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Strong Medicine

Exploring the Science, Art and Practice of Sustainable Health and Strength

Strong Medicine

Strong Medicine Questions and Answers

December 1, 2016 By Dr. Chris Hardy 23 Comments

Chris Hardy Strong Medicine Questions and Answers

This is the fifth and final post in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference. Click here to read the first article of the series. These questions were from the coaches, trainers, and fitness instructors in attendance.

 

Q: How do I measure HRV (heart rate variability) if I have eight people coming in for a group fitness class?

A: You would set this up with your clients beforehand. They would measure it first thing in the morning. In the back of Strong Medicine, I discuss how the optimum time to measure HRV is at first waking, before anything has an opportunity to fill the stress cup. This measurement will give them a baseline. Most HRV apps require two and a half minutes to measure and will use data from a chest strap like a Polar Bluetooth heart rate monitor. The app will determine the HRV as a number. It’s important to measure it first thing in the morning, because if you measure it throughout the day, even someone angering you in traffic will change it.

Measuring HRV is not perfect, but if you measure it the same time every day before anything else has effected your stress cup then it will be a good reference. It will also reflect if you’ve been up all night tossing and turning.

 

Q: I have a client who has a lap-band, so she’s only eating 200 calories a day. If she eats more she vomits yet she wants intense exercise. She’s stressed and thin but with a huge belly. How would we work with her if we can’t get her to eat more? Do we just take down the intensity?

A: First, it sounds like she’s protein deficient. And you won’t be able to workout with her—you can’t—it will hurt her. It’s like when people come to me and want antibiotics for a viral infection. Then, when I don’t prescribe the antibiotics, they just go to someone else who will. But you should not be training that person, because she could go off the rails in a second.

She’s protein deficient and malnourished. That large belly is basically a bunch of fluid because there’s so little protein in her bloodstream that an osmosis effect happens and draws water from the bloodstream, then it goes into the tissues. It’s called ascites, and patients will sometimes develop huge protuberant bellies. We see it happen in sub-Saharan Africa, and other places where people are malnourished. You need to say no, and she needs medical attention.

 

Q: We lead boot camps and have workouts on the board, what do you think about having our clients do their self reported health scale on the 1-5 range (will link to article) then adjust the workout accordingly?

A: Or they can monitor their own heart rates. This is also where you can use your creativity and find your own opportunities. You can stratify the workouts. Educate them to let them know that if they’re lower on their rating scale to be smart and that “this isn’t a punishment”. They need to know to be smart because they won’t do themselves any good by crushing themselves on that day—they’re just end up with a lot of cortisol. You’ve seen the ultra-skinny marathon runners that still have a little bit of a belly? It’s because of a cortisol response.

 

Q: You said that you have your clients measure their heart rates in the morning. My training classes usually take place at 8PM after they come from work and have done finished their day. How will the HRV measurement from the morning reflect how they are when they walk into my gym at 8PM?

A: It’s true that it isn’t perfect, and that’s the problem. But, as long as they’re not doing intense physical training before they get to you, if they measure their HRV in the morning, the biggest thing they will be affected by is sleep. Since HRV is the variability of the heart rate as measured on an app, it gives you an idea of where you were that morning. If your HRV is already low that morning, it will just get worse throughout the day. So, if they come in with a low HRV recorded in the morning, by the time they see you—especially if they have had other stresses during the day—then their HRV will be even lower.

HRV and Stress diagram

The morning measurement will give you a baseline, but that’s why you’ll also want to use the self-reporting scale. There’s too much that can happen during the day, and you’re trying to work with a consistent baseline. So, let’s say I usually run an “80” I’m picking an arbitrary number for my HRV, but that’s pretty high. But, this morning I measured my HRV and it was 62. When I come to train with you later that night I’ll tell you that my HRV was 62 this morning. Since I usually run in the 80s you would drop my workout down some. So in other words we are discounting what happened through the day unless a client did some other kind of training. It’s not a perfect system.

 

Q: What your favorite strategies for sleep? How do you feel about the different amounts of melatonin in supplements?

A: Sleep might be the same thing as attacking the circadian rhythm first. I hate to keep referring back to the book, but I do have a whole chapter on how to give your brain the right signals. So 2-3 hours before bedtime, no blue light from broad-spectrum sources. You can either use the goggles or my wife and I put yellow lights in the rooms where we spend our evening hours. We also follow basic sleep hygiene ideas—no electronics in the room. In the mornings we make sure to get bright, broad-spectrum light exposure, since most of us go to an office with poor lighting.

As for supplements, I am not a huge fan of melatonin, though I think it is very valuable for getting yourself back into another rhythm in the case of jet lag. The problem is most of the doses are supra-physiological. The pineal gland in the brain actually secretes melatonin on a pulse, about every 40 minutes since it has a very short half-life. Your body metabolizes melatonin supplements quickly, so it may help you fall asleep, but then you’re going to be back up again if you haven’t fixed your circadian rhythm. And it may also suppress your endogenous (internal) melatonin secretion.

 

Q: On Saturday and Sunday, 25-30 people come in to our gym for group classes. Either myself or the other trainer will greet the people as they are coming in and ask them how they are doing and how they are feeling. If they come in and say that they slept badly, just came home from an intense two-day conference, or they are still sore from working out, then we will then tell them that we will scale the workout of the day. We put up the workout and a scaled version in terms of volume or intensity and say that if we spoke to you and said you should do the scaled version, we can now train 20-30 people together.

A: I love it, but would say from a psychological point of view I would have them self-label.

Q: That was my follow up question. This is a physical/psychological assessment based on how they feel about today themselves that day, etc.

A: If a client comes in and says that they are feeling kind of cruddy, and then you say, “well we are going to do this to you” that takes some of the control from them. Instead you could have them self-label and say “I’m a 3 right now”. Since they put themselves in that category, it will be easier for them to understand that it’s not a punishment. They will just be doing the #3 workout today. It’s part of the psychology of getting them to buy in more because they have self-labeled.

 

Q: My question is goes back to using heart rate. How would you use the heart rate protocol with someone on beta-blockers?

A: That can be very inconvenient! Beta-blockers basically stick a wrench in the system, and prevent the heart rate from going up. It depends on why the client is on a beta-blocker—and if it is for arrhythmia then you don’t want to mess with it. But if someone is on a beta-blocker because their doctor is trying to use it as an inappropriate way to control high blood pressure, then you might suggest that they ask their doctor about alternatives. When someone is on beta-blockers, they will not be able to get their heart rate up, so rate of perceived exertion may be a better indicator for them.

 

Q: Melatonin was already discussed as a supplement for sleep, but how would you say performance supplements like pre-workout or protein supplements would affect allostatic load?

A: That’s a great question and, they do affect the allostatic load. It goes back to the idea of feeding your activity. We need the proper amount of protein so that amino acids hit our anabolic pathways—mTOR, the anabolic pathway where certain branched chain amino acids will hit. It can give the body fuel for activity. You need to fuel your body and give it the precursors of what it needs—whole regular food is always the best, but that is not always possible. So, supplementing something like whey protein, or a post-workout combination of protein and some glucose sources can work well, but be sure to tailor it to your activity. Do you really need to load up with a huge serving of starch or glucose for strength training? Probably not. You’ll want to use amino acids instead.

Q: But in regards to pre-workout energy supplements, I’ve tried some that just made me feel extremely crazy and full of false energy…

A: Honestly, if you are going to do one, the supplement I think is best for pre-workout is creatine. It hits the phosphogen energy pathway. But I am not a fan of the supplements that “jack up the nervous system” they can work for younger people, but in the older population it can affect the stress cup.

 

Q: What are your recommendations for determining optimal heart rates for training and interval training? Do you have any recommendations for estimating or determining maximum heart rate? What if someone is on a beta-blocker? Is a VO2Max test, a stress test, or a simple calculation the best?

A: It depends on your client. If you are working with an elite athlete, then you should probably do one of the more clinical assessments. This is because we all know that the samples for calculating max heart rate are estimates and they’re for a general population. They aren’t necessarily appropriate for everyone because they can be underestimated. If you used the formula on an athletic 50-year-old, it may underestimate their max heart rate. Some of the formulas are better than others—certainly better than 220 minus age.

trainingprescription

Q: When working with individuals who are nurses, police officers, fire fighters, and other shift workers, how do you help them make improve the sleep they are getting?

A: Shift work is actually classified as a carcinogen by large governing agencies. But they have done studies with shift workers and found that their environmental clues are the most important. Your circadian system is free running—they’ve done studies in caves in isolation—and will advance itself without external cues. Another study with police officers and nurses exposed them to maximum bright lights during their shifts at night—which was their mornings. Even though they are coming to their shift at night, they should get maximum bright light exposure. When they are coming home, they should use amber glasses or something to block out blue spectrum light. When they sleep, blackout curtains can make their environment as dark as possible. Are they getting perfect sleep? No, but these environmental cues can make a big improvement.

 

***

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

 

Filed Under: Cardiovascular training, Motivation, Strength Tagged With: Dr. Chris Hardy, importance of sleep, Q+A, recovery, sleep, Strong Medicine

HRV and the Self-Rated Health Scale

September 8, 2016 By Dr. Chris Hardy 2 Comments

HRV and Self-Rated Health

This is the fourth in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference. Click here to read the first article of the series.

In the previous posts of this series we were estimating the size of the stress cup. But, there’s a more reliable way to measure it. We’ll use the interrelationship of the brain, the cardiovascular system, and the musculo-skeletal system for another window into the stress cup. The first window is heart rate variability, the beat to beat variation of the heart rate.

We will use HRV as a window into the autonomic nervous system and how it relates to the heart. This will show us the stress load on a given day. On a high stress day, the sympathetic nervous system is dominant—the fight or flight system will drive the heart with a machine-like precision (low variability). This indicates a state of allostatic overload, poor health, and an overflowing stress cup.

Caption: In this chart, the beats are the same distance apart. That machine-like precision is not good. It's a sign of bad health and stress to the system.
In this chart, the beats are the same distance apart. That machine-like precision is not good. It’s a sign of bad health and stress to the system.

Now, in the normal state—when you have good readiness and a manageable stress cup—you’re in parasympathetic dominance and will have that good, high variability.

In this chart, the time between each beat is slightly different. That's how a healthy heart and nervous system actually works. It's imperceptible, but if you measure it accurately you'll see the variability between beats.
In this chart, the time between each beat is slightly different. That’s how a healthy heart and nervous system actually works. It’s imperceptible, but if you measure it accurately you’ll see the variability between beats.

There are several apps that calculate HRV and will give you a score. There’s also a section in Strong Medicine that shows you how to do that in training. It’s a very simplistic approach, but its good for our purposes.

Joel Jamieson, a Seattle area MMA trainer uses HRV in training in a very sophisticated way so definitely look him up if you want to learn even more. But, I prefer a more simplistic and intuitive approach. But, before I show you my approach I want to quickly review another simple way to assess the state of the nervous system.

MiniHomuncDiagA homunculus is a representation of what we would look like if we were physically configured according to the proportion of brain required to operate our body parts. Do you see how big the hands are? A huge portion of the brain is involved with the sensation and motor control of the hands. For example, grip training has a huge impact on the nervous system. Grip strength is also a good way to tell the status of the nervous system. This idea has been used in the former Eastern bloc countries for a long time, and Charles Poliquin wrote about it pretty recently.

Charles Poliquin’s protocol starts with recording a baseline using a Dynamometer. You can get them pretty cheaply on Amazon. Be sure to measure grip strength in kilos when you (or your client, if you are training others) are feeling good. Then on the morning of training, measure it again, and if you drop 2kg, then you may want to reconsider training. If you drop 4kg from the baseline, then you might even consider taking a rest day. it’s a simple way to do it. Do you have to continually measure grip strength or HRV with all your clients? No, that would be ridiculous, fortunately there’s another method.

 

The Self-Rated Health Scale

In terms of predictors of who will develop chronic diseases, and who is at risk of dying, what is the best marker to use? We’ve used all kinds of blood tests, and every other imaginable test, but the best predictor we’ve found is to ask this one question:

“In general, would you say your health is on a one to five scale? With one being the best and five being the worst?”

Believe it or not, that self-rated health question was more accurate than any medical test in predicting if someone would develop a chronic disease in the next 5-10 years. There’s a new area of neuroscience intensely studying interoception, the brain’s subconscious awareness of our organ systems. Many of you who read Strong Medicine know that our gut and intestinal tract has just as many neurons and nerve cells as the spinal cord. Some even call it the “second brain”. When you have a gut feeling about something or butterflies in your stomach, that’s the brain actually monitoring the state of our organ systems on a subconscious level. It can also induce stress responses, which is why diabetics have an on-going low-level “fight or flight response” due to this interceptive process monitoring the state of the internal organs and immune system. The brain knows something bad is happening and that we need to be on alert. This system also gives you an intuitive sense of how you are doing.

A new study came out about HRV and focused on measuring what correlated best to Self-Rated Health. We already know the question predicts disease very well—they measured every blood test, cholesterol, inflammatory monitors, and many other tests, but what correlated best with Self-Graded Health was heart rate variability. People with high HRV (good) usually said that their health was about 4-5 on the scale (the highest health scores). So, how you intuitively feel physically and mentally is very predictive of your stress cup. This is why an intuitive approach to a given day’s training could be very valid. Even though there are some really sophisticated tools such as the Recovery Stress Questionnaire For Athletes—which is a validated tool—I guarantee that none of your clients will want to sit down and answer 76 questions.

If you’re training elite athletes, it’s great, but it is not practical for those of us in the trenches. My next suggestion is not validated, and I haven’t tried it out—so you can be the test group—what if we replaced the Self-Rated Health question with the following:

“In general, would you say your readiness to train is… excellent, very good, good, fair, or poor?”

I would also suggest verifying it by testing grip strength and heart rate variability first before asking the question to see how they correlate. Over time it will help them get an intuitive sense of how they are and fine tune their conscious awareness of interoception. So, when they give you a rating, you can also look at the data (grip strength and HRV), and over time this will be a pretty good window into how they’re doing.

 

Getting Your Clients Onboard with Smart Programming and Recovery

How do you convince your client that this stuff really matters? It’s essential. If you want to train hard, you’ve got to recover harder. You need to tell your clients that they need to reduce their stress cup and earn the ability to train hard. The results they want will only happen with a proper balance of training and recovery.

The first thing they have to fix is their sleep, and there’s a whole chapter in Strong Medicine about doing that. Stress management, meditation, yoga, whatever you want to do is fantastic. Massage and acupuncture are unbelievable for helping to reduce stress and enhance the parasympathetic nervous system. If you like qigong, tai chi, all that stuff is fantastic as well to achieve the same goal.

Obviously, cleaning up the nutrition is a whole lecture into itself. As is feeding your activity levels. If you are going to crush yourself with high intensity training, you need to replace that muscle glycogen. If you’re only doing a walking and strength-based program, you can go very low carb and be fine. But if you want to push that anaerobic threshold, then you will need to feed that activity or you will overtrain.

 

Summary:

First, estimate their stress cup size. Then, estimate what is filling it today, since it will be different that what fills it tomorrow. Then, we will prescribe an appropriate exercise volume and intensity—and that’s what you guys as trainers know how to do well already. Now, you have the extra information to help you adjust the sets and reps, intervals and modalities. And while you don’t have to assess the stress cup every time you train your clients, I think you should always ask the self-report scale question and then prescribe the appropriate amount of training.

I don’t think you need to use HRV on the average client. But, if you are working with elite athletes, you will need to cover all those bases. The most important thing for everyone is to always emphasize the importance of recovery.

Now, using this approach is very simple, and I provided the scientific foundation for how we came up with this very easy system. If you train someone this way, they will meet their goals. It will be sustainable, unlike those three or four weeks crash diets and radical exercise routines. With this method, every New Year, instead of starting over with a resolution, they can just continue building on the success of the previous year. This is just a framework, so use your expertise as a trainer to customize your programs.

The final post in this series will be the best of the question and answer portion of Dr. Chris Hardy’s presentation.

 

***

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Cardiovascular training, Rest and Recovery Tagged With: Dr. Chris Hardy, exercise programming, exercise recovery, grip strength, Heart Rate Variability, HRV, Self Rated Health, Self-Rated Health Scale, Strong Medicine, training others

How to use the Burst Cardio Protocol for Accurate Exercise Dose

August 18, 2016 By Dr. Chris Hardy 9 Comments

Strong Medicine: Burst Cardio Protocol

This is the third in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference. Click here to read the first article of the series.

The Stress Cup dictates the beneficial, hormetic exercise dose. To apply this concept to our training, we need a scientific foundation—but it’s also an art. Elite coaches like Marty Gallagher—who has coached for over fifty years—have intuitively figured it out. In this article I will try to give you a foundation so that you won’t need all those years of trial and error to figure it out. Applying this science to your clients is the art of training. Since you already know how to adjust sets, reps, intensity, and volume, you’re already ahead of the game. We will try to hone your art with these concepts.

First, there are no hard and fast rules, this is more a conceptual thing. Remember that all of your clients are individuals and can’t all train the same way. Plus, their environments and stresses change from day to day. Our approach will allow for this day to day individualization.

Case Studies:

Our first example is someone with a “tall” stress cup. What’s filling his stress cup? On new client intakes, do you ask about their health problems? How about their stress levels and how they sleep? It’s really important that they tell you about these issues. This client has a small stress cup and a large amount of lifestyle stress will put him in allostatic overload. We will know that he’s been in this state for a long time if he has a disease resulting from a failure to adapt. Diabetes can be thought of as a failure to adapt to a lack of exercise, poor sleep, and/or terrible nutrition. The body will try to adapt to those stresses, and even though it does bad things for the body, diabetes is actually an adaptive condition.

Stress Cup Size Chart

So, how would we train this client? What would we do for strength training and for cardio? Like many other people, our client also doesn’t have a lot of spare time. One approach to consider for a guy like this is a stripped-down linear progression with a bit of a hypertrophy bias, in the 5-10 rep range. Diabetics and people with metabolic diseases work very well in that range and it helps clear out some muscle glycogen too. It’s beneficial, but it’s not the only way.

Let’s assume for example that he has diabetes and high blood pressure. Of course he could be walking but we could also try high intensity interval training—even low amounts of it can have incredible results for diabetics. Basically, it bypasses the normal insulin signaling mechanisms and gets some of the glucose from the blood stream back into the muscles. Emptying those glycogen tanks is really beneficial too, because lower glucose in the muscles will pull a lot more glucose from the blood. This process will increase insulin sensitivity for at least 24-36 hours.

Burst Cardio Protocol Chart

But, while high intensity interval training is a really good approach for the diabetics, our example client also has a small, and nearly full stress cup. We need to figure out how much exercise is too much. With our example client it would be very easy to overdo it, so we need to remove the guesswork. We will use the Burst Cardio Protocol we describe in Strong Medicine. You don’t have to use it with all of your clients, but it is a fail-safe. When working with a client who is at risk of exercise overdose, but who could really benefit from high intensity training, the Burst Cardio Protocol is a very good choice.

This protocol uses heart rate to set both the interval duration and recovery times. Depending on the state of the client’s stress cup, they will respond to the same exercise differently from one day to the next. Heart rate response will be our window to the state of their stress cup. We will start with heart rate max, which is not the most scientifically accurate, but will be a close enough estimate for most of you clients. So, we’ll start by leading them to warm up, then we will start their interval exercises as hard as possible. The goal is for them to reach 95% of max heart rate, though 90% is the requirement. Once the client reaches the heart rate goal, they stop and recover until their heart rate is back down to 70%, then they begin another interval. This works well for a 20 minute session and can be done with kettlebell swings or snatches, or other modalities like the hand bike, elliptical machine, medicine ball slams or even burpees. You can choose anything anaerobic that will rapidly increate the client’s heart rate.

The key point of this whole protocol is that on the day when the stress cup’s load is low, there’s room for a higher exercise dose. Since a low stress cup equals parasympathetic dominance, this means the client will recover faster because the parasympathetic system will lower the elevated heart rate from the exercise. Faster recovery times will also allow the client to do more intervals during the set period of 20 minutes. If they are recovering more quickly, they’ll be able to start the next interval more quickly, too. When the stress cup is nearly full, there’s less room for exercise, and the sympathetic system is dominant. Recovery will be slower. If the client gets up to 95% and they have slept poorly, they will recovery more slowly since the parasympathetic system won’t be able to bring the heart rate down as quickly. The client will not be able to do as many intervals in the allotted time.

I’ve tested the protocol myself for a few years. One workout I tried a couple of years ago used the twenty minute time period. I did a hideous alternating combination of kettlebell snatches and medicine ball slams. It was rough. You can see on the chart below that I spiked up to 95% pretty quickly. I recovered and managed to get six intervals in 20 minutes—and that was on a day when I was feeling great.

BurstCardioExampleChart1

I waited a week later and tried the same workout when I had had a night of poor sleep. When I did the exact same workout with the same time period, look what happened on the chart below! I spiked up to 95% again, but then it kept taking me longer and longer to recover. After the 4th interval, it took me so long to recover that I never dropped below 70% before the 20 minute session was over.

BurstCardioExampleChart2

So, even though I had fewer intervals, the protocol allowed me to exercise but not overdo it. My heart rate was a window into the state of my stress cup and adjusted the number of intervals for me.

The Burst Cardio Protocol automatically adjusts to the correct dose on a given day. As another example, let’s say that I’ve done a strength training session before my burst cardio. The strength training will affect the nervous system, along with my recovery time and the interval itself.

You can also use the Burst Cardio Protocol to train multiple clients with different stress cups. One client may end up doing more intervals during the time period, but since they will be regulating their own intensity you can concentrate more on watching and coaching their exercise techniques. When one client wants to know why they are not able to do as many intervals as someone else you can also explain how recovery itself is a trainable event. Between the intervals we can also coach our clients with breathing exercises and techniques to help them recover. A simple breathing technique such as breathing in, filling up the diaphragm, then slowly exhaling while watching their heart rate on a biofeedback device will allow a client to feel like they’re still training while they are resting. This technique will help them recover faster, too.

The protocol also works for mixed modalities—clients can do kettlebell swings for one round, the elliptical machine for the next, etc. I’ve tested it and found that when someone gets to 95% with kettlebell swings, it takes a lot longer to get back down to 70% as opposed to getting to 95% on the elliptical. The Burst Protocol also adjusts for the given modality. While it’s not necessary to use the Burst Protocol all the time, it is very useful if you are worried about overflowing someone’s stress cup.

The next post in this series will cover another common training scenario and how to use HRV and the Self-Rated Health Scale.

 

***

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Cardiovascular training Tagged With: allostatic load, burst cardio, Burst Cardio Protocol, Chris Hardy, Dr. Chris Hardy, stress management, Strong Medicine

The Stress Cup and Allostatic Load

August 4, 2016 By Dr. Chris Hardy 5 Comments

The Stress Cup Metaphor

This is the second in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference. Click here to read the first article of the series.

The Stress Cup is a visual representation of allostatic load, the total amount of stress. In the example above, the cup is pretty full—can you relate to it? We have a little space left at the top, and if you can stay within your stress cup without overflowing it, you can achieve a positive adaptation to your training.

Let’s assume my trainer says he has a great workout for me today: limit squats for four or five sets then full sprints afterwards. That might sound awesome, but the stress from the workout he planned for me might overflow my already full stress cup. Can my body successfully adapt to a training challenge that also over-filled my stress cup? No, I will experience allostatic overload. And, this failure to adapt will cause a huge stress response as the body and brain attempt to adapt. If this happens over and over, it will cause serious, deleterious health consequences far beyond an overtraining situation.

Allostatic Load and Daily Training

Undertraining is not enough stimulus for adaptation. The green area on the chart below indicates acute overload—a good workout session with good adaptation. Not much recovery will be needed. But, many times we will overreach with a session that pushes past our limits. While we can still experience good performance enhancement and positive adaptation, we must be cognizant of our recovery, which will take longer. Last, there’s overtraining, and since we can’t adapt to it we will have decreased performance and sometimes a very lengthy recovery period.

Training Stimulus Continuum

Too much overreaching without adequate recovery becomes overtraining syndrome, a medical condition. Overtraining syndrome is a prolonged imbalance of training load and recovery. For example, we might have a great session then rest for a day, then we hit it again and realize we need to rest more—but instead we do max deadlifts with no recovery. Basically, this will cause the stress cup to continually overflow since we have not allowed for recovery and have accumulated training load over time.

Overtraining syndrome is a big deal. If you truly have it, it can take months for a full recovery. While it happens more in elite athletes, it can happen with your clients, because they have other sources of stress beyond their training. Think about allostatic load and overtraining as the same thing. Your client might constantly have a high cortisol level because their stress response is over reactive. High cortisol for a long period of time is bad for body composition and general health.

A good coach should be able to spot the following problems early: fatigue, decreased performance, increased resting hart rate, insomnia, irritability. The stressed out brain starts overreacting. For example, if someone makes you mad at work instead of a calm conversation you snap at them—that’s the overstressed brain being more animal-like and it happens with overtraining too.

Remember, the brain is trying to protect you. So, if you feel like you shouldn’t be training, then listen and learn to spot this with your clients. Overtraining begins at this stage with a very animal-like dominant sympathetic system. Over time, if you don’t listen, your body can even become resistant to the fight or flight response. Parasympathetic overtraining means that you’ve dug such a deep hole for yourself that you can’t even raise your heart rate. I’ve heard of cases when people have needed one to two years to fully recover—and that’s not an exaggeration. It’s more than just your athletic performance, long-term failure to successfully adapt is the same as the long-term allostatic overload seen in all these conditions. In medicine, this is a new concept and new way of looking at chronic diseases.

Now, the mechanism—and this is in Strong Medicine as well—is that if your stress cup is overflowing for long periods of time, you are also generating inflammation or oxidative stress. Oxidative stress is an excess of free radicals or reactive oxygen species—and they drive chronic diseases. But if you’ve maintained your stress cup, even though you still get inflammation and oxidative stress from exercise, it will be short term and you will adapt to it. You need inflammation and oxidative stress to heal injuries, and for your immune system to respond to infections. Correctly dosed exercise can really be the fountain of youth.

Overtraining is catabolic. If your clients want to lose body fat and gain muscle, overtraining does the opposite. Excess cortisol wastes muscle and puts body fat in unfavorable places. The term “skinny fat” describes someone with low muscle mass, and low weight, but they look soft around the middle. Your clients don’t want that and you’ll need to educate a client who wants to try losing weight by eating an under 500 calorie a day diet while getting mashed under a high intensity exercise program. While they will lose weight with that plan, much of that weight will be muscle mass.

It’s important to keep in mind that we are all individuals with different issues filling the stress cup. Who are you training? It might sound intrusive, and your clients might wonder why you want to know about your stress, but it is important. You must know who are you training and what’s filling their stress cup. There are variations in what’s filling it, and there are many different sized stress cups.

Stress Cup Size Chart

This chart is inspired by Starbucks. You can categorize your clients into a stress cup size. If they’re on the small side of the chart, they’re vulnerable, and you won’t be able to do a whole lot with them right now. Then on the other side, there’s a 20 year old who can go drinking all night ,and train hard the next day with no problems because their stress cup is huge. …But it will shrink if they keep doing that!

For example, let’s compare the 20 year old and a 40 year old stressed out executive. If I am a trainer who wants to do a cookie cutter (one size fits all) bootcamp workout, the 20 year old will have no problem with room to spare. But it will be too much for the 40 year old. Is your client vulnerable or resilient? It’s really important to figure out who you are training. Even if you have a smaller stress cup or are older, it doesn’t mean you can’t still perform at high levels. There are the Mike Gillettes, and Marty Gallaghers out there and many others in the room who perform at high levels—but they often need more recovery than when they were 20. But there’s some good news, through exercise you can slow that progression down significantly. Greater resilience is the picture of healthy aging. We can also reverse the process. Over time with smart training at the correct dosing, we can slowly build the size of the stress cup to an extent.

But the largest cup on the chart is not the norm. The small crumpled stress cup on the other side of the chart is the sad truth I face very often in public health. Many people of the general public are dying in their 60s and even earlier. These are the people we need to help. Sure it’s great to train an athlete who wants to enhance their performance, but you can really make a drastic impact on public health by training everyday people. Unfortunately, the medical profession is not doing it—they’re managing diseases, not preventing or reversing them.

Estimating the size of someone’s stress cup is not an exact science. If someone has high stress, a chronic disease, poor sleep, and very little exercise, we can assume he has a small stress cup (or “Tall” on the Starbucks chart). Another example might be a 45 year old female and the only reason she’s a medium (“Venti” on our chart) is that she’s 45. But otherwise she has minimal work stress, good sleep, no diseases, mediates regularly, and has a high fitness level. We intuitively know that we can’t train both of these clients the same way.

Hormesis

Before we discuss exercise and recovery doses, we take a little step back and talk about the concept of hormesis. I learned about hormesis from my toxicology training—a small dose of something might be beneficial, but the same thing at a higher dose could be harmful or cause death. Radiation is a perfect example. Lose dose radiation accelerates DNA repair—it helps our cells regenerate and repair themselves. But, high doses of radiation can kill us.

Hormesis Quote

The famous quote is from Paracelsus in the 16th century. The chart below simply shows that when we go from left to right, the challenge increases. For our example, exercise, it isn’t really classic hormesis because doses that are too low are also bad. But there’s also a nice middle dose that’s “just right”, but as we continue to the right, the dose increases and begins to cause problems. In the example of exercise, point A represents a sedentary person who has very little physical activity. As we go right there’s an optimum dose that’s giving good effects, but if we keep going, overtraining occurs and can cause problems. The example can be made with food—under nutrition at point A, perfect the right amount of calories and the right kind of food at point B, and point C is over nutrition which we see all the time.

Hormetic Window Chart

The hormetic dose is the ideal dose leading to beneficial change/positive adaptation. Much like pharmaceuticals, prescribing the correct exercise dose is crucial. Consistent under dosing leads to no progress—you need enough exercise to promote positive adaptations. And overdosing leads to overtraining. Exercise is more powerful than any pharmaceutical across the board. Pharmaceuticals just manage diseases, while you can reverse chronic disease and improve health with exercise. As a trainer, you should place as much importance on prescribing exercise, and think about it as seriously as a physician does with pharmaceuticals.

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Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Strength Tagged With: allostatic load, Chris Hardy, fitness, hormesis, strength, Stress Cup, Strong Medicine, training

The Mechanics of Stress Response

July 21, 2016 By Dr. Chris Hardy 3 Comments

Chris Hardy Navy Diving School

This is the first in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference.

I was 23 years old and had graduated from one of the toughest schools in the military. It was designed to mentally and physically beat you down. After 5-6 months, I came out thinking I was super human—of course at 23 we think that anyway. We were crushed with physical training twice a day with academics in between. But, when I graduated, I really didn’t know anything about training others. I thought training and getting better was all about getting beat down as hard as possible. But, I didn’t know that I would soon be facing a different challenge.

When I arrived at my new unit as the new guy, and they put me in charge of their training. They were all seasoned deep sea divers—a very physically demanding job, probably one of the hardest on the planet. Training military divers is like training athletes. They’re a very resilient, self-selected group. My dive school class started with 35, and 13 graduated. So the people who graduate are pretty hard to break. They put me in charge of their training, and over the next two years I developed my own routine of mashing them as hard as I could, because that’s what they wanted.

Overweight General Population ClientDuring that same time, I got interested in medicine. I didn’t always want to be a doctor, but at 25, I decided I needed a change of pace. I went to college and thought that since I was already a trainer, I would train people while I went to college.

I was used to dealing with military deep sea divers, and all I was working with people who have diseases and were out of shape. I didn’t know how to deal with any of these conditions and it blew my mind. I decided to learn more and started getting certifications. Over the next 20 years, I tried to hone my training craft and I even became a doctor along the way!

I wanted to know how to get results for these people without breaking them in the process. I couldn’t train them like Navy divers, because they wouldn’t come back and I would certainly break them. In 22 years as a trainer, and 12 years as a physician I don’t have all the answers, but I have developed a framework.

Your clients want results from you, but what’s your responsibility to them? Safety, or as in medical terminology, “do no harm”. We want them to achieve their goals, but we want them to do it safely. Sometimes you have to save your clients from themselves, because they think they know what they want but you really need to educate them. We also have a popular culture that creates more challenges for us in the perception of what exercise and weight loss should be like.

Quote Primum Non NocereTV shows like The Biggest Loser and other transformation programs are what our clients are seeing. They’re getting the message that every workout needs to be a beat-down, and if you’ve watched that show or others like it, there’s a calorically restricted diet. And that’s what our clients think will get them results. How many of you have new clients come to you expecting that kind of workout—and who aren’t happy when they don’t get it? Or maybe you aren’t getting clients because they are too scared to even come to your gym.

We have a huge opportunity. As a good coach, we need to educate our clients on why the beat down workouts are not a good approach.

What is Coaching?

Coaching is an art with a scientific foundation. If you’re a professional, you have the art down, so now we will look at our foundation to answer some key questions:

  • How can I optimally dose the training on any given day for my client?
  • How can I prevent overdosing but still training the client hard enough so that they achieve their goals?

We aren’t letting our clients off the hook, this is the holy grail of training.

When I look at any problem, I want to go back to underlying foundations—that’s how I wrote Strong Medicine, and it’s how I approach medicine. I look at the foundations of the problem in the first place—it’s what I call first principles. Next, we can build a conceptual framework to answer the questions from the bottom up.

Before we could build a space shuttle, we first had to figure out how to make fire. In building up our conceptual framework, let’s begin by defining exercise. Exercise is a form of stress. What is stress? , Hans Selye defined stress as an engineering term as the amount of force per unit area. Now we say, “I’m under a lot of stress” or, “I am stressed out”.

Stress Examples

Anything that triggers the stress response is a stressor—including exercise. Getting attacked by a bear, traffic, or doing dumbbell presses are all sources of stress. External stress examples include food, water, activity, your work environment, traffic. Internal stress can come from diseases—it all activates in the brain.

Is Stress Good or Bad?

Both, it depends. Short term stress is necessary for survival and if you want to make any gains in the gym. Marty Gallagher will tell you that, you can’t have sub-optimal stress if you want to make gains in the gym. But the chronic stress in an over-trained endurance runner or someone who is just completely burned out at their job is not good.

These chronic stresses actually lead to physical changes in the brain and nervous system, and over-activates our stress response. You could argue that the modern environment has toxic levels of stress and that our physiology is at odds with our modern environment. We are probably not wired to handle what we’re dealing with on a daily basis. We can easily recover from short term acute stress, and most of the time we’re not under it. But, many people are now under constant chronic stress, including your clients. And, you can’t train your clients as if they live in a vacuum.

BrainThe brain is command central for the stress response. It receives, evaluates, and responds to stress in our environment from all sources. It is very important to understand that stress is everything the brain perceives as stress—whether or not the issue is a threat to life or limb. If your brain perceives something as stress, then you will trigger the stress response.

It is especially true in modern society. If your boss is a real jerk and you’re under stress at work, that same fight or flight response will be active as if you were running from a bear—maybe not to the same degree, but it will still be active.

We have fast and slow pathways. Simply put, the hypothalamus is a very small part of the brain but it’s actually central to the stress response. When the brain perceives something threatening—if someone scares you—then you get that fluttering heart, “all-jacked-up” feeling. That’s the fast pathway, and it’s direct to the adrenal glands. It dumps adrenaline, epinephrine, and norepinephrine. Afterwards, about twenty minutes later, the slow pathway through the pituitary gland and down to the adrenals is active. It’s a hormonal system that secretes cortisol which helps you recover from the stress. For the purposes of this post, that’s all you need to know about neuro-anatomy.

Those of you who have also trained in Chinese Medicine or follow Taoist philosophy know that the Yin/Yang concept works very well to describe the autonomic nervous system. (Autonomic just means that I don’t have to think about it for it to happen—I don’t have to think to raise my heart rate or to breathe at night.) The autonomic nervous system has two branches, sympathetic (fight or flight), and parasympathetic (rest and recovery). The “fight or flight” system is actually the most inflammatory response in the body. The parasympathetic system is the opposite. Typically, the parasympathetic system should be dominant most of the time, and the sympathetic should only be active when we need to use it for a “flight or fight” response or during exercise. The sympathetic system is used in response to stress—but it should be used minimally.

Autonomic Nervous System Diagram

The parasympathetic system is dominant for the recovery to all of the exercise you’re doing (and that your clients are doing). It’s also when that anabolic response to exercise occurs. But, if the sympathetic system is on all the time—as it is for many of our clients and ourselves—in the long term it will lead to muscle-wasting and chronic diseases.

How the Brain Controls Stress Response

Three main parts of the brain control the stress response to perceived threats. The prefrontal cortex (we also use it to maintain attention) right behind the forehead determines if something is truly a threat using higher reasoning. Our memory center, the hippocampus also helps us determine if something is threatening or not. The prefrontal cortex and hippocampus can override the threat response together if they have determined something has been seen or experienced before and is probably not threatening. The amygdala is the brain structure which drives the threat response, it responds to learned fear and the emotional reaction of stress. If I got an electric shock every time someone rang a bell or hit a gong, then pretty soon every time I would hear a sound like that, I would have a severe stress response. That’s what the amygdala does.

Normally, the hippocampus and prefrontal cortex inhibit the stress response, and the amygdala will activate it. It’s a three prong connection, and the brain will perform normally if the parasympathetic system is dominant most of the time. For example, if you see long cylindrical object across your path while walking in the woods, the prefrontal cortex will pay attention to it, the hippocampus will respond that it recognizes that it’s probably a stick, and will generally keep the brain from triggering the stress response.

Brain Diagram Stress StructuresBut over time, a brain will change in response to chronic stress. The word neuroplasticity means that the brain can functionally and structurally change. We used to think that psychological stress was “all in your head”, but in fact the brain can change its structure and how it functions—and you can actually be lose neurons. A person who is stressed out or depressed over a long term will have a physically different brain—the hippocampus will shrink under chronic stress.

Epigenetics is how the genes in our DNA are expressed. In Strong Medicine, I used this example: genes are a recipe that says I need four eggs to make a cake. So, if I do a mutation and use five eggs, then that’s a mutation to the genes. Epigenetics doesn’t change the genes, it just tells me how many “cakes” (if any) will be made from the recipe. When someone is under constant stress, everything is involved including hormone pathways. Everything involved with the stress response will be amped up and producing more products for the stress response.

So, someone under chronic stress will respond differently to exercise. If their stress response is overactive, it won’t take much to activate it, and they will have a harder time recovering from exercise because the sympathetic nervous system will be more dominant. If they are already in such a fight or flight state, it will take longer for the parasympathetic nervous system to allow for recovery. Normally the brain would use these mechanisms for survival, not a chronic perceived stress.

Stress Examples 2

Going back to our example with the stick across a path in the woods, if the brain is under chronic stress it will become more animal-like. The structure has changed and when someone with a chronically stressed brain sees something lying across the path, and the hippocampus memory has shrunk, you might jump straight to the conclusion that the object is a snake and trigger the stress response. The chronically stressed brain responds and reacts as opposed to focusing, maintaining attention, and drawing on previous memories.

How does all of this relate to fitness and training? As trainers—and I’ve done this myself—we often focus only on physical stresses. But, we aren’t training in a vacuum, so we must consider our environments. Our clients are faced with many sources of stress outside exercise stress, and we want to train them effectively. Allostasis is a broad concept that basically means “achieving stability through change”. While homeostasis means that a specific equilibrium is maintained, allostasis changes the point we come back to maintain that equilibrium. The stress response is part of this process. If you are trying to achieve stability with the environment, then we are also trying to achieve stability with anything perceived as threatening, challenging, or dangerous, right?

Allostasis is the mechanism responsible for adaptation to any challenge, exercise, or social, psychological activity. We need some psychological stress to become resilient, but too much of it and we can become depressed and anxious. Nutrition is similar, we need to be adequately nourished but not overly so, since the body will adapt to over-nutrition, and we see that all the time. The same is also true for sleep—too little sleep and the body adapts with a stress response, and new science is showing that too much sleep is also bad.

As far as the brain is concerned, recovering from a training challenge with endorphins, and growth hormone building bigger muscles and more mitochondria is allostasis—the brain will think that you need to get stronger to survive that type of challenge/stress again. Allostasis brings you to a new set point as opposed to homeostasis taking you back to the same equilibrium. This is a relatively new concept. Total stress is also called the allostatic load—allostasis is the change, and allostatic load is everything that the brain perceives from the environment as stress.

 

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The next post in this series will outline a visual representation of the Stress Cup and how to use it to optimize your training and client training programs.

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

 

 

 

Filed Under: Mental Health, Motivation Tagged With: allostatic load, autonomic nervous system, brain, Dr. Chris Hardy, mechanics of stress response, stress, stress adaptation, Stress Cup, Stress response, Strong Medicine, training

Building Your Health Fortress, One Brick at a Time

December 24, 2015 By Dr. Chris Hardy 9 Comments

Health Fortress

The New Year is almost upon us and millions of people will be making resolutions to improve their health. Gym memberships are purchased, new diets are tried, and home exercise equipment is ordered. Unfortunately most of these resolutions are doomed to fail, often by the time March rolls around. The gym memberships go unused, the diets are not sustainable, and the exercise equipment becomes an expensive clothes hanger. The cycle will repeat the following New Year, with many of us starting over again, sometimes in worse health than the previous year. No long-term progress is ever made. Why do we set ourselves up for failure year after year?

The modern environment lays perpetual siege to the health of our body and mind. Fast food, nasty bosses, long work hours, financial worries, domestic conflicts, poor sleep, and pollutants/toxicants are part of the world in which we live. With these health-destroying enemies at our gates, we have to put in more effort than ever before to achieve and maintain optimum health. We have to build a health fortress to protect us from the modern environment.

The primary reason most resolutions go unrealized soon after they are made has less to do with the actual resolutions themselves and more to do with how they are implemented-the plan. Attempting to radically change your current lifestyle overnight is akin to building a huge wall with brick and stone and not using mortar. You can build an impressive wall quickly but it will soon crumble under the slightest outside pressure, certainly not siege-worthy.

An instant gratification mindset leads to this sad excuse for a wall.
An instant gratification mindset leads to this sad excuse for a wall.

To build an impregnable Health Fortress, each brick and stone has to be placed and then sealed with mortar for strength and resilience. This process takes time and effort, but the result is a structure that you can build on year after year, not a flimsy construct that has to be rebuilt from scratch every year.

Each brick/stone for your fortress is a small positive lifestyle change. Each change must be sealed in place with time as the mortar. When you can incorporate a small lifestyle change into your daily routine for at least 90 days, the chances of it sticking for life increases dramatically. This is the way you can slowly build each wall of your fortress, and the building process is sustainable.

There are hundreds of potential bricks (lifestyle changes) outlined in Strong Medicine. In the book, we call them defensive tactics. On New Years day, pick a couple of these that you think you need the most and incorporate them into your life for 3 months. By the time March rolls around, the new bricks are no longer changes but have become part of your wall, set in place and resilient. Then pick a couple more bricks and continue the process. Even if you just picked 2 changes every 3 months, by next New Year you will be well on your way to having an impressive wall. Instead of starting over again, you now have a structure on which to keep building. This is how a Health Fortress is made, and sustainable wellness is achieved.

Don’t fall into the New Year’s resolution trap. Start 2016 with a New Life Resolution and build your Health Fortress.

Strong Medicine Scroll

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Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Motivation Tagged With: Dr. Chris Hardy, health fortress, healthy lifestyle, lifestyle change, lifestyle changes, motivation, New Year, new year's resolution, New Year's Resolution Alternatives, Strong Medicine

Quieting the Mind-Monkeys

September 17, 2015 By Dr. Chris Hardy 10 Comments

Quieting the Mind-Monkeys

“This restless monkey, which is thought, has broken up this world and has made a frightful mess of this world, it has brought such misery, such agony. And, thought cannot solve this, however intelligent, however clever, however erudite, however capable of efficient thinking, it cannot, thought cannot possibly bring order out of this chaos. There must be a way out of it, which is not thought.”

J. Krishnamurti

This quote from the brilliant Indian philosopher Krishnamurti references the Buddhist concept of “mind monkeys” or what is sometimes known as the “monkey-mind.” These monkeys are the thoughts comprising an incessant internal dialogue driven by worry, fear, anxiety, and rumination. They are constantly chattering and screeching, creating a cacophony in our mind that pulls us away from the present moment. They create imaginary scenarios, reliving recent past events and anxiety-producing worry about potential future problems.

How many times have you arrived at a destination in your car and can’t remember exactly how you got there because you were so immersed in an internal dialogue? For many of us, the monkeys are chattering all day in the background without our full awareness of their presence. The monkeys are not just distractions, but have real health consequences.

Strong Medicine discussed in detail how the mind-monkeys of worry and rumination put us into a constant low-level flight or fight response (sympathetic nervous system) and activate the stress response with real physiological consequences, contributing over time to chronic diseases such as diabetes, heart disease, high blood pressure, and even cancer.

I knew I had a mind-monkey problem, but did not realize the magnitude until I removed all outside stimulus from my environment. I found myself in this almost unimaginable situation during my first experience with a sensory deprivation float tank. The float tank is a futuristic looking pod filled to a depth of only ten inches of water. The water is super-saturated with epsom salt (magnesium sulfate) and warmed to skin temperature. The high concentration of salt allows you to float effortlessly almost on top of the water, and because the water and surrounding air is kept at skin temperature, it is difficult to tell that you are even in water. When the pod door is closed, all light and sound disappear and you feel like you are floating in a void with minimal sensations coming from outside your body.

Floatation Tank

Inside the float tank, the call of my mind monkeys was deafening. There were no outside sounds or sensations to compete with the monkeys in my brain and they made their presence known in an alarming way. I have had training in mindfulness meditation practices, but it still took me almost 30 minutes of floating to quiet these chaotic creatures of thought. I use mindfulness practices often at home and usually feel that I can get to a quiet state, but this experience has led me to question how effective I really am in silencing the monkeys. At home, there are still background noises and bodily sensations that may dull my perception of the monkeys still likely whispering in my head.

After the first 30 minutes in the float tank I was able to start tuning in to the state of my body’s internal workings. I could feel and hear my heartbeat stronger and start to barely detect my intestines rhythmic machinations.   I was finally able to strengthen my sense of interoception, sensations from within my body. I used the sound and feel of my heartbeat to get into a deep meditative state. The sound of New Age music drew me out of this sustained mindfulness, gentle notes hitting with startling force as I had been without external sensation for close to an hour.

The short time I spent in this deep state of meditation, tuned to the interoceptive sensations from within my body was the most profoundly relaxing experience I have had with mindfulness. This was the benefit of the sensory deprivation tank for me. It was nothing mystical or transcendental; it recalibrated my ability to detect the mind monkeys. Now I know how loud they really are behind the distraction of the modern environment, with products of industry and technology resulting in sensory pollution, obscuring the howl of the monkeys.

Knowledge is half the battle when confronting a problem. I have a new standard for my mindfulness practice, and re-tuning with periodic floats in the sensory deprivation tank will be integrated into my self care. Remember that the health benefits of reducing the chattering monkeys are real, with a foundation in modern neuroscience and wellness practice. This is a part of how we rebuild a brain physically and functionally changed by chronic stress (see more in Strong Medicine).

The availability of sensory deprivation float tanks is increasing. A one hour float is usually less expensive than a massage session. The experience of floating without external sensations has been invaluable to me personally. I was given a reality check; my monkeys were (and still are to some extent) running wild.

Filed Under: Brain Train, Mental Health Tagged With: Chris Hardy, Dr. Chris Hardy, floatation tanks, meditation, mind monkeys, mindfulness, sensory deprivation tank, stress management, stress reduction, Strong Medicine

Rekindling the Fire: The Dragon Door Health and Strength Conference

August 20, 2015 By Dr. Chris Hardy 20 Comments

RekindledFire

I must admit to feeling burned out of late. Strong Medicine was released several months ago and I have just completed the final requirements of a two year fellowship in Integrative Medicine. Both of these have been monumental personal achievements for me following my passion and mission to improve the dismal state of public health, specifically the seemingly unstoppable spread of preventable chronic disease. Despite these recent achievements, I have felt very alone and isolated within the conventional medical system. My Integrative Medicine classmates are like-minded, but many are struggling to find a way to earn a living putting a holistic model of medicine that emphasizes prevention into practice within the mainstream. I have been disheartened to say the least, but this last weekend was a game changer for me.

Dragon Door’s first Health and Strength Conference was an incredible experience as both a speaker and participant. I have never seen so many incredibly talented people under one roof who were all freely sharing their experiences and diverse approaches to the betterment of our collective health and wellness. I am posting this on the Strong Medicine blog, because the conference presenters and participants exemplified the Strong Medicine mission statement found on the home page of this blog in their own unique way.

Health and Strength Conference Group Photo

Rolando Garcia gave an insightful presentation on the business of fitness, but made a key point that left a lasting impression on me. He rightly pointed out that a trainer will potentially see a client 100-200 times per year (as opposed to a handful of 15 minute doctors visits) placing the trainer in a unique position with an opportunity to have a tremendous impact on a person’s health, potentially far more than their health care provider.

Danny and Al Kavadlo gave informative and entertaining talks, reminding us again that your clients don’t need gym memberships or fancy equipment to effectively rebuild bodies ravaged by the inactivity rampant in modern society. Their amazing bodyweight progressions make strength training truly accessible to all.

Max Shank knocked it out of the park sharing his stripped down approach to training. While I gave a theoretical talk about using the concepts of allostatic load in training, Max showed us how he is already doing it with his clients and getting fantastic results and keeping them injury free.

Zach Even-Esh is truly a warrior for public health. He is training our kids, a group many are predicting to be the first generation not to outlive their parents. Zach’s life story, work ethic, and commitment to improving the sorry state of fitness in our adolescents and teenagers was inspirational for me.

Andrea Du Cane put the spotlight brightly on the importance of training our aging population. She gave a fantastic talk that emphasized not only why we should be actively seeking this demographic as clients, but safe and effective ways to implement real strength training and reverse the scourges of sarcopenia and osteoporosis.

Steve Holiner filled in brilliantly for Josh Henkin. His presentation of the DVRT system was outstanding, filling in the gaps many of us have with our movement. The potential applications to rehabilitation and “prehabilitation” are very exciting for me. I was also blown away be his brief offline discussion with me on his biopsychosocial approach to training.

Phil Ross gave a barnstorming presentation on training and combatives that peaked my interest as a fledgling BJJ practitioner. Jon Bruney and Logan Christopher gave fascinating lectures on harnessing the brain and nervous system to improve performance.   Mike Gillette showed us how to save our joints while building incredible strength and resilience with his masterful presentation on ring training. Mike Krivka showed his passion and expertise anchoring our introduction to CrossCore HardCore.

And finally my co-author Marty Gallagher gave one of the most poignant and inspiration talks that I have ever seen. I am truly honored to call that man a friend.

The participants were out of this world as well. My discussions throughout the two days with so many of them were just as educational for me as the formal presentations. There were so many trainers and even some other health care professionals sharing their knowledge freely. This was the most collegial environment that I have ever experienced.

I have come away from the Dragon Door Health and Strength Conference with my fire burning again. The epiphany for me was that I need to spend my energy bringing groups like this together to better our collective craft, rather than wringing my hands over my frustrations with our current health care system.   If we can keep building our collective and synergize our efforts, we can truly have an impact on public health. My sincere thanks to everyone involved for making this experience one of the best in my professional career, and especially to John Du Cane for having the vision to make it happen.

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Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Motivation Tagged With: Dr. Chris Hardy, Dragon Door authors, Health and Strength Conference, motivation, Strong Medicine

Cardio Revolution: Part III

June 11, 2015 By Dr. Chris Hardy 2 Comments

Cardio Revolution Part Three

In this final installment of the Cardio Revolution trilogy, I will give you some of the basic scientific principles behind the benefits of 4-limb exercise. The best way to do this is to break down the techniques and tactics that Marty outlined in his Fan Bike protocol.

Marty’s Fan Bike protocol is very similar in concept to the high intensity “Burst Cardio” protocol described in Strong Medicine (SM p.424). Both protocols generate periods of very high intensity that shift us squarely into anaerobic metabolism (burning glucose for energy without oxygen). The high intensity anaerobic bursts are incredibly beneficial for metabolic health and promote a strong positive adaptive response in the body.

Metabolic Health

Intermittent anaerobic bursts are the best way to clear out muscle glycogen (glucose) stores.

Muscle Glucose Container Diagram

As discussed in Strong Medicine, emptying the glucose stored in muscle creates an “empty container” to deposit circulating blood glucose. This is one of the reasons why high intensity training is so valuable to Type 2 diabetics.   Traditional “moderate” intensity exercise doesn’t do as good of a job of emptying the muscle glucose (glycogen) “containers”.

As many of us know, glucose that is not stored in the liver or in muscle will be eventually stored as fat in adipose tissue. This is a protective mechanism to keep glucose from building up to toxic levels in the blood. Emptying the muscle glycogen “containers” gives excess blood glucose somewhere to be safely deposited without contributing to increased body fat or causing damage to the body by creating “Advanced Glycation End-products (AGE)” (SM p. 244).

Four-limbed anaerobic cardio such as Marty’s Fan Bike protocol maximally empties total body muscle glycogen “containers” by rotating and distributing effort to all four limbs instead of just the legs.

Glycogen Depletion With Fan Bike workout
Lucas is low on muscle glycogen after a high intensity Fan Bike workout

 

Four-limb high intensity anaerobic exercise is also one of the most powerful interventions for restoring insulin sensitivity in a diabetic. The adaptive response of muscle to clearing out glycogen is to try to “fill up” the glycogen tank. A main function of muscle glycogen is to provide a rapid source of energy for flight or fight situations. From a survival perspective it makes sense for the body to have mechanisms to make it easy to replenish lost muscle glycogen. Your body can’t distinguish between a Fan Bike protocol and running away from a bear. It wants to prepare you for another flight or fight situation as soon as possible so it bypasses the normal mechanisms for getting glucose back into the muscle (glycogen is the storage form of glucose in the muscle).

This bypass mechanism is very powerful for normalizing blood sugar in a Type 2 diabetic. Insulin is required under resting circumstances to pull glucose from the blood into the muscle cells for use in energy production. A Type 2 diabetic has insulin resistance, in other words, the signal insulin gives to open the muscle cell to allow glucose in is not working well (illustrated below in a graphic from Strong Medicine).

Insulin resistance: inflammation (in this case from enlarged fat cells) in diabetes short-circuits the insulin receptor, preventing glucose from entering the muscle cell.
Insulin resistance: inflammation (in this case from enlarged fat cells) in diabetes short-circuits the insulin receptor, preventing glucose from entering the muscle cell.

 

Bypassing Insulin Resistance Diagram
Bypassing insulin resistance: high intensity anaerobic exercise opens the muscle cell to allow glucose in without a signal from insulin. This is why protocols such as Marty’s Fan Bike routine are so beneficial to diabetics. As the muscle glycogen (glucose) stores are emptied by exercise, excess blood sugar can be transported into the muscle cells despite insulin resistance via the bypass mechanism. This can help tremendously to normalize blood sugar for the diabetic. Over time insulin sensitivity can be restored.

In addition to being a superior form of exercise to normalize blood sugar and maintain insulin sensitivity, intermittent high intensity exercise promotes a favorable adaptive response after the exercise is complete. The night after a high intensity exercise session, growth hormone secretion is maximized during slow wave (deep) sleep. Growth hormone is one of the most potent “fat-burning” triggers in our body’s arsenal. This is another way four-limb anaerobic exercise protocols help us lose more body fat after the exercise session (another reason why calories burned during exercise are not as important as the after effects).

Additional Benefits

Marty’s four-limb high intensity cardio protocol for the fan bike makes strategic use of alternating motor patterns. Switching from pedaling forward to pedaling backwards, using different arm positions, and alternating pulling and pushing, all challenge the nervous system, preventing us from becoming too efficient during the exercise session. Using myself as example: as a mountain biker for many years, I can generate fairly high power outputs with traditional forward pedaling for a substantial length of time.   Backwards pedaling is very foreign to my brain and is hugely challenging. I am only fractionally as efficient backwards as I am pedaling forwards. This inefficiency with movement translates into much more effort overall to generate the same amount of power output as a movement that is “hard-wired” from years of repetition.

Marty’s protocol makes use of these shifting motor patterns to minimize efficiency and maximize the adaptive response for exercise. People training for a specific sport such as cycling or swimming want to maximize efficiency to get the most performance out of the least amount of effort. We are trying to do the opposite, maximize our effort (and resulting adaptive response) by minimizing efficiency.   Whether it is with the kettlebell or the Fan-Bike, challenging the brain with new movement patterns is good for both your neurological and metabolic health.

Brain Heart Workout Benefits

The Fan Bike is a great option for four-limbed high intensity cardio, but certainly not the only way to go. The principles of Marty’s protocol can be adapted to many implements and in myriad systems. Use your imagination and have fun!

 

****

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Filed Under: Cardiovascular training Tagged With: 4 limb cardio, burst cardio, cardio, cardiovascular training, Dr. Chris Hardy, four limb exercise, full body cardio, glycogen, high intensity exercise, insulin resistance, insulin sensitivity, intermittant high intensity exercise, normalizing blood sugar, Strong Medicine

Kaizen and Strong Medicine

May 14, 2015 By Michael Krivka 8 Comments

Kaizen Strong Medicine Lead Photo

Strong Medicine has over six hundred pages of text and illustrations that will dramatically change how you perceive nutrition, training, and how you can effectively manage the stressors in your lifestyle. The concepts and how they can be applied are laid out in such a manner that, with the some simple planning, discipline and implementation, you will have no choice but to be successful.  This blog post is going to provide you with some tools and strategies that you can use in order to implement the concepts presented in Strong Medicine in such a way that you will not only succeed, but will be able to do so with the least amount of stress possible.

Change… Sucks!

Making drastic changes in your life does not lead to dramatic results–it usually leads to dismal failure and a lot of brow beating! Anyone who has made a New Year’s resolution only to have it crumble within a matter of weeks (or in some cases, a matter of hours) knows that making changes (big or small) in your life is hard to do. Everyone starts out with good intentions and a wealth of willpower only to see the good intentions crumble and the willpower dissolve like a puff of smoke at the first impasse. With all of these bad past experiences surrounding change, I’m sure you’re convinced that you can’t make any changes in your life and might as well just quit now. Wrong! Just because you failed in the past doesn’t mean you’ll fail this time–especially if you are honest with yourself about the plans and tools you need to succeed. So… how do you begin making changes? The same way you’d eat an elephant–one bite at a time!

Kaizen = Continual Improvement   Kaizen Diagram

Kaizen is a Japanese term that has been borrowed by the business world. Roughly translated, it means “change for the better” or “continual improvement”. As a business major in college (many, many, many years ago) I learned about the concept of “Kaizen” and how it was successfully implemented in the Japanese automotive industry. Kaizen gave everyone–from the guy sweeping the floor to the VP in charge of making million dollar decisions–the power to change how things were done on a daily basis. In other words, the power was placed in the hands of those who could make the most difference. Since then, the concept of Kaizen has been applied to banking, healthcare, government and other areas where complicated processes need to be considered and improved to increase efficiency and consistent outcomes.

How does this apply to you and how will it impact the implementation of what you’ve learned from Strong Medicine? You need to develop a simple but effective plan for implementing the nutritional and training guidelines presented in Strong Medicine. Your plan should be created and executed in a way so that changes can be small, easily managed, and built upon. Remember that the best plans are the simplest effective ones that also have the latitude for change and modification on the fly.

NOTE: Understand that these plans are best implemented one at a time. Trying to make too many changes too soon and with too much accompanying stress will make this process a lot harder than necessary. With this in mind, I feel that the concepts behind Kaizen are the best common-sense approaches to implementing any nutrition, training or lifestyle modifications.

“Eat like an Adult”

Strong Medicine goes into great detail about what and how you should eat–and how those choices are will effect you over the short and long term. There are many scientific theories and big words involved–which can be daunting to some people–but you will need to absorb it to understand what Dr. Chris and Marty are trying to do. They successfully make many complex ideas and concepts simple to grasp, and that’s vitally important for the subjects of nutrition and training. I admire people who can take complex problems and explain solutions in simple terms everyone can understand.  For example, when Dan John said, “Eat like an Adult” during a lecture a couple years ago, it really stuck with me. His comment was simple, direct and to the point. Those four words make choosing, preparing, and eating the right foods a lot easier! I know those four words help me get in the right mindset when I’m preparing, ordering, and even shopping for food.

Start with the Beginning     Small Daily Improvements

“Eating like an Adult” will help you succeed with the Strong Medicine guidelines. But first you need to know where you stand. The easiest (and the most eye-opening) method I know is to keep a food log for ten days. (Before you start grumbling and groaning, hear me out–the food log will give you some great intel into what’s going on and how to fix it!) Keeping a food log is as simple as folding a piece of paper into sections, then writing down everything that goes in your mouth. Breakfast, lunch, dinner, snacks, drinks, etc.–it all goes in the food log. Once you have all this information you’ll be able to create a baseline for what kind of food you are eating, how much you are eating, and what is missing from your diet. Remember, keep this as simple as possible and don’t stress out about what you are writing down. It’s just information you’ll use to create a plan!

Once you have ten days of information, what do you do with it? First, find the gaps in your nutrition. For example you might notice that during those 10 days the only time you ate any vegetables (not counting the lettuce and tomato on your hamburger) was with dinner. Over ten dinners you had a handful of salads, a couple baked potatoes (not to mention French fries), and several servings of broccoli. If that was the case, then introducing more vegetables into your evening meals AND including them as part of breakfast and lunch would be in order.

Getting Started

Does this sound like a big step and a major hassle? Not really! It just takes a little forethought and preparation and you’ll have it nailed. Prepare by having the food you need on hand, and by creating and using shopping lists. Your shopping list will guide you through the grocery store. For the most part you’ll stay in the periphery, where the vegetables, meat and dairy products are found. (Stay away from the middle of the store where the Mountain Dew and Fritos are located!) Grab your list and shop either once a week or several times a week, whichever is more comfortable or convenient for you. Remember, you’re only shopping for the things on your list! NOTE: if you don’t have a shopping list, you can Google “shopping list” for plenty to choose from and modify as needed.

Now that you have all this food in the kitchen, what do you do with it? Well, you will need to start making your own meals based on the nutrition gaps in your food log. It will be easy for the most part–in the above example, we simply need to increase the amount of veggies throughout the day. We need to make this change as simple as possible. Think about this: it only takes a minute or two to cut up some peppers or cucumbers and throw them into a plastic bag or Tupperware for later in the day. Grab some veggies and prep them for the day while you’re standing around waiting for your coffee to brew in the morning!

I can hear the whining and moaning already! “Veggies for breakfast and lunch? How am I going to do that?” Easily! Just add vegetables you like to meals you are already eating. Still confused? Here’s some ideas to help you jump start the process!

How to add vegetables to breakfast:

  • Add avocado and salsa to your scrambled eggs
  • While frying your eggs, sauté some spinach in bacon grease and serve it on the side or as a bed for the eggs
  • Warm up some sauerkraut for a tangy side (or kimchi for something spicy) with your eggs
  • Brown onions, tomatoes and mushrooms and make an omelet
  • Slice up some hard boiled eggs with ripe tomatoes
  • Slice red or yellow peppers, clean out any seeds and whatnot. Put the slices in a frying pan and add an egg inside the gap for peppers and eggs over easy
  • Grab a container full of sliced veggies (that you prepared the night before) and a container of yogurt for a quick and easy breakfast on the go
  • Chop bacon into bite-size pieces and toss them in a frying pan. Add onions and peppers then simmer everything together. Drain the excess oil, then toss the bacon and vegetables on top of scrambled or poached eggs

Small Steps Lead to Big Results

I guarantee that if you take a little time and mental energy and apply it to filling in the gaps of your nutrition, it will pay huge benefits in the short and long term. I’m not proposing massive changes. On the contrary, I think the best and most effective way to ensure your success is by making small changes that you can easily adjust to before moving onto the next step. Remember what you learned in Strong Medicine about how stress (in all its forms) adversely affects the body. Adding stress by making big changes in your nutrition will be counter-productive. Keep the concepts of Kaizen in the forefront of your mind–small changes leading to big results–and you will not stress out at all!

NOTE: The training for life guidelines will be in part two of this blog post. In the meantime, I want you to start improving your nutrition. Small increases in nutrients will have a major impact on how you feel and move. By getting your nutrition plan in place now, you will establish the foundation for a successful training program.

 ***

Michael Krivka is a Senior RKC with Dragon Door and has been training with, teaching, and sharing the gospel of the kettlebell for over a decade. As a life-long martial artist, he is a Full Instructor under Guro Dan Inosanto in Jeet Kune Do (JKD); the Filipino Martial Arts of Kali, Escrima and Arnis; and Maphilindo Silat. He lives in Gaithersburg, Maryland with his wife and two sons. He owns CrossFit Koncepts where he runs strength and conditioning classes with an emphasis on kettlebell training, mobility and longevity. Follow him on Facebook.com/CrossFitKoncepts or Instagram.com/Michael_Krivka

 

Editor’s Note:

Where the Strong Medicine book is the template for lifestyle change and taking charge of your health, Mike has the beginnings of a Strong Medicine Operational Manual with this first post. The philosophy of Kaizen melds so well with our philosophy of lifestyle change that I am kicking myself for not including it the book, but this is why I try to surround myself with talented people like Mike Krivka.

In keeping with the mission of the blog for a two-way exchange of information, please share your perspective on lifestyle change in keeping with the Kaizen philosophy. Fantastic job, Mike!

Filed Under: Motivation, Nutrition Tagged With: developing a plan, fitness, fitness strategy, fitness training, Kaizen, Mike Krivka, motivation, nutrition, planning, strength training, stress management, Strong Medicine

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