Dr Delanghe, Waterloo Chiropractor

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July 2018

keto 1

If you have been following along in my past articles, you saw the evidence for whether or not a keto diet is beneficial for endurance athletes. However, I wanted to also share my thoughts and some research on the keto diet for my non-athlete readers. In this article I will discuss why keto may, or may not, be a good choice for you.

 First off, I want to say that keto is likely not meant to be a life-time eating style.

Typically for weight loss, keto could be used for 2-4 months and then one could switch into a long term maintenance phase where you are including healthy carbohydrates.

Secondly there are some warnings that come with the keto diet. Our brains and hearts run exclusively on carbohydrates and when we severely restrict carbs, our body needs to switch to the use of ketones for fuel instead. There is a 3-4 day period of “brain fog” when you initially switch to a keto diet, where your ability to think is reduced. Not to mention food selection is quite limited and your social life may take a hit due to your restrictions. Plus, fair warning, your breath will smell bad too!

There are risks!

Very close monitoring is required for implementing a keto diet (especially to assess if keto would be a benefit to you). You also have to have a solid plan for transitioning into a regular diet, which should also be lead by a dietitian or qualified health care professional. The latter is quite important. This is because when you starve yourself of carbohydrates and then suddenly reintroduce a large load of carbohydrates, the body switches to an anabolic (or build up) mode and causes increased insulin, increased uptake of carbohydrates into the cells, increased utilization of those carbohydrates, all which increases the uptake and use of potassium, magnesium, phosphate, thiamine and increased sodium and water retention. The sudden changes in these electrolytes and vitamins can cause serious issues that can be as severe as a heart attack. AKA you can not have a cheat day in a keto diet and have yourself a big old piece of cake.

iron sources

Keto & weight loss

Most of the research as a whole shows that you MAY lose more weight on a keto diet vs. regular diet.  However, when studies include body composition analysis they show that on average keto leads to more overall weight loss, but the amount of fat lost is the same. This means that keto diets lead to more muscle mass loss compared to a traditional diet.

Therefore, you may see a better outcome when you step on the scale but it may have less desirable body composition changes.

 The main reason for this finding is that you have to have a moderate protein intake while on a keto diet because protein can be used in a process called gluconeogenesis, where amino acids are (inefficiently) used to make glucose, thus keeping you out of ketosis, where as a traditional weight loss diet will be higher in protein to support the muscle mass retention. Other reasons could also include you can not have dairy, which has been shown to be an important food group to stimulate weight loss and muscle mass retention due to its leucine content.

It is also important to note that resistance exercise is a VERY powerful stimulus of muscle protein synthesis and muscle retention during weight loss, and regardless of diet should be included in your weight loss plan.

There may be benefits too

Keto may work for certain people. For instance, people who are on a keto diet often feel more satisfied with their diets. This is likely because higher fat foods are often pleasurable foods and provide flavour and mouth-feel to food (ie cheese, who doesn’t want to eat a brick of cheese every day!). Johnstone et al. (2008) conducted a study where participants were able to eat ad libitum (ie no restrictions or standards for caloric consumption) and participants were assigned to a keto group or a moderate carbohydrate group. They found that people on a keto diet felt less hungry, and lead to them eating less than compared to a moderate carbohydrate diet.

To my surprise, keto does seem to have a beneficial effect on decreasing blood glucose and HbA1c levels, decrease triglyceride levels, LDL cholesterol, and may increase HDL cholesterol levels. One thing I think is important to remember here is that in most cases, healthy dietary changes (ie more vegetables, fibre, less processed carbohydrates and sweets etc.), decreasing alcohol consumption, and increasing exercise can do the same for you, without doing something as intense or dramatic as a keto diet.

 Take home:

My personal and professional opinion on this is that I would first have someone try a to make healthy diet changes which would include consuming good sources of carbohydrates such as beans, lentils and whole grains before trying a keto diet. Keto in my mind is a last ditch effort if no other dietary interventions have worked.

Summary:

  • Keto diets can be somewhat dangerous and should be eased into and out of with the help of a qualified health care professional
  • Keto diets sometimes result in more weight loss but fat loss is comparable to typical diet
  • There must be a caloric restriction to create weight loss, no different than a regular diet
  • Keto may help keep you full and more satisfied with the diet and may help you adhere to the diet plan
  • Keto does seem to have beneficial therapeutic effects for type 2 diabetes, pre-diabetes and on blood lipid profiles (but so does healthy diet/exercise)
  • Ultimately the diet needs to be something you can follow and stick to before transitioning to your maintenance phase, if that’s keto, great!
  • Bottom line: Try traditional approaches first, if that is not successful, you could consider the keto diet for the short term and transition into a healthy diet intervention for maintenance

I hope you found this helpful, this is not a full list of keto uses and I did not list all the pros and cons for you, as I wanted to keep this conversation relatively short. If you have any further questions about dietary interventions for building a healthier you, please feel free to come in for a visit. To learn more about me, you can find my bio here.  

Reference:

Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. 2008. Effects of a high-protein diet on hunger, appetite and weight loss in obese men feeding ad libitum. Am J Clin Nutr. 87, 44–55.

delanghe chiro

Here at Delanghe Chiropractic & Health we are really excited to be leading our first beginner run program!

Date: Starts Sept 4th, 2018

Price: FREE

SIGN UP NOW

The idea is simple:

Every week, you will tackle a progressive plan that will take you from zero all the way to 5K in 6 weeks!

Each week will also include an information session from trained medical professionals.  Your coaching team includes:

Together, we will be tackling the VERY fast and fun course at the Run Waterloo Fall 5K Classic.   

Afraid you won’t be able to do it?  Don’t be!  Both Karen (mom of 4, new to running) AND Amanda (Olympic medalist, but now busy mom of two) of Delanghe Chiropractic will be starting from scratch and going through the plan with you!

Oh, and did we mention it is FREE?  Join us, have some fun, and reach your fall fitness goals! You can register HERE or by e-mailing info@drdelanghe.com or calling (519)885-4930

learn2run5K

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We’ve all heard of DOMS (delayed onset muscle soreness) and the majority of us have experienced it at least once.

It’s that muscle pain and weakness that we feel a day or two after some exercise. It can be caused by any type of muscle contraction but it is most commonly caused by an eccentric exercise such as downhill running and resistance training. (Reminder: an eccentric exercise is a movement where the muscle is under load as it lengthens. For example, a raising part of a bicep curl is a concentric exercise but the lowering part of a bicep curl is the eccentric part)

The typical symptoms include strength loss, pain, muscle tenderness, stiffness and swelling. Symptoms typically peak 24-48 hours after exercise and fade within 96 hours. The severity of DOMS depends on several factors but in general, more damage occurs with higher intensity and unfamiliar actions.

Physiologists do not have clear understanding of the mechanism behind DOMS, however the proposed theory involves a mechanical disruption to the sarcomeres (the fundamental unit of a muscle structure) which then sets off an inflammatory response. The swelling is caused from the movement of cells and fluid from the blood stream to the muscle, where it contributes to the sensation of pain.

I’ve often been asked if it’s okay to continue exercising and/or what can someone do to help reduce the feeling of DOMS. A recent meta-analysis looked to compare the effects of the most commonly used recovery techniques on muscle damage, DOMS, inflammation and the feeling of fatigue from physical exercise. The authors looked at the effects of 1 session of several different types of recovery techniques after physical exercise on:

  • DOMS
  • Perceived fatigue (ie: how much someone feels tired)
  • Inflammatory markers (IL-6, CRP)
  • Muscle damage markers (CK – creatine kinase)

Let’s have a look at the evidence!

Massage

Based on this meta-analysis, massage was the most effective for DOMS and perceived fatigue! The authors reported that a 20-30 min massage performed immediately after or up to 2 hours after exercise has been shown to help reduce DOMS for 24-96 hours after exercise. Elite athletes (in this case ultra-marathon runners) reported a significant improvement in lower perceived pain after massage. Not only does a massage feel good, but it has also been shown to reduce CK and IL-6 in the blood after exercise which may help towards a faster recovery.

Rationale:

Massage seems to help the symptoms of exercise-induced muscle damage by increasing blood and lymph flow which can stop the CK response and clear it from the blood. It’s assumed that massage flushes out neutrophils (an immune cell that responds to inflammation) from the damaged area which would otherwise cause more CK in the area.

Compression Garments

Compression garments have a significant and positive impact on DOMS up to 96 hours after exercise. It has been shown that wearing a whole-body compression garment over a 24-h period after intense heavy resistance training significantly reduces perceived fatigue. That might not be realistic for us but other compression garments such as leggings and socks can be used.36391146502_1bd4d6090e_k (2)

Rationale:

The beneficial effect of compression garments might be explained by:

  • A reduction in the space available for swelling and edema
  • Better venous return (blood flow back to the hear)

Cold Water Immersion

Cold water immersion (CWI), aka: ice baths, showed a significant effect on DOMS and perceived fatigue after training and competitions/tournaments as well as after strenuous exercise in both trained athletes and recreational subjects.

Ice baths in water at 11-15⁰C for 11-15 minutes is considered the optimal dose to have a positive impact and reduce DOMS.

Rationale:

CWI seems to help reduce exercise-induced inflammation, edema, pain sensation, and muscle damage through these ways:

  • The hydrostatic pressure from being immersed in water may help transport fluids from the muscle to the blood and therefore eliminate inflammatory products
  • Narrowing of blood vessels from the cold temperature may reduce fluid diffusion into space in the muscle and reduce the inflammatory reaction

Contrast Water Therapy

Contrast Water Therapy (CWT) which is bathing alternately in warm and cold water seems to have a small effect on DOMS but not perceived fatigue. CWT has been able to reduce the perception of pain at 24, 48, and 72 hours post-eccentric exercise. CWT also reduced CK concentrations in the blood.

Rationale:

CWT promotes the opening and narrowing opening of blood vessels which may reduce the formation of edema, inflammatory pathways and decrease feeling of pain.

Active Recovery

Active recovery also has a significant effect on DOMS, but not effect on perceived fatigue however, the impact of active recovery is only significant during a short period after exercise. There seems to be no influence of active recovery on CK, IL-6 and CRP concentrations in the blood.

Rationale:

Active recovery seems to help DOMS by enhancing blood flow in muscle tissue, which helps to remove metabolic waste and therefore reduce muscle pain.

Cryotherapy

Cryotherapy is the exposure to a cold chamber and appears to be effective in reducing DOMS after exercise. The authors found that cryotherapy had an effect on DOMS but only for about up to 6 hours after exercise and any cryotherapy done 24 hours after the end of exercise is ineffective in alleviating DOMS.

Stretching/Electrostimulation

The meta-analysis did not find any significant influence of stretching or electrostimulation on DOMS and fatigue. In fact, results showed that stretching less than 6 hours after exercise might even produce DOMS.

Take Home Points!

At some point we will experience DOMS and with time, it will go away on its own but there are some ways to help reduce the feeling and possibly recover faster. Massage seems to be the most effective in relieving DOMS and fatigue. Ice baths and compression garments can also help but are less effective.

Keep in mind that the outcomes from this meta-analysis looked at many studies with different protocols and the results can vary depending on many things such as the type of exercise, level of immersion in water, and amount of pressure from compression garments to name a few.

One final note is that while research shows that these post-workout techniques can make us feel better faster, over time we might we lose some of the benefit from that hard workout or training session since the signal to adapt to the training is blunted from using these recovery methods. So, it is important to use them strategically (ie: after a race where you went too hard or leading into a big race) and to avoid using them during base training and instead just give yourself more time to recover.

Hope this helps with your recovery!  If you have any other questions, or would like to learn more about me, check out my profile HERE.

References:

Dupay et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Frontiers in Physiology. 2018

 Connolly et al. Treatment and prevention of delayed onset muscle soreness. Journal of Strength and Conditioning Research. 2003

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