Sensing Your Reality

Courtesy of Dr Matthew Long.

As chiropractors we are fascinated by the intricacies of spinal manipulation, and even more intrigued by what it might do to the nervous systems of our patients (particularly the brain). In the last few Clinical Clarity Blog articles we have looked at the evolving brain-based models of spinal derangement, and discussed new ideas about how and why such problems might develop in the first place. Increasingly, it seems that those with spinal disorders have a distorted sense of 'self' - a misperception of their spinal tissues that has been described as a disruption of their 'body schema' or 'cortical body matrix'. This is a far more profound idea than a simple proprioceptive deficit, and impacts upon other important areas of the brain such as the limbic system, and the autonomic nervous system.

In essence, the human nervous system requires vast amounts of sensory data to orchestrate its responses to our ever-changing environment. The more accurate and timely the data, the more likely that we can respond in an appropriate fashion. Furthermore, our great capacity to learn means that over time our brain will enhance this data with its own predictions about what future inputs it is going to receive, in the hope of improving response times and survival. But in order to make informed predictions, our brains need data. Lots of it. Unfortunately, those who live a modern, and relatively sedentary, lifestyle are starved of the rich data supply necessary to allow their brains to function as nature intended. Without sufficient data they cannot construct an accurate three dimensional model of their world - both external and internal.

This brings me to the main subject of this Blog article - a TED talk by cognitive neuroscientist Professor Anil Seth entitled"Your brain 'hallucinates' your conscious reality". As Professor Seth says,

"Imagine being a brain. You're locked inside a bony skull, trying to figure what's out there in the world. There's no lights inside the skull. There's no sound either. All you've got to go on is streams of electrical impulses which are only indirectly related to things in the world, whatever they may be. So perception - figuring out what's there - has to be a process of informed guesswork in which the brain combines these sensory signals with its prior expectations or beliefs about the way the world is to form its best guess of what caused those signals. The brain doesn't hear sound or see light. What we perceive is its best guess of what's out there in the world."

To quote Professor Seth again,

"Instead of perception depending largely on signals coming into the brain from the outside world, it depends as much, if not more, on perceptual predictions flowing in the opposite direction."

This is an important idea that is worth pondering for a moment. Our sensory perceptions are largely dependent upon internal models that we have developed over time, and we use these to predict our world. But we can only predict what we have experienced, and we can only build models based upon data that we have accumulated. If we all still lived the 'hunter-gatherer' existence that nature intended, then we would have developed a vast repertoire of movements and motor patterns necessary to survive in such a variable environment. But most of us subsist with a limited array of stereotypical movements (walk, sit, stand, sit, text, type, sit, text, etc), with the odd gym session thrown in. This is not the same as a life that is lived in variable motion. As such, our brain struggles if we suddenly ask it to perform a movement for which it has limited data to work with, such as cleaning out a cupboard under the stairs, or reaching up at an awkward angle. These are the stories that our patients tell us every day, usually preceded by the words, "But I didn't do anything". Without data we cannot make accurate predictions and our ability to control our body is compromised. When we move, we make mistakes - internal mistakes - and this can lead to tissue injury and pain. 

So what has all of this got to do with chiropractic? 

Spinal manipulation should be seen as a method of enhancing input to the nervous system. Adjustments may help our patients by delivering highly leveraged proprioceptive stimulation to areas of the sensory neuraxis that have become depleted and deconditioned through disuse and injury. Hopefully then, with more data flowing in, the brain can make better predictive models that allow us to navigate our world more safely and accurately.

Something to think about...

Dr Matthew D. Long

BSc (Syd), M.Chiro (Macq)

Opioid drugs and back pain - the chiropractic view

Opioid drugs and back pain - The chiropractic view

Melbourne, Vic, 1 February 2018 

Changes to the availability of codeine as an over the counter pharmacy product have reignited the debate on the value or otherwise of opiates for the treatment of back pain. A high proportion of opioid use in Australia is for spinal pain, especially low back pain. But misuse and overuse of these drugs and their serious side effects, including addiction, have forced the Federal government to take action. “Chiropractors have a strong role to play in this time of change” says the President of Chiropractic Australia, Professor Rod Bonello.

Calls to fight the opioid crisis have led to recent action being taken in Australia and elsewhere. From February 1st codeine is no longer be available from pharmacists without a prescription. Further, the Therapeutic Goods Administration (TGA) has proposed that in future GPs be banned from prescribing S8 opioids such as oxycodone and fentanyl. It has reported that prescription opioid overdoses, which include accidental overdose, are the highest they have ever been. The TGA advises that 2145 deaths in Australia were associated with oxycodone, morphine, codeine, fentanyl, tramadol and pethidine between 2011 and 2015. According to the United Nations, Australians used almost 20,000 daily doses of opioids per million population in 2016.1

The ban on over the counter sales of codeine will have an impact on pharmacies. Perhaps it is not coincidental that the Federal Health Minister, Craig Hunt, has approved a $20 million trial to take place in pharmacies where pharmacists will review patients on prescribed pain killers and write action plans for those who have chronic pain and may have self-management problems or drug-dependency. Every pharmacy in Australia will be eligible to access the funds, meaning patients will not have to pay for the service until the trial ends in 2020. That means that taxpayers are now funding pharmacists for a job which should not be required. The AMA has struck out against the Government with AMA President Dr Michael Gannon calling this move “another slap in the face for GPs”. He believes that this undermines the authority of the medical practitioner.

Where do chiropractors stand on this matter? Of course medications have their place in managing mechanical pain syndromes such as back pain. And of course as guidelines have long pointed out opioids should be a last resort medication for this purpose. The best evidence confirms that multimodal care is superior to medical care alone, but bickering over who is best to treat the patient and, worse still, who should be recommending which drug does not serve patients best interests. Asked to comment Professor Bonello said, “We have known for a long time that opioids have very limited use and are dangerous. It’s high time that their use and availability is being reviewed.”

It’s obviously time for Australians to rethink the use of drugs for back pain; they should only be used as last resort. First line must be employing the help of a team of health practitioners, including a chiropractor. 

It is the view of Chiropractic Australia that wherever possible quality evidence should guide clinical decision-making. Senior health policy researcher at the RAND Corporation Professor Coulter, writing in the Spine Journal this year published a systematic review and meta-analysis on the use of manipulation and mobilisation.2 His team found that the available evidence was of moderate quality and showed that both therapies are likely to reduce pain and improve function for patients with chronic low back pain. Further they confirmed that both treatments were relatively safe and may be promising additions to multimodal care programs.

In November last year a review of low back pain management undertaken by Sydney University reported that “an overwhelming amount of research showing most pain medicines have little to no effect compared to placebo for people with low back pain” and “Other effective options could include spinal manipulation, acupuncture, or multi-disciplinary rehabilitation programs”. 3

Twelve months prior to this, and partially as a response to the opioid crisis, the Canadian Chiropractic Association released a position statement “A Better Approach to Pain Management”.4 They called for increased availability of alternative treatments to opioids, especially conservative care strategies. Physical treatment solutions for mechanically based problems are inherently attractive. Chiropractic health commentator Marc Bronson has said “Chemical solutions for mechanical problems has failed. Going to see a GP for low back pain is like calling your plumber when you have electrical problems.” Chiropractic Australia believes that in complex pain cases relying on any one practitioner or a drug is unwise.

1. United Nations International Narcotics Control Board.
https://www.incb.org/…/Technica…/narcotic_drugs_reports.html

2. D. Coulter, C. Crawford, E. Hurwitz, H. Vernon, R. Khorsan, M. S. Booth, & P. M. Herman .
Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The Spine Journal. Open Access DOI: http://dx.doi.org/10.1016/j.spinee.2018.01.013
3. A. Traeger, R. Buchbinder, I. Harris & C. Maher. Diagnosis and management of low-back pain in primary care. CMAJ November 13, 2017 189 (45) E1386-E1395; DOI: https://doi.org/10.1503/cmaj.170527
4. CCA. A Better Approach to Pain Management.
https://www.chiropractic.ca/…/A-Better-Approach-to-Pain-Man…
5. Photo credit: By Rotellam1 (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

If you would like more information about this topic, please contact Rod Bonello on 0402 907 515 or email rodneybonello@chiropracticaustralia.org.au
You can download this press release from:http://chiropracticaustralia.org.au/f…/press-media-releases/

Harvard Health Letter Recommends Chiropractic For Back Pain

Health Care Professionals are supposed to be problem solvers.

Chronic spine related problems are the worlds number one health burden, both a major problem for the public at large and a health care system which often struggles to deal with this difficult health issue. And Better health care depends upon close collaboration between the various professions. Different professions have their strengths or historical focuses on particular problems or conditions, making the chiropractic profession unique in some respects. For over 100 years it has, ironically, chosen conservative or non surgical spine care as it's 'backbone' with regards to patient care.

So how does a member of the public make a decision with regards to their problem? Who do you see? You GP? Physiotherapist? Chiropractor? Osteopath? Massage Therapist? Exercise physiologist?

Most people operate on a combination of referral (GP, close colleague or friend) and convenience when making a decision as to who to consult. No matter who you see, what we are all supposed to be doing is referring to what is called the 'literature' (the most up to date information) once we have made a tissue diagnosis - our questions and examination should lead us to a better understanding of what your problem is and therefore what the literature suggests is a beneficial treatment for you. This should include a prognosis or how long we can expect the problem to resolve.

D.Scown

Keeping an Open Mind

This following article is borrowed from Matthew Long (Chiropractic Development International)

The twin worlds of health care and education tend to be conservative places. New ideas are treated with scepticism, whilst entrenched dogma often persists without question. Although this culture makes it hard for new and valid ideas to take hold, it also serves to prevent dangerous, costly and unethical practices from gaining traction. However, this situation really only works if we can keep an open mind.

Over the past month I have read two interesting papers that caused me to question some assumptions I had held - specifically about the notion of visceral manipulation. On first glance the concept of moving one’s internal organs for some therapeutic effect seems far-fetched. Indeed, every rationale proposed thus far for visceral manipulation has, for me at least, not satisfied the first hurdle of even being biologically plausible. There are just too many unproven assumptions about the supposed dysfunction occurring, the reliability of palpatory methods, and the efficacy of the treatment. Apparently the goal of such treatment is "to encourage the normal mobility, tone and motion of the viscera and their connective tissues. These gentle manipulations can potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body" (1). While such notions are admirable, they are not backed up by the quality of evidence one would hope might exist to support a revolutionary new treatment.

But does this mean that visceral manipulation is entirely without merit? Perhaps not. A recent study in the European Journal of Pain suggests that the use of visceral manipulation might be useful in the long-term management of lower back pain (2). While the short-term benefits weren't obvious, those undergoing visceral techniques did show benefit over a longer duration, prompting the authors to suggest that, "It is possible that, with continuing visceral nociceptive input, control patients experienced greater rates of recurrences of LBP compared with the visceral manipulation group."

This isn't the only study to find clinically meaningful benefits to visceral manipulation. A paper by McSweeney et al in 2012 examined the immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine (3). In this study,

"Pressure pain thresholds were measured at the L1 paraspinal musculature and 1st dorsal interossei before and after osteopathic visceral mobilisation of the sigmoid colon. The results demonstrated a statistically significant improvement in pressure pain thresholds immediately after the intervention (P < 0.001). This effect was not observed to be systemic, affecting only the L1 paraspinal musculature. This novel study provides new experimental evidence that visceral manual therapy can produce immediate hypoalgesia in somatic structures segmentally related to the organ being mobilised, in asymptomatic subjects."

So it just might be that such techniques are clinically useful. But what of the theories used to guide their application and explain their action? Unfortunately there is a paucity of sound research to underpin the biological construct of 'abnormal visceral motion', or the reliability of methods used to detect this phenomenon. Most of the available literature originates from our osteopathic colleagues, but the explanations given tend to remain abstract in nature and devoid of concrete facts or ideas. Attempts have been made to measure kidney mobility using diagnostic ultrasound (4), but whether the differing patterns of motion represent a true 'abnormality', or just normal human variation remains to be seen. However, is a motion-based model of organ dysfunction actually necessary to support the use of visceral manipulation? Could it be that the existing theories are completely wrong, yet the treatment itself might be useful for some other reason?

This brings me to the second intriguing paper that I reviewed in recent weeks, entitled "You May Need a Nerve to Treat Pain - The Neurobiological Rationale for Vagal Nerve Activation in Pain Management" (5). In this article De Couck and colleagues reviewed the role of the vagus nerve in modulating pain signals, discussing five distinct mechanisms by which it exerts inhibitory effects upon the pain experience. They wrote,

"The vagus nerve may play an important role in pain modulation by inhibiting inflammation, oxidative stress, and sympathetic activity, and possibly by inducing a brain activation pattern that may be incongruent with the brain matrix of pain. Finally, vagal activation may mediate or work in synergism with the effects of the opioid system in pain modulation. All these mechanisms are thought to influence neuronal hyperexcitability, culminating in the perception of less pain. For all the above neurobiological reasons, it seems justified to increase vagal nerve activity to reduce pain as this targets all 5 mechanisms with 1 intervention. This hypothesis is supported by experimental studies on animals and preliminary intervention trials on humans."

The vagus nerve has been used experimentally to influence pain in a variety of fashions. Simple deep breathing will augment vagal activity and has been shown to reduce pain, while electrical stimulators have been trialled in both implantable and transcutaneous forms (6). In each case, it appears that vagal stimulation influences central pain processing, rather than peripheral nociceptor activity. Could it therefore be that visceral manipulation, as performed by chiropractors and osteopaths, serves as a novel form of vagal stimulation? We might therefore suggest that the established theories of visceral manipulation as a tool for improving organ mobility be revised in light of more biologically plausible mechanisms. Perhaps the true value of visceral manipulation lies in its ability to increase vagal inhibition of pain, leading to widespread suppression of nociception from multiple sources? If this is so, then it would require the active proponents of visceral manipulation to update their understanding and refine their message. But will this happen easily?

At this point I should point out that I am not trying to single out the supporters of visceral manipulation for criticism. Indeed, the pretext of this article is to maintain an open mind, and I have found the topic to be one that lends itself to this exercise very well. So often the field of biological science is challenged to redefine its theories when new evidence comes to light, and we must learn to walk a balanced line of judgment. Unfortunately, this can be difficult once we have become emotionally invested in a practice or an idea. When presented with new information that conflicts with our long-held beliefs it is both easy and natural to dismiss it out of hand. Cognitive change can be costly, both in terms of mental effort and the possible impact upon our established patterns of practice. According to Chris Mooney in "The Science of Why We Don’t Believe Science” (7), it can be extremely hard to convince others of new ideas simply by presenting them with evidence and argument. Indeed, often this can have the opposite effect.

"...an array of new discoveries in psychology and neuroscience has further demonstrated how our preexisting beliefs, far more than any new facts, can skew our thoughts and even color what we consider our most dispassionate and logical conclusions. This tendency toward so-called “motivated reasoning” helps explain why we find groups so polarized over matters where the evidence is so unequivocal...

The theory of motivated reasoning builds on a key insight of modern neuroscience: Reasoning is actually suffused with emotion (or what researchers often call “affect”). Not only are the two inseparable, but our positive or negative feelings about people, things, and ideas arise much more rapidly than our conscious thoughts, in a matter of milliseconds - fast enough to detect with an EEG device, but long before we’re aware of it. That shouldn’t be surprising: Evolution required us to react very quickly to stimuli in our environment. It’s a “basic human survival skill,” explains political scientist Arthur Lupia of the University of Michigan. We push threatening information away; we pull friendly information close. We apply fight-or-flight reflexes not only to predators, but to data itself..."

'We apply fight-or-flight reflexes not only to predators, but to data itself.'

"In other words, when we think we’re reasoning, we may instead be rationalizing. Or to use an analogy offered by University of Virginia psychologist Jonathan Haidt: We may think we’re being scientists, but we’re actually being lawyers. Our “reasoning” is a means to a predetermined end - winning our “case” - and is shot through with biases. They include “confirmation bias,” in which we give greater heed to evidence and arguments that bolster our beliefs, and “disconfirmation bias,” in which we expend disproportionate energy trying to debunk or refute views and arguments that we find uncongenial."

So faced with new ideas it seems very 'human' to resist the cognitive burden of change. However, change we must if we wish to remain up-to-date and relevant as a profession. I would suggest that there are two distinct personality types that we need to consider when reflecting upon the subject of keeping an open mind.

1. The traditional 'scientist' type, who remains cynical until there is an overwhelming body of accepted evidence. These individuals use their faith in science to resist change.

2. The front-line clinican, who may view the greater scientific community with scepticism and as having an overly pessimistic view of the realities of clinical practice. These individuals use their lack of faith in science to resist change.

Obviously there are many other personality types who lie in between these polar opposites, but it is these two stereotypes who probably have the most difficult time keeping an open mind. To quote George Bernard Shaw, "The reasonable man adapts himself to the conditions that surround him... The unreasonable man adapts surrounding conditions to himself... All progress depends on the unreasonable man."

But why should we even care? Does it really matter if clinicians still explain their treatment rationales using ideas that are somewhat outdated?

I would suggest that it does matter, because in health care at least, truth is preferable to fiction. As our understanding improves, so does our capacity to target our treatment better. Furthermore, the long-term future of the chiropractic profession is one that will increasingly become intertwined with other health professionals and third-party payers, all of whom need to understand chiropractic through contemporary neuroscience theory. It is my contention that much of the clinical practice of chiropractors is uniquely helpful to our patients, but it just might not work for the reasons that we've traditionally thought. As long as we maintain an open mind we can retain the practical usefulness of our techniques, while upgrading the theories supporting their application.

Something to think about...Dr Matthew D. Long
BSc (Syd) M.Chiro (Macq)

References:
1. http://www.barralinstitute.com/about/vm.php
2. Panagopoulos, J., Hancock, M. J., Ferreira, P., Hush, J., & Petocz, P. (2014). Does the addition of visceral manipulation alter outcomes for patients with low back pain? A randomized placebo controlled trial. European Journal of Pain, n/a–n/a. doi:10.1002/ejp.614
3. McSweeney, T. P., Thomson, O. P., & Johnston, R. (2012). The immediate effects of sigmoid colon manipulation on pressure pain thresholds in the lumbar spine. Journal of Bodywork and Movement Therapies, 16 (4), 416–423. doi:10.1016/j.jbmt.2012.02.004
4.Tozzi, P., Bongiorno, D., & Vitturini, C. (2012). Low back pain and kidney mobility: local osteopathic fascial manipulation decreases pain perception and improves renal mobility. Journal of Bodywork and Movement Therapies, 16(3), 381–391. doi:10.1016/j.jbmt.2012.02.001
5. De Couck, M., Nijs, J., & Gidron, Y. (2014). You May Need a Nerve to Treat Pain. The Clinical Journal of Pain, 30 (12), 1099–1105. doi:10.1097/AJP.0000000000000071
6. Busch, V., Zeman, F., Heckel, A., Menne, F., Ellrich, J., & Eichhammer, P. (2013). The effect of transcutaneous vagus nerve stimulation on pain perception – An experimental study. Brain Stimulation, 6 (2), 202–209. doi:10.1016/j.brs.2012.04.006
7. Mooney, Chris. The Science of Why We Don’t Believe Science. https://medium.com/mother-jones/the-science-of-why-we-dont-believe-science-adfa0d026a7e?goal=0_9f67e23487-a5da358f4e-97580213

Can Spinal Manipulation Reduce Pain and Stress?

For years chiropractors observed curious responses in patients.  Not only did people often feel 'better' following treatment with often sudden reductions in pain, they would also express feelings of well being (even euphoria) and 'clear headedness' as well as being able to move more freely and this often appeared to be more prevalent following cervical or neck manipulation.

How so?

So far there have been 8 recorded neurological effects of spinal manipulation many of which 'fire' impulses into the very busy and electrically sensitive brain stem where many of our body functions are housed and where our outer 'self' is represented by the brain.  The release of hormones is a knock on effect and although how long these effects last is still a question we also understand that with repetition of such treatments positive 'plastic' brain changes occur, principally in the way the brain 'maps' the body's movements and sensations.  It is fascinating and useful information to communicate with patients that the targeted and gentle input of spine movement affects more than just 'sore backs'. It appears that it may influence the way we perceive our world.

Changes in Biochemical Markers of Pain Perception and Stress Response After Spinal Manipulation

Authors: Gustavo Plaza-Manzano, PT1, Francisco Molina, PT, PhD2, Rafael Lomas-Vega, PT, PhD2, Antonio Martínez-Amat, PhD2, Alexander Achalandabaso, PT1, Fidel Hita-Contreras, MD, PhD2 

AFFILIATIONS:

1Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.

2Department of Health Sciences, Universidad de Jaén, Jaén, Spain.

Address correspondence to Dr Fidel Hita-Contreras, Department of Health Sciences (B-3/272). Universidad de Jaén. Campus Las Lagunillas s/n, 23071 Jaén, Spain. E-mail: fhita@ujaen.es

Published: Journal of Orthopaedic & Sports Physical Therapy, 2014, Volume: 44 Issue: 4 Pages: 231-239 doi:10.2519/jospt.2014.4996

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• Abstract
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• References

Study Design

Controlled, repeated-measures, single-blind randomized study.

Objectives

To determine the effect of cervical or thoracic manipulation on neurotensin, oxytocin, orexin A, and cortisol levels.

Background

Previous studies have researched the effect of spinal manipulation on pain modulation and/or range of movement. However, there is little knowledge of the biochemical process that supports the antinociceptive effect of spinal manipulation.

Methods

Thirty asymptomatic subjects were randomly divided into 3 groups: cervical manipulation (n = 10), thoracic manipulation (n = 10), and nonmanipulation (control) (n = 10). Blood samples were extracted before, immediately after, and 2 hours after each intervention. Neurotensin, oxytocin, and orexin A were determined in plasma using enzyme-linked immuno assay. Cortisol was measured by microparticulate enzyme immuno assay in serum samples.

Results

Immediately after the intervention, significantly higher values of neurotensin (P<.05) and oxytocin (P<.001) levels were observed with both cervical and thoracic manipulation, whereas cortisol concentration was increased only in the cervical manipulation group (P<.05). No changes were detected for orexin A levels. Two hours after the intervention, no significant differences were observed in between-group analysis.

Conclusion

The mechanical stimulus provided by spinal manipulation triggers an increase in neurotensin, oxytocin, and cortisol blood levels. Data suggest that the initial capability of the tissues to tolerate mechanical deformation affects the capacity of these tissues to produce an induction of neuropeptide expression. J Orthop Sports Phys Ther 2014;44(4):231–239. Epub 22 January 2014. doi:10.2519/jospt.2014.4996

Keyword: cortisol, neurotensin, orexin A, oxytocin, spinal manipulation

Read More: http://www.jospt.org/doi/abs/10.2519/jospt.2014.4996#.U-QGyo2SzWo

What's the Best Diet?

We are what we eat. Literally. All of the parts of your body are entirely dependant upon what you poked into the hole in the middle of your face coupled with whatever activity and genetic influences you inherited.

We are made of what we eat - made of it.

You can calorie count but it's boring and psychologically depressing, no one wants to accept that they are actively depriving themselves of fun stuff so I suggest take a long term view and stick to simple rules and basics (you can add detail as you like (or not)):-

1.  Avoid 'White' Stuff. Read Tim Ferris Slow carb Diet.  You can get as elaborate as you like with tweaking (like using cinnamon, water, timing your meals with exercise, etc) but in essence FAT is NOT an issue.  If you want to know what 'simple carbs' are then read Ferris lists but understand this - during most of human evolutionary history quick energy foods were hard to get hold of so we have a biology which, when presented with sugar, bread, pasta, rice, pasta, bread, corn flakes, sugar, etc on what has become a simple carb conveyor belt of hell our body will latch onto it pronto and do what? Does it stay a carb? No. It turns it into FAT - it get's stored by your body 'just in case' it's the last meal for a while (as it must have been in out not so distant past).

Is this oversimplified? Except for rare cases that's pretty much it and it's been the thrust behind the Paleo Diet Fad which to some has become a lifestyle.  Due to human variability we don't all respond exactly the same way to this diet.  Personally if I don't eat ANY 'white' stuff I can eat like a horse and drop 5kg in 2 weeks.  As soon as I eat chocolate and ice cream or just lots of cereal (obvious simple sugary things) I can put 5kg back on in the same time.  If I eat or don't eat fat it makes little difference.  If you eat fat AND sugar together all hell breaks loose. Females hold onto fat easier (sorry, talk to your creator) so you wont experience (nor should you) such dramatic short term changes if you are female.

2. FAT DOES NOT MAKE YOU FAT.

3.  Willpower.  Noooooooo!  When presented with the truth of our biology our first reaction is to ignore it, pray, and continue on our merry path to weight gain and metabolic breakdown.  Old habits die hard so it does take mental effort to walk back into Coles and choose differently.  We're like robots really, so ingrained is our cultures approval of stuff which just isn't good for us. "But it's LOW FAT!"  This was my wife's mantra for years and no amount of reason made any difference so one day I said "Don't listen to me, just look at the label and ask yourself how many spoonfuls of sugar are in that."

4.  Cheat Day!!  Yay!  To offset the mental breakdown you are about to have by forcing yourself to change habits, there is the cheat day.  One, even two days (if you're active) a week of eating whatever the hell you want and not feeling like a diet leper makes such a difference and not just because it's a mental health day.  If you've been a good boy or girl the other 5 days your body will react to the 'starvation' of simple carbs by lowering your BMR (Basal Metabolic Rate).

This means that your survival mechanisms will slow you down to conserve resources - you don't want that.

BMR is the rate your body burns calories while you are doing nothing.  Our body evolved to survive so if it senses that it's being somehow deprived it will down regulate.  This is often why people diet, loose weight, then plateau, get frustrated then break diet and go back to the chocolate Isle at Woolies. The injection of fast food one day a week tricks your body into maintaining it's BMR.

5. What about exercise?  Go to the other post.  Strictly speaking you don't have to exercise to lose weight but of course it can help.  Also if you are active you have to inject some simple carbs into the routine otherwise you hit an energy wall and fall over.  Ferris goes into that.

7.  Body loves a Shock!  Anything new or 'novel' gets noticed by our organism (us).  Abrupt changes force adaptation.  Sorry to sound morbid but if you want to kill Granny (or a pet) just prevent her from moving and feed her the same dull, white diet.  Again we evolved to engage with different situations and we thrive when challenged.  Food is no different hence the restriction/binge nature of this approach can work quite well.

Regards

Doug Scown

What's the Best Exercise?

Hello,

This will be a post I will continually update.  Why?  There is no 'best' but there are certainly some principles which remain, some which die because they're just wrong, some which survive because they're wrong but popular and the biggest group, the stuff which we just don't know about yet.  I'll refer to us as organisms a lot because 'brain-body' is cumbersome and they work together.

Hang Your Hat

The HYH category are things which we understand quite well, things we understand quite well.

1. Humans evolved as movement based organisms (movement has been described as nutrition for your brain).  If you deprive them of movement, they weaken and become increasingly susceptible to injury even without even trying. The 'best' movement is walking because it's easy and we're made for it.  Walking (and movement generally) works best if it's done for at least 1/2 an hour or more each day and movement has all sorts of benefits - it improves posture, inhibits pain, clears your head, improves mood, slows brain shrink (doesn't make you smarter but keeps you less dumber) and makes you more attractive (true).

2. We love complex movement, novel movement.  Complex movement requires complex brain firing and brains love 'novel' things so every now and then vary your movement. It's also why we suspect that Tai Chi, Pilates and dancing are very useful for chronic pain and general well being because they challenge the brain.

3. Exercise is for your brain, less for your body.  The brain controls the body so although every problem combines an 'in' body or tissue problem the effect of disease or dysfunction is as much a brain issue as a body issue.  It's a chicken - egg paradox. In reality our entire body is quite seamless from a development point of view even though we can separate it into organ systems.

4. The organism is highly adaptable - bouts of High Intensity (HIT - high intensity training) force the organism to shift.  Athletes have been doing this for centuries.  It's simple, effective and allows you to eat more (yum!). Weights once or twice a week can do this but it has to be difficult.  Short, heavy, simple (one or a few exercises) workouts (which of course anyone can be trained for) do it.  It's not for everyone but if you like it, do it.

That's it for now.  Anyone is welcome to suggest alterations.  I'll keep 'eating' to another post.

Regards

Doug