Monday, September 2, 2013

The Upper Back: Why It May Hurt and What You Can Do About It

One of the more common complaints I hear from people when they come to see me is of a chronic pain, one right between or just below the shoulder blades in the upper back.  It’s usually dull, but can sometimes be sharp, and is usually at it’s worst later in the day.  While it is most often found in writers, students, and people who spend long periods behind either the wheel or the keyboard, it has also shown up in dancers, athletes, and hobbyists of all kinds.  What is this pain, how does it come to be, and what can be done about it?  These are the questions that will be addressed in this addition to the Caveman Medicine Blog.

Upper Back Pain - What is it?

The reason why upper back pain is so persistent and so hard to completely eliminate on one’s own is because it involves muscles, fascia, and repetition.  As the muscles become tight and stiff (the how’s of which will be explained in the next section), the lack of movement causes pressure to build in those muscles and the tissues around them.  This pressure causes nearby structures to be impinged and otherwise negatively effected which the body then translates as pain and discomfort.  As the tension continues to affect the area, the body will start to stiffen the connective tissue as well, in an effort to aid the body in maintaining the adopted posture.  This further increases the tension and pressure in the area leading to more pain while simultaneously making it harder to find relief.  This pattern of ever-increasing tension and pain often continues until eventually some other structure in the area gives, leading to a sharper, more acute pain that is often what finally causes the person to seek treatment.

Some common examples of this type of injury include torn labrums, rotator cuff injuries, rib head subluxations (which can often be triggered by something as innocuous as a sneeze), or even vertebral disc issues.  While these conditions can all be treated on their own, independent of treating the tight muscles, failure to address the muscles as part of the treatment and recovery process increases the odds the injury or condition will return.

How Does It Happen?

The most important thing to remember about the body when dealing with this type of situation is that it exists in a constant state of balance.  Our muscles are like cables attached to pulleys and for every muscle that pulls something one way, there is another muscle that performs the opposite action.  Even when we are perfectly still, there is a constant application of force by these muscle pairings that hold us in whatever position we may find ourself in.  If one muscle in a pair is considerably tighter and/or stronger than it’s opposing muscle, then this will usually result in one of several outcomes, depending on lifestyle, general health, and time involved. 

The most common result is low level muscle strain in the weaker muscle, not enough to keep the muscle from functioning, but enough to limit it as well as cause chronic pain and discomfort.  This is a direct cause for the second result, which is an increased rigidity in the connective tissue.  When this occurs, it is a sign that the strain has become constant enough that the body is trying to correct for it by using the connective tissue as a splint in an effort to take some of the pressure off.  By stiffening this tissue, the muscle does have some of the strain reduced, but at the cost of range of motion and it can no longer fully relax.  This increases the pressure in the area over time and leads to increased discomfort in the long term as well as allowing for the formation of adhesions (which are more permanent connections between the muscles and connective tissue and require much more work to reverse).

As this tension continues to affect the body, over time the constant pulling of the tense muscles on the joints themselves will start to have a negative effect on joint stability and integrity.  In many cases, a joint can become loose enough to allow for minor, incomplete dislocations (such as in a ‘rib out’ where the head of a rib dislocates from between two vertebrae).  While these often aren’t serious, they can be very painful when they occur and often require outside intervention to reverse.  The greater problem is when the constant force in an area like the shoulder weakens the connective tissue in that joint to the point where serious damage can occur, damage which often requires surgery to repair and which can permanently weaken the joint.

The most counter-intuitive aspect of this type of situation is how it is often the result not of some sports-related accident, car crash, or other large moment in one’s life, but instead it is something that builds slowly over time, usually exacerbated by daily habits, including one’s workout.  As I said above, the body maintains posture through the balance of muscles pulling against each other.  What many people don’t know or realize is that any time we hold one position for an extended period of time, the muscles involved in holding us in that position gain strength.  Picture someone working at a computer.  His or her arms are extended in front of his or her body and the palms are facing the keyboard.  In this position, the primary muscles groups that are being engaged are those of the chest and the flexors and internal rotators of the shoulders.  Over time, especially as these muscles become tired from holding in this position, other muscles will become recruited, like those in the tops of the shoulders, to make this posture easier to maintain.  As those muscles wear out, the connective tissue will start to stiffen, also making the posture easier to maintain.

Unfortunately, as these muscles become stronger and this posture becomes more pronounced and easier to hold, the muscles that pull a person out of this position are simultaneously being put under more and more stress while also becoming weaker.  This leads to increased strains and stiffness, which causes increased discomfort.  If a sudden or rapid movement is forced on these areas of the body, the injuries that occur are much more likely to appear in the back of the shoulders than the front, since those muscles are under increased strain.  While the shoulder itself is the most common location for this type of injury, the rhomboids (the muscles between the shoulder blades) can often be affected as well, leading to that very familiar tension in the upper back that can sometimes be a cause of issues like headaches and a stiff neck in addition to localized discomfort.

Another factor which can aggravate this condition is one that you may not suspect: exercise.  The reason for this is, as mentioned above, the muscles in the front of the shoulders are often far stronger than the ones in the back.  But when people work out, they often spend far more time building up the chest, shoulder, and arm muscles that are already strong while neglecting the weaker ones.  Push-ups, bench press, bicep curls - these exercises can all aggravate an existing muscle strength disparity, especially if they are not performed properly or are done at far higher intensity than exercises that work the opposing muscles.

What To Do About It

Fortunately, there are a lot of things that can be done to treat this condition.  Acupuncture, massage, and cupping can all be very helpful in relieving the discomfort associated with this type of muscles tension and for reversing any connective tissue adaptations that may have occurred.  For long term relief, however, the only reliable method of treatment is through stretching and exercise.  In the section below, I’ve included several stretches which can relax the muscles in the chest, shoulders, and upper back as well as exercises to build up the muscles in the back and posterior shoulders.  The biggest things to realize are that it’s better to do less than more, as long as you are doing something every day, and to keep in mind that the goal is to build up the muscles of the back and shoulders while relaxing the chest.  This is especially important to keep in mind when doing the push-ups (which can work the entirety of the upper torso when done correctly, which unfortunately, few of us are taught to do).

The Doorway Pec Stretch

This is one of the easiest and most effective stretches for the chest. Find a doorway and place your toes so that they are level with the doorframe. Now rest the forearms against the door frame. Your elbows should be bent to about 90° and should be about level with your nipples (or 5th rib space). Now let gravity do the work as you fall forward, being supported mostly by your arms. If done correctly, you should feel a gentle stretch across the chest and front of the shoulders and your shoulder blades should be drawn together in the back.  Do this stretch for about 30 seconds at a time and whenever you feel it is necessary.

Levator Scauplae Stretch

This one can be intense so be careful with it.  The first thing you will want to do is find something that weighs between five and ten pounds.  It can be a weight, a water jug, or even the edge of a counter.  The key is that whatever you choose, it's heavy or immobile enough so that you can tell if your shoulder muscles engage.  So first, take your chosen object in your left hand.  The shoulder should be as low and relaxed as possible.  Next, tilt your head to the right.  This may be enough for you to feel a stretch.  If it isn't, then take your right arm and extend it straight out to your side.  Bend the elbow and place your palm on your ear.  DO NOT PULL!   Instead, let gravity provide the force as the combined weight of your head and arm increase the stretch on the left side of your neck.  If you feel your left shoulder start to rise, take a breath and try to relax it back down. After ten seconds, gradually come out of the stretch.  Switch arms and repeat the stretch for the other side of the neck.

The first few times you do this stretch, you might feel some discomfort in your neck.  This is due to the connective tissue being stretched as well as the muscles.  The pain should fade relatively quickly.  Be aware there is a chance to overstretch with this movement so proceed very, very slowly.  If the pain on the stretched side feels especially hot, there might have been a tangle in the connective tissue that tore (this is not a bad thing, just uncomfortable).  If that is the case, running an ice cube over the area can help reduce discomfort.

Standing Lateralis Stretch

Stand with your feet about hips with apart and raise your hands over your head until your arms are mostly straight. Take the right wrist in your left hand and do a side bend slowly over to the left with your right hip jutting to the right. If done correctly, you should feel a stretch through the ribs and muscles in the right side. Reverse the directions to stretch the left side. Hold each side for about 5 to 10 seconds, switching once and repeat once or twice a day.

Morning Stretch


Stand with your feet hips distance apart (this one can also be done in the seated position once you have it down). Now raise your hands directly above your shoulders with the palms facing forward. Once the arms are fully extended, pull the arms down so that your elbows are bent and are alongside the body. You should feel the shoulder blades coming together as the arms come down. As you bring the arms down, come down slowly like you are moving through molasses. If you feel unsure about this stretch, perform it with your back against a wall so that your arms are in contact with the wall throughout the movement. Repeat as often as you feel you need to.

Rows
 
This is one of the best exercises for balancing out the strength differences between the front and back of the shoulders. If you have access to a gym, you can use the standard upright row machine, with a few caveats. First, make sure you are using a weight that you can move comfortably. If you are grunting and straining, it's too much. These muscles tend to be weak, so especially when starting out, too little weight is preferable to too much.  Second, don't hyper extend the chest. When lowering the weight, stop the movement when the arms are completely extended. If your chest moves forward, you've gone too far.

If you don't have access to a gym, or if your gym doesn't have the right equipment, there is still a variation you can do.  You can use free weights, resistance bands, or even water bottles or cans of food for this. Start by standing with your feet shoulder distance apart with the weights about a foot in front of your feet. Now bend through the hips (not the waist) until your upper body is perpendicular to the floor. Reach down and take the weights. Then, with your palms facing each other and your hands under your shoulders, bring your hands towards your shoulders. Your arms and shoulder blades should be the only parts moving during this exercise. Try to use a weight that allows for 15-20 repetitions and multiple sets. Finally, when you are finished, but before you straighten up, release the weights to avoid straining the low back.

Reverse Flies

This is another exercise that will help build up the muscles of the upper back and shoulders, which in turn will balance out the muscles of the chest and help maintain proper posture.  There are several variations that can be done depending on one’s preferences, limitations, and equipment available.  The most important factors to keep in mind are that the back should be straight (but not rigid) between the hips and the neck, doing more reps with less weight is better than doing fewer reps with a higher weight (this exercise can be done with no weight at all if necessary and still be effective), and if at any time the breathing becomes rapid or labored, then it’s time to take a break.

As mentioned above, there are several positions this exercise can be done in.  The most common position is standing with the knees slightly bent, the waist bent to 90°, and the upper body parallel to the floor.  The arms should be hanging perpendicular to the floor, hanging straight down from the shoulders, with the hands directly below the shoulder joint. Another common variation is to lay on one’s stomach on a weight bench, which will often limit the range of motion, but allow for much less stress to be placed on the low back.  A third variation is to lay on one’s stomach on the floor with the arms stretched out at a 90° from the body with the hands parallel to the shoulders on the horizontal plain.

There are some basic elements in performing this exercise that remain the same regardless of which position is chosen.  The primary focus of this exercise should be shortening the muscles in the back of the shoulders and between the shoulder blades.  If starting from a standing position or lying on a bench, the hands should hang directly below the shoulders with the the palms facing each other and the thumbs parallel to each other and pointed forward.  If no weight is being used, then gently curl the hands into fists while performing the following movement.  Bring the shoulder blades together as you move the arms from a perpendicular position to the floor to a parallel one.  As you do this, the arms should remain slightly bent at the elbows and remain at a 90° to the body at all times.  Also, as the arms move up away from the floor and the shoulders come together, there will be tendency for the shoulders to come up towards the ears.  This can be stopped by pushing the chest out as the arms come up.  Once the hands are slightly higher than the body, slowly release them back to the starting position.  A good pace to keep is to perform the  first motion on the inhale and bring the arms back down on the exhale with a slight pause at both the top and the bottom.  

If lying flat on the floor, this is performed as a micromovement.  By contracting the muscles between the shoulder blades and in the backs of the shoulders, the arms will lift slightly off the ground until they are higher than the shoulders.  As long as the muscles are engaging, the benefits from this exercise will be there, in spite of the smaller range of motion when performed this way.

Push-Ups
   
Push-ups can be an incredible exercise for working both the core muscles as well as those of the chest and upper back, but they can just as easily create muscle imbalances if done incorrectly.   The biggest problem most people face when performing this exercise is that they have a tendency to focus on moving the body up and down and in doing so, lose focus on maintaining the proper form needed to get the most positive benefits from the exercise.

To properly execute this exercise, lay face-down on the floor with the hands directly below the shoulders.  Engage the muscles of the core by drawing the belly button in towards the spine while simultaneously drawing the muscles from the sides of the abdomen towards the center.  This will help keep the back straight and prevent excessive lumbar curve.  The preferred execution of this exercise is balance on the toes, but if the muscles of the upper body aren't developed enough to do this, balancing on the knees is also acceptable. 

So, whether using the toes or the knees, straighten the arms while keeping the elbows tight against the sides of the body.  There will be a temptation to allow the elbows to move perpendicular to the torso, especially as fatigue sets in, but by allowing this to happen, the shoulders will start to rise, and neck and shoulder issues can develop as a result.  Continue to straighten the arms until they are almost completely straight, but do not lock the elbows.  Pause here as this is the point to start doing push ups.

Allow the arms to slowly bend, again making sure they are tight against the torso, while gently lowering the chest towards the floor.  Go down as far as feels comfortable with the goal of touching the tip of the nose to the floor.  As the body descends, the shoulder blades should move towards each other.  Pause at the bottom before straightening the arms and returning to the starting position.
There are several things to keep in mind while performing this exercise.  The back should remain as straight as possible.  If the belly starts to sag during the course of the movements, this is a sign that fatigue is setting in.  Breathing is also important, so inhale during the descent and exhale upon rising back to the starting position.  As mentioned, the elbows should stay tight against the body throughout the movement.  If any of this becomes difficult to maintain during the course of the movement, it is better to stop than to continue to do the exercise incorrectly.  25-50 repetitions 3 to 4 times a week should be enough to develop and maintain good upper body strength, but only as long as they can be done correctly.  Keep in mind that even working towards this point will aid in developing the muscles so it's a goal, not a starting point.


Conclusion
So hopefully you now have a somewhat better idea of both the causes and some solutions to the issue of chronic upper back pain.  For more information and exercises, I’d recommend also checking out my guide to the shoulder.  For those of you with the resources available, working with a physical therapist or personal trainer can also be extremely helpful, but since that isn’t always an option, my goal with this was to give people some tips for dealing with it using the resources they do have.  I hope it helps, and as always, if you have any questions, feel free to email me at cavemanmedicine @gmail.com.

Sunday, September 2, 2012

Digestion 101

One of the most idiosyncratic things about American culture is its relationship to food.  The citizens of the United States are some of the most diet-obsessed people in the world, counting calories and and studying ingredients while at the same time battling out of control obesity rates.  One of the reasons for this is that while people are more educated than ever about aspects of how food can have specific effects on the human body, many people lack a basic understanding of how the various elements of the digestive system work together to turn food into energy.  The goal of this guide is to look at how those elements fit together and how each one contributes to the process of turning food into the raw materials that the body needs to fuel and maintain itself.  While the focus will mostly be at the organ level (as opposed to the cellular level), there will be times during the discussion where it'll be necessary to examine what is happening on a smaller level.  For the most part, however, this will be a general guide to the digestion and its component parts.  So, with that in mind, let's start this exploration at the beginning of the digestive tract - the mouth.

The Mouth

Most people think of digestion as something that occurs once food reaches the stomach, but in fact the process of breaking down food begins when before the first mouthful ever crosses the lips.  As Pavlov famously documented, salivation begins to occur in anticipation of food, not with its arrival. There's an important reason for this. Saliva not only aids in consumption by moistening the food as it is consumed (which makes it easier to swallow) but it also contains enzymes which begin the break down of nutrients in the food that was just consumed.  Specifically, it contains two enzymes which aid in the breakdown of starches and fats.  These nutrients tend to be denser than simple foods like carbohydrates and therefore need more time to break down in order to get the most nutritional value from them.  This is also why they provide more energy to the body over a more extended period of time.  Saliva also assists the digestion by neutralizing certain harmful bacteria that may be on the food, easing the demands on the immune system while food is being broken down later in the digestive process. 

The tongue and teeth also play an important function in digestion.  Things are needed or wanted by the body and brain tend to taste better than things that are less needed.  Many of the strange cravings that people experience at various points in their lives are related to this phenomena.   For example, it is not uncommon for women to crave dirt during pregnancy.  This is related to a need for certain minerals that may be insufficient in the diet that are needed for the development of the fetus.  Because these minerals may be more abundant in the soil, the brain will translate this need into a craving and a material that would not usually be considered a normal "food" suddenly seems not just edible, but needed. 

Another example is sugar cravings.  As explained in previous articles on this blog, the brain loves sugar. Unlike other organs and tissues in the body, the brain's preferred source of energy is carbohydrates, and simple sugars are the fastest way to deliver those carbs to the brain.  So during times of need or anticipated need - such as when extreme or prolonged stress is ongoing or anticipated - the brain will communicate to the body that it wants those carbohydrates.  This is will manifest as a craving for sweet foods, as that flavor is what is associated with simple carbohydrate content.  Many times, these cravings are actually reflecting either anxiety or true hunger and are better satisfied by more substantial fare, but, especially in an environment where simple sugars are plentiful and easily acquired, a more thoughtful approach to stemming the cravings must be learned as cravings are a powerful instinct.

The role of the teeth in digestion is much more straightforward and mechanical. Teeth are there to make big pieces of food into smaller pieces.  Much like cooking (or most chemical reactions), the more surface area of a substance that is exposed to the forces affecting it, either in energy or chemical form, the faster and more efficient the break down of the material will be.  The design of the teeth and mouth evolve in very different ways depending on what that creature's diet consists of.  Animals who exist primarily on plant materials tend to have broad, flat teeth that grind food into an almost paste-like substance that is easy for them to break down.  Species whose diet consists primarily of other animals have sharp, pointed teeth that are mostly designed to make it easier to rend the flesh from the body of the animal they are consuming.  Most of the non-protein elements of their diets comes from eating the digestive organs of vegetarian animals, where the plant matter is already mostly broken down and therefore easier for their own digestive tracts to extract what the carnivore needs dietarily.

Humans, along with a few other species of animal, are omnivores, meaning they have the theoretical capacity to consume both plants and animals (due to dietary, cultural, or religious reasons, individuals may choose to limit their diet, but in terms of anatomy, most of humanity is born with the same basic mouth design).  This is reflected in the mouth by the variety of teeth present.  The incisors cut plant and animal material into smaller pieces while the canines allow for the grasping and tearing of larger pieces of flesh. Finally, the molars grind both plant and animal material down into smaller matter clumps that are held together with saliva called a "bolus".  When discussing digestion, the bolus (in layman's terms, one swallow's worth of chewed food and saliva) is the general term used as the consumed food works it's way through the upper digestive tract, so this will be the primary term used as the discussion continues.

As was mentioned before, the primary function of the teeth is to break down the food being consumed so that as much of its surface area is exposed and broken down as possible to the chemicals and enzymes that will break it down into components the body can use. This function is so important that many digestive issues can arise simply by not chewing one's food enough.  For example, if a large piece of food matter is swallowed intact, the chances that the digestive processes will be able to fully break it down as it travels through the organs becomes reduced, increasing the chances of undigested food in the stool.  While it remains in the digestive tract, the chances that the undigested food will contribute to issues such as gas, bloating, and added fermentation increases, leading to abdominal discomfort and blockages.  There are many schools of thought on this, but it's is commonly agreed that each mouthful of food should be chewed at least fifteen to twenty times before swallowing.  One of the reasons why processed food is often more attractive to the body is because many of these foods have already been broken down and reconstituted, so that they require much less energy to digest.  (Unfortunately, that also means many more preservatives are required to keep the food from spoiling, which makes these foods overall much less nutritious that foods which are less processed.)

The Esophagus

After the food has been turned into a bolus by the teeth and the saliva in the mouth, swallowing then transports the bolus from the mouth to the stomach by way of the esophagus.  The esophagus is a hollow, muscle-lined tube that moves the bolus by the way of smooth muscle contractions.  These contractions further break down the bolus through agitation of the substance as it is passed down towards the stomach.  Much like clothes in a washing machine, agitation helps aid digestion by further breaking down the bolus and exposing more of its surface area to the chemical processes that are occurring in the digestive system.  This is an important factor in almost every step of digestion.  If a person attempts to swallow something too big to be digested or if the body is attempting to reject something from the throat, the same muscles which move food downward to the stomach will instead try to force the offending substance back out through the mouth.  If this occurs at the top of the throat, it often presents as gagging.  When the offending material is in the stomach, vomiting will occur, and if the substance becomes stuck in the esophagus in such a way that it blocks the flow of air to the lungs, the person will begin choking and may need additional assistance (such as the Heimlich maneuver) to clear the offending material.  If the bolus is appropriately sized and there are no complications during its passage through the esophagus, after about a minute, the bolus will arrive in the stomach.

The Stomach

As the bolus reaches the end of the esophagus, it passes through a sphincter to arrive in the stomach.  (When part of the stomach sits above this sphincter, a condition known as a hiatal hernia is the result and can contribute to such conditions as heartburn and GERD, as the body is less able to keep its contents from passing back up into the esophagus.)  The stomach contains nerves unrelated to the taste buds which can relay information to the body about the protein, starch, carbohydrate, and fat content of the food.  This data can then be used by the brain to determine if the food being consumed will meet the body's nutritional needs.  Unfortunately, this information often comes either too late or is ignored, which contributes to over-eating and poor food choices, but it is valuable information for people who are trying to control their appetite as part of a program to eat healthier foods and amounts of those foods.  Digestively, the stomach exists to further the breakdown of proteins, decontaminate the substance that has been consumed, and to transform the bolus into chyme.  This is accomplished partly by the secretion of gastric acid which unbinds proteins, kills offending bacteria, and further breaks down other non-protein materials.  Gastric acid, which contains a concentration of .05% hydrochloric acid, is secreted by the walls of the stomach itself, and is an extremely necessary part of the digestive process.

When stomach acid is insufficient, proteins become harder to digest and the chances of bacteria surviving into the small intestine increases dramatically.  In a healthy individual, the stomach is coated with a layer of mucous that protects the lining of the stomach from the acid it produces.  However, there are certain conditions and situations which will cause this mucous layer to become insufficient to protect the lining and the results often include ulceration of the stomach lining, a painful and potentially dangerous situation.  As a result of the discomfort, a common treatment involves reducing the amount of acid being produced, which can create even problems such as those mentioned above.  Certain medications for issues unrelated to ulcers and heartburn can also reduce the amount of stomach acid being produced, which can create further problems down the road such as malnutrition and digestive upset if the person taking those medications is not prepared for them. 

Another element in the breakdown of foods in the stomach is agitation of the stomach by the smooth muscles lining it.  As the bolus is exposed to the acid inside the stomach, certain enzymes are activated, further breaking down the proteins inside.  The stomach will churn during this period, helping to expose as much of the bolus as possible in order to maximize the amount of the bolus that is broken down into a more liquid-like substance called chyme that is transported to the small intestine by a second sphincter in the lower part of the stomach.  This agitation also helps moves the bolus through the stomach towards that opening.  Breaking down the bolus into chyme takes approximately forty minutes to an hour from the time it arrives in the stomach.  While some substances are absorbed by the stomach (alcohol being a notable example), most of the actual breakdown and absorption of the chyme is done in the next organ, the small intestine.  But before that, there are two other organs that contribute to the digestive process that should be looked at first.

The Pancreas

While food doesn't pass directly through the pancreas as part of the digestive process, this organ is nonetheless contributes very important enzymes and chemicals which aid in the break down of food into something that the body can make use of.  A full analysis of these substances could be an entry on its own, but for the purpose of this article, there are two that are worth noting specifically: bicarbonate and insulin.

As chyme enters the small intestine from the stomach, it still contains a large amount of stomach acid.  The tissues of the small intestine need to be more absorbent than those of the stomach and therefore don't have the thick layer of mucous to protect them from the acid.  The bicarbonate (an alkaline) released by the pancreas is thus necessary to neutralize this acid so that those tissues aren't damaged.  As chyme passes through the sphincter between the stomach and the small intestine, the pancreas releases bicarbonate to raise the ph of the chyme to a more neutral level.  If the amount of bicarbonate is insufficient to fully combat the acidity of the chyme, it can result in ulcers in the upper tract of the small intestine that can be quite painful. 

The second product of the pancreas that should be noted is insulin.  This substance is much better known than the first thanks to the dramatic increase in the number of cases of diabetes across developed nations.  Insulin is released by the pancreas in response to the increased presence of glucose in the blood stream and plays a large part in carbohydrate and fat metabolism.  The presence of insulin in the bloodstream also activates other metabolic and cellular functions, making it an important part of overall health as well as digestive function.  High glucose levels can be toxic to certain bodily tissues and can contribute to increased infection and tissue damage, so healthy pancreatic function and insulin response is essential in maintaining good health.  There are two types of diabetes which, when contrasted, illustrate how common problems with insulin can come about and, when compared, show how insufficient insulin response can create very serious health issues.

The oldest form of diabetes, Type 1, used to be called "child-onset" diabetes, but with the increasing number of children developing Type 2 diabetes, this moniker is no longer appropriate.  Type 1 diabetes develops out of an autoimmune disorder where the immune system attacks the insulin producing cells in the pancreas.  This process occurs over several years with the patient seeing gradually increasing symptoms that become fully realized around the beginning of adolescence, include mood swings, stomach pain, and other signs of digestive disfunction.  Because the body no longer produces insulin, the diet must be carefully managed and blood sugar must be closely monitored.  This condition has existed in humans through much of recorded history and was referred to by the Greeks as "sweet pee" (due to the body exuding extra sugars through the urine, giving it a sugary smell) and by the Chinese as "xiao ke" or "wasting thirst" (due to the greater occurrence of dehydration as the body uses water to exude the extra sugar, meaning greater amounts must be consumed).  In previous generations, control of the diet and some herbal remedies were used to control the condition, but in the early 1900's, insulin harvested from pigs became available to control sugar levels as needed.  Today, much of that insulin is produced by plants using genetic engineering.  Because the stomach acids render insulin taken orally into an unusable form, it must be injected into the body as opposed to take orally.

Type 2 diabetes, or what was formerly known as "adult-onset" and is now commonly referred to a insulin-resistant, is a form of maladaptation that occurs in the human body when blood sugar levels remain high over an extended period of time.  The body begins to lose the ability to use its own insulin properly, leading to higher glucose blood levels than are healthy.  Poor diet and a lack of physical exertion over an extended period of time are a major factor in developing type 2 diabetes and correcting these poor habits can be an effective way to regulate and even reverse the damage that is being done.  While some type 2 sufferers may also be insulin deficient, in most cases using exogenous insulin injections is an insufficient treatment plan. 

In both types of diabetes, the higher glucose levels have a toxic effect of sensitive body tissues such as the capillaries.  Over time, these tissues will die off, which starves nearby nerve tissues of the blood needed for their own health.  This is the primary cause of certain common diabetic side effects such as the loss of sensation in the feet and hands and over time can include blindness.  The lack of proper blood flow and sensation as well as the higher blood sugar levels also make the individual more vulnerable to infections and tissue necrosis, which is why, in extreme cases, limb amputation becomes necessary.  Also, because the extra sugar is excreted in the urine, the kidneys become exposed to much higher levels of glucose, a situation that causes them to become to damaged.  This reduction of functionality can be a precursor to complete kidney failure which will then require dialysis and in extreme cases, a complete kidney transplant. 

Hopefully this detour into diabetes was not too distracting, but it seems an excellent way to both explain the function of insulin as well as showing the dangers that can be posed to health by its absence or the body's failure to regulate it.  Before moving on to the small intestine, there is one more secondary digestive organ to cover.

The Gall Bladder

As its name suggests (a bladder being a hollow, yet flexible container), the gall bladder is a hollow organ designed to hold a substance, in this case bile.  Bile is released into the small intestine when lipids (or fats) are detected in the food being consumed.  Produced in the liver out of substances such as water, bile salts, and cholesterol, bile is stored in the gall bladder until it is needed.  When that time comes, it is squirted out and mixed with the chyme in the small intestine to help break down lipids contained within.  In cases where the gall bladder has been removed, usually due to gall stones, the liver continues to produce a steady stream of bile, but without the ability to control its release, either a low fat diet or bile in pill form must be consumed to avoid abdominal pain and nausea. 

Gall stones can occur for a number of reasons, but some common ones include a low fat diet (so less bile is released, increasing the chances that the bile in the gall bladder will have time to form stones), dehydration (less water means the bile will become thicker and more likely to harden into stone form), and blockage of the duct by bacteria or other substances.  A common remedy is to remove the gall bladder surgically, but as mentioned above, this can create other issues or require the addition of a supplement to make up for its absence. 

The Small Intestine

This is the longest organ in the human body (it can vary from fifteen to thirty-five feet in length) and arguably the most important aspect of the digestive system when it comes to absorbing nutrients from the substances that are consumed.  Fats, proteins, carbohydrates, vitamins, and minerals are all absorbed through the tissue walls of the small intestine as the chyme passes through it on its way to the large intestine.  While some of these substances are broken down by organs or substances outside of the small intestine (proteins by the stomach, fats by the bile from the gall bladder), without the small intestine, the body would still have no way to make use of them.  One of the reasons for the length of this organ is to allow as much of these materials to be absorbed as possible.  The tissues of the small intestine themselves are designed to maximize surface area so that the nutrients can be diffused through them to the capillaries where they enter the bloodstream to be distributed as needed. 

Another reason that the small intestine is so long that the chemical breakdown of chyme into nutrients is an uneven process.  More complicated nutrients take longer to break down into usable components than less complicated ones.  As these materials pass through the intestines, easily obtained nutrients are absorbed earlier on while more complicated ones continue to work their way through the organ as they move towards the large intestine.  By the end of it's trip through the small intestine, most of the nutrients and some of the substances released by the body to help with digestion (bile salts, for one example) have been absorbed through the cells lining the small intestine.

Unlike most of the other organs that nutrients pass through in the digestive tract, the small intestine does not use peristalsis to move the chyme through itself.  Peristalsis is the rhythmic contraction of smooth muscles lining the organ which fire in a wave-like sequence to push food through the organ.  Instead, the small intestine uses villi, small hair-like projections that line the inside of the organ, to gently push chyme along, similar to how a gondolier pushes a boat through water.  These villi are aided in their efforts by the contraction and expansion of muscles in the abdominal core such as the obliques and the transverse abdominis.  When a person moves in such a way that engages these muscles, predominately movements where the torso is engaged in horizontal rotation (walking is one such movement), the contraction and expansion of the muscles helps move food through the small intestine, increasing the amount of agitation that occurs and further breaking up the chyme, which in turn exposes more of it to the inner surface of the intestine.  This allows for more of the nutrients to be absorbed and for the chyme to move more quickly through the small intestine.

Because so much of the absorption and movement of the small intestine occurs along this inner surface, anything that blocks or coats that surface will have an overall negative effect on both the speed and efficacy of which the intestine absorbs nutrients.  Substances like mucous which are produced by the body in response to dietary elements which the body finds disagreeable either because of sensitivity to them (such as in a gluten sensitivity) or the presence of an offending or non-food element (which includes some preservatives in addition to other chemicals added to food) as well as the overgrowth of native bacteria and yeasts can occlude the inner surface of the intestine, slowing the transport of chyme through its length and reducing the amount of nutrients absorbed.  Also, the longer the chyme remains in the intestine, the more chances there are that gases will be produced from the chyme in a process similar to fermentation.  These added gases increase the pressure inside the small intestine, which can alter the shape of the organ, further reducing its efficacy as well as create sensations of pressure which lead to abdominal discomfort. 

Speaking of bacteria and yeasts, there is one more organ that is involved in digestion that should be touched on before the large intestine is covered.  It's not an active part of the system as it doesn't actively transport food or secrete a substance which aids in digestion, but instead is thought to act as a storehouse for the healthy bacteria that live in the intestines and which aid in digestion.  For a long time, western medical science believed this organ to be vestigial, but recent research has revealed a potential purpose for it. 

The Appendix

This small organ was once thought to be a vestigial element of the digestive system that was nothing more than a site for potential health problems.  A burst appendix is a life threatening emergency that can require extensive surgery and medical intervention if not caught in time.  Recent additions to medical knowledge have caused that opinion to change in recent years, however.  The current medical opinion is that the appendix exists as a storehouse for helpful bacteria that live symbiotically in the gut and which exists to 'reboot' the digestive system in cases where that bacterial population has been killed off or is otherwise compromised.  Before moving on, a closer look should be taken at the role microorganisms in the gut play a role in the digestive process and how there presence is so necessary that a system that can replace them would be helpful in maintaining good health.

Because of the variety of foods that are consumed, at some point in the evolution of living beings, a symbiotic relationship was began with certain microorganisms such as bacterias and yeast.  In return for a safe environment to grow and exist, these organisms provide living beings with aid in converting food into usable nutrients as well as fighting off other, more harmful organisms that might cause disease.  Predominately found in the large intestine (with a smaller population also occupying the small intestine), these organisms aid their host in a variety of mutually beneficial ways.  While the host can survive without them, functions such as immunity, maintenance, and overall metabolism are negatively impacted. 

In mammals, these bacteria are passed along from the mother during birth (during passage through the birth canal) and breast feeding.  As they are some of the first microorganisms the newborn is exposed to, the immune system regards them as a natural presence and, with the exception of certain immunological conditions, doesn't react to their presence.  As the young mammal develops and is weaned, they aid the body in breaking down foods that were a common part of the mother's diet.  Some of the problems that exist with a radical diet change is the immune system reacting to either unknown bacteria entering the digestive tract or a lack of the proper bacteria to break down foods.  Common negative reactions include gas, bloating, and diarrhea, which can all be symptoms of the body improperly breaking down unfamiliar foods. 

If the populations of these native bacterias are decimated, such as through antibiotic use, current theory holds that the appendix will then release some of it's storehouse of "native" bacteria to help restore the body back to equilibrium.  Since most of these bacteria live in the large intestine, the location of the appendix is extremely fortuitous, as it is close enough to the beginning of the large intestine that it can deposit its load of bacteria in a way that the organisms can distribute themselves equally throughout the organ.  Its proximity to the small intestine also allows for some of the bacteria to migrate back up to the small intestine where they can aid that organ as well, though to a lesser extent.

Candida, a yeast, is another example of a native microorganism.  Inside the body, candida helps with extracting needed energy from sugars.  In recent history, however, due to the increase in sugar in the average person's diet, the chances that the population of candida will surpass healthy levels of equilibrium has risen greatly.  If it becomes too great, this yeast can contribute to abdominal upset through increased levels of fermentation, greatly increases the levels of gas produced in the large and small intestines as well as taking on a parasitic relationship with the body, damaging the host as it overgrows.  One advantage of maintaining healthy bacteria in the body is that the native gut flora will act to control the growth of candida in the body.  When those bacteria are killed off through medications or poor diet, the odds that the yeasts will engage in massive overgrowth increases dramatically.  The immune system will attempt to control this to a degree, but it's also a good strategy to replace the native bacteria as quickly as possible, using probiotic foods and supplements in addition to the storehouse of bacteria in the appendix to return the body to a state of equilibrium as quickly as possible.

The Large Intestine

The final organ involved in the digestive process is the large intestine.  This is where the water the body uses in the breakdown of food is resorbed and the last of the nutrients are synthesized and absorbed before the elements that can't be used are combined with waste products from the body and expelled as feces.  As mentioned in the last section, the largest concentration of bacteria in the body can be found in the large intestine.  These bacteria break down the remaining nutrients that were not absorbed by the small intestine and convert them into substances the body can use.  Vitamin K, a nutrient essential in the creation of clotting factor and the prevention of hemorrhages, is one major example.  Without the bacteria in the lower intestine, the amount of vitamin K provided by the daily diet would be insufficient for most individuals. 

Water reclamation is also a very important function of the large intestine.  The body's ability to hold on to as much water as possible can be very impressive, especially when the amount lost through urination, respiration, and perspiration is figured in.  Since the large intestine is a mostly closed system, it's one of the few locations where the body has a significant control of the moisture used.  That is the reason why in cases where a person becomes dehydrated, constipation and dry, hard stool are one of the first signs.  Most of the substances that the body produces and absorbs which can be toxic in larger amounts (such as sugar, mentioned above) are disposed through urination.  In cases where a person cannot urinate, negative symptoms start appearing fairly quickly.  Other substances, which may be less toxic, but which can still create problems if too concentrated in the body, are expelled through the feces.  When there is insufficient water intake to properly hydrate both functions, water is pulled in greater amounts from the large intestine in order to ensure that urination can still occur, hopefully long enough for a safe source of hydration to be found. 

While the large intestine does use peristalsis to move substances along its length, it, like the small intestine, benefits greatly from voluntary movements of the body such as walking.  Contraction and extension of the muscles of the abdomen and hips aids in the breaking down the contents of the large intestine making it easier to absorb nutrients from them and moving them through the length of the organ.  In fact, leg movements might even be more beneficial to the large intestine than the small, as constipation is a major complication of a sedentary lifestyle.  A factor in this might be that the psoas major, a muscle which initiate ship flexion (or bringing the knees towards the chest), crosses the large intestine as the muscle passes through the abdomen.  When this muscle is tight, it can obstruct the large intestine, contributing to constipation by applying pressure to the organ, making it more difficult to pass the digested material through to end of the digestive tract.  Speaking of muscles, there is one last thing that should be mentioned before this article on the digestion can be closed out.

Posture

It may seem like a simple thing, but poor posture can have an extremely negative effect on the ability of the digest food and expel waste.  Humans have evolved to predominately be either standing, squatting, or lying flat.  In modern society, however, more time is spent in the seated position, where slouching often leads to the digestive organs being compressed, especially the organs found below the belly button.  In proper seated posture, the hips should be below the shoulders and the hips should bent to ninety degrees, ensuring the torso is as aligned as possible.  When the torso is curled or bent, the organs of digestion become folded, which makes the smooth movement of digesting food through the intestines more difficult as there is less room for them to pass.  This means that food passes through the system more slowly, which increases the amount of gas released, as well as the amount of food that may still be in the system when the next meal is consumed.  Either alone or combined, these factors increase the pressure in the system, increasing discomfort and decreasing digestive efficiency. Therefore, a simple step to increase digestive health is to maintain good posture whenever possible.

Conclusion

So concludes another chapter in the user's guide to the human body.  Hopefully the information found within will be helpful in understanding why the human form functions the way it does and may even provide a few answers to lingering questions.  Thanks for reading, and as always, be safe and be healthy. 

Tuesday, August 14, 2012

What is "The Core"?

Maybe it was in a yoga class or an advertisement on television promoting the latest workout craze, but it's a safe bet that most people have at one time or another have heard that there is something called "the core" and that it's something they need to exercise.  But how many of those people actually know what "the core" is and whether or not they need to work on theirs?

Simply put, the core are a group of muscles that exist between the bottom of the rib cage and the upper thighs and are some of the most important muscles in the human body.  Seriously.  It may seem that having strong and healthy core muscles is only important to people who want to have sexy abs or a trim tummy region, but the reality is that these muscles assist in a variety of ways that contribute to balance, digestion, and protecting the torso from muscle strains and damage.

The core is made up predominately by five separate muscles - the transversus abdominus, the internal and external obliques, the psoas major, and the illiacus.  The two other major muscles involved in the movements of the torso - the rectus abdominus and paraspinals - can sometimes be considered as part of the core muscles, but as will be explained, these muscles can often be part of the problem when dealing with issues related to weak core muscles.

The first three muscle groups - the transversus and the obliques - combine to form what can be called the 'corset' muscles.  Each of these muscles exist separately on the left and right side of the body and form a wrap around the torso which can be visible to the naked eye in people who have both a strong core and low body fat.  The transversus abdominus muscles start in the rear of the torso and connect to a large sheet of connective tissue near the spine called the thoracolumbar fascia.  These muscles travel laterally around the body and connect in the abdominal region near the center line of the front of the body and are involved in movements such as rotation of the torso.  The obliques are made up of two separate muscle pairs, the internal and external obliques, and which connect the ribs to the pelvis in the front of the body. They assist in movements which involve rotations that have a vertical element as well as a horizontal one.  Think of bringing an elbow on one side of the body to the knee on the opposite side, or chopping wood, and that's the type of movement that makes use of the obliques.

The second two muscle groups - the psoas and the illiacus - are mainly used in providing the initial force in flexing the thigh at the hip, or to put it another way, in raising the legs in front of the body.  Both of these muscles are ones that most people will never see, but which they use all of the time.  The psoas major muscle starts on the front of the lower lumbar vertebrae and travel through the center of the body to connect to the femurs (the bones of the upper leg) just below the groin.  The illiacus muscles originate inside the bowl of the hip muscles and connect in a space near the psoas on the femur.  These muscles work in tandem to lift the upper leg toward the torso as when raising the leg in front of the body.

The final muscles that were mentioned  - the rectus abdominus and the paraspinals - aren't strictly core muscles, but they are involved very strongly in posture and can have a significant impact on movements involving bending or extending the upper body and hips as well as with posture.  The rectus abdominus is commonly referred to as the 'six-pack' muscle and is the one that receives the most attention when it comes to what is commonly thought of as a pleasing abdominal aesthetic.  This muscle runs down the center of the torso and is primarily used when bending forward through the waist and hips (or a bowing motion).  The paraspinals provide much of the opposition to the rectus and are what are known as extenders. These muscles run from the base of the skull  on either side of the spine to the top of the sacrum and hips and pull the body backwards.  (If the rectus is the bowing muscle, then the paraspinals are what pull the body back upright.)

Structurally, these core muscles provide much of the support that is required to keep the body upright and are in use constantly, even when lying down.  Whenever a child is told to stop slouching, what is actually being said is for that child to engage these muscles to keep the torso straight so that the shoulders are above the hips and the spine is in proper alignment.  When this posture is not being kept, strain is put on the back, especially the low back, and the organs of digestion and respiration are often being adversely affected.

To look at it another way, the muscles of the core form a column that connects the upper body (for the purposes of this example, the head to the bottom of the rib cage) to the lower body (the top of the pelvis to the feet).  When the core is weak, the rectus abdominus and the paraspinals will still allow the person to maintain an upright position, but in effect, the column has been removed and all that is holding these two body parts together is a pair of two by fours, one in the front and one in the back.  As can be imagined, this is far less structurally sound than the column would be, with a lot more constant strain being placed on the muscles involved and potential for problems when movements such as twisting are performed or over extended periods of time.  An example of this would be lifting something up from the ground.  If there is a twisting motion that occurs when lifting a heavy object, in a person with a healthy core, some of the impact of that force would be transferred into one of the muscles on the side of the abdomen, but if those muscles are absent, strain to the back is often the result.

The muscles of the core also aid with internal processes, specifically digestion.  When food moves through the intestines, it does so mainly through the contractions of the smooth muscles that line the small intestine.  This series of contractions is called peristalsis and, combined with the force of the food consumed after what is being focused on, gradually moves the digesting mass from the small intestine to the large intestine and finally out of the body.   When the core muscles are strong and engaging on a regular basis, they apply and release pressure on the intestines which aids in the movement of these materials through the digestive system.  When this help is absent, however, the organs of digestion must then work harder and as a result, food moves more slowly, which creates some problems that will be detailed below.  When those same core muscles are also weak, then not just the digestion is affected, as the respiration also suffers.

What often happens is that the muscles of the rectus abdominus become much stronger than those of the paraspinals, which pulls the front of the pelvis upward.  This then forces the paraspinals to exert more force on the back of the pelvis to maintain the lumbar curve.  As a result, the psoas muscle then tightens in response to reestablish the lumbar curve.  The psoas muscles travels past the intestines as it goes from the spine to the legs, and when it becomes tight, it can actually obstruct the large intestine, affecting the body's ability to eliminate waste and causing pressure to build up.  This pressure, combined with the added mass of the waste that can no longer pass through the large intestine, begins to compress the small intestine, causing it to become more bloated and filled with pressure.  That will have a negative impact on its ability to break down foods and will result in more gas and bloating.  As a result of the organs of digestion being taking up more space, the diaphragm (a muscle which pushes the intestines down toward the pelvis in order to draw air in to the lungs) is unable to move as far downward, meaning less air is drawn in when a breath is taken. Another affect of the movement of the diaphragm is to add extra mechanical effort to digesting foodstuffs as they move through the digestive organs.  So when it doesn't move as freely, then food moving through the organs of digestion doesn't travel as quickly, giving it even more time to ferment, which adds to the amount of gas and bloating experienced in the abdomen.  This cycle can continue to the point where the extra gas and undigested food can actually increase the protrusion of the abdomen, giving it a distended appearance as well as increasing its forward and downward drag on the torso, which puts further strain on the lumbar.

In women, this added pressure can also have a negative effect on the menstrual process, increasing the incidence of cramping and bloating during their cycle.   Without strong core muscles to aid the uterus in the contractions that occur during menses, and with the added pressure from both the tight psoas and the added mass in the intestines, the uterus will often have to strain harder and cramping can become a much more common occurrence.  This also means that not all of the tissue is expelled which then creates a cycle of building cramps with each subsequent cycle.

When these muscles are weak or have developed out of alignment, balance can become negatively affected, as well.  In younger people, this loss of balance is relatively unnoticed, but as an individual becomes older, it becomes a serious health concern.  Falling is often seen as a predicator of major health issues in the senior population and a fall that results in a broken hip can often lead a person to develop serious illnesses over a relatively short period of time.  But it's not only seniors who need to be concerned with a weak core or the problems that can result from the muscles being out of balance or too weak.  Even in younger people, a weak core can increase the incidence of falls and serious injury as the body is less able to absorb the impact in a way that minimizes damage to the body.  Over an extended period of time, a weak core can also create permanent damage to the spine and joints by creating a situation of building pressure that manifests in a need for surgical intervention.

As mentioned above, a tight psoas will pull the lumbar vertebrae forward, a situation which increases the chance of a forward subluxation of the vertebral disc (where the disc slips forward so that it is out of alignment with the discs above and below it).  This can then put a significant pressure on the spinal cord  and nerves which connect to the lower body, such as the sciatic nerve.  As a result of this pressure, pain and numbness can result.  When left untreated and uncorrected, this pressure will often require surgical intervention that may result in the fusion of the vertebrae or removing sections of bone in order to ease the pressure.

In an effort to protect the spine, the body will often make adjustments to the alignment of the knees and hips to alleviate the pressure, but these adjustments over the long term carry the possibility of increasing the wear and tear on these joints.  As a result of this wear and tear, the hips and knees will develop problems of their own and once they are no longer able to tolerate the alignment changes, they may also develop chronic pain to the point where those joints may lose the ability to properly function.

Much of the modern study of the core comes from disciplines such as yoga, the martial arts, and Pilates.  Pilates is a type of exercise that was originally developed by Joseph Pilates in part as a way for injured dancers to stay in shape and for healthy dancers to avoid injuries.  The focus was on building a frame that was simultaneously strong and yet still lean and flexible, where power and strength were built without increasing the mass.  This is incredibly important for dancers as too much mass comes at the cost of speed and ease of movement, things which are obviously important when there is a need to move quickly and in a variety of directions, including leaping and twisting.

One of the nicknames for the core is 'the powerhouse' because a healthy core will allow a person to utilize more strength than they could with their extremities alone.  Much of this comes from the benefits it provides with regards to proper alignment and balance.  When the core is strong, less effort is required by the legs and arms in order to protect the back both when moving and lifting both objects and the body itself, easing strain on the joints and connective tissues, which gives a greater sense of security and coordination as well as allowing a maximum of force with a minimum of effort.  In the absence of a weak core, these benefits are considerably minimized, but this may not be readily apparent due to the body's amazing ability to compensate for weakness.

As mentioned above, strong paraspinal muscles combined with a strong rectus abdominus may contribute to the problems of a weak core.  This occurs because while these muscles may offer the illusion that the torso is unaffected, over time they will be unable to protect the body from certain movements while in some cases the forces they exert on the skeleton and joints may contribute to the very problems they were helping to initially hide.  Exacerbating this situation is the fact that many individuals will focus on strengthening these muscles to the exclusion of the other muscles that make up the core, often under the mistaken belief that their efforts are in fact helping to relieve the very problems they are trying to avoid.

Sit-ups are one of the first exercises a child learns and they focus almost exclusively on the rectus abdominus muscle.  The core muscles are engaged, true, but only for the first few inches of movement.  To look at it another way, humans spend much more time with the their torsos flexed fifteen degrees forward or backward than they do with the more extreme flexion seen in a sit-up, where the torso may be flexed up to ninety degrees.  A tight or overdeveloped rectus abdominus also makes bending backwards more difficult as well as flattening the lumbar curve.  This is important because on the reasons for the lumbar curve is to help absorbs shocks that may affect the spine from activities such as jumping, running, or walking.

Speaking of walking, walking is one of the best exercises to maintain a healthy core.  When walking properly, the torso engages in small rotations that engage the transversus and oblique muscles, which tones and strengthens them.  One way to diagnosis a person with a weak core is to watch them walk. If they move in a very straight manner with little rotation of the core and hips, it is often due to weakness of those core muscles.  Dancing is another activity that can both benefit and benefit from stronger core muscles.  Belly dancing specifically uses the core muscles in order to accomplish its signature movements of the hips and torso.

Other exercises can also help develop the muscles of the core and in almost every case, small movements accomplish more than large ones.  Leg lifts where the legs are brought just an inch or two off the ground and crunches that involve just lifting the shoulders from the ground are just two examples of these types of exercise.  Pilates, as mentioned above, focuses on the core primarily and the explosion of related videos and classes has made it easier than ever to engage in.  Caution should be used, however, as improperly performed movements can jeopardize the core, so professional instruction should be obtained before trying any tapes or home programs.  Yoga can also provide benefits to the core, but the same cautions should be exercised.

This article was intended more as an introduction to the core and its relationship to the body, and should not be seen as a comprehensive guide to this important yet often ignored aspect of the body.  Please feel free to engage in further research into both how these muscles work and how they effect the body, and while there are other articles on this blog that relate to both it and exercises that can benefit it, please don't hesitate to seek further information either online or from a trained health or fitness professional.  Hopefully, this served to illuminate a much talked about but little understood aspect of the body. As always, be safe and be healthy.

Sunday, August 12, 2012

Cupping - A Video Demonstration

Last year I did a demonstration on cupping for the internet talk show "Have You Heard with Byron and Karol". For anyone who is interested in this form of treatment, click here and give it a watch. It's a pretty good overview of what cupping is and how it works.

Sunday, August 5, 2012

Caffeine - A User's Guide

It would be fair to say that caffeine is the most commonly used stimulant in today's world and is consumed in a variety of forms.  Historically, most cultures developed a form of caffeine that was linked to the plants found in the geographic area where that culture was located.  However, as humanity engaged in trading and communication with other cultures, caffeine spread across the world in a multitude of forms.  In the past, tea and coffee were the predominant forms, but in the modern world, soda and energy drinks have become more and more common caffeine delivery systems.  As wide spread as caffeine use has become, many people only have a limited understanding of this substance, the differences between the various delivery methods, and how these different forms affect the body.  This purpose of this guide is to illustrate what caffeine is, compare and contrast some of the ways people ingest it, and point out some of the ways that it affects the body.

Caffeine occurs in nature as an oil that is exuded by plants as a toxin to keep insects at bay.  This oil is exuded through the leaves and fruit of the various plants that are the source of coffee beans, tea leaves, and guarana fruit (among others).  It acts as a neurotoxin on insects, leading to paralysis and coordination difficulties.  This affect can also be seen in humans, though only at much higher doses.  The basic equation for determining a toxic dose of caffeine in mammals is around 150-200 milligrams per kilogram of body mass (or around 80-100 cups of coffee for the average adult).  This effect can be seen at lower doses as the loss of coordination, shakiness, increased heart rate, and higher blood pressure that comes with drinking too much caffeine in too short a time period.  Coffee is an exception to this, as there are other elements in play which will be discussed later.  The chances of an overdose are extremely rare however, as the body would filter most of the caffeine out of the body before a toxic dosage could be ingested.  Also, in its pure form, caffeine powder is extremely bitter, making it almost impossible for any creature to consume a toxic dose orally.

Like most stimulants, caffeine affects the body by increasing neurological and metabolic rates, leading to increased blood flow and heart rate, which produces a feeling of wakefulness.  In people who are not regular caffeine consumers, there is also a mild diuretic effect.  However, caffeine tolerance builds fairly quickly and can turn into dependence in a relatively short time.  The signs of caffeine withdrawal can include feelings of depression or anxiety, sleepiness, headaches, and nausea.  Fortunately, this period of withdrawal is relatively short and for many people, the psychological addiction to caffeine is far harder to kick.  In some cases, it has to do with the establishment of habits, such as the first cup of coffee to start the day, while for others it comes from a dislike of being aware of the natural cycles of energy and fatigue that occur throughout the day, such as sleepiness after meals.

Coffee is one of the oldest forms of caffeine that has been consumed by humans, second only to tea in the Western and Eastern world.  The oils of the coffee bean are rich in caffeine as well as other substances that increase wakefulness and energy.  One of the primary complaints about coffee is its bitter flavor which comes from the high levels of caffeine in the oil (this bitterness also contributes to the nausea that can arise from too much coffee consumption).  The bitter nature of coffee does have some benefits in breaking down fats and proteins, which makes it a popular beverage to accompany the consumption of meals and desserts, especially heavy meals that may not digest comfortably without it.  This makes it a popular choice as a breakfast or post-desert companion.  The heavy foods also add the benefit of easing the effects of coffee's acidity on the digestion, leading to less stomach upset and irritation.

As mentioned before, coffee has some characteristics that set it apart from other forms of caffeine.  For one thing, oils separate from caffeine can stimulate the body to produce adrenaline and cortisol, two natural occurring hormones which have a major impact on wakefulness, energy, and body function.  Adrenaline is a fairly well known substance and can be pointed to as one of the reason why coffee consumption tends to lead to increased levels of both physical and mental irritability as well as confrontation and aggression.

Cortisol, another naturally occurring steroid in the body, plays a much more subtle and less well known role.  One of the primary functions of cortisol is control overall wakefulness and energy levels.  To contrast it to adrenaline, which provides quick bursts of energy, strength, focus, and endurance, cortisol levels fluctuate throughout the day.  As morning approaches, cortisol levels rise to make waking easier and allow the person to have the energy to start the day.  They then level off and start to decrease, lowering energy levels and allowing sleep to come more easily.  Cortisol also plays a large role in metabolism, helping to control blood sugar levels and lowering inflammation.  This is one reason it is called the stress hormone, as a person whose body poorly manages its cortisol levels will be much more vulnerable to stress-based health issues.  In people whose cortisol levels are too high or too low, sugar cravings, inflammatory conditions, swelling, respiration, and circulatory issues can all arise.  A cup of coffee can be used to stop an asthma attack or reduce allergy symptoms, but high levels of cortisol can also lead to facial swelling and circulatory issues, among other problems.

The substances in the coffee bean oils that cause the body to increase the production of both adrenaline and cortisol are separate from the caffeine and can exist even in decaffeinated coffee.  Their presence increases the effect coffee has in terms of providing a sense of wakefulness and energy, but also increase the amount of shakiness and irritability that are signs of caffeine over-consumption.  They also decrease the amount of time it takes for caffeine dependence to set in as well as worsening the symptoms of withdrawal.  Coffee is also very dehydrating, which can make both the symptoms of excessive consumption and withdrawal more intense.

Coffee, which is usually made by exposing the ground form of the roasted bean to boiling water, can also be prepared in a cold-pressed form.  Using cold water often makes the process of extracting the coffee itself take a longer period of time, but it also makes the coffee sweeter in flavor as less of the other oils are released.  This lack of bitterness also generally makes it easier to digest the coffee as the stomach is less irritated by it.

Tea, in comparison, has much higher levels of caffeine than coffee by weight, but is usually served in much smaller amounts in order to make it more palatable.  The bitter nature of tea, defined here as the leaves from the plants of the Camellia Sinesis plant, has similar effects to coffee in terms of aiding with digestion or in causing stomach upset, but without the accompanying adrenaline or cortisol reactions.  There is also an additional astringent effect due to an increased levels of tannins in the tea, which can also aid digestion.  Generally, tea is thought to be a much gentler form of caffeine than coffee, and is consumed in much greater amounts with less negative side effects.  However, high levels of caffeine can still have an overall negative impact on resting ability, even without the cortisol-altering elements found in coffee.

Tea leaves are generally sold in three different forms - black, green, and white. Black teas have been roasted to maximize the amount of caffeine available and are generally easier on the body, producing a warming effect. Green teas are only mildly prepared and have less caffeine available and contain a higher level of antioxidants, but they also have a cooling effect on the body, which can make them less appropriate for consumption in colder months or climates. White teas come from baby tea leaves and have the lowest levels of available caffeine but also the least effect on the body.  All have a stronger diuretic effect on the body than coffee, partially because the lower amount of actual material used leads to a less dehydrating effect on the body.

Two other plants that are common sources of caffeine and which have become more widespread in their use in recent years are guarana and yerba matte.  Guarana has twice the caffeine content of coffee and in comparison is more bitter in flavor, increases metabolism to a higher degree, and has more blood thinning effects.  The greater bitterness has made it less popular as a standalone beverage, but it has become more popular lately as an ingredient in energy drinks and weight loss supplements (the majority of which are stimulants).

Yerba matte leaves have also become more popular lately as a source of caffeine, but due to some differences in how it effects the body, it is used less for stimulant purposes than coffee, tea, or guarana.  It has more of an effect on the muscle tissues in the body than the central nervous system, giving those who consume it less of a feeling of wakefulness than the other common sources of caffeine.  Instead of stimulating the nerves, it relaxes smooth muscle tissue and stimulates the myocardial tissue of the heart.  This creates a more relaxed feeling overall, with less of the increased alertness that comes with other forms of caffeine, an alertness that is often the reason that caffeine is consumed in the first place.

Before moving on, it should also be noted that chocolate naturally contains some caffeine as well, but in much smaller doses.  A 28 gram chocolate bar contains the same amount of caffeine as a cup of decaffeinated coffee, which can still be enough to have an effect on someone who has a low tolerance to it, but which is not enough on its own to create a caffeine "buzz".

Sodas and energy drinks have, in recent years, become more and more popular in recent years as the caffeine delivery method of choice.  However, because the ingredients used in making them contain no naturally occurring caffeine, the caffeine is instead added artificially.  This caffeine is usually derived by boiling  coffee or guarana beans or tea leaves and then collecting the caffeine from the water, or by steaming the beans or leaves and then spraying them with a solvent.  It's important to note that not all of these solvents can be removed, leading to some contamination of processed caffeines that their more naturally derived alternatives don't have.  This caffeine is then harvested as a bitter white powder and sold in bulk to various soda and energy drink manufacturers to be added in to these beverages as part of their production process.  The concentrated form of caffeine is often incredibly bitter, which is why the manufacturers of these beverages often have to use so much sweetener.  It's necessary for them to cover the taste and often leads to the beverages incredible sweetness.

Because they use a more concentrated form of caffeine while also covering up the bitterness with a greater amount of sweeteners and fluid, these drinks are often consumed in much high quantities than either coffee or tea.  Unfortunately, that means that a much higher amount of calories are also consumed.  Some manufacturers will attempt to counter this by using artificial sweeteners, but many of those will also negatively affect the metabolism as well.  This is one reason that the consumption of soda and energy drinks has been repeatedly linked to the obesity epidemic currently affecting the developed nations of the world.

Another risk with artificially caffeinated beverages, much more commonly seen in energy drinks than soda, is that they often have other herbs, minerals, and vitamins added to them in order to maximize their effects in raising the energy level of the individual consuming them.  Ginseng, taurine, and vitamin B12 are all examples of commonly added supplements which can increase energy but which have their own risks.  Ginseng is an herb which has a strong effect as a stimulant and is often used to treat congenital deficiency in Chinese herbal medicine.  Used improperly, however, it can have negative affects on the metabolism and cardiovascular system and create increased anxiety.  Taurine is an amino acid that can also boost energy, but in increased amounts can also lead to increased heart rate which can contribute to feelings of anxiety and raise the metabolism past comfortable levels. Vitamin B12 is often used to treat both anxiety and depression as well as certain forms of anemia and neurological disorders, but can have similar negative effects when used in a high dosage.

Another disadvantage to sodas and energy drinks is because they are consumed cold and usually in much greater amounts than coffee and tea, they often hide the effects of dehydration more than latter.  This can contribute to the crash effect that occurs as these substances wear off, which often prompts the consumption of more beverages.  Adding to this effect are the greater levels of sugar they contain (which can increase dehydration and stimulate urination).  Combined, this cycle of higher consumption and urination often robs the body of needed electrolytes which then further increases the lack of energy and feelings of fatigue.

A final note on energy drinks is that they are sometimes combined with alcoholic beverages, either pre- or post-production (in other words, either on the shelves as an alcoholic beverage or mixed with alcohol at the bar).  A large part of this is to combat alcohol's depressive effects and allow people to feel aware and awake later into the night.  Not surprisingly, this is very common in dance clubs.  Unfortunately, the stimulating effects of the energy drinks often hide the effects of the alcohol, leading to an increased chance of alcohol over-consumption that leads to negative events due to the individual being unaware of how inebriated they are.

So, as a final comparison, each form of caffeine has its own benefits and costs, and for many people, these benefits and costs may mean far less to them than personal taste preferences, convenience, and habit.  But for those who wish to lessen the impact of their favorite form of liquid energy, hopefully this guide will at least give them a starting point to either alter which form they consume or alter other habits to remove some of the more harmful side effects they may encounter.  As always, hopefully this information will be of use and in the meantime, stay safe and stay healthy.

Thursday, May 31, 2012

The Caveman Medicine Guide to Single Herbs

Back when I was still a Caveman Medicine practitioner-in-training, I decided to compile all of the single herbs they taught in herb class into an easily searchable, alphabetical format. Now, with the proliferation of tablet devices and phones that can read and store PDF files, I revisited this project and have decided to make it available to all of you. It's free to download, but I should warn you that this was written for people in the field of Oriental Medicine, so the terminology may seem a bit odd to the layperson. However, students and fellow practitioners might find it to be a valuable resource and people with an interest in herbs might find some interesting things in here as well. Click here to download.