Sunday, January 1, 2017

Defense within Offense: Training to not get hit

There is a lot to be said about striking defense, so please understand that all I'm going to do in this post is make a small point, it's not at all meant to be a comprehensive treatment of defense.

We're a couple of days removed from Ronda Rousey's massive loss to Amanda Nunes, who treated her like a punching bag and stopped her in 48 seconds, less than a year after Holly Holmes did something quite similar to the once-dominant champion.

For now, a great video of the fight and a lovely analysis of what happened can be found here on Dan Djurdevic's blog (I'm not confident that the video will stay up because of copyright issues, so watch it soon).

Nunes and Holm used somewhat different tactics, but what their approaches showed in common was that Rousey doesn't know how to integrate defense into her offense (or, even, show effective defense even when that's all she's trying to do).

What does that mean?

If you watch some MMA you can see a vast difference in skill levels between competitors. There are some fighters who are really good at protecting themselves while they are attacking. So while they are throwing kicks and punches they are still not completely vulnerable to counterattacks. This can be done in a few ways:

1. Keeping a good stance (weight centered, chin tucked) so any returning strikes can be absorbed efficiently.
2. Staying mobile, both keeping the feet moving (not simply planting the feet and swinging for the hills) and keeping the head moving while throwing combinations so that they are presenting a more difficult target to hit.
3. Maintaining good position with the off hands for defense - for example, while throwing a left jab, keeping the right hand near the jawline to provide some protection. The shoulder can be used in a similar way (acting as a shield for the chin).

Again, some fighters are good at this, and some (probably most) are terrible. No fighters do it perfectly all the time, but Jose Aldo is usually pretty good at it, for one example. Lots of fighters who are said to be good strikers are effective because their offense is overwhelming, but when they get into situations where their opponent isn't cowed and starts hitting back they take a lot of punishment.

Now if you get a chance to watch fighters during training sessions, often the ones who are worst defensively show that in training.

Watch a fighter when they practice their offensive techniques - striking the heavy bag or pads held by a coach. Some fighters are good at moving their head off line, slipping and weaving, while practicing their offense, but most fighters will just wing punches while their head remains in a completely static position.

The problem is that during a fight (or even a sparring session) it's really hard to develop new habits (having another person trying to hit you is distracting). If you are used to throwing kicks with your arms flailing at your sides for balance, then try to keep your hands up in protective positions while you spar, either your kicks will suffer or you'll start to forget the modifications.

To avoid this: always practice your offensive techniques the way you'd want to use them in a fight/sparring session. If you know you should keep your off hand near your chin when you punch, make sure you're doing that when hitting the heavy bag, even if the heavy bag isn't going to punch you back. If you know you should be pivoting and moving laterally while throwing long combinations in a fight, do that when you're hitting the heavy bag or the mits, even if your target isn't throwing back at you.

Maintain responsible defense even when you don't need it.

A short list of things to do (I'm sure there are more suggestions that could be added to this list):

  • Make sure your head does not stay in one place while you throw punches and kicks - keep slipping it into different positions.
  • Keep your hands in responsible defensive positions while kicking (and your off hand while punching).
  • End every attack combination by stepping back, pivoting, or moving away, not frozen in place waiting for a counter.
  • Keep a good stance - balanced, weight centered - at all times; don't 'reach' too far to land your strikes.
  • Have a coach/ training partner watch you occasionally to make sure you're not presenting yourself as a sitting duck while practicing your offense (sometiimes this is hard to notice yourself).
Overall, the idea is to maintain in your mind a strong awareness of keeping yourself hard to hit while your'e attacking, while by inclination I think most of us tend to think only of how to hit the other person when we practice hitting techniques.


Saturday, December 3, 2016

Creating a Caloric Deficit through Training

Your training sessions (and your overall training plan) should always have a purpose. For example, a training session might be for skill acquisition (getting better at a skill), hypertrophy (building muscle), strength development, endurance development, and so on. The more advanced you are, the more nuanced your purposes need to be (an advanced trainer might have sessions devoted specifically to power endurance; a beginner probably doesn't need to make such fine distinctions).

Having said that, a particular training session can serve several purposes at once. You can build skill while building endurance. The problem is, sadly, that the more purposes you have for a training session, the less effective it will be at any of them, especially as you become more advanced (beginners can get away with anything; if you could respond as a beginner for your entire training life you'd be a world champion with ease). Very careful planning and programming can help, of course, but there's an upper limit to how many qualities you can improve at once.

So if you want to get strong, and lean, and build muscle, and develop skills (say, in martial arts), you can do all of those simultaneously as you start to train, but the more advanced you become the harder it will be to advance all those qualities unless you rotate your goals (focus on one or two goals in each training session, instead of trying to hit them all every time you step into the gym or the dojo).

Now one potential purpose for a training session is to burn calories. Every workout will burn calories of course, whether it's your goal or not! Movement burns calories. But many people will not have that as a goal - if you're already lean, or just not interesting in losing fat, you might not care about how many calories you're burning in your workouts.

So who should have burning calories as a training goal? Mostly people who need to lose some bodyfat. For everyone else, you have two ways of looking at it: if you're underweight, you might need to minimize calorie burning so you can gain weight (assuming you have a hard time eating enough calories); if you're at the right body composition for you, then you might just ignore this topic altogether. Good for you; and by the way, I hate you. Nothing personal.

I'm sure there are ways to train that minimize calorie burn. I have never, for one second, thought about any of them. Because I am fat and could not imagine caring less. Read someone else's blog if you're worried about burning too many calories.

Here are the guidelines for us regular people who need to burn some extra energy:

1. Normal people can't exercise their way past a bad diet. Now we've all read stories about how much Michael Phelps or some other Olympic athlete can eat and still stay lean. Repeat after me: you are not an Olympic athlete (unless you are, in which case, welcome to Karate Conditioning!) You aren't training 6, 7, or 8 hours a day, every day. 

Normal people (meaning, people who are not professional athletes; people who have jobs or kids or whatever) can't exercise enough to make up for a bad diet. It is so much easier to consume energy than it is to burn it. I can easily eat a pint of ice cream or 4 donuts in a sitting, but "burning off" the 1000-2000 calories that food represents takes hours of hard exercise.

If your diet is pretty good (you're consuming an amount of calories close to your maintenance needs, or a bit less), then exercise can help create fat loss IFF you don't then go ahead and 'make up' for the calories you burned by eating more. And research shows over and over again that people who exercise and don't pay attention to diet don't end up losing weight, they just end up eating more.

So IF you are training in the hope of losing weight, you simply can't ignore diet and hope to be successful. You CAN use exercise as a supplement to careful control of your caloric intake to 'add up' to a caloric deficit.

2. Calories burned during the workout is pretty much intensity X time. Roughly speaking, how many calories you burn in a workout roughly depends on two things: how hard you work and for how long. A max squat or bench press (lifting as much weight as you can handle for a single rep) just isn't going to burn very many calories no matter how strong you are - yes, you'll burn more calories benching 500 lbs. for a single rep than you would benching 250 lbs. for a single rep, but you'd burn way, way more calories benching 250 lbs. for 10 reps. Doing a single 100 m sprint won't lean you out. However, things get more complicated when you repeat maximal efforts - benching 500 lbs for a single, repeated 10 times, will burn more calories than 250 lbs. benched 10 times in a single set and might burn more than twice as many.

3. Calories burned during the workout is only half the picture. If you read #2 above, you might think that the key to sustainable fat loss would be to do long medium intensity work. That is, go to the gym, hop on the elliptical or treadmill, and get your heartrate up to about 155 or 160 or however high you can stand it and keep that pegged for as long as you can. And that is, in fact, probably the best way to burn the highest number of calories in any single workout (you can try this for yourself - use some machine that measures calories burned, and do interval training, where you put in maximal efforts for 20 or 30 seconds, then rest, then repeat. Try it again another day where you hit a medium heart rate but sustain it for the full time. You'll see that you end up burning more energy with the sustained workout than with the intervals).

Now I'm not saying that approach absolutely won't work. But it isn't the best way to get results. If you try to lose fat by heading into the gym, hopping on the elliptical, and jacking your heart rate up to 165 for 50 minutes, then repeating 4-5 times per week, you will definitely burn calories. But you probably won't be maximizing your overall fat burning.

Why not? Two reasons. First, that kind of medium intensity, long duration work will push you way into a sympathetic state. It's a lot of stress for your body, and unless you're very resilient that will lower insulin sensitivity, increase inflammation, and generally have a lot of effects that will prevent you from achieving your physiological goals.

Second, while that workload is kind of a grind, it isn't intense enough to force your body to make energetically expensive adaptations. You won't build new muscle, or at least not much, from that (at least not as well as you would from higher intensity, shorter workouts). Which leads us into #4...

4. Maximize post-exercise caloric burn with highly varied, highly intense workouts. The thing about low or medium intensity workouts is that you adapt to them really quickly. And that's fine, except for this: adaption requires energy. If you do the kind of workout that traumatizes your body, makes you sore, damages muscle tissue, etc., then your body will have to expend energy to repair that damage and to supercompensate for it. In other words, not only will very intense workouts build muscle, which leads to a higher basal metabolic rate and contributes to fat burning, but the very act of repairing and building muscle takes energy

If you're relatively new to exercise, you might get that kind of muscle damage/ repair going with just about anything. But if you're in relatively good shape, you're going to have to work hard to prompt those kind of adaptations. And moderate intensity, long duration exercise isn't going to cut it.

You're going to have to work at the kind of intensity that you simply can't maintain for 45 minutes. We're talking HIIT, hypertrophy workouts, something more intense than a treadmill at 10 degrees elevation and 3.5 mph.

And, to really promote adaptions, you can't just do the same thing every time, over and over again. You have to frequently switch exercises, rep schemes, and loads, to continually force your body to adapt. Think about how sore you get from an exercise you've done every week for 3 months vs. the exercise you've never tried before - which one do you think is stimulating more energy cost in repair and growth?

5. You can only handle a limited amount of varied, highly intense workouts. Ha! You read #4 and you're thinking, 'great, I can do super hard 20 minute workouts all the time and I'll get super lean and jacked.' That can work, for some people, of course. If you have a metabolic and hormonal profile that lets you recover from those workouts quickly, and repeat them often, then this might be enough for you (this usually applies to young, healthy people, especially males). But for many of us, the recovery is slow (meaning, we can't do those workouts more than 2 or maybe 3 times a week without getting wrecked), and the stress is too much (meaning, those workouts shove us so far into the sympathetic side that we end up with high inflammation, poor sleep, and a host of other ill effects). So your personal mileage may vary in trying to get lean on HIIT alone.

6. If you've 'maxed out' your load of high intensity training, you can probably manage to add some low intensity along with it. Let's assume that you're doing 2 or so really intense workouts every week. You might want to do a third, but you start to feel stressed and burned out from that much really hard work (maybe you're older, have a hard job, are in less than perfect health, have kids, whatever). But two workouts a week, even if they're relatively intense, aren't going to burn a ton of calories. Where can you go from there?

If you added long, medium intensity workouts (160 heart rate on a treadmill), you'd probably just recover even less from your 'hard' workouts, add to your stress, and end up miserable. Yes, those workouts would burn plenty of calories, but they might mess you up in all those other ways.

BUT if you instead do more training in the lower intensity ranges, say below 130 beats per minute for aerobic benefits, or even lower, say leisurely strolls around the neighborhood with your dog, you can create a larger energy deficit without suffering too many of the problems associated with being over stressed.

TAKEHOME MESSAGE: To create a larger energy deficit, do very high intensity training a few times a week - two or three. Vary the exercises, pace, and so forth, so that you are constantly adapting to the varying stresses. Then fill in the rest of the time with low or very low intensity work, the kind that doesn't even leave you out of breath, to burn extra calories.

Friday, November 18, 2016

Intensity is the Key to Conditioning

I've been experimenting a lot lately with lower intensity training, as I've written about here and here, among other places.

Now intensity can mean many different things in different contexts - like percentage of one rep max when lifting weights, for example. From a conditioning perspective I mean something more like heart rate. I think of low intensity as any activity that keeps my heart rate lower than 140 or so beats per minute, or averages around that but never goes much higher. Jogging, not sprinting. If you do intervals in that zone, they have to be short with decent amounts of rest in between - maybe bursts of activity lasting no more than 5-10 seconds.

There was a time when I thought such work was useless - that was a big trend in fitness towards the early part of this century. There was a sort of general overreaction to the old paradigm, which placed a lot of importance on doing lots of low intensity training. Just as the proponents of doing lots of low intensity work were wrong, I was wrong to say it was useless.

The thing is that low intensity training (again, keeping heart rate at or below 140 beats per minute, more or less) does result in some adaptations that are useful. You'll increase your cardiac stroke volume, which will increase the rate of recovery from training, and make you more fit for daily life (activities like light hiking, climbing stairs, etc.). That will probably help you recover faster in between workouts, which will ultimately lead to an increase in how much training volume you can withstand. all of these are good results, and important to martial artists.

The problem/concern/thing to keep in mind is that low intensity training really doesn't do much to improve your ability to do high intensity exercise.

To put it a little more technically, work done that doesn't involve the lactic energy system won't result in improvements in the lactic energy system. And low intensity work isn't very lactic.

This all came to a head for me the other week. I've been doing, as I said, mostly alactic and aerobic work - work that kept my heart rate in the lower range. When I did strength training, which was more intense, I was doing very short sets (although a lot of them), which again doesn't really tap the lactic energy systems, even though it's been doing interesting things for hypertrophy.

That's been my training modality for probably six or eight months.

Then I joined a gym.

First, a personal trainer put me through a short but fairly intense workout - short circuits with weights, sled pushing, that kind of stuff.

Now I'm fairly strong - I've been doing strength training - but my body's ability to handle those longer sets is completely gone. I'm strong enough to push the sled hard, but I'm not able to handle the lactic acid buildup from doing so.

Then I started doing kata for the first time in a year.

Now kata, unlike the microsets I've been experimenting with, are definitely long enough to put some serious demands on that lactic energy system. Kata in my style take roughly 45 s to a couple of minutes, rarely less than that, certainly not 5-10 seconds.

And. They. Kicked. My. Ass.

What's the take home?

Aerobic endurance training, by itself, will NOT get you in shape for more intense activities. I've said this before (but sometimes it seems I need a reminder).

If you want to get in shape for sparring or kata practice some (or most, but not all) of your endurance training has to be at an intensity at least as high (preferably higher) than your sparring or kata practice.

And by intensity I mean the heart rate that results from the training.

HIIT (High Intensity Interval Training) is probably the best way to do this. I've written up HIIT protocols before on this blog, I'll add some more soon.

Low intensity training like the SVT I described before is good for you, will make you healthier, help you recover between workouts better, and improve your quality of life, but it will NOT get you in shape for serious work. My aerobic fitness is higher than it's been in a long time, but my ability to handle lactic work is shot.

The good news is that lactic conditioning comes fairly quickly. If you're in decent aerobic shape, a few weeks/months of HIIT will make you significantly better at high intensity training. It's hard work, and very unpleasant, but the results come quickly (unlike strength training, where it takes years to make real progress).

So wish me luck as I pull out the old dumbells and start up my Tabata -style One Arm Dumbell Power Snatch workouts again.

Thursday, November 10, 2016

What I've been listening to (Podcasts)

I'm a big fan of podcasts, to listen to during steady state cardio, while driving, and sometimes while working (I work from a desk and have relatively little verbal interaction with anybody while working, so the podcasts are rarely interrupting, say, a phone call or a conversation).

There are podcasts on every topic under the sun, but I mostly listen to podcasts related to martial arts or fitness/nutrition.

I tend to think of podcasts I like in two different ways. First, how much information do you get - and by information I mean the kind of stuff you might learn from a textbook or training manual. Second is how entertaining or motivational it is - how funny are the hosts, how interesting are the stories involved.

There's nothing wrong with a podcast that aims to be primarily entertaining, just as there's nothing wrong with one that can be dry but contains lost of information.

Also keep in mind that these vary in what kind of content they include. Iron Radio is really for strength athletes - it's about getting big and strong. If you're not interested in that, it won't be for you.

I'm going to include all my regulars, with ratings based on both parameters and a little writeup.

One other note: All of these podcasts are free. Some have ads. Some have patreon support enabled, which allows you to easily make regular contributions to the shows, but you don't have to do so (I personally give them money whenever I can).

Martial Arts:

Entertainment Value: High
Information Content: High

Hosts Connor Ruebusch and Patrick Wyman analyze fights, mostly discussing MMA with a few forays into boxing and even fewer into kickboxing. All the analysis is geared exclusively to combat sports, so if all you care about is self defense/streetfighting this isn't the place for you.

Both hosts are personable and fun, so they engage in some entertaining banter and occasionally disagree, making this an easy and fun listen. But it's the quality of the analysis where this show really shines. The hosts consistently analyze fight sports from a position of understanding the styles of various fighters - outfighters, pressure fighters, counterpunchers, etc., complete with a lot of discussion of how fighters of each style can make adjustments to match up better against their opponents.

Fights Gone By (Jack Slack)
Entertainment Value: Medium/Low
Information Content: Very High

Jack Slack is by far the best and most interesting combat analyst in the game today. Like Heavy Hands, focuses mostly on combat sports, but he will dip his toe into analysis of other topics, like history of combat techniques and even karate style sparring analysis (that's more in his writings than in his podcast). You should definitely be reading his articles for Fightland.

He podcasts by himself, and has a rather dry tone, but the content is absolute gold and very, very technical. They're available on YouTube, but there isn't a ton of visual content, so don't sweat it too much if you can only listen.

Entertainment Value: Medium
Information Content: Medium

Steven Wright, a high level MMA striking coach, podcasts about his first love, kickboxing (both Muay Thai and European style). It's usually just him, though he occasionally has an interview scheduled.

I put the information content as medium because the show isn't very technical - you're not going to learn how to be a better kickboxer from listening to it. It's (by design) really just coverage of the sport, and Steven excels at covering each week's important bouts, their ramifications, and so forth. For what it's trying to do it is great, but if you don't care about the sport of kickboxing give this one a pass.

Entertainment Value: Low
Information Content: High

Iain Abernathy's podcasts come across like a guy reading a blog post he's written. He seems like a lovely fellow, but it isn't sparkling entertainment.

What he does deliver is, unlike the previous three podcasts, is information related to traditional karate practice. He focuses a lot on bunkai (applications taken from kata), self defense, some historical analysis of karate, and some philosophical posts about karate. Very informative if you're interested in that stuff, even if you don't agree with everything he says.

Honorable Mention:
Applied Karate (Des Paroz)
Entertainment Value: High
Information Content: High

Des hasn't put out a new episode in almost 5 years, but you should listen to the first 14 episodes if you have a chance. Des interviewed some really high ranking, important karateka (and me, though that apprently killed the enterprise entirely.) Super valuable for the history contained there, and great to listen to if you care about the history side of martial arts.

General Fitness/Nutrition:

The Fitcast (Kevin Larrabee)
Entertainment Value: Very High
Information Content: Medium

This was one of the first podcasts I listened to, so it holds a warm place in my heart. It's been running for 10 years, but the quality has really gone up dramatically in the  last 2. I don't recommend going back before episode 300 (it's up to 412 as I write this).

The show is free, though patreon supporters get early access. Kevin interviews leading professionals in the strength and fitness industry. The discussion tend to be more about his guests' personal history and experiences in the industry, and less technical, with occasional exceptions. He does get deep into motivational/self help topics on occasion, so if you like that you'll love the show.

Entertainment Value: High
Information Content: Medium

I love this show more than I can say. It's more about strength athletes (powerlifting, strongman, bodybuilding, weightlifting), so the information tends to be more specific to that group. Three out of the four regular hosts are just exceptional people - if I had to get stuck on a desert island with a group of people they might be my top choices.

A lot of the 'information' is actually the opposite - rather than delving into complex periodization programs or the latest in edgy supplement/nutrition notions, these guys emphasize the basics; lift heavy but intelligently, eat big, get strong. A lot of it is very motivational, and moreso, the guys are just so much fun. It's like being a fly on the wall of a locker room full of dudes who just finished a high level strength competition.

Entertainment Value: Medium
Information Content: Very High (sometimes maybe too high)

Robbie Bourke, my personal hero, loves training and nutrition and it shows. He interviews high level strength coaches and physicians in the field of human performance. His show is super technical, and it's a place where you'd go to get the nitty gritty details on why a specific kind of endurance test might be suboptimal for a particular population of athletes but not another one.

This is mostly stuff applicable to high level athletes in a field sport, but there real nuggets in there good for anybody who trains. Every episode is super interesting, although this is more on the "like someone reading a textbook out loud" end of the spectrum (but not that bad).

Entertainment Value: Medium
Information Content: High

A recent addition to my list, this podcast is mostly about (wait for it...) nutrition, but covers other issues in strength training as well.  Less about personal stories and more about technical issues related to nutrition for health and for performance. Also hits on combat sports topics like nutrition for weight cutting, if you like that sort of thing.

Entertainment Value: High
Information Content: Medium/Low

A little more over the top entertainment wise (the hosts joke around a lot - out of this list, this is the podcast where you're most likely to hear screaming and threats of physical violence) that sometimes hits on some serious topics.

I'm sure there are other great podcasts out there, but I can recommend these to start with. I wish I had more on the list that had to do with tradtional martial arts.

Please share to comments if you have an podcasts to recommend!

Friday, September 2, 2016

The Importance of External Measurements

People who give fitness or fat loss advice often tell their readers and clients not to pay too much attention to the scale when assessing their progress. This is good advice. Sometimes your exercise/diet program is building muscle, so even though your scale weight either doesn't change or perhaps even goes up, your body composition is improving dramatically.

Then again, sometimes your scale weight stays the same or goes up because your weight management program is failing, your cheat weekends are overwhelming your metabolism, and your exercise is not, in fact, burning 1,000 calories an hour.

The advice to not use the scale is usually followed up with one or two alternatives. One is to gauge your progress by the mirror. This might work for some people, but not for me, and I suspect, not for most. It's too easy to let your mind play tricks on you with the mirror. You're comparing an image, the way you look at the moment, with your memory of what you looked like weeks or months before, and trying to compare them. If you have actually gained some muscle it can be even harder to make a good comparison. Adding a couple of  pounds to your shoulders can really make it look like you lost a bunch from your waist, even if you, in fact, didn't.

I'm sure there are some people who are objective enough to judge themselves just on their appearance, but a better metric is something more objective: seeing how your clothes fit. If the waist of your pants is tighter, you've moving in the wrong direction, even if the chest and arms are also tighter.

Another popular claim people make is that some lifestyle change gives them "tons of energy." My question is always, "how do you know?" If you think some new habit is increasing your energy levels, make sure by tracking some metric. Maybe look at how many naps you need during the week, or how often you hit the snooze button, or how many workouts you skip (or don't skip) because you're just too tired. If those numbers change, you're onto something. If they don't, then you might just be fooling yourself.

I'm not bringing this topic up at random. I let myself slide quite a bit in body composition over the last year or so, eating out at restaurants two or three times a week instead of once, joining the kids for a special ice cream treat every week instead of every month, and generally not doing enough exercise to overcome my very sedentary job.

It took a trip to the doctor and a bodyfat analysis (plus some blood tests that came back saying "you should already be dead") to wake me up.

And, in retrospect, my clothes don't fit as well as they used to. I'd gotten into the habit of not wearing certain pants, and looking back I think it's because they're a bit tight. It was a gradual change, and items do phase in and out of my wardrobe regularly, but I was avoiding certain clothes probably in part because they made me think I was doing better weight-wise than I really am.

I suspect that the same kind of problem creeps in with many martial artists. I don't mean that they're having problems with weight management necessarily, but of gauging their progress in their skills. I suspect that many of us reach periods of stagnation with our movement quality, where we might go months or years learning new forms or techniques but not really getting better at how well we do the basics.

The solution?

There's no single answer, but I really think (and I've mentioned this before) that every martial arts school should have a video camera - not necessarily the highest quality - and some kind of setup where they standardize the position (the camera goes here, you stand there, that sort of thing). And every practitioner should videotape themselves doing a couple of kata - maybe always a very basic one, then one or two more advanced - perhaps every 6 months.

I've been saying this for years and haven't done it. Next year I'm going to definitely invest in a camera and start keeping a library of records of my movement.

You should too, and let me know how it goes.

Tuesday, August 16, 2016

Worried Well, Subclinical Sickness, and your Right to Seek Health

[This isn't a post about psychiatry, but I'm going to start there... please bear with me.]

I'm not a psychiatrist, but I dated one for a year and a half, so I'm highly qualified to talk about all things having to do with psychiatry.

Psychiatry is especially interesting to me because psychiatry has a long tradition of acknowledging that its field is hard to define. What constitutes a psychological illness, exactly? The question was considered difficult enough that the American Psychiatric Association publishes a book (the DSM) to list the "Mental Disorders," and disorders are added and removed from the list with each revision (homosexuality being a particularly famous example of something listed as a disorder in earlier revisions, then removed).

While there is plenty of controversy around the DSM, I'm sure there are also plenty of core disorders that we can all agree 'count' as mental disorders, mental conditions that make a person an immediate danger to themselves or to others. But there are equally lots of mental conditions that we'd mostly agree are on the opposite end of the spectrum. Suppose someone is feeling anxious because of a difficult job situation, and has some trouble sleeping. It would be strange to call that a mental disorder, or to say that person is ill. Yet I also think we'd agree that it would be nice if that person could get some help.

Luckily, the psychiatric community has a term (which I love) for people who might want some 'help' with their mental condition, yet don't qualify as actually having a full blown mental disorder - they're called the "Worried Well."

What I love about this term is that it expands the scope of practice of practitioners in the psychiatric community to those who might not have diagnosable mental disorders. It says, "you don't have to be REALLY sick in order for us to try to help you."

I don't mean to suggest that this notion is altruistic. Obviously, psychiatrists and psychologists don't want to restrict themselves to patients who fit in to some category in the DSM-V, they need to make money. But it's still a valuable notion, that nearly anybody experiencing psychological suffering, even if it's not DSM-V worthy, can legitimately seek and possibly receive help.

For a variety of reasons, some historical and many economical, many (not all) non-psychiatric physicians are less likely to acknowledge, treat, or research concerns that don't meet the criteria for an actual diagnosis. I like the term subclinical to refer to these things.

What do I mean by subclinical?

Suppose someone feels tired and worn out all the time, but not to the point where that person can't hold down a job or fulfill their responsibilities. What's a typical doctor going to do about it? Probably run a bunch of tests to rule out things like cancer, anemia, and a host of other disorders that count as an actual diagnosis that can be checked off on a electronic medical record or submitted to a billing company. What if those tests come back negative? I'm sure many decent doctors would make some generic recommendations, like telling that person to sleep better or improve their diet, but generally speaking there won't be any aggressive pursuit of any remedy.

Have a lower libido then you had as a teenager? Your physician might test your hormone levels, but if they come back within the normal reference range you're probably out of luck. You might get a casual recommendation to try some herb, but rarely more than that. If you're older and have minor aches and pains many physicians will just shrug and tell you to make the best of it.

I'm not blaming physicians. They need to put something on the bill they send to the insurance company to explain why they treated you, and "feeling meh" is not a box you can check (I looked).

There's a trickle down effect from this. Since physicians aren't really in the business of treating issues that don't qualify as an actual disorder, they're not really interested in doing or reading any research on the topic. And, to be honest, it's probably a lot harder to research "causes of feeling not too great," simply because feeling not to great is very hard to measure and quantify.

Things are improving in some ways. I know there are tons of great doctors who try to help any way they can. Doctors who specialize in functional medicine often seem to address these subclinical concerns more seriously. I'm sure that in other scenarios where you are willing to pay out of pocket for treatment you can get a physician to take these things seriously. But in my experience there isn't a very broad middle ground between the physicians who will treat what your insurance will cover and the very expensive ones who will do whatever you ask for because you're paying through the nose for it. And even if you find the physicians who will help you with your subclinical issues, they don't have the same body of research to fall back on that they do for diagnosable disorders.

But without the guidance of a physician and the medical establishment, most lay people end up turning to the internet, or their personal trainer, or the salesperson at GNC, or their hairdresser, or whoever, to find 'solutions' to what ails them. And sometimes that information turns out to be helpful, and sometimes, not so much.

At this point, if you're still reading, even if you agree with what I've said, you might be wondering what the point of the article is. Well, there actually are several.

1. Keep in mind that medical research is aimed at the clinical, not the subclinical, in what it measures and how it evaluates results. So research that aims to determine whether gluten (see what I did there?) affects health can't, and won't really try to, evaluate subclinical effects. If you see some article headline claiming that, "Gluten Consumption Doesn't Impact Health!" they don't really mean that gluten doesn't make people feel slightly worse, because they didn't look at that. They only looked at whether gluten led to an increase in something diagnosable. The gluten they were feeding their subjects might have  made them all feel a little bit more meh (or blah if you want another adjective), but the researchers weren't asking that question.

2. You have a right to seek help for your subclinical symptoms. Ask your doctor about them, you might be pleasantly surprised. But even if your doctor won't help, try things on your own, like dietary changes, exercising more, more or less fiber, whatever (don't be stupid, don't try just ANYTHING), because you have a right to try to feel good. Just because some ailment or issue doesn't warrant major medical intervention doesn't mean that it's not real or that it's not meaningful.

3. If you can find a doctor willing to prescribe meds off label or seriously investigate your issues, try to do that. It might cost you something out of pocket; you have to decide for yourself how comfortable you are with that, and how much money you've got. [Note: there is room for a debate about how this sort of treatment ought to be paid for, in a perfect world, but I'm not interested in having that argument here.]

4. Other people might dismiss your concerns. I can't tell you how often people have suggested that 'avoiding gluten only makes sense if you have celiac disease.' We don't have a culture that emphasizes taking care of ourselves (for example, we don't value getting enough sleep, and we admire people who seem to function well on very little sleep, even though sleep is a key factor in maintaining good health). This is especially true of aging related issues. Many, many people will look askance at someone who wants to maintain their physical fitness into their later years. I'm not telling you to argue with those people, but stick to your course. If you want to improve your quality of life, do it. You don't have to have an actual disease to want to improve your health. And the fact that others approach their declining health and fitness with a fatalistic attitude doesn't mean you need to.

Many of us function suboptimally our entire lives, and we ALL lose functionality as we age. Not all, but many of those conditions can be treated, some by readily available lifestyle choices, some with prescription medications. If you're not operating at a level that makes you happy, change something! Your situation might not be fixable, but I bet you can feel better if you make the right choices.

And if you're looking for a good place to start when making those lifestyle changes, consider taking up a martial art!

Friday, July 15, 2016

Why We Binge Eat (maybe)

I've been chubby my entire life. I once dated a fairly slim woman whose mother was equally slim. One day, while talking about pie, she (the mother) wondered why anybody ever overeats pie - she asked, "why don't you just have a single piece of pie, then stop?" She legitimately didn't understand. Don't worry, I resisted the urge to punch her. It was hard.

Not everyone who trains in martial arts needs to lose bodyfat, and not everyone who needs to lose bodyfat has a problem with binge eating, but I suspect that a significant number of us belong to both groups. I personally have had problems with binge eating for my entire life. I'm the type of person who usually consumes fewer than 3,000 kcal/day, but I can easily scarf down 2,000 + kcal in a single sitting and still find myself tearing through the refrigerator looking for more food. I've eaten half gallons of ice cream in a single sitting. So I've thought about this topic quite a bit.

There are a few odd things about binge eating.

  • Most binge eaters do NOT binge every time they eat, but only on certain occasions. So it's not as simple as saying that for certain people food is "addictive" or that they can't control their food intake.
  • Binge eaters will repeatedly binge despite the unpleasant immediate (upset stomachache) and long term (unwanted weight gain) side effects.
  • Binge eaters will often eat long past the point of enjoying the eating experience - the food no longer tastes or feels good to eat.
  • Food does not seem to have the kind of chemical impact that might explain this behavior, the way illicit drugs or alcohol do - we don't see the kind of dopamine spike from donuts that we get from snorting cocaine, and eating doesn't in itself impair judgment (making us more likely to continue eating) the way psychoactive chemicals (like alcohol) do.
So why does this happen? It seems counterintuitive that people would engage in this sort of behavior, yet many of us do. Over and over again.

I've always had a few hypotheses about binges (these are not original to me). First, binges were the result of out of control blood sugar - if our blood sugar got too high ("spiked") and insulin levels rose too high, the excess insulin would drive blood sugar down too low, triggering a binge. In other words, low blood sugar triggers a binge. Another hypothesis was that if we dieted too long or denied our favorite foods for too long a kind of psychological pressure would build up, resulting in an inevitable binge, like a volcano erupting. Third, binges were the result of some nutritional deficiency, the body's way of desperately trying to acquire some micronutrient that wasn't present in the diet.

I was listing to my new favorite podcast, Sigma Nutrition, and in episode 23 the host interviewed a man named Marc David who works in the field of nutritional psychology. I highly recommend listening to the entire show, but at one point Mr. David suggested a cause for binges that really resonated with me.

Please remember the important distinction between the sympathetic and parasympathetic nervous systems - the sympathetic is activated during fight or flight situations, when you are stressed or anxious. The parasympathetic is activated when  you're relaxed and feeling safe and secure. The sympathetic directs blood away from the gut and into the limbs (so you can run or fight), the parasympathetic directs blood back to the gut (so you can digest your meal) and lowers blood pressure and overall stress.

Now obviously a big meal puts an unusual stimulus on the body - not the kind of stimulus that would make us need to run or fight, but a stimulus that forces the body away from the sympathetic system and towards the parasympathetic. In other words, really overeating signals your systems that you need more blood in your gut, not less, to digest that meal. And that can only happen when the sympathetic system is depressed and the parasympathetic system is activated.

In other words, overeating leads to an immediate, short term activation of the parasympathetic nervous system, which makes you relaxed, calm, and feeling safe and secure.

Now, if you're a binge eater, think to times when you binge eat. I'm going to bet you anything that most binges are triggered by stressful situations, times when you're unconsciously seeking to relax and de-stress, times when life has pushed you into the anxious, jittery end of the parasympathetic-sympathetic axis. 

In other words, for at least some binge eaters some of the time, binge eating might not be the result of a craving for food. It is, instead, the result of a craving for deep relaxation.

Why does it matter why we binge eat?

The approach we take to avoid binge eating has a lot to do with what we believe causes our binges in the first place. If you think that your binges are the result of out of control hypoglycemia (low blood sugar), you're going to try to avoid binges by altering your diet to keep your blood sugar normalized (which isn't a bad thing in itself). However, if your binges is really caused by stress, the blood sugar regulation might not help, and then you're both demoralized and failing to control your binges.

If you think your binges are caused by micronutrient deficiency, you might attempt to stave them off by eating a nutrient rich diet, or carefully going over food logs to find the 'thing' you're missing. Again, this would be doomed to fail. And if you're convinced that binges are caused by some psychological pressure from food deprivation, you might schedule 'cheat' meals (or cheat days! cheat weeks!) in a vain attempt to alleviate that pressure in a somewhat controlled way.

And this, I think, is why so many binge eaters fail to control the binges. 

However, if Mr. David's suggestion is correct, and binges are the result of a search for parasympathetic stimulation, what could we do to address that?

Maybe the way to stave off an oncoming binge is to do something deeply relaxing. Take a walk in the woods. A bubble bath. Meditate for 20 minutes. Watch a comedy show. Whatever you do to de-stress.

This is, of course, easier said than done. Please don't punch me for suggesting that you can overlook that pint of Ben & Jerry's in the freezer by meditating. But it can't hurt to try, can it? 

One 'trick' I use is to promise myself the thing I'm craving... but only after some intervention. I'm not denying myself the ice cream, I'm promising it to myself, but only after the walk, or the meditation. Then, once the intervention is over, re-evaluate and you might be okay breaking that promise and skipping the binge.

Take home point: being aware of your position along the parasympathetic - sympathetic axis may help you alter hard to control behaviors, like binge eating, more efficiently.

And if all else fails, please remember that your binge has not ended the world. Get right back on the healthy eating horse and waste as little time in self recrimination as possible.