Friday, September 27, 2013

"Seven Things I Wish I Knew When I Started Running"

Nice list, especially this part:
"Run in Less Shoe

"I used to wear bulky ASICS Kayano running shoes (I wonder why my achilles always hurt?) and never wore flats during workouts. Things have changed and the evidence is piling up that wearing a little bit less shoe and being strategic with barefoot running can really help your overall training.

"Just one session of barefoot strides per week and a good pair of minimalist running shoes can dramatically help you reduce your injury risk. You’ll strengthen your lower legs and feet and become a more efficient runner. It’s easier to run with better form in less shoe—and much easier barefoot.

"Ease into your new minimalist shoes. They can help you a lot—but only if you’re smart and gradually introduce them to your training program.

"...Jason Fitzgerald is a 2:39 marathoner..."

Monday, September 23, 2013

Is Science Broken? Part 7: "Current Hydration Guidelines are Erroneous..."

"Current hydration guidelines are erroneous: dehydration does not impair exercise performance in the heat."

But they're profitable. And that's what matters, isn't it?

Waterlogged covers this topic incredibly well.

Via Prof. Noakes on Twitter, naturally:

Thursday, September 19, 2013

The Ketogenic Diet In A Top Endurance Athlete

N=1. This is from Mike Morton's website. Read the whole thing, but I've excerpted the interesting (to me) bit below. (If you read this, Sgt. Morton, please add an RSS feed!):
"...Something that I have been getting questions on is the ketogenic diet. The questions are from one end of the spectrum to the other. Some general health to performance issues while in ketosis. I’m convinced that the diet is perfect for my athletic aspirations. Recovery is improved and I feel a level energy curve. I don’t ever “bonk” during races or training and my mental clarity is better. During Western States I consumed maybe 1200 calories through Coke, a couple gels, hard candy and food at aid stations. During races I don’t worry about consuming carbs; it is part of the “strategic carb use” of the diet. Peter Defty who helped me out with switching is the master mind behind what I’m doing. He has a lot of good info on his VESPA website. I use VESPA and I feel it is a big help, I take a concentrate every two hours during a race. Peter is very sincere about the diet from a health stand point but he sees great potential in endurance sports for a ketogenic diet.

"Another common question revolves around cholesterol and the effects of eating “all that fat”. I’m not a scientific guy so I trusted Peter and his accomplices when they told me if I was strict with eating low carb my cholesterol would go down. After years of eating a high carb, whole grain “healthy” diet I was scared to eat meat and cheese again! After nine months of eating bacon and eggs for breakfast, hard salami and cheese for lunch and a rib eye or porter house for dinner the blood tests are in!

"When I went in to finish my physical and go over my labs the first thing out of the doc’s mouth was “I’ve don’t see results like this often.” Part of her reaction was because of the heart rate being at 40 BPM but the cholesterol was not typical for a 41 year old soldier.

  • My good cholesterol (HDL) went from 43 to 89 MG/DL. The “normal” range is 35-55.
  • My bad cholesterol (triglyceride) went from 77 to 51 MG/DL. The “normal” range is 0-150.

"My cholesterol count was down from 184 to 174 MG/DL. Less than 200 is desirable.

"Another interesting experience I had was using getting a body scan to determine body fat and lean muscle mass of the body.

"I had a dexa scan a couple of weeks after winning the World 24 Hour Championship in Poland last year. This was after a nine month training block averaging about 140 miles per week on a high carb low fat diet. The results were:

  • 14.2% of my tissue was fat
  • Total mass was 126.9 pounds
  • 103.49 pounds of lean mass
  • 17.14 pounds of fat
  • 6.26 pounds of bone mass

"(Keep in mind this is measuring ALL the fat in the body to include organs and the Brain) [Moved this from above to make the list more readable -Tuck] At the end of March after three months of eating a ketogenic diet I repeated the scan. This scan took place after five weeks of ZERO running due to a torn tendon. I didn’t do any cross training either. I took advantage of the time and built a dog kennel/future chicken coup/ future horse stall. The results of the scan were:

  • 11.3% of my tissue was fat
  • Total mass was 124.4 pounds
  • 104.98 pounds of lean mass
  • 13.61 pounds of fat
  • 6.26 pounds of bone mass

"After five weeks of ZERO exercise I lost almost 3% of total fat mass and GAINED lean muscle mass. The human performance staff was amazed at this. 3% body fat loss in someone less than 130 pounds is a really big number.

"The Bottom line is the diet works for me in training, life and racing and so far the “side effects” are all positive…other than not being able to eat a jar of nutella. Again I feel compelled to state I know that no one diet works for everyone. I just want to share my experience with a ketogenic diet."
A few thoughts:
  1. We can put the notion that a ketogenic diet causes the body to cannibalize muscle to bed. There's no evidence for it, but, like a zombie, it keeps coming back.
  2. HDL going up and Triglycerides going down is what happens when you switch from a high-carb/low-fat diet to a low-carb/high-fat diet. This also happens to mean that one of the primary cardiovascular disease risk factors improves. That's a nice bonus, and one which I covered in this post. (As an aside, Morton says "My bad cholesterol (triglyceride)..." LDL, not triglycerides, are what is known as "bad cholesterol". He doesn't mention his LDL levels, but they must be low.)
  3. "Less than 200 is desirable." This is only correct from the perspective of the companies selling statin drugs. In epidemiologic terms, total cholesterol lower then 200 is where the risk profile starts rising again. If I had Morton's cholesterol numbers (especially the low LDL), and had spent as much time as he has in primitive conditions, I'd be worried about parasites being the cause of my low cholesterol numbers.
As a reminder, Morton's the current Masters' record-holder at the Western States 100-mile foot race.

I think we can safely say the ketogenic diet is, at worst, a reasonable option for an endurance athlete looking for top performance.

(Morton's post via Prof. Noakes on Twitter.)

Wednesday, September 18, 2013

Pacific Crest Trail FKT In Altra Lone Peak Shoes

Bravo to Heather Anderson for setting an unsupported record time [P.S. FKT is Fastest Known Time, an informal record.]:
"This summer, the 32-year-old, whose trail name is ‘Anish’ as a tribute to her Anishinaabeg heritage, set a truly obscene long-distance hiking record. She hiked the 2,663-mile Pacific Crest Trail (PCT) between the United States’s borders with Mexico and Canada and through Arizona, California, Oregon, and Washington. She did so in traditional thru-hiker style, meaning she carried all of her gear in a backpack, resupplied her food via personally sent mail drops at post offices and purchases from grocery stores on and near the trail, and received no planned assistance.

"Somehow, Heather managed to squeeze all of that into 60 days, 17 hours, 12 minutes. On the day she finished, her time was the fastest-ever for the PCT. Faster than all self-supported thru-hikers before her. Faster than the supported/crewed hikers, too. Faster than any woman. Faster than every man.

"Her record now has a qualification. The day after Heather finished, Josh Garrett finished his own PCT thru-hike in 59 days, 8 hours, 14 minutes. That’s 33 hours or so faster than Heather. But his hike was supported, meaning he had crew stationed occasionally along the trail for resupplying his food and other needs, and meaning he didn’t have to leave the trail to do so himself.

"Heather traveled an average of just under 44 miles per day...."
Emphasis mine. Read the whole thing. Pretty incredible.

Heather did this hike in a pair of "minimalist" shoes, although the Lone Peaks are one of the beefier "minimalist" shoes out there: they're designed for running ultra-marathons in really rocky areas.

Heather's blog includes a gear review post, which I'm guessing will now be quite popular. Her review of the Lone Peak is:
Altra Lone Peak
Grade: A-

Old and New
"I have been running ultras in these shoes for about a year. I love the roomy toe box and the neutral “Zero Drop” sole. These are a more minimal shoe however, and I noticed that on this hike my feet took a serious beating. A shoe with more cushion would have made them much happier, especially in the first 1,000 miles."

Pros: Roomy allowing plenty of space for swollen feet to expand
Neutral sole allowing a more natural, nimble foot movement

Cons: Not much cushioning
From another post:
"Once again, my Altra's took the terrain in stride. I've now run rooty, sloppy PNW trail; flat, loose, sandy desert; and now hard packed snowy trail. I have yet to be disappointed in them!"
The Barefoot Sisters, who I discussed in this post, were able to do about 35 miles per day on the Appalachian Trail in the eastern United States, and commented that they were unable to do much more because of fatigue in their feet. They also, however, hiked with packs that weighed up to 70 pounds, whereas Heather went so ultra-light that she didn't bring a stove.

There are a number of big variables here that I'm unable to quantify: I've not hiked the PCT myself, so I can't judge the relative difference in difficulty; it's hard to judge the difference the weight carried made, although it had to have been significant; and we can't underestimate the fact that Heather was alone, and had a lot of ultra-running experience. (The Barefoot Sisters had never done an over-night hike prior to hiking 2,100 miles on the AT. Heather is an incredibly experienced long-distance hiker and runner.)

For all those reasons, I think it's tough to attribute the 9 miles/day (25%) improvement over the Barefoot Sisters' daily hikes solely to shoes. But one can clearly understand that shoes weren't invented all over the world just for fashion. Correctly designed, they can provide a real boost to performance. But don't forget: the Barefoot Sisters hiked nearly 4,200 miles in their bare feet, with virtually no foot problems. In fact, their bare feet seem to have acclimated faster than Heather's shod feet did.

Altra has done a great job of creating well-designed footwear that add to your feet's capabilities. They deserve congratulations as well.

Friday, September 13, 2013

Science-Based Medicine on Gluten Sensitivity

Here we go.  A good article, overall.  Scott Gavura is one of the better contributors* to this group blog, but even he indulges in a bit of head-in-the-sand, blame-the-patient foolishness so typical of the medical profession:

"The current fad food “allergy” is gluten, a self-diagnosed condition in which gluten is believed to be some sort of dietary toxin – which must be distinguished from (1) the person with the documented anaphylactic wheat allergy and (2) those with celiac disease, an auto-immune response to gluten that requires absolute avoidance (but does not cause anaphylaxis if ingested)."
Well, there’s a third possibility, non-celiac gluten sensitivity, which has only recently been demonstrated to be a real condition.
Non-celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity.”

Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial.

A Controlled Trial of Gluten-Free Diet in Patients With Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function.

Spectrum of Gluten-Related Disorders: Consensus on New Nomenclature and Classification.
Gluten clearly meets the definition of a “toxin” ("Toxins can be small molecules, peptides, or proteins that are capable of causing disease on contact with or absorption by body tissues interacting with biological macromolecules such as enzymes or cellular receptors.") in people who have one of the gluten-related disorders. Gluten is a protein that causes not one disease, but several.

The blog Science-Based Medicine exists, in practice, to defend the medical establishment against Complementary and Alternative Medicine.

They're relentless in this attack, and many times it's merited. However, the CAM community is often much more open-minded than the establishment medical community, and the topic of non-celiac gluten sensitivity has been one of those cases. After years of pooh-poohing claims by patients that they had such a problem, lo and behold the medical community has discovered that in some cases they're right. Meanwhile the CAM community has been correctly counseling people who have a gluten sensitivity that they should be avoiding wheat. They've been correct. Credit where it's due.

Mr. Gavura, sadly, does not seem to be familiar with this fact, and that lack of knowledge severely undercuts the thrust of this post. And I'll say again, it's a good post as far as it goes, and contains some terrific information (I did not know, for instance, that benedryl is useless in case of an anaphylactic reaction. And his list of bogus tests looks valid to me.)

I posted the list of links above as a comment, I'll be interested to see if he incorporates this research into his post.

* A great tip I got from the article linked to above (written by Gavura) was to get retested for my penicillin “allergy”. I’d had a reaction to it once, and was thus diagnosed. Sure enough, I did a challenge at my allergist’s office: no reaction. I’m “officially” not allergic to penicillin. Thanks.

Friday, September 6, 2013

Is Science Broken? Part 6: Most Medical "Advances" Are A Waste Of Time And Money

From Dr. Eades on Twitter:
"After 65 yrs of [Random Controlled Trial]s, ineffective, harmful, expensive med practices are being introduced more freq now than ever."
He links to "How Many Contemporary Medical Practices Are Worse Than Doing Nothing or Doing Less?" [PDF] which opens:
"How many contemporary medical practices are not any better than or are worse than doing nothing or doing something else that is simpler or less expensive? This is an important question, given the negative repercussions for patients and the health care system of continuing to endorse futile, inefficient, expensive, or harmful interventions, tests, or management strategies. In this issue of Mayo Clinic Proceedings, Prasad et al describe the frequency and spectrum of medical reversals determined from a review of all the articles published over a decade (2001-2010) in New England Journal of Medicine (NEJM). Their work extends a previous effort that had focused on data from a single year and had suggested that almost half of the established medical practices that are tested are found to be no better than a less expensive, simpler, or easier therapy or approach. The results from the current larger sample of articles are consistent with the earlier estimates: 27% of the original articles relevant to medical practices published in NEJM over this decade pertained to testing established practices. Among them, reversal and reaffirmation studies were approximately equally common (40.2% vs 38%). About two-thirds of the medical reversals were recommended on the basis of randomized trials. Even though no effort was made to evaluate systematically all evidence on the same topic (eg, meta-analyses including all studies published before and after the specific NEJM articles), the proportion of medical reversals seems alarmingly high. At aminimum, it poses major questions about the validity and clinical utility of a sizeable portion of everyday medical care....

"...Despite better laboratory science, fascinating technology, and theoretically mature designs after 65 years of randomized trials, ineffective, harmful, expensive medical practices are being introduced more frequently now than at any other time in the history of medicine. Under the current mode of evidence collection, most of these new practices may never be challenged."
Emphasis mine. Read the whole thing.

Doctors are notoriously prone to jumping on the latest treatment bandwagon without waiting for valid scientific confirmation of treatment, and without following up to see if the treatment is found to be ineffective, or fraudulent.

Of course patients assume that they do. The logical course to take, therefore, since new treatments are untrustworthy, is not to take any. Take treatments that have been around for a few generations, ideally, since the effectiveness and the side-effects should be well-known, and you can double-check what your doctor is telling you to confirm that he knows what he's talking about.

If it's a life-or-death situation and a you want to take a flyer on a new treatment, fine; but be aware that that's what you're doing. For most medicines and most situations, that's not the correct approach.

(See my series Is Science Broken? and You Are The Long-Term Test for more, if you have the stomach.)

Thursday, September 5, 2013

Is Science Broken? Part 4: Studies Often Aren't Reproducable

“Towards Better Papers, With Real Results in Them.”

What a radical notion.

“This has to be a good thing. From the latest issue of Nature comes news of an initiative to generate more reproducible papers:

“From next month, Nature and the Nature research journals will introduce editorial measures to address the problem by improving the consistency and quality of reporting in life-sciences articles. To ease the interpretation and improve the reliability of published results we will more systematically ensure that key methodological details are reported, and we will give more space to methods sections. We will examine statistics more closely and encourage authors to be transparent, for example by including their raw data. . .

“…I hope that Science, the Cell journals at Elsevier, and other other leading outlets for such results will follow through with something similar….”

Indeed.  Science has slipped pretty badly, as the need for an initiative like this demonstrates.  Reproducibility, not “statistical significance”, is the sine qua non of Science, after all. 

At least some are trying to fix the problem.