Category: Exercises

Former Marathoner and Triathlete Achieves Pain Relief with Dr. Jessica Miller’s Functional Medicine Approach

“On January 23, 2023, I set a personal goal of cumulatively swimming 150 miles (equal to the width of the English Channel.) I will complete my goal this week, November 2024. Determining my next challenge comes next. I could not have achieved this without the care and guidance from Dr. Miller.”

When Stuart had exhausted traditional medicine treatments and medications, he refused to give up and sought the guidance of Dr. Jessica Miller, a Marlboro, NJ, physician specialist specializing in Functional and Integrative Medicine.

“When I met Dr. Miller in 2017, my health was a mess,” recalls Stuart G., a retired optical industry professional and competitive athlete. “I was a competitive recreational athlete for over 30 years until health and environmental issues compromised my ability to participate.”

How does Functional Medicine differ from traditional medicine?

Functional and Integrative Medicine differs from the standard healthcare most Americans receive today. Its practitioners diagnose and treat the root causes of illness; this approach combines personalized, science-based, non-invasive therapies and lifestyle adjustments to optimize overall health.

Patients benefit from this type of holistic care that considers diet, stress, environment, and genetics, promoting long-term wellness and disease prevention.

Frustrated, exhausted and in pain

Stuart met with Dr. Miller in 2017 during a particularly difficult time, personally and professionally. Understandably, his worsening mental and physical health, including a significant battle with chronic pain syndrome, was compromising his ability to enjoy his passion for recreational sports.

“Dr. Miller spent a lot of time with me during my initial visits. She analyzed my health history and symptoms and ordered several blood and gene tests,” Stuart explains. “I quickly realized my health issues were going to be treated very differently, which I welcomed.”

After studying his results, Dr. Miller prescribed a new health plan that included changes in diet and lifestyle and the addition of specific supplements to address Stuart’s health deficiencies. His health improvements were significant and sustained far beyond his previous treatment efforts. As needed, he continued to see the doctor to measure his improvement and address any new concerns.

Seeking renewal after a second Covid battle

After a second Covid diagnosis in 2024, Stuart returned to Dr. Miller for guidance to regain his physical strength to start swimming again, a passion for Stuart. “I admire Dr. Miller’s expertise in Functional Medicine and her desire to continuously learn more about this emerging field of medicine.”

Stuart says. “She is at the top of her field and uses the latest clinical studies to benefit her patients.” Since Dr. Miller prescribed specific supplements for Stuart, he has felt strong enough to get back into the pool again, a major milestone to support his mental and physical health.

“I’m especially appreciative that Functional Medicine is non-invasive and does not focus on prescribing pharmaceuticals for every acute and chronic health issue.”

Dr. Miller weighs in on Stuart’s case

“Stuart arrived frustrated and worried about his worsening health symptoms, which had taken over his life,” Dr. Miller explains. “I was impressed how open he was to adopt a different health strategy to address his specific issues, particularly those related to pain management.” Dr. Miller stated that she admired his zest for many types of exercise, which she knew sustained him physically and mentally.

The peace-of-mind of ‘lifestyle medicine’

Today, Stuart says he won’t change his current health management plan without consulting Dr. Miller first. “She improved my health in countless ways, and I have no intention of returning to where I was before I started working with her.”

Stuart offers words of experience to others considering a Functional Medicine doctor: “If you are unsatisfied with your current health plan, you have nothing to lose by meeting with the doctor and learning more about her approach to health and wellness.”

Get the FAQs about Fusion Integrative & Functional Medicine

Are you getting the healthcare you need to truly thrive in wellness and disease management?

Functional Medicine and Integrative Health take a more proactive approach to helping treat chronic medical conditions and help support optimal health through all the phases of life. If you’d like to learn more about working with Dr. Miller and her team, call our Practice Manager at 732-631-4410 or click the button below for a no-cost New Patient Discovery Session:

The Power of a Healthy Lymphatic System

How to detoxify, boost immunity, and support your well-being through a well-functioning lymphatic system.

By Cortney Goodstadt, DPT, AFMHC – Certified Functional Medicine Health Coach

The lymphatic system is a complex network of tissues, vessels, and organs that play a vital role in maintaining the body’s overall health and immune function. It works in close coordination with the circulatory system to transport a fluid called lymph throughout the body. The lymphatic system is responsible for filtering out waste products, toxins, and pathogens, while also helping to regulate fluid balance.

The lymphatic system has several key components that work together to facilitate its functions. These include lymphatic vessels, lymph nodes, spleen, thymus, tonsils, and adenoids.

While it may not get much attention, the lymphatic system is vital in maintaining overall health and well-being. One of the primary functions of the lymphatic system is waste management. It collects and transports excess fluid, waste products, cellular debris, and toxins from the tissues back into the bloodstream for elimination. This is crucial to maintaining a healthy fluid balance and preventing the buildup of harmful substances in the body.

The lymphatic system is intimately connected with the immune system. Lymph nodes, present at various points along the lymphatic vessels, serve as hubs for immune cell interaction, helping to detect and fight off infections, pathogens, and foreign substances. They act as a vital line of defense, safeguarding the body against illness and disease.

The fluid that circulates within the lymphatic system is known as lymph. It contains white blood cells, proteins, fats, and other substances necessary for immune function and tissue nourishment. But unlike the blood that has the heart for a pump, lymphatic fluid is only propelled by rhythmic contractions of muscles, movement, and breathing throughout the body.

Therefore, lymphatic fluid is pumped into the body only when the fascia moves. As it travels around the body, the fluid collects cellular waste and toxins that need to be eliminated from the body. The body eliminates waste through the bowels, urine, breath, blood (menstruating women) and sweat. This means the body must move to stay healthy!

The lymphatic system is like a highway of health, helping to clear away waste, toxins, and inflammation from the body. It is a vital system that deserves attention and support for overall wellness. But just like your car’s oil filter, if it hasn’t been changed or cleaned recently, it will get clogged, lessening the efficiency of potentially every system in the body.

Warning Signs of a Sluggish Lymphatic System

So how do you know your lymph may be sluggish or clogged?  Some common symptoms of stagnant lymph are: Persistent swelling, Fatigue and Low Energy Levels, Recurrent Infections, Brain Fog and Cognitive Issues, and Digestive Issues.

In today’s world, every body on the planet is challenged with keeping their lymphatic filter clean! We must make a diligent effort to live a lifestyle conducive to assisting our lymph instead of asking our lymph to work harder due to modern conveniences.

Movement is a MUST for lymphatic health:

You can support optimal lymphatic flow and prevent stagnation by incorporating specific movements and exercises into your daily routine to stimulate lymphatic circulation. The best choices are walking, rebounding, yoga, arm swings, and breathing exercises.

READ: Learn more about some of our treatment specialties

Eight Practices to Promote Optimal Lymph Flow

  • Relax – Get Parasympathetic

The toxic load will overcome us if we don’t engage our parasympathetic system more frequently. We must allow the body to recover, regenerate and drain to enhance the flow of our lymphatics. There are many ways to assist the body: breath practice, yoga, manual relaxation like massage, acupuncture, walks in the woods, and the ocean.

  • Dry Brushing

Dry brushing is one of the best ways to keep your body healthy and smooth. It’s an excellent way to remove dead skin cells, improve the skin’s appearance (including cellulite), and promote cell renewal and lymph flow.

  • Drink More Water

Well-hydrated cells are necessary for the lymph to remove the “trash.” Of course, always provide the body with only the purest water you can, as it is counterproductive to add water to the trash. We are asking it to help take out the lymphatics.

  • Castor Oil Packs

Castor oil can, unlike other oils, penetrate through the upper layer of the skin. When applied externally over specific body areas, these packs can help improve circulation, reduce inflammation, and promote detoxification.

  • Manual Stimulation Drainage Therapy

My favorite drainage exercise that you can do at home is the Big 6 technique.

  • Vibration Platforms

Vibration machines produce mechanical vibrations that travel through the body, forcing your muscles to contract. These muscle contractions help by strengthening bones, improving circulation, and increasing blood flow. They increase the flow of lymphatic fluid through the lymphatic vessels, which helps remove toxins and waste products from the body.

  • Epsom Salt Baths

Epsom salts aid the lymphatic system due to their high magnesium levels, a mineral known for its anti-inflammatory properties. In combination with the natural diuretic quality of mineral salts and the water temperature, Epsom salt baths have been shown to stimulate lymph circulation in the body.

  • Saunas

The deep penetrating heat of infrared saunas aids the body’s natural process, allowing it to flush out toxins and, in turn, prevent a buildup of excess foreign bodies in the lymphatic system.

Functional Medicine and Lymphatic Health Treatment in Monmouth County, NJ

Cortney Goodstadt, DPT, AFMHC

At Fusion Integrative and Functional Medicine, we offer expert guidance on improving lymphatic health through natural healing methods. If you’re experiencing signs of lymphatic stagnation or want to learn more about improving your lymphatic health, contact Certified Health Coach Cortney Goodstadt. She offers personalized treatment plans that include dry brushing, lymphatic drainage therapy and more.

Could Adrenal Fatigue Be Sabotaging Your Weight Loss?

Your workout might be the reason you’re not losing weight.

By Cortney Goodstadt, DPT, AFMHC, Fusion IFM Health Coach

When it comes to losing weight, the intensity of your workout might be working against you, especially if you’re dealing with adrenal fatigue. This condition involves an imbalance in hormones produced by the adrenal glands, such as cortisol, which can hinder your weight loss efforts and even lead to weight gain.

Understanding Adrenal Fatigue

Adrenal fatigue occurs when you have a prolonged period of excessive cortisol. The prolonged excess cortisol eventually downregulates the brain’s signaling to the adrenal gland. This results in decreased cortisol production, leading to hormone imbalances that affect your body’s ability to manage stress, energy and metabolism.

Symptoms include feeling constantly run down, brain fog, poor sleep quality, salt cravings–and unexplained weight gain, particularly around the belly. If these signs sound familiar, your overtaxing exercise regime could be the culprit.

Why High-Intensity Workouts Can Stall Weight Loss

High-intensity workouts–running, cardio boot camps, CrossFit or competitive sports seem like the key to maximum weight loss, but if your HPA (hypothalamus, pituitary, adrenal) axis is disrupted, these exercises can increase cortisol production. In a healthy body, this helps manage energy levels. However, if your cortisol levels are already imbalanced, your body may start storing fat instead of burning it—especially in the abdominal area. This can lead to a frustrating cycle where the more you work out, the more weight you gain.

Learn more about the Functional Medicine supplements, tests and products curated and endorsed by Fusion IFM:

The Right Exercise for Adrenal Health

Low-impact activities are often better for those with adrenal fatigue. Walking for an hour or more at a leisurely pace can help your body recover and gradually return to a state where it can effectively burn fat again. Other beneficial exercises include yoga, which helps reduce stress, water aerobics, which is gentle on the joints and light strength training, which can build muscle without stressing your system.

Listen to Your Body

A good rule of thumb for adrenal fatigue sufferers–if you work out and still feel energy-depleted 30 minutes or more later–you have gone too hard. This is a sign that you are not doing the right kind of workout for your body. Rather than pushing through the over-exertion and demanding your body exercise again, do the opposite and give it a rest.

Remember, the goal of exercise should be to boost your energy levels and overall well-being. If a workout leaves you feeling depleted, it’s a sign that your routine needs to be adjusted.

Personalized Functional Health Support for Your Fitness Goals

Finding the right real-life fitness balance is essential for optimal health. No one knows your body better than you do. If something doesn’t feel right when you workout, it probably requires professional guidance to help identify the issue and help to avoid injury and possible medical complications.

As a Certified Functional Medicine Health Coach with a lifelong devotion to fitness, I would be happy to meet with you and determine the ideal fitness strategy for your life today and in the future. Contact me at 732-631-4410 or click below to schedule your no-fee Discovery Consultation:

*This article is for informational purposes only and should not be used in place of an individualized healthcare visit.

Don’t Forget Your Back

Most of us spend a large portion of the day hunched forward.  Think about when you are working on the computer, cooking, driving or even relaxing.  Your typical posture during these activities is head and neck forward, shoulders rounded forward, back curved and hips flexed.    When you remain in this position for an extended period of time, the muscles in the front of the body tend to shorten or contract, while the muscles in the back of the body tend to weaken.    This can be a set up for back, neck and shoulder problems and in addition, tends to make you look shorter, heavier and less confident.

Stretching before and after exercise as well as during the day is often overlooked in the rush to “get your workout in”.   Stretching however, has numerous benefits.   According to a study published in the Annals of Physical Medicine and Rehabilitation Medicine in September 2016, by I Fekhfekh, et al, dynamic muscle stretching of the knee musculature actually resulted in an increase strength gain in those muscles.  Interestingly, this study also found a decrease in the postural stability of the knee after stretching.    In English, it appears that stretching helps your to build strength, but may decrease the stability of the muscles you stretch at least temporarily.

In general, stretching helps to improve flexibility, joint range of motion, and usually is helpful for injury prevention.    Stretching helps by increasing blood flow to the muscles stretched.  This increased blood flow carries important nutrients to your muscles to allow for muscle growth and repair.  In addition, the increased blood flow helps to wash away muscle “waste” which leads to decreased soreness and inflammation of the muscle.

If allowed to remain in a contracted position for a prolonged period of time, our muscles will shorten.  For example if you spend a large portion of your day sitting in a chair or driving, the muscles in the front of the hips, your hip flexors will shorten.  These muscles have a direct effect on both your posture and your back health.

 

So what should you do?

It is important to stretch the muscles in the front of the body at least daily.

Exercises that focus on the hip flexors:

-Kneeling hip flexor stretch  – in the position of a lunge, allow your back knee to touch the floor and drive the hip of your front leg forward.  This will stretch the hip flexor of the knee on the floor

–Pigeon stretch – extend your right leg straight back and bring the heel of your left leg underneath your right hip.  Then drive your hips forward towards the ground.  Stretch and repeat on the other side.

– Yoga poses such as: low lunge, crescent lunge, upward facing dog, and revolving side angle pose

 

Stretches that focus on the chest muscles and prevent rounded shoulders:

– Door Frame stretch- stand in a doorway or at the corner of a room with your arms up like you were going to stop traffic.  Line your arms up from the elbow to the hand with the doorframe or in the corners of the wall.   Step towards the door and you should feel a stretch in your chest (pectoralis “pec” muscles) and hold for 20-30 seconds.

– Wall slides – stand with your back to the wall and keep your shoulders against the wall.  Walk forward 1-2 steps and slide your arms up and down the wall and squeeze your shoulder blades together.  You should feel a stretch in your upper chest muscles.

–Shoulder squeeze stretch –  clasp your hands together behind your back and slowly try to lift your hands.  Squeeze your shoulder blades together to stretch out the chest wall.

– Yoga poses include : bridge pose, camel pose, cobra pose and cow face pose

 

Stretches for your neck:

– Chin Tucks (Neck Retraction) – keep your shoulders back and your head in a neutral position (eyes facing forwards, chin level) slowly move your head backwards until you feel a slight stretch in the back of your neck.  Hold for 10-20 seconds and repeat.  If needed you can apply a gentle pressure on your chin with your fingertips to press your chin backwards and deepen the stretch.

Incorporating these exercises into your daily routine will help to prevent shortening of the muscles in the front of the body which leads to poor posture and often pain of the neck and back.  As always, if you are having pain which persists you should be evaluated by a certified health care professional to ensure that these exercises are safe for you.

This week we primarily discussed stretching exercises to prevent muscle contraction, and next week we will discuss the importance of strengthening the back muscles to further combat the issues of a hunched posture.

Common Causes of Knee Pain

The primary function of the knee is to bend and straighten the leg, to allow for a smooth gait during walking and running and to allow for jumping.    It is very common to develop knee pain in both new and seasoned exercisers.  Often the type of pain which develops is related to the type of exercise being done.

To understand knee pain, it is helpful to have a basic understanding of knee anatomy.

The knee joint can be divided into intra-articular and extra-articular compartments.

Intra-articular – structure inside the knee  joint

Extra-articular – everything else

The knee joint is where the surfaces of the leg bones meet and interact.  In order for the bones to move smoothly against each other and to provide additional stability, there is articular cartilage or cushioning shock absorber called the meniscus on both sides of the knee joint.  There are also many important ligaments which connect one bone to another and provide stability.  In addition, there are fluid filled sacs called bursae which allow for separation between solid tissues so that smooth movement can occur.

To help visualize the components of the knee, let’s break it down into 3 parts.

  • The anterior (front) of the knee
    •  Knee cap or patella
    •  Quadriceps tendon
  •  The medial aspect (side) of the knee  closest to the other knee
    • Medial meniscus (cushion)
    • Medial part of the joint capsule (the whole joint capsule encloses the entire knee)
    • Medial Ligaments  (provide stability for the knee and connect bone to bone)
  •  The Lateral aspect (outer) part of the knee
    • Lateral part of joint capsule
    • Lateral meniscus
    • Lateral ligaments

The knee is actually more complex then described above and does have the ability for rotation in addition to bending and straightening and other components not described above.  For the purpose of this article, we will focus on basic knee motions and components.

Now that we have a basic understand of the knee, let’s focus on what can go wrong with the knee.

In general, knee pain can be caused by:

  • Injuries due to trauma
  • Overuse injuries due to
    • Body misalignment
    • Muscle imbalances
  • Degenerative conditions
  • Injuries in the hips or feet

Patellofemoral syndrome (Anterior knee pain – front of the knee)

Common in new exerciser, especially runners and jumpers.  This is usually due to irritation between the patella (knee cap) and femur (thigh bone).  This pain can occur with increased jumping, squatting, running and climbing stairs.  Usually pain occurs if there is repeated stress on the knee or if there is a sudden significant increase in physical activity.   It is often treated with rest, ice, elevation and compression (RICE) and specific exercises to strengthen muscles surrounding the knee, and core.

Structural Injuries 

Knee injury can also result from structural changes or damage such as a dislocation, slippage or tears of the menisci or ligaments surrounding the knee.

Meniscal Injuries – The meniscus serves as a shock absorber for the joint.  Injuries of the meniscus can be the result of a twisting injury and can cause considerable pain, joint swelling, difficulty with stairs and the sensation of locking of the knee.  Occasionally the pain in the joint due to meniscal injuries will cause the brain to “shut off” the quadriceps at the knee causing the knee to “give way”.

Ligament Injuries – Ligament tears, such as a tear of the ACL (anterior cruciate ligament) can occur with a twisting injury and results in knee instability and may require surgical intervention depending on the degree of the tear.  It is common to sense a “pop” and immediate leg instability with this injury.    If surgery is used to repair the ACL, recovery is long and only low impact exercises are recommended initially to strengthen the muscles around the joint.  In contrast, PCL (posterior cruciate ligament) tears often can be treated non surgically with physical therapy and if indicated bracing.   When ligaments are torn or lax (loosened) it is common to have the sensation of poor balance or joint instability.

Tendon Injuries – Tendons are tissues that connect muscle to bone.  Typically, complete tendon ruptures are abrupt and result in the inability to move the joint.  The quadriceps tendon is quite large and a significant amount of degeneration must be present for it to rupture.  More often this injury is the result of a high force injury.   A completely torn tendon requires surgical intervention, but a partially torn one, will likely heal with immobilization followed by physical therapy.

Overuse injuries

Overuse injuries such as bursitis (inflammation of bursae), tendonitis (inflammation of the tendons), muscle strains, and Iliotibial band syndrome are usually the result of repetitive stress on a muscle, tendon or bursa.  Usually there is a component of body malalignment, muscle strength imbalance, improper shoe wear, or poor form which leads to the development of these conditions.  Treatment may include RICE (rest, ice, elevation, and compression) along with a detailed musculoskeletal exam to determine the etiology of the injury.  This will allow for a proper treatment plan to prevent recurrence.

Arthritis

Arthritis can be divided into Osteoarthritis (wear and tear), Rheumatoid (immune mediated), Gout (due to gout crystal build up) and Septic (due to infections).   Arthritis may be the result of poor diet or gluten sensitivity in some individuals.   While some forms of arthritis are genetic, diet modifications, weight loss, proper shoe wear and exercise may help to offset the severity of these conditions.

Exercise Through The Pain Versus Get It Checked?

As an individual either new or returning to exercise it is very common to sustain injuries.  Most often injuries occur in the joints such as knees, hips, feet, low back, neck and shoulders.   Although there are numerous reasons for injuries, the most frequent injuries are a result of poor body alignment, overuse injuries, increasing exercise duration or intensity too quickly, unequal strength that develops in opposing muscle groups, and improper shoe wear.

The warm up before exercising is very important because it allow for an increase in blood flow to the muscles.  Red blood cells carry oxygen, a requirement for muscle function.  As you become more “fit” your muscles get better at extracting oxygen from the blood.   In addition to carrying oxygen, the increased blood flow to the muscles helps to “wash away” hormones and neurotransmitters that can build up in the muscles and cause irritation and pain.

Pain is an adaptive mechanism that the body uses to prevent injury.  For example, if you put your hand near a fire you will sense instant pain and reflexively pull your hand away to prevent a burn and limit further damage.   In this case the sensation of pain in beneficial.

The pain pathways are very complex and the body has a remarkable way of increasing and decreasing pain sensation.  When you bang your leg and develop a bruise, the bruise and the surrounding areas become exquisitely sensitive.   Due to the release of certain substances, the body is able to up-regulate the sensation of pain.  Over time, as the bruise heals and the swelling decreases, the sensitivity in that area returns to baseline. However, sometimes the pain system can go awry.

In some cases, there is an acute injury that causes increased pain sensitivity, but instead of the pain receptor sensitivity returning to normal over time, they remain ultra-sensitive.  Even though there is no longer a reason for the sensation of pain to be generated, the body gets “confused” and can interpret sensations of light touch, heat, cold, or pressure as pain.   In this instance, the pain is no longer adaptive nor beneficial.   This malfunction is often seen in individual with chronic pain.

In my mind, there are two types of pain, “safe pain” and “dangerous pain”.   Safe pain to me, is pain that does not indicate worsening damage, cancer pain, or harmful injuries.  Safe pain is pain that often gets better during exercise and mobility.   In contrast, dangerous pain is pain that indicates a significant issue that needs prompt attention.   Some examples of dangerous pain include but are not limited to:

A fall or high-speed injury resulting in immediate severe pain and the inability to bear weight.  This pain can indicate conditions such as fractures, ligament injuries, or instability.

Chest pain or heaviness which occurs during exercise should never be ignored.  Typically, cardiac pain is described as chest tightening or pressure which often radiates down the right arm or into the jaw.  However, in individuals with diabetes, chest pain can be atypical and present like indigestion.  Chest pain is a medical emergency and should be evaluated immediately.

Neck or low back pain with associated numbness, tingling, or weakness should also be evaluated promptly.  In addition, any neck or back pain associated with bowel and bladder symptoms such as difficulty controlling urine, loss of sensation or funny sensation around the buttocks, and/or constipation and loss of bowel control needs to be addressed by a doctor.

The general rule of thumb is that pain which worsens incrementally with activity, persists despite rest, or is associated with numbness, tingling, radiating pain down arms or legs should be evaluated by a trained medical professional.   Pain that improves after a few minutes of exercise and is not associated with the above mention symptoms will often improve in its own.  Again, it is most important to listen to your body.  If you feel that “something isn’t right” or your symptoms are not improving you should  go with your gut and have your symptoms evaluated.

Eating Time With Regard To Exercising

To answer this question, I have been reviewing the literature on this topic and it appears that there is not a general consensus on this subject.  The answers, which are still up for debate seem to depend on the goals you are trying to achieve.   It appears that not only the timing of meals, but the type of meals, and the timing of exercise plays a role on the metabolic effects.

In an animal study by Sasaki published in Nov 2014, his findings suggest that eating in the morning and exercising later in the afternoon or evening has a more beneficial effect with regard to body fat and weight gain.  In the group that ate early and exercised later, the was less body and fat weight gained.  In addition, there was an increase in skeletal muscle weight gain.    So according to his findings, eat earlier in the day and exercise later for increased fat loss and increased skeletal muscle weight gain.

Bo published a study in Dec 2015 in the International Journal of Obesity that found that the same meal consumed in the evening resulted in a decreased resting metabolic rate and increased insulin response. In English, this means that you will essentially burn more Calories by eating a meal in the morning then you would by eating the same meal in the afternoon or later evening. Furthermore, multiple studies have observed that skipping breakfast is correlated with obesity, elevated BMI (body mass index) and increased waist circumference.

According to KJ Hackney in a study published in the journal of Medicine and Science in Sports and Exercise, consuming protein before heavy resistance training (weight training) results in an increase in resting energy expenditure (increased metabolism) as compared to consuming carbohydrates prior to heavy resistance training.   Other research suggest that whey protein is beneficial because it is fast absorbing and contains branched chain amino acids, specifically leucine, which has anti-catabolic (muscle breakdown) and increased anabolic (muscle building) signaling.

For trained athletes who are competing in endurance (long time or long distance) exercises, the recommendation at this time is to consume low glycemic carbohydrates or complex carbohydrates such as oatmeal, heavy mixed grain breads, or most vegetables.  Exercising in a fasted state compromises fuel stores and results in less than optimal performance.    There is also some research to suggest that high fat or even protein intake before exercise can be beneficial as well.  Therefore, again there is no definitive consensus on the type of food to consume prior to exercise.

In another study, published by Sasaki in 2014 in the Journal of Nutritional Science and Vitaminology, eating between 1 and 4 hours before exercise resulted in no difference in the metabolism of trained subjects.    The metabolism of both carbohydrates and fat oxidation remained the same despite the timing of intake.  Thus, as long as you eat between 1 and 4 hours before exercise there is no difference in the body’s ability to metabolism fat and carbohydrates afterwards.

Obviously, eating a very heavy meal immediately before exercise is not recommended because your body will shunt blood to your stomach and GI tract to help with digestion and this blood flow will be at the expense of your muscles.    Small meals with moderate complex carbohydrates and protein, such as an almond milk smoothie, with protein powder and a little fruit, eaten at least 30 before exercise may be ideal.  This allows for some digestion to occur prior to exercise and allows for fuel stores to replenish.

With regard to eating after exercising, the British Journal of Nutrition published a study in 2013 by NM Farah, that contradicts the above studies, and demonstrated that there may be an advantage for body fat regulation exercising before breakfast instead of after breakfast.

Further research suggests that eating a meal right after resistance exercise (weigh training) may increase muscle mass and decrease adipose (fat) tissues as opposed to eating a meal several hours after weight training.  After your workout, your body needs to repair itself and restore the energy you just burned.    For the first 2 hours after your workout, your body uses your food intake to refill your muscle energy stores.  Two-hours post exercise, this ability to store energy decreases by about 50%, and then those Calories are more likely to be stored as fat.

As was discussed in prior articles, insulin sensitivity is very important.  The more resistant you are to insulin, the more likely you will have issues such as abdominal obesity, heart disease, high blood pressure, diabetes, etc.   By eating within 2 hours after exercise, there is a beneficial effect on your body’s insulin sensitivity for the next 24 hours.

A small meal at least 30 minutes to 1 hour prior to exercise appears to refuel your energy stores and enable more optimal performances during exercise.   Eating within 2 hours of completing exercise helps to refuel your muscle glycogen stores and appears to enhance metabolism and increase insulin sensitivity for the following 24 hours.    Our bodies are remarkably complex and depending on genetics, environment, and baseline level of fitness, our needs are different.   As always, it is important to listen to your body and eat accordingly.

Exercising With Arthritis

 

We have all different levels of fitness. Some individuals have been exercising for years, while other individuals have never exercised a day in their lives.  We are all at different levels in terms of our cardiovascular fitness, our muscle strength and flexibility and our overall health.   It is quite important to remain active in spite of arthritis.  In fact, movement in people with arthritis is crucial to health and well-being.

Despite what we once thought, it is my experience that it is possible to modify the severity of certain types of arthritis.   In my mind, arthritis, chronic pain and other autoimmune diseases are the result of multiple factors.  All these factors such as genetics, environmental exposures, nutritional deficiencies, dietary influences, and gut health to name a few factors, all line up as if you were to “win” in the slots.  When this potent combination occurs in your body, havoc ensues.   The result is inflammation and chronic disease.   While you can’t change your genes per se, it is now thought that you can change or modify your gene expression.  In addition, you can certainly modify some of the other risk factors just mentioned to offset the severity of your debility.

In most cases, moderate exercise is essential to health and well being.  Proper, varied forms of exercise raises heart rate, raises endorphins, improves muscle strength, improves balance, improves flexibility and increases blood flow throughout the body including the muscles and joints.  In the case of arthritis, there is inflammation in the joint capsule and the bones themselves which leads to severe pain and often deterioration.     The nerve endings in the joint become super sensitive and pain can be unbearable.

Believe it or not, your choice of diet can directly impact your ability to exercise. When you consume an Anti-Inflammatory Diet, often you will notice you will able able to exercise with less pain is because this diet eliminates many known triggers for arthritis.

 

Some examples of arthritis triggers include:

  • Fried and processed foods
  • Thought to be due to compounds called AGE – (advanced glycation end products) These products are the result of heating, grilling, and frying foods.  The body utilizes pro-inflammatory molecules called cytokines in an effort to break them down and the result is excess inflammation in general as well as in the vascular system (blood vessels).
  • Sugary foods
  • Dairy
  • Alcohol
  • Foods/Oils with Omega-6 fatty acids – such as vegetable oil (safflower), corn oil, fried foods, certain nuts and seeds, mayonnaise

 

Some examples of beneficial foods include:

  • Foods containing high levels of Omega-3 Fatty acids – (ex. salmon, herring)
  • Avocados
  • Flax seed
  • Cherries and other berries (contain anthocyanins that are thought to be anti-inflammatory)
  • Leafy vegetables, broccoli – contain vitamin D
  • Green tea – has EGCG (epigallocatechin-3-gallate) a powerful antioxidant
  • Vitamin C containing foods (ex. papaya, brussel spouts, broccoli, citrus fruits)
  • Garlic, onions and leeks

 

It is very important to listen to your body.  Pay attention to the foods you are eating and the way you feel.  Often times, foods that are considered healthy may cause issues for you.  If you suffer from arthritis, try rotating your foods (i.e. do not eat the same food everyday).   If there are certain foods you think might bother you, wait 3 days in between eating them.  Then pay attention to the way you feel when you re-introduce those foods.  If you notice you have more difficulty with pain or decreased ability to exercise try eliminating the offending foods for a week or two.

Typically, it will take several weeks of following the diet closely before you see results with regard to decreased pain from inflammation.

When exercising with arthritis, it is important to modify your exercises as per trainer recommendations.  If exercises hurt, if possible, discuss with your trainers to find another way to exercise that muscle group.  In the beginning, there may be some exercises you simply cannot do.  What is important is that you are attempting to exercise.  With each passing week you will find that you can do a little more than the previous week.  Progress may be slow, with ups and downs.  As always, if despite closely following the diet, you are still having issues, it might be time to seek the advice of a health care professional.

Aerobic Versus Anaerobic Exercise

There are various types of exercises that affect our bodies differently.  Done in combination, this affords you the most “bang for your buck”.    By changing up the type, frequency, intensity and cardiovascular demand in your exercise regimen on a daily basis, you will have a synergist effect and derive numerous benefits from your exercise.

There are to major classes of exercises with regard to oxygen utilization. Aerobic exercise, exercises that utilize oxygen for energy, and anaerobic exercise, exercises that utilize fuel already present in the muscle for energy.

 

Aerobic exercises:

In this type of exercise, our muscles require the oxygen carried in the blood to be used for energy production.  Our muscles use this oxygen to burn both fat and carbohydrates as fuel.  Fuel can be constantly produced in the presence of oxygen, therefore, aerobic exercise can be sustained for a prolonged period of time. The body reacts accordingly by increasing the heart rate and breathing rate to keep up with the muscle oxygen demand.   Over time with training, our muscles become more efficient at extracting oxygen from the blood stream and thus we become “fitter”.  When this happens, you will notice that you will be able to exercise at a higher intensity without feeling winded or noticing a significant increase in your heart rate.   During aerobic exercise, you should feel slightly out of breath, but be able to carry out a conversation.

Some benefits of aerobic exercise includes: 

  • Improved overall level of fitness
  • Improved mood
  • Possible reduction of
    • Cancer risk
    • Cardiovascular disease
    • Osteoporosis
    • Diabetes
  • Higher level of fat burning (as opposed to anaerobic exercises)
  • Improved bone density (less beneficial then anaerobic exercises)
  • Moderate reduction in blood pressure
  • Decreased insulin resistance
  • Increases likelihood of surviving a heart attack

Anaerobic exercise:

In contrast to aerobic exercise, anaerobic exercise is exercise performed without oxygen.  This type of exercise is performed at a higher level of intensity and can only be sustained for a few moments.  Sprinting and heavy weight lifting are two examples of anaerobic exercise.   Anaerobic exercises utilize the energy that is already present in the muscle tissue.  However, because no oxygen is present to produce more energy, these exercises cannot be sustained once the fuel present in the muscle runs out after about 10-15 seconds.

Some benefits of Anaerobic exercise:

  • Strengthen bones and improves bone density
  • Builds and maintains lean muscle mass
  • Burns fat (though less so then an aerobic exercise)
  • Increases performance in sports by increasing strength, speed and power

A specific type of anaerobic exercise is Plyometric exercise.

Plyometric Exercises:

These types of explosive exercises are known as plyometric exercises (jump training).    This type of exercise uses your own weight and the force of gravity to provide resistance during the exercise.    The reason to incorporate these exercises into our exercise regimen is that plyometric exercise helps to develop explosive power and increase agility.

Without getting too technical, plyometric exercises are based on the muscle stretch reflex.

Whenever a muscle is stretched, a signal is sent to the nervous system that indicates that the muscle has been stretched.  The nervous system processes this signal and stimulates the muscle to contract in response to this stretch.    This is a reflex because the response is instantaneous.  Over time and with training, the fibers in the muscle (fast twitch fibers) become more sensitive to the stretch and maximize the speed and number of motor units that respond to the stretch.  By increases the fiber number and sensitivity, the muscle response becomes more explosive and generates more power.

Numerous studies have demonstrated that plyometric training should start slowly and work up gradually in intensity.  Plyometric training can be general such as jumping, jump squats, jump lunges but can also be more sports specific depending on the activities you would like to improve.    Typically plyometric exercises tend to focus on the lower body and utilize muscles around the knee and hip.    However, the use of medicine balls allow for plyometric activities of the shoulders and arms.

It is very important to warm up properly to increase the flexibility of the muscle and connective tissues around the joints to prevent injury.  It imperative that you slowly add in and increase your plyometric exercises when you feel your body can handle the impact.   For example, start off doing stepping jumping jacks and then gradually add in 1 jumping jack for every 5 stepping jacks.  Over a period of days to weeks, continue to add more jumping jacks and decrease the amount of stepping jacks.  Once you are able to comfortably complete a minute of jumping jacks without any pain or significant shortness of breath, you can start adding in superman jacks.   Again add 1 superman jack for every 5-10 jumping jacks and gradually increase the amount of superman jacks.   Since this is an anaerobic, plyometric exercise, if you are doing them correctly, you will only be able to do about 10-15 seconds of this until you become winded and need to take a break.

Shortness of Breath During Exercise

 

According to the American College of Sports Medicine, to attain the cardiac benefits from exercise, the exercise should be

  • At least 3 times per week for at least a 12 week duration
  • At least 30 minutes per session (can be broken up into 3 ten minute sessions)
  • Performed at an individual’s perceived intensity of 13-15 on a scale of 6-20 (the Borg Exertion scale) or at a level of “somewhat hard to hard”.

Some of the most common benefits of exercise include:

  • Improved exercise tolerance
  • When Exercise and Diet is combined:
    • Improved Lipid (fat) and Lipoprotein (fat/protein) levels
    • Decreased blood pressure
  • Stress Reduction
  • Improved Psychological well-being

One important question, especially among beginning exercisers and those returning to exercise after a long hiatus, is “Is this safe for me?”

Certain risk factors increase the likelihood of heart attacks and strokes and it is important to be aware of these factors when deciding on your exercise regimen.   Some risk factors are modifiable and can improve with exercise and diet, while others are fixed risks. Some common risk factors are:

  • High Blood pressure (hypertension)
  • Diabetes
  • Elevated Cholesterol or abnormal lipid (fat) profile
  • Family history of heart disease or strokes
  • Smoking
  • Sleep Apnea
  • Abdominal Obesity

According to Dr. Baggish, the Associate Director of the Cardiovascular Performance Program at the Massachusetts General Hospital, “ Everyone can do a form of exercise, if it is done carefully, with the supervision of a doctor”.  If you are starting and exercise regimen with a significant number of risk factors, it is important to first be evaluated by your Primary Care Physician or Cardiologist for clearance to begin an exercise regimen.   In general, it is important to “start low and go slow”.   Even just doing brisk walking does provide substantial improvement in overall health.

 

When beginning with an exercise regimen it is perfectly okay to try modifications first and increase your intensity as tolerated. Sudden start and stop exercises can put extra stress on the heart, especially if you are normally sedentary so it is important to all yourself a cool down period after exercising.

SYMPTOMS occurring during exercise that can require immediate attention are:

  • Left sided chest pain
  • Pain radiating into the jaw or down the left arm
  • Significant shortness of breath that does not quickly improve with rest
  • Dizziness
  • Sensation of an irregular heartbeat or pounding in the chest
  • Nausea or indigestion (usually Gastrointestinal related but can be a sign of heart issues)

In addition, if you suffer from chronic shortness of breath with minimal to no exertion, or from swelling in both legs, this can indicate issues with the hearts ability to pump.   It is important to note that individuals with diabetes, especially females, may not always have the “classic” symptoms for heart issues.   Vague complaints, flu-like symptoms and/or indigestion may be the only symptoms. Or you may have none at all.

If you suffer from any of the above listed symptoms, it is crucial to be evaluated to make certain that you are not putting your self at risk during exercise.