Why Europeans are Skinnier than North Americans

I am late publishing a monthly blog as my family spent three weeks in Europe visiting four countries (Netherlands, France, Austria and Croatia).  While it has been 10 years since returning to Europe, I was even more "hit in the face" at how much slimmer Europeans are compared to North Americans. 

The food was very similar to what we would eat (McDonald's is everywhere), and they seem to eat more bread, cheeses and processed meats, but I found it difficult to see any native Europeans that were obese.  An observation was also made of not only the higher amount of alcohol consumed (beer is cheaper than coke), but also the large number of smokers, particularly in Paris. 

So why are the Europeans slimmer?  My only conclusion can be that they walk more, as many do not own cars in the city, due to lack of parking and high cost, and also excellent transportation systems.  In Amsterdam, they have also developed an impressive bike system, with bike lanes paralleling roads and bike parking lots.  I had never seen women in short skirts and high heels bike before, but it can be done! 

On spending time in rural Austria, however, I did find much more "weighty" people, as they were more reliant on vehicles.  So a conclusion can be made,  that we have to encourage more people to get out of their cars and on to their feet or bikes.  This will only be possible if we have more compact cities, and also improved public transit.  A three times expected load of the light rail transit system in one year happened in Vancouver after the Canada Line was constucted for the Olympics.  So the old saying goes "build it and they will come"! 

Neck Pain: No Drugs Required

A January 2012 study published in the Annals of Internal Medicine has found that conservative care consisting of either spinal manipulation or home exercise to be more effective than over the counter and prescription medication for relieving both acute and subacute neck pain.  The study involved 272 adults with nonspecific (muscle-ligament-joint) neck pain of 2-12 weeks duration, excluding more serious pathologies such as discs, fractures, and instabilities. 

Subjects were randomized into three groups for 12 weeks: spinal manipulation (SMT), home exercise and medication. Self report outcomes (pain, function) were measured at 2, 4, 8 and 12 weeks during the trial period,  and at 6 and 12 months follow up.  Results were as follows:

12 week comparisions of pain reduction

Improvement                   >50%                     75%                        100%

SMT Group                       82 %                       57 %                       32 %

Exercise Group                 77 %                       48 %                       30 %

Medication Group           69 %                       33 %                       13 %

At long term follow up, 75 % at 6 months, and 81 % at 12 months of SMT group reported at least a 50 % reduction of pain.  71 % at 6 months and 69 % of 12 months of exercise groups reported at least a 50 % reduction of pain.  59 % of 6 month and 69 % at 12 month of the medication group had a pain reduction of at least 50 %. 

What can be concluded is that both the SMT and exercise groups had similar short and long term outcomes, more favorable than the medication group.  This further reinforces past research which has shown active therapies for neck and back pain (exercise and manipulation) to be the most effective treatment for these common and reoccurring conditions.

Four Pillars to Manage Osteoarthritis

Osteoarthritis (OA), common in 80% of the population after age 50, is considered an inevitable part of aging, but research is showing that there are steps you can take to minimize OA or stabilize further joint erosion once you have it.   A contributing cause of OA is now thought to be due to age related decline in the body’s synthesis of glucosamine after the age of 40.  Glucosamine is important in making proteogylcans, the ground substance to form joint cartilage; as well as hyaluronic acid, which is used to increase viscosity of synovial fluid to reduce wear and tear on the joints and allow nutrition to the cartilage.

Inflammation occurs with the degeneration of cartilage and causes the pain associated with OA.  Inflammation occurs when the body makes a hormone like substance called prostaglandin-2 (PG2), whereas the synthesis of PG1 and PG3 exert and anti-inflammatory effect and can control the symptoms of OA.  PG2 is produced by the polyunsaturated fats that we consume, mainly from high fat meat and dairy products.  Omega-3 fats from fish and flaxseed provides the building blocks for PG3 and borage oil, evening primrose oil and black current oils for PG1.  There is also a natural anti-inflammatory that is often used in OA, MSM, which research shows not only helps inflammation but the sulfur in MSM is used to make enzymes that are needed for connective tissue, such as cartilage.

The first two pillars of managing osteoarthritis involve dietary changes and supplements to improve the structural integrity of the joint itself.  The other two pillars involve improving the function of the joint.  As cartilage has no blood supply, it relies on its nutrition from the synovial fluid, but if there is no movement in the joint, this increases the likelihood of OA changes to develop.  Movement of the joint involves exercise, which is important even in advanced OA to decrease joint stiffness and slow progression of the disease.   If the joint becomes fixated, periodic treatment from a manual therapist such as a chiropractor to mobilize and manipulate joints is also recommended to maintain joint function. 

Four Pillars of Osteoarthritis Prevention and Treatment

1. Eat a diet low in saturated fats: reduce red meat, dairy products above 1% MF, fried foods, high fat pastries
2. Supplement with Omega -3 (1200 mg/day) and Gluscosamine Sulfate (1500 mg/day) with additional MSM (400 mg/day)
3. 30 minutes at least 3 times a week of endurance exercise (walking,biking,swimming), adding strengthening  and flexibility exercises is also beneficial
4. Periodic mobilization or manipulation of fixated joints (monthly maintenance)

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in athletes, particularly young women and those who are involved in running.  The pain is felt around or behind the kneecap, and is often of gradual onset unless trauma is involved.  There is increased pain with prolonged sitting (knee flexion), stair climbing, squatting, running, kneeling and jumping.  Generally there is no swelling around the knee cap, nor is there any pain in the patella tendon or surrounding ligaments.

PFPS is usually a functional problem rather than a structural one.  It has to be differentiated from another patella condition, chondromalacia, which is the wearing down of the cartilage under the knee cap, and may accompany PFPS.  The causes are multifactorial and can be broken down into three categories:

Biomechanical, or patellar tracking problems, are caused by lower extremity malalignment, which pulls the patella out of its groove.  Factors such as flat feet which cause the knee to internally rotate (knock knees) and wider Q angles of the hip, which are more common in women, contribute to PFPS.  A “J” sign can be seen with lateral patellar tracking, as the knee is extended from 90 degrees of flexion to full extension. 

Muscular imbalance is another factor, with weak quad muscles (particularly the medial quad) and a tight iliotibial band and hamstring, as well as weak hip extensors/abductors and tight hip flexors. Overuse or overload of the patella caused by repeated weight bearing impact, such as with running, is also a contributing factor in PFPS. 

 Conservative treatment is multipronged, based on the underlying reasons for the PFPS.  Relative rest from aggravating activity (running) to another non impact activity (swimming, elliptical); icing after activity; cold laser therapy to reduce pain/inflammation and heal the tissue; taping or a knee brace with a U shaped insert to keep the patella in alignment; orthotics to help support the arch; and specific exercises to strengthen weak muscles (quads and gluts) and stretch tight muscles (TFL ,hams and psoas).  Rarely surgery is indicated, but true chondromalacia may be amenable to arthroscopic surgery to smooth out the cartilage under the knee cap, and lateral retinaculum release if the problem is caused by excessive lateral pulling.

Peripheral Neuropathy

Peripheral neuropathy is nerve damage which is caused by long standing diabetes.  The injury to the blood vessels by elevated blood sugars causes a lack of oxygen and nutrients to the nerves, most commonly in the toes, feet and lower legs, but also in the fingers and hands.

Symptoms include progressive numbness or insensitivity to pain or temperature; tingling, burning, prickling sensation; sharp pain or cramps; or extreme sensitivity to touch.  If symptoms are in the lower limbs, loss of balance or coordination can occur because of the weakened muscles leading to falls.  Blisters or sores may develop in numb areas, resulting in infections which may lead to amputation, making it important to have regular foot exams.

The risk of developing neuropathy increases with age and with those who have uncontrolled blood sugars, elevated blood fat, and high blood pressure.    Other causes include autoimmune factors which lead to inflammation of the nerves and smoking which decreased oxygen to tissues.

Besides keeping the blood sugars in a normal range, treatment for pain includes antidepressants, anticonvulsants or opiods; and topical lidocaine or capsaicin cream.  Some supplements that have shown promise include alpha lipoic acid (50mg/day) and omega 3 oils for inflammation.  Acupuncture may also help with pain control.  A newer therapy, cold laser, has shown in clinical trials to increase blood flow and help regenerate damaged nerves as well as accelerate wound healing for diabetic ulcers.

Sources:

 http://diabetes.niddk.nih.gov/dm/pubs/neuropathies

Diabetic distal symmetric polyneuropathy: effect of low intensity laser therapy; Lasers Med Sci, 2011

A randomized clinical trial on the effect of low level laser therapy on chronic diabetic foot wound healing; Photmed Laser Surg; 2011

Cold Laser in the treatment of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is caused by the entrapment of the median nerve as it travels through the carpal tunnel in the wrist.  Signs are pain, numbness and paresthesia in the thumb, index, middle and inside ring finger; increased pain and numbness at night due to prolonged wrist flexion; and if long standing, weakness in pinching and grip strength and atrophy of the hand muscles. 

Causes of CTS include inflammatory conditions such as pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, and obesity.  Cumulative trauma from repetitive activities such as typing and guitar playing which puts the wrist into forced flexed positions are also implicated.  History and clinical tests to stress the nerve give a diagnosis, with a nerve conduction study being conclusive. 

Non surgical treatments have included night splints, NSAIDs, cortisone injections, ultrasound and modifying or changing certain activities.  Cold laser, a new treatment now being offered at our clinic, has shown promise in treating CTS to reduce pain and inflammation, as well accelerate healing. Surgical release of the carpal ligament may be indicated if conservative treatment has failed, if so cold laser can also be used post surgically to assist in healing. 

Several recent clinical trials have compared cold laser with sham laser, splinting and ultrasound. Results have shown cold laser to be effective in pain alleviation; reducing the numbness and paresthesia; improving hand grip strength and even improved EMG findings with no side effects, and to be superior to both splinting and ultrasound.   

Sources: The effectiveness of conservative treatment of carpal tunnel syndrome: splinting, ultrasound, and low level laser therapies; Photomed Laser Surg, Feb 2009 and The effects of low level laser in clinical outcome and neurophysiological results of carpal tunnel syndrome; Electromyogr Clin Neurophysiol; June 2008                                              

Sports Supplements that are Clinically Proven to Work

Athletes may ask about the value of certain supplements to enhance performance or gain muscle strength, but many supplements have more hype than science to support their use. While whey protein in shakes to replace protein loss during workouts is common, creatine, L-glutamine, ornithine and arginine also top the list of legitimate sports supplements. 

Creatine leads to an increase in muscle mass which is thought to occur from increased protein synthesis, this allows athletes to train harder as there is increased energy available for muscle contraction, promoting strength gain.  Creatine can also preserve strength as athletes age, keeping them functional longer. A loading dose of creatine monohydrate crystals is 20-25 grams per day for the first week, and than 10 grams per day for maintenance. 

 L-glutamine has been shown to decrease muscle breakdown during workouts and also reduce the incidence of upper respiratory infections by providing fuel for immune cells.  Optimal dosage of L-glutamine is 1,000 – 2,000 mg per day.

Ornithine and arginine are amino acids that have been shown to increase the release of growth hormone.  As we age, growth hormone declines, facilitating breakdown of lean muscle and bone mass.  Supplementing with arginine and ornithine may not only enhance muscle mass and strength gains, but as it elevates metabolism, it can help reduce body fat too.  Recommended dosage is 500 mg twice a day for five days a week.

So to maximize your athletic performance, consider using creatine monohydrate, L-glutamine, ornithine and arginine at these clinically proven dosages stirred into a glass of juice on an empty stomach.  Happy training!

Author:  James Meschino, DC, MS, ND; Dynamic Chiropractic