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Running on Empty

Planet earth really should be called the water planet. 71% of the earth’s surface is covered with water. Also, when you explore land, air, and sea, it becomes quite obvious that perhaps the most interesting world lies under the water. An ecosystem so diverse, expansive and fascinating.

It should be no surprise that water has an even more amazing impact on the human body where well over 50% is made up of water-moreso for some parts (blood 90%, brain 85%, muscle and skin 70%). It is no wonder why you can go many weeks without food but can survive only a few days without water. Water is an essential nutrient for optimal function of the human machine, yet most of us (estimated 75%) do not get enough. Most of us spend the day mildly dehydrated, approximately one quart low, something not good for your health.

Water is important to virtually every organ system in the body. It carries nutrients through the system and aids in purification, kidney function, bowel function, joint lubrication, cooling and temperature control mechanisms, and biochemical activity at the cellular level.

“Unlike an automobile, we don’t have an Empty/Full gauge and a red light that comes on when out tank is low”

Unlike an automobile, we don’t have an Empty/Full gauge and a red light that comes on when our tank is low. Thirst is usually the first sign that you are running dry but that sensation does not kick in until you already low on H20. Not a great alert system. So you need to stay ahead. Some signs of mild dehydration include daytime fatigue, dizziness, headaches and muscle aches or weakness. A 2% drop in hydration can result in problems with short term memory and concentration. If you exercise regularly you are even more prone to chronic dehydration. Air Conditioning robs your system of fluids as does air travel.

Water is also important for weight control. The body sometimes confuses thirst for hunger, partly because the thirst center is very near the hunger center in you brain. The result, if you are a little dry, you eat-not great for weight control. This is one reason to drink lots of water when you are trying to lose weight. You can often fool the hunger center. Even mild dehydration can slow down your metabolism also leading to weight gain. Water is the perfect weight-watcher beverage-zero calories, and if you drink enough, especially cold, it has a calorie burning effect! A great way to curb night snacking is to first brush your teeth and then drink a full glass of ice water-good for hunger pangs.

Also all beverages are not created equally when it comes to fluid replacement. Coffee, tea and sodas with caffeine don’t count. In fact they create, through their diuretic effect, a net fluid loss to your system, thus increasing dehydration. Also, they are often filled with naked calories (no nutritional value). Sports drinks are useful if you are exercising over one hour especially in hot weather or involved in endurance activities. Proper fluid intake and hydration is the key to preventing illnesses such as heat stroke in athletes especially in the summer months. This is a totally preventable cause of death in young athletes. Learn more about the science behind hydration from the Gatorade Sports Science Institute.

Your goal it a minimum of 8- eight oz glasses (2 quarts) of water a day. Try to get it in earlier in the day so that you are not visiting the bathroom all night. There may even be added health benefits to drinking a full glass of water upon awakening in the AM. A twist of lemon or lime removes some of the monotony. Bottled water has become the rage with over 700 choices worldwide and competition heating up for your dollars. It is a $7 billion industry in North American alone and more in Europe where they’ve been imbibing for years. There are even designer brands with vitamins, supplements and even oxygen. Adds for Fiji water remind us that the word SPA comes from the Latin “Salus Per Aquam” which means “Health By Water”. There are indeed touted purity and health benefits, none proven scientifically but I must admit that they do seem to taste better and go down a little smoother, although I usually stick with my home grown Eau d’ faucet. There are even water taste-testing competitions (International Water Tasting Awards) something I tried many years ago with my sister Linda (an early adopter water snob) to see if she could actually tell the difference between Philly tap and French bottled water. I’ll never tell the results!

If you are going bottled, be prepared to get out your wallet, especially in some restaurants where waiters are pressured to sell more (at 300-500% mark up). Some fancier restaurants and hotels even have “water list” menus and a water sommelier, an aqua expert, to help with your choices, before you take the plunge.

Spring, bottled or tap, to me is less important than being sure that you get enough. To learn more including the difference between purified, artesian, mineral, sparkling, spring and other waters, and even calculate your own fluid needs, checkout bottledwater.org or get your feet wet with these Fun Water Facts for Kids.

So, camel-up. Head over to the water cooler, not only for small talk, but also for big health gains.

Originally published on the Huffington Post. Reprinted with permission from Dr. DiNubile.


Nicholas DiNubile, MD is an Orthopedic Surgeon, Sports Medicine Doc, Team Physician & Best Selling Author. He is dedicated to keeping you healthy in body, mind & spirit. Follow him MD on Twitter: twitter.com/drnickUSA

Are You BUILT TO LAST?

Lately I can’t go to the gym without someone coming up to me looking for advice because in their efforts to remain fit and active they have hit a roadblock. Something hurts- a sore knee, achy shoulder or bad back that goes out more than they do. Ditto for my practice where I have seen a significant increase in exercise related ailments. I should give out orthopedic frequent flyer miles.

I’m an orthopedic surgeon specializing in sports medicine who has also had a life long interest and commitment to exercise. What I have learned over the years is that the far majority of exercise related ailments are preventable with some simple measures. That is why I wrote FrameWork- Your 7 Step Program for Healthy Muscles, Bones and Joints, as well as the FrameWork “Active for Life” series (Rodale Press).

Exercise is essential for maintaining optimal health, and being sedentary is just not an option, yet many individuals run into difficulties in their quest to be fit. Just about anyone can get into trouble, from young, fit and seemingly indestructible, to older and somewhat “beat-up”. We all bring “weak links” to the gym or out on the field. I‘ve learned this from working not only with my sports medicine patients but also athletes at the highest levels, including professional and Olympic. I have also learned the harder way, personally. A high school football injury that came back to haunt me, and a more recent low back issue.

The key is to find those “weak links” before they find you!

The human body does, and will, breakdown, especially when often pushed to the break point. Some of us are more vulnerable than others. And many of our “weak links” are of our own making. Workouts, activities or sports that leave imbalances in your frame, overuse, inadequate recovery, and so much more, mostly preventable factors. Musculoskeletal ailments have surpassed the common cold as the #1 reason people seek medical care in this country. It is no wonder for many, that workouts can be a challenge. Also, as Arnold Schwarzenegger so wisely said in the FrameWork forward, “I have really come to appreciate how the body is a dynamic, ever-changing structure that is different at different times. At 30 you need a different approach to fitness than when you were a teenager”. His workouts have evolved with him and even the Terminator himself has had to visit the repair shop. So, how can you be more durable, with less risk of breakdown? FrameWork offers 7 easy steps that can benefit everyone, young and old.

In FrameWork, I outline a 7-Step comprehensive plan for optimal health and durability. In Step 1, a unique self- test (take the interactive on-line version of the self-test) asks the question “are you built to last?” and finds your individual “weak-links” (we all have them). These “weak-links” or points of vulnerability may be old injuries or ailments, suboptimal nutrition, genetics, lifestyle, workout design, mindset and more. They are like hidden land minds, just waiting to be found, waiting to rear their ugly heads and put you on the sidelines, rather than in the game.

Step 2 thru 7 allow you to customize a program for your unique frame (based on the self-test and your own history) focusing on balanced workouts, frame-friendly nutrition and the important role of recovery and mindset. The program combines healing and restorative methods from the worlds of rehabilitation, martial arts, and yoga in a way never presented before. A “troubleshooting” section teaches you how to prevent, treat and safely work (out) around the “Top 20” sports medicine ailments from tendinitis and knee problems to back pain and pinched nerves. I also offer an insiders view of safely navigating the healthcare system, including a look into the very promising future for those with stubborn musculoskeletal issues. Most importantly, I use stories, drawn from my experience treating many wonderful athletes, entertainers and my many patients to help you better understand, and listen to your body- so that you can extend the warranty on your frame and it will be there for you when you go the distance. Remember, longevity and durability, two sides of the same optimal health and aging coin, are very different. We are certainly living longer and better, but without durability, problems are certain as we age. Fortunately many are preventable!

Find your “weak-links” and get a body that’s “Built to Last”.

Originally published on the Huffington Post. Reprinted with permission from Dr. DiNubile.


Nicholas DiNubile, MD is an Orthopedic Surgeon, Sports Medicine Doc, Team Physician & Best Selling Author. He is dedicated to keeping you healthy in body, mind & spirit. Follow him MD on Twitter: twitter.com/drnickUSA

happy-feet

Footnotes: Your Amazing Feet and How to Keep Them Healthy

It’s pretty amazing that we all don’t suffer with achy feet. Leonardo Da Vinci, artist and engineer, said that “the human foot is a masterpiece of engineering and a work of art”. According to The American Academy of Orthopedic Surgeons, each foot has approximately 100 working parts including 26 bones and 33 joints. Twenty-five percent of all the bones in your skeleton reside in your feet, and they work hard. One mile of walking places over 60 tons of stress on each foot. The average person walks approximately 1000 miles per year. Serious runners often log 30 miles per week pounding their feet with forces 3 to 5 times body weight, absorbing 110 tons per foot, for each mile they run. It’s no wonder that 20% of all musculoskeletal related office visits involve the foot and ankle area. Foot problems cost the U.S. approximately 3.5 billion dollars a year. Perhaps Leonardo should have also warned us that artistic and durable do not often go together.

Interestingly, it’s not just the pounding that gets your feet into trouble — it’s often the shoes. Hard to believe but a significant number of individuals are wearing the wrong size shoes. This is in part because most of us do not realize that your shoe size actually changes as an adult. Even though the bones in your feet stop growing in your teens, your feet still expand with age. Your arch drops, leading to a lengthening of your foot and the ligaments weaken resulting in widening or “splaying” especially in the forefoot area. The overall result is a longer, wider foot and the need for shoes or sneakers one or two sizes bigger and with a wider toe box area. Women are particularly susceptible, and I’m not just talking about Sex and the City’s Carrie and her infamous Manolo’s. Most of their lives, they have jammed their poor feet into tight narrow high heeled shoes, almost the modern versions of foot “binding” popularized in China where women’s’ feet were tightly wrapped to keep their feet small and aesthetically pleasing. It’s no wonder that over 70% of women complain of foot pain. One study found that women stopped on the street were much more likely to be in a shoe too tight, than their correct size. This leads to many painful foot conditions like bunions, corns, calluses, neuromas (pinched nerve) and more. I recall a sweet older patient who came into my office and when asked how I could help her, she took off her shoes, pointed to her feet and said “these dogs are barkin”. Of course her shoes were two sizes too small.

Fashion is part of the problem, especially with kids who will often sacrifice proper fit to get a pair that is cool. Also, with the rapid growth spurts, even a shoe that fits well one month may not the next. Parents need to check often. Also, for both kids and especially adult shoewear, cost does not always equate with comfort.

Marketing drives much of what kids and adults want in terms of shoewear. Nike still wants you to be like Mike (Air Jordans started in 1985 and still going srtong!). And in a 1993 basketball sneaker commercial, Charles Barkley was perhaps the most honest when he said “These are my new shoes. They’re good shoes. They won’t make you rich like me, they definitely won’t make you handsome like me. They’ll only make you have shoes like me. That’s it.”

The influence starts quite early. I remember when my daughter’s Barbie Doll had such high fashion (i.e. high heeled, too tight) shoes that I hoped for her sake that Ken was studying to be a podiatrist.

So how do you keep your feet happy and healthy?

Learn to listen to them. If they are “barkin”, first be sure you are in the right footwear. Also, follow these tips:

  • Get both feet measured every time you buy shoes.
  • Shop at the end of the day when your feet tend to be their largest (swelling etc).
  • Be sure there’s plenty of room in the toe box area. Toes should wiggle freely not feel pressured or cramped. There should also be a thumb’s width space between the tip of the toes (especially the longest one) and the end of the shoe.
  • Ladies, try tracing your foot on a piece of paper. Next, place one of your “high fashion” shoes over the tracing. It should be pretty clear why your feet hurt.
  • Never think that you can “break-in” a shoe. The shoe always wins that battle.
  • Always wear the correct footwear designed for your specific sport or activity. All sneaks are not created equal!
  • A good shoemaker can help with minor pressure or hot spots, or a heel area that’s too loose. Remember, I said minor not major adjustments.
  • For more tips, check www.orthoinfo.org and click on the foot icon on the skeleton.

If symptoms persist, see an orthopedic surgeon or podiatrist who can help you better understand and resolve your foot problem and also assure that there is not other medical issues going on since systemic conditions (like diabetes and rheumatoid arthritis) can begin with foot related issues. Also, foot pain can be referred from other areas like a pinched nerve in your lower back. Get things checked!

Over the years many have philosophized about the foot. I suspect that it started with their own achy feet. A classic orthopedic surgery textbook about the foot (by Melvin Jahss) notes that “the foot is often neglected unless it is your own; it then becomes the pedestal on which the rest of you stands”. My mother even had a view – “You can’t cheat your feet.” Abraham Lincoln suggested that “a man only needs to be so tall that his feet reach the ground”. Along that line, Oprah Winfrey remarked, “I still have my feet on the ground, I just wear better shoes”. Hopefully they’re the right size.

So, be kind to your feet-use them, but don’t abuse them. It’s hard to keep a smile when your feet are frowning.

Originally published on the Huffington Post. Reprinted with permission from Dr. DiNubile.


Nicholas DiNubile, MD is an Orthopedic Surgeon, Sports Medicine Doc, Team Physician & Best Selling Author. He is dedicated to keeping you healthy in body, mind & spirit. Follow him MD on Twitter: twitter.com/drnickUSA

wine-glasses

Alcohol and Your Health – Cheers! or Not?

Depending with whom you speak, alcohol can be a villain or it can be a hero. We have long known that alcohol can help reduce the stress of everyday life, and even relaxes our most tightly wound friends and associates. Recent data also suggests that fairly regular alcohol ingestion is actually good for your heart. This is probably one of the reasons that many European countries, where wine is a normal part of everyday life, have significantly lower rates of heart disease despite relatively high fat diets. The protective effects may come from substances called flavonoids and also antioxidants that are found in alcohol, especially wine. It also can increase HDL levels (the good cholesterol) and lower the risk of blood clots by slightly “thinning” your blood (anti-platelet effect). Red wine also has resveratrol, a compound that has been shown to possibly reduce lung damage in patients with chronic bronchitis and emphysema, by lowering levels of interleukin 8, a chemical that causes lung inflammation. It has also been touted to have life extension (i.e. longevity) and disease fighting capabilities but more research is needed.

Too bad it’s not that easy, i.e. “drink to your heart’s content.” There is a dark side. Even the American Heart Association cautions people NOT to start drinking if they do not already drink alcohol. For many, alcohol can be deadly. It can be a cellular toxin, with brain cells and liver cells particularly susceptible. Alcoholism is a serious disease, with some predisposed from a genetic standpoint. For them, there is no safe amount. It is also never safe or recommended during pregnancy because of the harm it can cause to the developing baby. Alcohol can be dangerous for those with certain medical conditions such as diabetes and liver ailments and also has been implicated in the development of certain cancers. Also many alcoholic beverages pack a significant amount of calories which contribute to obesity risk and much of the obesity epidemic.

Alcohol also kills when mixed with driving. I believe we will see tighter restrictions regarding the legality of drinking and driving especially in terms of acceptable blood-alcohol content. Recent scientific data suggests that we actually loose coordination as well as other important motor and cognitive skills essential for safe driving, even while we are within the legal limits of blood alcohol levels. The National Highway Traffic Safety Administration, in conjunction with The University of Iowa, is doing research on driving under the influence using a three ton, $81 million DUI simulator. This simulator puts the drunk driver in “real life” road situations using high resolution 3-D images, and monitors reaction times and other motorist behaviors. Hopefully studies like this will help provide safer guidelines for us. I am fairly certain that study will have no trouble finding volunteers. There are even commercially available simulators (drunk driving and texting while driving) for educational purposes.

Being an orthopedic surgeon, who has spent plenty of time in the ER, I can state without hesitation that impaired driving kills, and kills many, dramatically changing lives (even innocent ones), be it alcohol, marijuana, or other drugs. Ditto for cell phone distracted driving. All preventable.

So, what is the right answer for you in terms of alcohol? The key, like so many other things in life, is balance and moderation. Weighing risks with rewards and being responsible, not only to yourself, but to those around you.

Poison or potion? It is up to you. Remember, moderation is the key. Check with your doctor to see if there is a place for alcohol in your path to better health.

Originally published on the Huffington Post. Reprinted with permission from Dr. DiNubile.


Nicholas DiNubile, MD is an Orthopedic Surgeon, Sports Medicine Doc, Team Physician & Best Selling Author. He is dedicated to keeping you healthy in body, mind & spirit. Follow him MD on Twitter: twitter.com/drnickUSA

kettlebell-sneakers

For Optimal Workouts, Learn to RECOVER Like the Pros

Your body was built to move but to move effectively and efficiently, especially over the long haul, it needs to rest. At any given point in time a significant percentage of competitive athletes and even fitness buffs are over-trained. The “overtraining syndrome” is brought on by athletes falling into the ‘too much, too hard, too frequent and too little rest’ mode. Usually done to improve performance, but ultimately resulting in a point of diminishing returns- or gains actually turned to losses. Common symptoms can include all of some of the following: fatigue, irritability, muscle soreness, difficulty sleeping, elevated resting heart rate, decline in performance and even the onset of overuse injuries.

Exercise and the training associated with it, are a very powerful stimulus. Your body is challenged on multiple levels, from individual body parts to the system as a whole. For example, if you do a typical weight training session, each muscle that you work is stimulated and there is a local response in that muscle. There is also a cumulative metabolic cost to your entire system from that workout. This is true also of any vigorous workout including running, cycling and swimming. Local body parts are challenged as is the entire system. Your body needs to recover from both, and each has its own timetable.

To make gains – either muscle growth with weight training or cardiovascular with aerobic exercise – you need the exercise stimulus (ideally a near maximal effort) followed by adequate rest and recovery. It is on that rest stop where gains are actually made, as the body repairs itself, adapts, and you are taken to the next level. It should be clear why the mindset of “if a little is good, more is better” does not work here. It is also why smart successful professional and high performance athletes schedule recovery time as they would a workout, practice or a training session. It is critical to optimal performance. In fact, in recent years, we have made such tremendous gains in the areas of training and nutrition, that we may be reaching the point of maximum benefit for those variables. I believe that recovery is the next frontier in optimal training and achieving peak performance.

Also recovery doesn’t mean you need to be on the coach doing nothing. There are forms of “active rest” that can actually enhance and speed recovery. Take a walk or do a very light aerobic activity. Blood-flow to the nooks and crannies of the body enhances recovery and the repair process. Also, try yoga, get a massage, or hit the whirlpool. Water is a great medium for recovery, so hit the pool and try some light movements like treading water. But think twice before taking the ice plunge as recent research suggests that ice baths may delay or interfere with the recovery process. Drinking plenty of water and eating properly are also critical. The timing of your nutrition is also important, especially after a hard workout, as there is a golden 30-60 minute post-workout window where certain nutrients can make a recovery difference. Chocolate milk is one nearly perfect choice. And never underestimate the power of getting adequate shut-eye. The body repairs itself mentally and physically during sleep. I recently saw a funny but astute tweet (by Shower Thoughts @TheWeirdWorld) that said, “your bed is pretty much just a charger for your body.”

When it comes to the body’s adaptability and recovery response, the key is not pounding your body the same way everyday. Also follow the 10% rule-never increase your program (i.e. the amount of weight lifted or miles logged) more than 10% per week. This especially true when coming off an injury. Trying to make up for lost time courts disaster. Increasing the intensity, duration or frequency of your workouts too rapidly can interfere with your body’s amazing ability to adapt, resulting in overtraining, injury or both. Also there are new technologies like the Marc Pro device that can enhance muscle recovery and it is no surprise that so many professional and high level athletes are using it regularly. For those aging athletes and Master’s athletes, remember that the body does not recover as efficiently as we age, so you may need a little longer time to bounce back.

Remember what Lau Tzu said many years ago, “a bow that is stretched to its fullest capacity may certainly snap”. In your effort to constantly improve your fitness or specific sports skills you are probably at times pushing yourself to that very brink. Be aware of that predictable time of vulnerability for you, one that is usually remedied by a little R&R thrown into the mix.

So, for optimal gains, in the gym or on the field, learn to kick back at times. Give yourself a break – you will comeback even stronger.

Originally published on the Huffington Post. Reprinted with permission from Dr. DiNubile.


Nicholas DiNubile, MD is an Orthopedic Surgeon, Sports Medicine Doc, Team Physician & Best Selling Author. He is dedicated to keeping you healthy in body, mind & spirit. Follow him MD on Twitter: twitter.com/drnickUSA

scale

Hit a Plateau on Your Fitness Path???

It shouldn’t take a genius to realize when something just isn’t working, yet every day so many of us seem to get nowhere with where we are trying to go. This happens in all aspects of life, our work, relationships, and many other areas, but where I see it cause the most difficulties and frustration, is with our health and fitness plans.

ORTHOPEDICS CONSULTATION WOMAN

Rebuilding and Regenerating Damaged Knees: The Future Has Arrived!

If you grew up in the 1970s, you may remember the Six Million Dollar Man TV show with Steve Austin. The show began with a futuristic-type regeneration of an injured Steve Austin, and they would say, “we have the technology, we can rebuild him.” It was a great one-liner, but seem so far-fetched. Fast forward 30 years, or just one generation. The future is now. We have the technology!

tennis

Are You 3D Fit?

Designing workouts for optimal health, performance and longevity can be a challenge. Over the years I have worked with many high level athletes and the fittest and most successful rarely ever rely on any one workout or routine. They usually approaching it like assembling pieces of a puzzle, consistently challenging their bodies in multiple ways. No single workout or activity provides all the necessary pieces. Does your training and workouts have all the necessary ingredients? If you are a fitness professional, can you be doing more for your clients?

boomers-biking

Longevity vs. Durability: Can You Have Both?

We’ve extended the warranty on the human heart, and people are living longer. We’ve improved care for skin, and people look better. But it’s your frame that gets you where you need to go whenever you need to get there. Without the proper care, your bones and joints can all too easily become the limiting factor in your enjoyment of life. Have you outlived the warranty on your frame? Would you like an extended warranty?