids are too low, you’re typically looking at needing to take, somewhere in the range of 1500 to 2000 milligrams of DHA EPA blend, to get your essential fatty acids levels back up to where they should be.  And with 200 milligrams of DHA in most servings of like either algae-based DHA or another source of DHA which is called krill, it’s meaning that you got to take a lot of it and buy a lot of it, so you’re typically looking at happen to spend almost a hundred dollars a month on a DHA capsule in order to get enough DHA.  So it’s well absorbed; it is a sustainable source of DHA; it’s non-toxic, this algae oil, but the problem is that it’s just very low in DHA or I mean, the amount of DHA that you would actually need.  You asked a follow-up question about something called astaxanthin and actually it’s something that Dr. Richard Cohen recently talked about in the live seminar that we did called “The Shocking Truth about Vitamin D and fish oil”.  Astaxanthin is something that actually compliments quite nicely of the addition of fish oil to the diet; it’s a naturally-occurring red pigment, it’s actually found in the tissue of wild salmon, a lot of crustaceans like lobster and shrimp; krill is another source of it; and it is an anti-oxidant and a very rich source of carotenoid which would be things like Vitamin A, Vitamin C, Vitamin E, and astaxanthin kind of falls into that category.  So it gives some really good anti-oxidant property, it helps to neutralize a lot of the free radicals that can take place when you’re exercising or even when you’re just digesting food or living, and it is something that tends to compliment very nicely the use of fish oil.  The interesting thing about astaxanthin is it also crosses the blood brain barrier so if you’re taking something like a fish oil for you brain health, astaxanthin kind of gives you a 1-2 combo with that as well.  Plus, the reason that it’s packaged and included with a lot of fish oils, I will put a link to a fish oil astaxanthin kind of 1-2 combo in the show notes for you, Episode #143 show notes, it’s the same one that Dr. Cohen talked about in the live seminar that we did, in case you missed that seminar.  So that is the deal with the algae DHA and the astaxanthin.

Graeme asks:  What are your thoughts on ab wheels?  The type where you have a handle on the other side of a single wheel and you roll out to a plank position and then roll back in.  Is this good for ab recruitment or just a waste of time?

Ben answers:              Well, I can tell you one thing it’s good for – it’s good for wanting to punch your friends in the face if they make you laugh the day after you did this because this thing leaves your abs sore.  It’s also a great shoulder workout, and if you kind of roll your elbows up and keep your elbows high as you do the exercise, it hits a lot of the lat and swimming type of muscles as well.  So, it goes by a couple of different names; the ab wheel, the other one that I’ve heard most frequently is a power wheel, and yeah, like Graeme says, you hold on to it, you roll your body out, your entire body is supported between the wheel and your knees, then you roll the wheel back in and there’s quite a bit of abdominal recruitment that needs to take place in order to roll that wheel in and out.  And they actually did a study on this and compared it with a hanging knee-up and a reverse crunch which are also considered to be fairly difficult abdominal exercises so they hooked up electromyographic  patches to assess the muscle activity on the upper and lower abs, on your bleaks, on the rectus femoris, on the lats, on the lumbar pair spinal muscles which are basically your lower back muscles and they compared which of these using the ab wheel, using the hanging knee-up with the straps, using the reverse crunch, elicited the greatest amount of muscle activity in all of these muscles and there is a huge amount of activity in the ab wheel compared to these other traditional abdominal exercises and I can personally attest to that just based off of the fact that my core’s in pretty good shape and I still get fairly sore if I do like say, three sets of 20 repetitions with this ab wheel.  The issue is that the electromyographic study also showed that there is a very large amount of hip flexor recruitment when using the ab wheel, and for a lot of people, it’s not an issue but for anybody that has low back pain, one of the primary issues of low back pain aside from sacroiliac joint misalignment is very tight hip flexors and if your hip flexors are super tight, and you’re doing an exercise that involves a massive contraction of the hip flexors, you’re significantly risking your propensity to get low back pain during the abdominal exercise, so I highly recommend the ab wheel if you’ve got good flexible hip flexors and you don’t get low back pain frequently.  If you do get low back pain frequently, I would make sure that your hip flexors are stretched out first by doing lots of like lunging type of stretch exercises and then eventually work the ab wheel into your program.  Alright!

Tony says:     I read an interesting article about frankenfoods.  How does something like this fall into your morals and teaching?

Ben answers:              I put a link to this franken foods article, and the title of the article is “Franken Foods in Your Natural Food Store: Whole Foods or Whole Hypocrisy” and the idea behind this article is that there are organic grocery stores like whole foods selling tons of genetically-modified foods in their stores and still advertising themselves as being very natural food stores, you know, Whole Foods, Trader Joe’s is another example, and in the article, there is a quote from one of the guys who stands behind what’s called the “Millions Against Monsanto: Truth in Labelling Campaign” and for those of you who don’t know what Monsanto is, it’s one of the primary seed producers in the US that uses genetically-modified foods or genetically-modified seeds, and what this quote says from this gentleman who directs that strategy behind the anti-Monsanto campaign, is that it says “Over 90% of Americans want genetically-modified  foods labelled.  Why?  So that we can avoid buying these foods. This is a major reason why millions of us are buying certified organic products which preclude the use of genetically-modified ingredients as well as toxic chemicals and animal drugs. Since the politicians in Washington apparently prefer to listen to Monsanto rather than their constituents, we need to put our efforts where we currently have the most power in our local communities, especially at the retail grocery store level where 15 million of us are regularly buying certified organic and natural foods or so called, natural foods. What most consumers don’t understand yet is that most of the so called naturally- processed food and animal products which make up 2/3 of the sales at whole foods market, we are still buying GMO contaminated.  Either they contain genetically-modified ingredients like soy corn, canola cottonseed oil or sugars deep sweetener or else the animals have been forced fed a steady diet of GMO grains and drugs.  We need to clean up our act and walk our talk in the green and natural product sector, we need to tell natural food giants like Whole Foods or Trader Joe’s that you can’t claim to support GMO labelling and then proceed to sell billions of dollars of unlabelled GMO food in your stores, green washed as natural”.  That quote basically sums up what I think about this entire franken foods concept.  I agree 100%, we should be told what we are eating and if a company is going to genetically modify its ingredients, we, as consumers, have the right to be able to find out about that.  And I’m not going to get any more political than that but I do have to say that I do agree with this idea that you really do need to know what you are eating, especially if you’re walking into a natural food store and expecting that everything you grab is going to be healthy, when in fact, it could be heavily genetically-modified.

Dawn asks:    My husband was told today by his doctor that his HDL was too low, and that he should exercise and take Niacin.  Anyways, my question is, would more strenuous exercise raise his HDL?  And what do you think of Niacin?

Ben answers:            Well first of all, just we make sure that we’re on the same page, the HDL or High Density Lipo proteins, they’re very good for you; they’re made by your liver; they carry cholesterol and fats from your tissues, from your organs, back to your liver where those tissues can basically be, or those fats and lipids can be recycled or degraded and multiple studies have shown that having these high levels of HDL can lower your risk of getting clogged arteries or getting heart disease.  It’s basically a fat transport mechanism, and studies have shown that moderate exercise will raise your HDL cholesterol levels, where I say something like smoking would lower your HDL levels.  Another thing interesting that can raise your HDL levels is moderate drinking.  They had one study that shows that HDL levels would go up significantly when you had about 1 to 2 drinks on a daily basis, so one drink, remember being about 12 ounces of beer or 4 ounces of wine, so basically about half as much as what most of us actually considered to be a drink, but drinking alcohol can raise HDL as well.  The answer to your question is yes, moderate exercise can raise HDL, and extensive exercise can actually technically lower HDL especially if you’re eating a low fat, high sugar diet along with a bunch of exercise so there’s kind of a caveat to that.  Now remember, of course, on this show we believe or I believe several things.  First of all, that cholesterol is not an issue; it’s not dangerous by itself; having high cholesterol could reflect an unhealthy condition or could be totally innocent.  High blood cholesterol, what they tell you is that it promotes atherosclerosis, that it promotes coronary heart disease, but there have been many studies that have shown that just how many people have high blood cholesterol get heart disease as people that have low blood cholesterol get heart disease.   Your diet can influence cholesterol.  It’s not the only thing that can influence cholesterol because your body produces about 3 to 4 times more cholesterol than you actually eat, so lowering cholesterol doesn’t just come down to diet, it does have a lot to do with your activity levels and the way that you live, and there is zero evidence that animal fat and cholesterol or too much animal fat and cholesterol would promote atherosclerosis or heart attacks.  There have been tons of studies that have shown people who have a heart attack have eaten more fat of any kind than any other people and that this high cholesterol or this degree of atherosclerosis rather, is really not related necessarily to a high fat diet, unless that high fat diet is paired with a lot of other unhealthy dietary habits.  So I could go on and on but remember, most physicians are going to just try to go after cholesterol with a shotgun, bring HDL way up or LDL real low and it could be even healthier to just bring cholesterol as a whole up and just decrease the amount of inflammatory sugar that are being consumed.  Now as far as this Niacin goes, Niacin really doesn’t have many horrible side effects.  There could be a little bit of flushing, basically what’s called a Niacin flush that comes along with taking Niacin in high doses like taking more than a thousand milligram and it’s annoying but it’s not really harmful.  What Niacin does is it’s a B-vitamin, it’s used by your body to essentially turn carbohydrates into energy, it supports a healthy nervous system, digestive system, good skin, good hair, and it can raise HDL and as a matter of fact, it can raise HDL by 15 up to over 30 %, so Niacin can bring up your HDL levels and there’s not a lot side effects with it, so it’s something that I wouldn’t worry about.  The only issue is that I would make sure that you’re purchasing Niacin from a certified good manufacturing practices facility that is somewhat regulated, they’re never as regulated as prescription medications but somewhat regulated so that you know what you’re getting.

Danny asks: I have been training with weights and I recently lost a lot of muscle weight, I’m not too happy about that.  As a result, I’ve been reading about “Overtraining” and this whole CNS or central nervous system response is something that is unfamiliar with me.  Do you have a couple of minutes to discuss this on an upcoming podcast?  How does one know if their CNS is fully recovered and ready for more weight training?

Ben answers:              Well, this is a really good question because traditionally overtraining really isn’t considered as big of an issue for the central nervous system compared to what’s called the peripheral nervous system.  So, there’s kind of 2 different types of overtraining.  We’ve talked about overtraining before in the show, we haven’t talked about the 2 different types of overtraining, so basically, the first type would be an overtraining on what’s called your sympathetic nervous system, and then there is the type of training that would be considered a parasympathetic overtraining.  So, usually what happens is that if somebody’s going to be overtrained, endurance athletes typically tend to experience this parasympathetic nervous system overtraining and people who are like weight trainers, football players, power athletes, they tend to experience more of these sympathetic nervous system type of overtraining.  So for like an endurance athlete, what happens is that when you’re always going out and exercising, getting a lot of volume in, you work your sympathetic or kind of your fight or flight nervous system quite heavily and when that happens in that system, it kind of burns out, your parasympathetic nervous system begins to dominate and your parasympathetic nervous system would be kind of like your rest and digest part of your nervous system and so, what happens is an over-trained endurance athlete or someone who’s overtrained because of a high volume of kind of, low intensity exercise would get decreased testosterone levels, decreased testosterone to cortisol ratios, decreased resting what are called catecholamines, and we’ll discuss those in a second, but those are really linked quite highly to the central nervous system, and then increased levels of inflammatory markers in the bloodstream, specifically stuff like creatine kinase, and a lot of times they’ll be unable to produce as much lactic acid or get to as high as the heart rate during exercise as well, although a lot of times like post workout, there’s kind of an even more rapid drop in the heart rate so the heart rate is just like always low cause your parasympathetic rest and digest type of nervous system is always predominating.  And so with an aerobic or with kind of power sprint athletes as well as with people who tend to just have a lot of emotional stress, anxiety, whether it’d be like social stress, or school stress or family stress, they tend to get a lot more of this sympathetic type of overtraining which is kind of just the opposite where the parasympathetic nervous system is kind of getting burnt out and so the sympathetic nervous system is still operating okay but what happens is that you don’t see the same type  of decrease in testosterone or increase in cortisol and you don’t see a ton of the same effects that you get with parasympathetic nervous system overtraining but what it comes down to is that either way you define overtraining, most of the time, it’s focused on what would be considered your autonomic nervous system, and not your central nervous system which would be like your brain and your spinal cord, but the idea behind the central nervous system is that because your brain and your spinal cord are acted upon by things like neurotransmitters and catecholamines, specifically Serotonin and what’s called dopamine, what can happen is that if there’s an imbalance in these neurotransmitters, so a big rise in serotonin or big drop in dopamine levels, that would be considered an example of central nervous system fatigue and there’s been some studies that suggest that overtraining results in this big spike in serotonin and a big drop in dopamine levels and that, along with some of the other effects that I kind of just described on the almost called autonomic nervous system or the peripheral nervous system, would be responsible for kind of this total overtraining so typically it’s not like central nervous system fatigue, or this big rise in serotonin or drop in dopamine, is the only thing that happens when you’re training too much.  It’s typically like a cluster of symptoms between your peripheral nervous system and your central nervous system.   But of course, the most important thing that comes down to is, what can you do about it?  How do you know when it’s okay to go back to training?  And really, the only really good treatment for overtraining syndrome for like being full blown overtrain, a big drop in testosterone, big increase in cortisol, unable to get your heart rate, anywhere near where you used to get it, immediate rise in blood lactate levels when you start to exercise, complete drop in motivation to train, loss of sleep, and GI distressed, ton of the things going on.  You got to rest, and the longer you’ve been over-trained, the more you typically have to rest.  I knew a body builder who literally was bed-ridden for a few months and then he still didn’t workout or do much at all or very light activity for almost 2 years, that’s how long it took for his nervous system to completely recover from full blown overtraining.  The good news is that when most of us are feeling kind of down in the dumps and not too motivated to train or maybe our bodies aren’t doing what we want them to when we go out and exercise, we’re technically not overtrain, we don’t fall into the category of OTS or overtraining syndrome.  We’re usually simply overreached and a couple days of rest or light activity combined with kind of rebuilding yourself nutritionally is all that it takes.  But full blown overtraining, can require a lot of things, combination with rest, doing some nutritional therapies, stepping up the fat in the diet, doing a lot of stress reduction techniques, I mean, it’s kind of a discussion for another day, what you can do to recover from overtraining, but ultimately what it comes down to is that, this idea that a big rise in serotonin, drop in dopamine and effect on the central nervous system could cause overtraining, definitely has something to it, but I don’t think that that’s the only reason that someone can become over-trained.  I think that, combined with a cluster of other problems, would result to the overtraining syndrome, so hopefully I didn’t create more questions and I answered with my response to that.  Okay!

Cathy says:    I am an active 46-year old woman who is recently fit, but working to improve fitness, strength and my running.  I wanted to focus more on strength training so I invested in dumbbells to workout at home.  However, I’m a little worried or it’s just I’ve decided to invest in some dumbbells, however I’m a little worried that I might over underbuy, not to mention some practical space considerations.  I’ve narrowed my choices down to either a 10 to 35-pound set of rubber hex dumbbells with a rack or a set of adjustable dumbbells with 5 to 75 pounds.  The difference in price between these two options is not as big of a deal as getting something that I can get maximal use of over the years.  What would you recommend?  Thanks.

Ben asnwers:              I actually don’t really see a huge need, if you’ve got a variety of things to work out with, of having more than about three different dumbbell selections.  I personally, in my home gym, I have a set of 40-pound dumbbells and a set of 10-pound dumbbells, and that’s it.   But I’ve got other stuff.  I’ve got a yoga mat; I’ve got a pull-up bar; I’ve got a gym stick which is basically like a couple of elastic bands that are adjustable that attach to this kind of aluminum stick that you can do a bunch of different exercises with; I’ve got some elastic tubes and elastic bands, both the short kind and the long kind and what else do I have?  I’ve got a stability ball and what’s called the bosu ball.  I’ve probably got about, right around 400, maybe 500 dollars invested in our home gym, that’s about it.  Because frankly you tend not to use that entire range of dumbbells when you’re lifting weights, if you have access to a bunch of other body weight exercises, elastic tubing exercises, stability ball exercises and any other little toys that you may happen to pick up along the way.  So, rather than getting into a huge range of dumbbells, and limiting yourself to just doing free weight exercises, I would get fewer dumbbells and for females I recommend that you get something like a 10-pound set, a 15-pound set or maybe a 25-pound set, and then grab yourself a pull-up bar, or dip bar, or get yourself a stability ball, maybe a bosu ball for some balanced work, get some elastic tubing or gym stick or both and that would get you basically equipped with the ability to do lots of different exercises rather than just free weight exercises which are good but it’s kind of like, if you’re just going to body build then free weight would be good but if you’re going to total functional fitness, don’t limit yourself with just free weight, cause this means different varieties of things you can are going to help you as may as different movements as possible, keep your workouts as fresh and as varied as possible and that’s the direction I would take rather than just focusing on free weights.  So for females, most of the females, I’d recommend again, somewhere in the range like 10-pound dumbbells, 15-pound dumbbells, 25-pound dumbbells, that will allow you to do a ton of different things.

Kim asks:      If I can only afford cheap fish oil, should I take that or just not take fish oil?

Ben answers:              Okay, good question.  So I talked a little bit about regular supplements versus expensive supplements or what type of fillers is going to cheap supplements and in the case of fish oil, there’s some issues, so when you extract EPA and DHA, which are those two Omega 3 fatty acids that you get from fish oil, it involves or can typically involve, especially when you’re getting the less expensive forms of fish oil, the use of hexing, which is a petrochemical solvent that they use to extract and purify the oil and that can make the EPA and the DHA very prone to oxidizing, and that’s another reason that they’ll throw anti-oxidants in there along with it like that astaxanthin I mentioned earlier but a lot of lower quality fish oils, when they use an anti-oxidant, they use something called alpha-tocopheral which is really not that great of an anti-oxidant.  Better anti-oxidants you should be looking for would be like that astaxanthin I mentioned, another good one would be like a rosemary extract, the gamma tocopherol is a good one but the type of antioxidant used in the fish oil and the amount of exposure to hexing that occurs in the formation of fish oil is something that is going to be affected by the actual price of the fish oil, and you could be getting free radicals, ransom fish oil, sub par oils, when your consuming a fish oil that would be considered just like a cheaper off-the-shelf version and although fish oil manufacturers, a lot of times they’ll say that their products are chemical free, it’s unfortunately not always the case.  They did that study that tested like 15% of consumer fish oils and found that all of them we’re contaminated with PCBs.  So you want to look for fish oil that’s been certified free of toxins by independent testers and then the other thing comes down to the actual type of fats that you’re going to get in that fish oil.  So fish oil supplements that have the natural triglyceride form of fish oil are going to be way more advantageous than the ethyl ester form in terms of the amount of absorption and utilization in your body, but the ethyl ester form, because it’s a lot cheaper to make, is what’s used in most of the less expensive fish oils and there really hasn’t even been done a bunch of research on the potential toxicity of the ethyl ester form of the fish oils.  So, what this comes down to is that, to answer your question, I would not take a fish oil unless you’re taking a good brand.  Just don’t go out and buy any fish oil off the shelf because what you’re getting may do you more harm than good.

Lisa asks:       Hi, Ben.  I heard that a weight plateau is due to apoptosis of omentum body fat.  I can’t find any references to learn more about this.  Do you think cell apoptosis explains why a weight loss stagnates for a short while?

Ben answers:            Well apoptosis, for those of you who aren’t familiar with that term, is basically cell death.  And the omentum that is mentioned here is, think of it like a drape, you split it into a couple of parts or greater and the lesser omentum, and it’s a layer of fat tissue that drapes off your stomach and hangs down underneath the muscles and kind of partially attaches to the colon and it serves a bunch of different functions.  It supports your organs, it stores visceral fat which is supplied from your small intestines, it secretes a bunch of immuno-response factors to protect you from infection, it can bind to cortisol, that stress release hormone, it has stem cells in it so it’s got some regeneration properties, it supplies fat to the liver via the portal vein, from the omentum to the liver for energy, and when surgeons do stomach surgeries, they’ll even use parts of the omentum to wrap around injuries or incisions.  So the omentum is basically a storage depot, when you have excess fat.  It has the potential to have a ton of fat globules that swell up to maximum capacity and give you a fat belly just because it is that abdominal fat depot and of course, because the liver has direct access to your omentum via the portal vein.  That’s nice when you need energy, when you need fat-based energy to burn, but if you’ve got a bunch of fat stores coming in and a bunch of fat in your omentum, your essentially setting yourself up to have some serious liver issues in terms of fat and also, to have a great, big belly.  Now the omentum also has a lot of cortisol receptors in it and, remember, that cortisol is secreted from our adrenal glands.  It’s decent, kind of wakes you up in the morning and balances your sleep-wake cycle but when you are chronically stressed or training too much or basically, you’re not taking care of your body, your cortisol levels get elevated and the omentum helps to clear the cortisol by binding to it and uptaking the cortisol and what happens is that it can increase the omentum’s ability to store fat when we get all this cortisol uptake.  So we’ve got stress, we’ve got increased fat intake and we got increased belly size and the omentum is basically part of that process.  The omentum can also pull a lot of the insulin from the bloodstream, so it can impair some of the ability of your body to take a glucose and nutrients stored just because the omentum that has a lot of fat in it will have greater insulin requirements and of course, you also just get the idea that your organs are squished up against the omentum when it becomes full of these fatty globules and the omentum can secrete a lot of inflammatory chemicals through the abdomen and directly into the liver, again via the portal veins so it can be responsible for part of this systemic inflammation that occurs as well.  So it’s got some good services, the omentum does in moderation, in terms of delivering healthy fat energy to your body,  but it can also, in over fat individual, cause belly fat and a lot of other issues.  Now you asked if apoptosis or cell death of omentum belly fat could cause a plateau in weight loss and the only link that I could see between this is because your omentum can serve as a portal from your omentum and your storage belly fat to your liver for your liver to convert the fat into usable energy.  If for some reason there was some type of apoptosis or cell death or malfunction of the omentum, it could inhibit its ability to mobilize belly fat stores and lie to lose belly fat and if belly fat is the main weight on your body, it could potentially cause a weight loss plateau.  However, I haven’t seen any research that looks into a link between cell death and the omentum inhibiting delivery of belly fat stores to the liver and thus, causing a weight loss plateau.  But if it were going to cause something like this, that’s basically how it would work because your liver would not be able to get the fats that it needs to burn via the portal vein and thus, you would have a much harder time burning off belly fat or specifically, the omentum-based belly fat, that causes the protrusion of the abdomen.  So, interesting thought, interesting question.

Ginette asks:  Presently I’m reading Art De Vany’s New Evolution Diet that you    recommended.  It’s a very interesting read.  I teach a unit on evolution and nutrition and my degree’s in biochemistry so the book is a nice fit.  But of the many interesting things that I came across was the mention of artificial sweeteners elevating insulin levels.  Is this true?  And will stevia have the same effect?

Ben answers:            Well, the talk kind of goes back and forth about whether artificial sweeteners could induce basically, insulin secretion by the pancreas.  And so, if we look at the different artificial sweeteners, if we take aspartame, they’ve done some studies on that and aspartame has really not been shown to have much of an effect at all on insulin levels in the studies that have been done on it and there’s really not much going on at all when it comes to aspartame.  As far as saccharine or sweet ‘n low, there have been studies where they had people swish around different taste solutions and then spit them out without swallowing and the solutions that had sucrose and saccharine did cause an insulin release even without them being swallowed.  So by just tasting that artificial sweetener, you could get an insulin release.  There’ve been other studies that didn’t happen with the swishing and the spitting and so, it kind of goes back and forth.  Acesulfame potassium, how does that affect insulin?  It does appear to affect insulin levels.  They’ve isolated pancreatic cells that produce insulin and found that artificial sweeteners like acesulfame potassium could cause an insulin response if there was some glucose present.  It would basically augment the response or increase the response if glucose was present.  So, if you’re having artificial sweeteners like a diet coke with a meal, you could get a greater insulin release than if you didn’t drink the diet coke.  There was another study that found that in a rat pancreas cells, that has acesulfame potassium also, could cause a little bit of insulin secretion and direct transfusions of acesulfame potassium also cause insulin secretion in rats and that was basically a study where the more acesulfame potassium that gave them the greater insulin levels would rise so there was kind of a dose response effect to that.  So insulin could be affected by acesulfame potassium and then if we look at sucralose, sucralose in most studies, hasn’t really done much in terms of insulin.  There was one study that showed that it may stimulate the release of what’s called the “incretin hormones” and those could increase the secretion of insulin.  That’s basically kind of like, the taste receptor hypothesis that because artificial sweeteners taste sweet; they might actually cause an increase in the production of these gastric hormones which could stimulate the pancreas to produce insulin.  So, it’s not like there’s hard and fast research on this.  There’s some suggestive evidence that some artificial sweeteners, specifically like acesulfame potassium and sucralose, could affect insulin levels and then as far as stevia goes, yeah, stevia could definitely have a mild insulin effect and specifically, that’s why it’s been used in some cultures to lower blood sugar and people with diabetes, because what it can do is actually cause a little bit of a release of insulin which causes your body to store blood glucose as energy and this kind of comes full circle to the whole issue with this question is that you need to look more at whether or not something has the propensity to cause deleterious health effects than whether it causes a rise in insulin.  Because a lot of times, it’s not the high levels of circulating insulin that are the issue, it’s the high levels of circulating glucose that are the issue, in terms of causing nerve damage and cell vessel damage.  Now granted, if you’re constantly consuming something that’s ampping up the insulin levels, you’re eventually going to become insulin insensitive and that is an issue because then, you’ll always have high levels of glucose, no matter what type of sugar you eat because the insulin won’t be able to take the glucose and put it where it belongs.  But artificial sweeteners, you know, elevating insulin isn’t necessarily my reason that I would avoid artificial sweeteners.  There’s a host of other potentially neurotoxic effects of artificial sweeteners, it affects some of the neural system, and the fact that they’re simply chemicals, that’s the reason that I personally don’t ingest them.  I think the insulin effect isn’t really much of an issue, and as far as stevia goes, yeah, there is a little bit of insulin release with that as well, but it’s an insulin release that has a blood sugar-lowering effect and it’s a very mild and sudden release that it’s not going to be something that would cause insulin, the insensitivity, unless I suppose, if you’re consuming lots and lots of stevia on a frequent daily basis, it could be an issue, but ultimately, not something that I would worry about too much in terms of insulin insensitivity.  So, good question and what this comes down to, in my opinion is, if you’re going to sweeten something and you want to use a non-sugar-based sweetener, then use stevia and use it in moderation and stay away from artificial sweeteners.

Andre asks:   Hi Ben!  What do you think about compression gear?  Does it really work?

Ben answers:              I personally have been using compression gear recently.  I’ve been using something put up by a company called the 110% and it gives you this tight, compressive effect on your calves, those got calf sleeves.  They make another one that’s a little better like full-body tights, they’ve got some that are shorts, they’ve got an upper body.  Thing I like about this is they’ve got ice pockets in them too, so you can literally put these special ice sleeves that come with the compression gear into the compression gear as you’re wearing it and if you’re wearing it for recovery, then you get both compression and ice, which can reduce inflammation and speed up recovery.  And many studies have shown that compression gear actually works to enhance recovery and decrease soreness so, very good for that.  As far as increasing performance, there hasn’t been a ton of data on whether or not anything can happen with compression socks.  There was a study done, back in 2007, where they measured max oxygen uptake, heart rate, blood lactate, ventilation, you know, with compression socks versus without.  Didn’t find any effects.  In another study in 2009, they tried a bunch of stuff: compression socks, compression tights, full-body compression gear – didn’t find any effect on performance but some people swear by them, basically saying that long-term, like used over the course of something like an Ironman triathlon, they can decrease the amount of muscle jostling that occurs and thus, decrease the amount of muscle damage and improve time to recovery.  So for that, they might be good and definitely good, in terms of improving recovery.  Performance, jury’s still out on that, but I personally have started using compression socks when I race long distance triathlons and I use compression gear very frequently for recovery.  You’ll find me a lot of times sleeping in compression tights or wearing compression calf sleeves that are in the house and a lot of times, directly after workout, those also have ice in them and what that does, it puts pressure on the blood vessels; it constricts the blood vessels; forces the blood to flow up to your heart and basically prevents blood and fluid from pooling in your lower extremities.  So, that’s how it would decrease soreness, increase the movement of the metabolic by-products of hard exercise out of your muscles and back up to your heart, and I’m a fan for recovery, if it’s something that you can include, it will definitely help.  As far as performance, you just got to use yourself as a case study of one, and see if it works for you.  Okay!

Zack says:      I injured my shoulder doing dumbbell swings improperly.  It’s healing, but it’s a long, slow process.  My question is what are some ways that can speed healing and still get a good effect of upper body workout without putting too much strain on the shoulder?  It seems like every good upper body exercise all stress the rotator cuff to 1 degree or another.

Ben answers:              Well, the idea is that, the reason all of these exercises you mentioned are stressing the rotator cuff is because they all include a component where you’re holding your arm out and away from your body.  Anytime your arm is elevated away from your body or specifically, anytime the weight that you’re holding is far away from the shoulder, you’re going to increase torque on your shoulder, just like if you’re holding a box and you hold it close to your body, you’re going to decrease torque on the low back, so as you hold the box out away from your body and not hug it in your body, you’re going to increase torque on the low back.  So, all muscles kind of work on this concept of torque, and it’s the reason that a dumbbell held at your side is a lot easier to hold than a dumbbell held at arms length.  You increase what’s called the leverage arm or moment arm of that weight that you’re holding and it increases torque in the joint that’s supporting that weight.  So based on that concept, the trick is to choose exercises that work your upper body, that do not involve holding a weight far away from the body, which basically or more specifically, holding a weight far away from the shoulder.  There’s certainly exercises that you can do that are decent upper body exercises that aren’t going to put the same type of stress on the rotator cuff.  That would include something like a narrow grip pulldown.  So when you’re doing a pulldown, a cable apparatus rather than holding a wide grip which puts the weight farther away from your shoulders, you move that center of rotation closer to the axis of your shoulders and do a narrow grip pulldown.  Shoulder shrugs could be another example; you’re holding the dumbbells close to your body, shrugging your shoulders up and down; not putting a huge torque on the shoulder muscles, that because again, the weight is held in tightly to the body when you’re doing a shoulder shrug.  Bicep curls, where most of the weight occurs around the elbow joint as long as the upper arm is held stationary, those would be okay.  Cable bicep curls or dumbbell bicep curls, same goes for tricep pushdowns.   Those, again, are more of a rotation around the elbow joint; most of the torque is on the elbow joint, not on the shoulder joint.  A partial motion flies using something like a fly machine that you sit down in; you can do partial motion of a fly machine basically, you know, directly in front of your body and not go through a full range of motion and those can be great for working the chest without putting all the stress on the rotator cuff, keeping those distress on the pecks.  If you’re doing lower body work, I mentioned this in the previous podcast episode, but doing something like instead of a barbell squat or a squat where you’re holding the weight out away from the body, you do a goblet squat where you take a dumbbell and you just clutch it in towards the chest and you do a squat with a dumbbell or a medicine ball clutched into your chest and of course, you can do high intensity interval training, cardio-interval training that doesn’t involve a lot of swinging of the arms like bicycle.  You can definitely do lower body work, you can do things like lunges, you can even use machines like leg extensions and leg curls and there will be some crossover effect up into the upper body and so yeah, there’s a lot that you could do for your rotator cuff, just make sure that you aren’t holding a weight out away from your body.  As far as speeding healing of the rotator cuff, listen in to the interview that’s coming up here pretty soon with David Minkoff, that’d be one perfect way to do it.  Alright!

Dale asks:      In part 2 of the interview with KC Craichy…

Ben:                And that’s come up a couple of times.  I’ll put a link to that in the show notes; I’ll put it with everything that I talked about.  If you’re listening in, you want follow-up on some I talked about, just go to Episode #143 at BenGreenfieldFitness.com.

Dale:               Plastic bottles leaks chemicals into the water in the bottle.  My bottle says it’s ‘BPA Free’.  Do I need to throw it out?

 

Ben:                Well, the idea is that yeah, plastic bottles do contain harmful chemicals, those can leak out the contents and they can cause some serious health issues.  And there are numbers given to each type of plastic that’s used in soft drink bottles and some of these plastics are less likely to leach compounds that basically mimic the hormone estrogen, so they can increase your risk of cancer and cause some estrogenic effects in your body.  Too much estrogen circulating around in your body, it’s not a good thing.  So, plastics 1, 2 and 4, if you look at a bottle and then they all have the numbers on there, all bottles have the numbers on there, it’s usually in the bottom.  Plastic 1, 2 and 4 are considered relatively safe.  They’re high density, low density forms of polyethylene and for example, there’s the rule that go along with each one like a lot of soft drinks and water, they’re sold in number 1 plastic bottles.  Lower levels of estrogen from those, generally recognized as safe, I still don’t personally use them.  But those of you consider like, single-use bottles.  So what research has found is that if you use them more than once, they release DHEA which is a known carcinogen.  I play it safe and I just try not to use them, at all.  Number 2 plastic, that’s used in a lot of different like milk and yogurt and juice containers, it’s recyclable, they say you can reuse it.  It’s called a high density polyethylene.  And then number 4 is like a low density polyethylene and it’s used also in a lot of plastic water bottles, it’s considered recyclable as well.  The type of plastics that are considered unsafe would be number 3, number 6 and number 7.   And number 6 would be basically, Styrofoam.  Definitely, don’t use Styrofoam.  You can get away with it.  Yes, that means that your take out from the restaurant is not something that you should be eating out of or heating with food in it.  Keep the food in there for a shorter time as possible.  Now, what KC recommends in his book are several different types of water bottles or bottled water that would be considered safe, and he recommends in his book Mountain Valley Spring Water, which is made from a glass bottle and it doesn’t include this plastic that’s considered unsafe.  VOSS or VOSS Artesian Water also comes in a glass bottle, and it’s sold in a number 1 clear plastic bottle as well.  That would be another one that would minimize the chemicals leaching out from the plastic.  Penta Water is another one.  Penta Water, being something that’s highly purified, available in the number 1 plastic bottles and ultimately, what it comes down to is if you look for that number and you see number 1, that’s good, number 2 is better, number 4, not quite as good.  Ultimately, I just try not to use plastic at all when I can afford it.  I drink out of glasses from the water filter in my own home or take my water bottles where I go.  If water bottle says “BPA Free” though, that’s really good.  You do want to look for the BPA-free bottles.  So hopefully, this helps to give you a little bit of reaction in terms of checking for your plastic and what type of plastic could be considered more dangerous.  Okay!  These last 2 questions are very related so we’re going to answer them in kind of a one-tell swoop.

Josh says:      I recently got a ton of tests done from the Naturopathic doctor as I was constantly feeling lethargic, having sleep problems as well as having a noticeable decline in my training performance.  Everything came out great except for my testosterone levels, which is the main reason I got the testing done.  I had a hunch they were low.  I also had an excessive amount of enzymes being produced and I’m only 22 years old and currently training for Ironman or for Half-Ironman, putting in around 20 hours a week.  I’m pretty sure I hit a phase of overreaching or overtraining so I took a few days off due to the symptoms I described earlier.  My doctor prescribed me to try out coconut oil and flax seed oil for a few months to see if that would help increase my testosterone and decrease inflammation.  I also bought some tribulus to help as well.  Is there anything else that you would try, if you were in my shoes?  P.S. I know you’re an advocate of high intensity training but I have some extra time at the moment so long sessions work fine for me and I love lengthy sessions outside, not really willing to give that up.

Ben answers:              Okay!  So, let’s follow that up with this question from Jerry.

Jerry asks:     Hey Ben, this is Jerry in Missouri.  I was getting caught up on my Ben Greenfield podcast addiction and came across the interview with Art De Vany and you’ve mentioned something in that interview that sort of struck me and I wanted to, maybe you could help me understand a little bit better about what the point was and maybe clarify something for me.  You’ve mentioned at the end of the interview that you are a tri-athlete and I am a tri-athlete and that you realize that your training and racing was actually taking months or even years off of your life and it sort of struck me, I’m a tri-athlete myself and it caught my attention when you said that.  I’ve always realized that training and endurance training and really anything that puts the body through hard training, had a catabolic effect on the body, but I’ve always considered that I can manage it through proper sequencing of training, maybe help balance hormonal disruptions and along with supplementation and that everything would work out okay and that my body would recover and so forth.  When you made that comment in the interview with Art, it really got my attention because I thought well, if Ben is acknowledging that he’s taking months or even years off of his life, then I certainly, I’m no better than Ben so it sort of struck me.  I wanted your comments, your clarification and maybe your thoughts to expand upon that process.  Are we tri-athletes actually destroying our bodies?  Are we really taking years off of our life?  If that’s the case, then it makes me wonder if I need to restructure my priorities but anyway, I’d appreciate your thoughts and comments and, thanks Ben.

Ben answers:              Well, the reason I chose to answer these questions is kind of, one answer is because my main recommendation that Josh would be to significantly cut his hours down, to about 8-10 hours a week, from 20.  And that is for several reasons, including some of these issues that Jerry brought up about this chronic high level training because there’s a few things that happen when you’re training with a type of training that these Ironman athletes or Half Ironman athletes do and I just want to go through some issues with you that you may want to think about.  So first of all, when you’re always training, you’re always depleting your body’s glycogen or storage carbohydrate levels and your body, to a certain extent, no matter how much you’re eating, it’s going to incur to a certain extent, your body has to cannibalize muscle tissue in order to help make blood sugar.  It’s a process called gluconeogenesis and whereas gluconeogenesis, in a resting or lightly active individual, it’s not that big of a deal.  Once you start tearing down muscle, what happens is you get a big release of the adrenal hormone cortisol, and this chronic cortisol release can suppress your immune function, so it opens up the door for you to have lots of infections, lots of sickness and potentially more serious issues like chronic, degenerate diseases or asthma, cancer, heart disease, and this cortisol release also, it limits the ability of your bones to re-uptake calcium so, you get low bone density along with that.  That’s why a lot of female athletes who train a lot have this issue with low bone density.  So, the other thing that happens that increases cortisol, it’s kind of this 1-2 combo with people who are training a lot is that carbohydrates, or just meals that are high in calories in general, can also cause this bump up in cortisol suppression of the immune system and some of these other issues that I just discussed.  So, we also can look at the burning of fats.  Beta-oxidation of fats is completely healthy, it’s how your body metabolizes fats.  But beta-oxidation of fats also produces free radicals and the amount of oxidation of fats that has to occur, during the amount of training that takes place for Ironman, creates a ton of oxidative or free radical damage, sometimes 10-20 times of what you would normally get if you were just, say, oxidizing fat at rest.  So, you get all these free radicals circulating around, damaging DNA, damaging protein, damaging cell membranes and participating in this gradual destruction of a lot of your cells in your body’s tissues and so, this again, can be a huge contributing factor to a lot of diseases that could cut years off your life like cancer or heart disease or aging and yes, your body does have anti-oxidants and you can take anti-oxidants but you can only control this oxidative damage so much.  One big correlative factor with your longevity is your amount of lean mass or your lean muscle.  So, what happens when your organs fail and you die?  As your organs basically lose their functional capacity and they lose what’s called their organ reserve, and their lean tissue.  And there’s a direct correlation between your drop in organ reserve and your drop in skeletal muscle mass.  So, if you look at most endurance athletes or Ironman athletes, they’re pretty dang skinny.  They have a lot less muscle mass just because of this gluconeogenesis I mentioned earlier, and even though they’re exercising and many of them may appear to be fit, more often than not, you get a lot of very skinny, kind of atrophied, endurance athletes and basically, the amount of muscle you go into the latter years of your life with is what you’re stuck with.  So if you’ve cannibalized a lot of that from long training, and large amounts of gluconeogenesis, you’re really limiting your organ reserve.  The benefits of low amounts of physical activity, like really life physical activity, they’re great.  So if we look at like, somebody walking, somebody farming, they’re going to be developing all these blood vessels to burn fatty acids, to fuel muscles into developing lots of the enzymes responsible for fat burning so we’re not getting a lot of like plaque formation.  They’re improving their cardiac muscle efficiency, improving their cardiac capacity, basically giving the body a lot of benefits and so we hear about that in the endurance world and we think “Well, I’m doing that too”.  It’s like I’m going out and I’m farming or I’m hunting for 3 or 4 hours a day during my Ironman training.  Well, the problem is, you’re in nowhere near what farming and walking is; you’re putting your body under stress.  When you’re out on a 3-hour bike ride, you’re easily exceeding or doubling up the amount of activity from what would really be considered low-level training, and you’re doing that over and over and over again.  So, you’re decreasing your muscle mass, you’re decreasing your immune system, you’re decreasing your testosterone, you’re increasing your cortisol, you’re ampping up the insulin levels, you’re just getting a ton of free radical formation and don’t fool yourself into thinking that you’re doing the same thing that our farmers or say like our evolutionary Palaeolithic ancestors did.  Very few of them even go out and do like an endurance hunt.  Those things are very stressful, that’s why not a lot have tried to really do hunts, where they hunt down the animal.  A lot of it is very easy tracking and then taking the animal down as quickly as possible.  So, you’d only look at it from like an evolutionary perspective.  Now, I want you to combine this with Episode #133, where I talked about all of the acute effects, what happens to the body for about 1-3 weeks after you run a marathon or do an Ironman triathlon and think about what happens if you do 20 or 30 of those in your life.  I’m not going to repeat what I said in Episode #133 but I gave you a huge laundry list of what happens to you when or right after you do a marathon or an Ironman.  Jury’s out on how well you actually recover from that type of activity.  So what this comes down to is number 1, there are things that you can do to limit the damage.  Yes, you can take a full spectrum anti-oxidant.  Yes, you can get a ton of your dietary intake from things that aren’t going to increase the cortisol and the insulin quite as much like Omega 3 fatty acid-rich foods, just the high fat, high lean protein fat intake in general.  You can monitor your blood levels and monitor your hormone levels and do things like the bioletic testing on a yearly or, even if you can afford that every couple of years, go out and get things like your cortisol and testosterone levels and your ferritin levels tested and check out what your blood glucose and your insulin is at and maybe go out and look into things like how saturated your blood is with oxygen, your hematocrit levels.  Look into as many things as you can, you know, doing something like the complete athlete profile through something like bioletics; I’m not saying as being commercial for them, but you want to track.  And then, then other thing that you do want to think about is how much you’re going to train and race.  I personally, if I really could, I could probably find the time to train about 4 hours a day.  I cut myself short, even on the weekends, of doing no more than 2 hours, right now.  Now, if I qualify for the Ironman World Championships for Hawaii in October, that will increase to a maximum of 4 hours on a weekend of training and I will max out the most hours that I’ll do in a week would be about 17, 20, 25, 30, 35 hours, wouldn’t even approach it.  And I still think that I’m probably doing a little bit of damage to my body, even going out and doing my 10 to 15-hour training week, versus doing an easier, 6 to 8-hour training week which is some high intensity intervals and stay active and eat healthy.  So, I guess what this comes down to, and I kind of just say this in a way of the fact that the physician that we’re about to interview has done 37 Ironman triathlons, I guess what this comes down to is, if that’s what you’ve chosen to do with your life, and you don’t mind the fact that there may be some increased oxidative damage or a decrease in your organ reserves and some other issues that are going on, that’s fine.  I don’t think that we have this moral prerequisite to try and live as long as possible.  However, if that is your goal, you’re not serving it by doing an Ironman triathlon, and don’t fool yourself into thinking that you’re extending your life through your participation in endurance sports because that is probably not the fact; the fact is probably quite the opposite.  Okay, I did not mean to depress you, remember, I’m a tri-athlete; I love to train, I love to race, but I will be the first to admit that it is not the healthiest sport that I could be participating in and I am probably taking a couple years off my life by doing it.  But again, I don’t believe that your goal in life should be to live as long as possible; I think that’s grasping in straws.  Alright, let’s go ahead and wrap this up and move on to the interview with Dr. David Minkoff.  I’m sure I generated a lot of questions and you can ask them over on the show notes for this podcast, Podcast #143.

Ben:                Hey folks, this is Ben Greenfield.  I’m here with Dr. David Minkoff who you may have heard of before if you’re a long-time listener to BenGreenfieldFitness.com.  He’s one of the celebrity physicians that joins us, he himself having finished 39 Ironman triathlons and he runs a very cutting-edge facility down in Clear Water, Florida and that’s called the LifeWorks Wellness Center and he also owns Body Health, which is basically a really helpful website as well and he’s one of the guys that developed the amino acids that I take on a daily basis, the Master Amino Pattern and today, he’s here to talk to us about Prolotherapy which I actually get a lot of questions about and because I know that Dr. Minkoff actually has a lot of experience with this himself, I figured that he’d be the perfect person to ask so Dr. Minkoff, first of all, thank you for giving your time and coming on to the show.

David:            It’s great to talk to you again Ben.

Ben:                Well, tell us about Prolotherapy.  What is Prolotherapy?

David:            Well, the term was coined by a physician in Ohio or Illinois named Hemwall and he was looking for a way to help people who had chronic body pain, especially joint pain and he coined this word prolo, which is short for the word “proliferate” which means to make something grow or expand or increase in number and so, he coined its term prolotherapy which the idea was, you could get soft tissue or connective tissue, it’s the stuff that holds us together, the ligaments and tendons in the body that hold the structure together, that you could get them to grow and heal when they weren’t healing before and the typical thing that happens to an athlete is either from overuse or injury or malnutrition.  They get… what occurs in their ligaments and tendons is that they stretch out or they get partially torn and those are the structures that are supposed to hold joints together and keep them in a very specific range of motion.  So let’s sample a few, at a knee joint, and you stretch the lateral ligaments so that the knee joint now isn’t, you know, the hinge on the joint isn’t holding right and on the lateral side, it’s weak and so the joint is now starting to move a little bit out of the range that it’s supposed to.  You will get a wear and tear on the cartilage which is abnormal.  You may or may not get pain but you will get wearing down of the joint in an abnormal pattern and it could be after an injury, let’s say you twist it or you’re tackled by someone or you make a quick turn on the basketball court or you’re a soccer player and you go one way and a guy tackles you and you get the joints stretched out.  The ligament is stretched or partially torn; there may be pain and swelling, there may not be.  In older folks, there may not be an acute injury, it’s just that their nutrition hasn’t been good and their connective tissue breaks down and usually what people do is they do RICE.  They’re supposed to rest it and ice it, compress it and elevate it and they usually take anti-inflammatories like Advil or Motrin or Aspirin, and what occurs is that the healing response gets blocked, and the normal thing that’s supposed to happen to heal that connective tissue gets blocked by that drug, because they’re anti-inflammatories and the way the body heals an injury is by inflammation.  Inflammation, it means it sends in there white blood cells and little things called “fibroblasts” which re-grow the connective tissue so that they can heal it up.  And for one or another reason, the ligament never quite heals or it heals in a condition where it’s too long and you end up with a joint that’s got too much motion, and when you get too much motion, it wears funny and then you get pain or you then tear cartilage or the original injury, maybe a torn the cartilage or you get arthritis because now, the body is trying to get, it’s laying down calcium deposits to try keep the motion the way it should be, and then since the motion isn’t right, the body doesn’t like the extra motion that it’s got.  It’s trying to use muscles to hold the joints still and so, you get resting change in the muscle tone, which is too high; that causes painful muscles, and usually, the complaint we see from someone, is pain.  It’s either chronic joint pain or chronic muscle pain and it’s an athlete and they need help and the idea that in what we do often is prolotherapy.

Ben:                Okay!

David:            And so, the idea of prolotherapy is that if you inject into where the ligament attaches to the bone, something that isn’t irritant that will set off a new inflammatory response, the ligament will shorten and thicken and get stronger, and the cartilage in the joint will re-grow and you then, you can rehab a joint that before was causing you chronic pain and, once the joint structure is now normal because the ligaments are shortened, the cartilage re-grows, the muscles around the joint will relax and the chronic pain will go away.

Ben:                Okay, so, in terms of how it actually works, is it like an injection?  Is it something that you smear on top of the joint?  How does prolotherapy actually work when someone goes in?  What do they expect?

David:            Ben, it’s an injection.  It’s actually multiple injections so, if I’m doing a knee joint, I will inject about 10cc of a mixture of the stuff we call a “proliferant”, it’s the stuff that does it.  And for most cases, it’s a 15% sugar solution with a local anesthetic, with usually I put in some homeopathics which help in the healing response, something called Traumeel or Zeel, these help joints to heal.  And I’ll put about 10cc into the knee joints base, and then I’ll put another 10cc, I will trace where the ligaments that hold the knee together are, so it’s on both sides, it’s in the front, and I will inject about a 10^th to a quarter of a cc in multiple places around the joint so that the ligaments, and where I inject it is where the ligaments attach to the tibia which is the lower leg bone, the main lower leg bone and the fibula, the other leg bone and the femur, and around the knee cap where all the ligaments attach and then, for about 24–48 hours the guy will feel kind of a heatness and maybe a little pain, maybe a little swelling, and then over about 3-4 weeks, the stimulation of that will cause those ligaments to shorten and thicken and the joints base cartilage, to re-grow.  And during this time, we keep people off of any kind of anti-inflammatory medicine; we don’t use ice, we use heat; we don’t have them doing any kind of ballistic motion because I don’t want them to irritate it so, no jumping, no running, no heavy squats; they can do an elliptical, they can ride a stationary bike but I want to give it a couple of weeks so that it can heal and then we check them in 3 weeks and see how they’re doing.  Usually there is improvement and most guys, somewhere between 1 and 6 treatments, the pain will go away and the joint will rehab and then it’ll feel really good, and that can be a shoulder, it can be a knee, it can be a neck, it can be a low back, it can be an ankle, it can be a chronic plantar fasciitis; it seems to work, probably 80% of the time in most people.  I’ve had it done myself a couple of times.  It’s not a fun treatment because it hurts if you get the shot, but it’s a very effective treatment for most people because if you compare it to like, a guy who has a knee injury and he gets an MRI, and there’s partially torn ligaments and there’s torn cartilage and the orthopedic goes in there with the scope, and he wants to clear things up, I would say that most guys won’t do that yet.  Come in, do a bunch of prolotherapy treatments.  He has to rehab it by itself because the chances that are working are probably in the 80% range and they won’t need to have somebody go in there with a scope and open it up.  There’s really no downside other than the pain in the treatment, which lasts about 10 seconds because there’s a local anesthetic in it, it takes the pain away.  And it’s a brilliant treatment.  I love doing it because the success rate is really high and a lot of people will come back and they’ll say “You know man, you’ve fixed me.  I’m good.” and then I just  say, if it hurts again, if you re-injure it, if you re-overuse it, come back.  I put them on…

Ben:                Oh, go ahead.

David:            I beef up their nutrition; I put them on MAP, Master Amino Acid Pattern, because they need extra amino acids to re-heal their cartilage; usually, most guys are Vitamin D deficient; I put them on some extra Vitamin D; I put them on some fish oil; I put them on a multi because they need these extra things because their nutrition hasn’t been good.  I try to get them off the drug anti-inflammatories and if you’ve travelled at all, I was flying this weekend and if you look in an airline magazine, there is a picture in there, it’s usually an elbow joint where they show a guy with an elbow joint before and there’s almost no cartilage pad and then they call a joint rehabilitation therapy as an advertisement and then, they showed the elbow joint 3 or 4 treatments later and they showed that the cartilage is re-grown on the elbow joint and now they got a good joint and they’ve been advertising it for some guys who are doing prolotherapy, that isn’t what they call it, but that’s what they’re doing.

Ben:                I think it’s interesting that you actually can mix other things in with the elements that you’re injecting into the joint like traumeel, you mentioned, that’s something that people would normally put on as a topical anti-inflammatory and you can literally just inject that into a joint huh.

David:            Yeah!  The company that makes it as an injectible homeopathics.  So, we usually use a combination of traumeel, which is common, and there’s zeel which is another one, which is, it rehabs joints cartilage so I mixed a unitrol vial in there and sometimes, on a resistive case, we might inject some growth hormone into a joint, to get it to stimulate, sometimes guys need extra other stuff, you know, their testosterone’s low or their, they needed other stuff depending but for most guys, it’s pretty simple.  It’s the local injection repeated from 1-6 times, if after 1 time, on the knee joints, most guys, 1 time, sometimes 2 times, the pain’s gone.  And they’re ready to go again and then they’ve done it.  They have trouble again, they can come back and get another one.  I had my groin done.  I tore my abductors, which is the muscles that move your leg from outside to in; I got up, and I caught my leg on my desk and I tore my abductors and it was 10 days I couldn’t run.  It was painful to walk.  I had the prolotherapy done.  Within 7 days, I was running.  The pain went completely away.  It was great!  So, for low backs, it can be terrific.  A lot of guys with chronic low back pain, they’ve got loose ligaments in their low back.  They go to the chiropractor.  They get adjusted.  It feels better for 2 hours and then they move and it goes out, that is a symptom of ligament laxity.  And ligament laxity, the ligaments are not holding the bones in place where they should be and prolotherapy is a solution to it, disk surgery isn’t.  And, it can stabilize the low back or it can stabilize the pelvic and it can really help so, I love doing it because it’s really good.  There’s a lot of guys around the US who do it.  There’s a website which is GetProlo.com, which has a bunch of guys who do it so, you can find somebody in your area who are experienced.  You know, all the theories, in all the research; there’s been actually quite a lot of literature now on it’s scientific literature.  It’s an orthopedic nightmare because most of them don’t like it because it’s so effective, it reduces really the amount of surgery that has to be done because a lot of times it helps and I’ve done a lot of pro-athletes like skateboarders where they’ll twist ankles and they’ve got chronic pain or knees, or baseball players with elbow pain or shoulder pain, or a guy with low back pain or chronic neck pain, or sometimes people with chronic headaches.  It’s muscle spasm in their neck trying to hold their neck straight, that’s causing the chronic headaches and if that’s the right thing, it can help them out.

Ben:                Wow, interesting.  And, does insurance cover something like this all the time?

David:            Mostly not.  It’s not super expensive like, to do a knee joint in our office, it’s a hundred and fifty-five bucks; it’s pretty reasonable, and if we do 2 joints, I think we had 55 bucks for the 2^nd joint so if you need both knees, or if you need a knee and a hip, it’s not going to break anybody’s bank and send you to a couple of them; it’s usually doable.

Ben:                Yeah, that’s not bad.

David:            Yeah.  I mean, you get a sculpt knee, it’s going to be in the multiple thousands, at least.

Ben:                Yeah, interesting.

David:            So, there’s a couple of books that, if people want to look at it or even on the website, the GetProlo.com.  There’s lots of things that people can educate themselves and you know, talk to somebody, cause usually in most big cities, there are guys that are doing it and for athletes, I think it’s fantastic because your down time is short.  You don’t even really have to be down all the way.  So, if it’s a knee or an ankle or a hip, you can still ride; you could do an elliptical and if 1 or 2 treatments, you know, in 6 weeks, you could be on your feet again and you could be running.  So, it won’t put you out for a season and when the pain’s gone, it’ll just feel a lot better so, I really like it.

Ben:                Got it.  So, if you’re in the Florida area, obviously Dr. Minkoff’s LifeWorks Wellness Center would be the place to go, otherwise, check out that website that he gave GetProlo.com.  These sound like it could be really good for a lot of people who have some of these issues so, Dr. Minkoff, thanks for your time and for explaining that to us today.

David:            Absolutely Ben, my pleasure.

Ben:                Well, folks that is going to wrap things up.  Remember, you can donate a dollar to the podcast to keep this discussion going and keep these podcasts coming to you week after week over at BenGreenfieldFitness.com and there are lots of you out there downloading these things so it gets spendy, those hosting fees so, every little bit helps and then again, if you want to also use a dollar and sign-up for a sneak peek into the healthy lifestyle membership website that my wife and I run, that’s over at BenGreenfieldFitness.com/innercircle, you can go check it out for a dollar.  Now, if you have questions, you know where to go.  I always love to hear your comments on these podcasts and you can do that all, over at BenGreenfieldFitness.com.  Until next time, have a healthy week.

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