Thursday, May 28, 2015

The Real Deal With “Whole-Grain”

The number of products labeled “whole-grain” is blooming these days. People looking for healthier food are moving away from refined flour products and picking up “whole-grain” versions instead. But are they really better for you? And does it matter?

To answer those questions, we need to look at how our bodies process the foods we consume. While our bodies are generally quite efficient at absorbing nutrients and energy from the foods we eat, it’s not 100% efficient. Just because you put 2000 calories into your mouth doesn’t mean your body absorbs all 2000 calories. How many calories your body actually absorbs depends on many factors.

For example, the type, amount, and mix of foods you eat affect nutrient absorption. Certain foods are digested and converted to energy more readily while others can slow down the digestive process. The health of your digestive tract can also matter. When you have an intestinal infection or severe food poisoning, food can go through with little of it being absorbed. Even the microorganisms in your gut can affect how much you can extract from your food.

If you consider the ease with which your body digests and absorbs nutrients from various “whole-grain” products, it becomes pretty clear which ones can be healthier for you, and which ones are not much different from refined flour products. Digestion takes place in many phases. We commonly think of it starting in the mouth when we chew and mix saliva with the food. This helps break down the food into smaller particles, giving the rest of the digestive process more surface area to work on. However, if you think about it, we often “pre-digest” our foods by preparing and cooking them. For instance, a tough cut of meat can be made quite tender and easy to eat if tenderized or cooked long enough.

It’s a similar story with whole grains. Left completely intact, they are quite difficult for our body to digest since each grain has several fibrous outer layers protecting it. If you don’t chew and break apart the protective layers, the grains go through you relatively untouched. However, when whole grains are ground into whole-grain flour, the fiber-rich outer layers are broken up, exposing the readily-digested carbohydrates inside. White flour takes this “pre-digestion” a step further and removes all of the fibrous parts, leaving a fine powder of quickly-absorbed carbohydrates.

Since white flour is so refined, your body will readily digest and absorb it as if you are eating sugar. This is why your blood sugar can spike quickly when eating foods made primarily with white flour. Whole-grain flour is essentially the same as white flour but with the ground-up fibrous parts left in. The presence of fiber in the whole-grain flour may slow down absorption slightly but not to a great extent. So, your body will also rapidly absorb the carbohydrates and cause your blood sugar to spike. Neither option is as favorable as eating intact whole grains. These take longer to digest and therefore affect your blood sugar levels less quickly.

So, if you are watching your waistline or your blood sugar levels, consider buying foods that haven’t been “pre-digested” (i.e. processed) as much. Don’t let the marketing on the packaging fool you into thinking a product is healthier than it really is. Think about what the labels really mean, and when in doubt, choose foods that are closer to their natural form.

Monday, May 18, 2015

The Differences Between Brand Name and Generic Medications

With rising health care costs and health insurance premiums these days, you’ll inevitably be asked whether you will accept a generic alternative for your prescription. Some people will tell you they are clinically the same while others will insist they are not. So who’s right? More importantly, does it matter?

The answer to the first question is it depends. It is true that the two have the same active ingredients. But, they may not necessarily have the same inactive ingredients. The answer to the second question is that for most people, these differences won’t matter much since both will provide the same intended effects. However, if you are one of the few people sensitive to certain ingredients, knowing how they can differ can help your doctor and pharmacist find the medication best suited for you.

So, how do brand and generic medications differ? The most obvious difference is cost. Generic medications tend to be cheaper since competition between multiple drug manufacturers bring down cost. As a result, insurance companies usually put them higher up on their formularies, or preferred medication lists. This is why an increasing number of prescriptions are, by default, being filled by generic versions. Note that there may be several generic manufacturers with different prices so it’s a good idea to compare options at different pharmacies. In certain cases, prices may be significantly different.

Aside from cost, there may also be chemical differences. Medications consist of active and inactive ingredients. The active ingredient(s) is what creates the therapeutic effect. Inactive ingredients make up the vehicle that delivers the active ingredients into your body (e.g. pill, capsule, syrup, etc.) While the listed active ingredients and dosage should be the same between comparable brand name and generic medications, the other ingredients and impurities contained within them may differ.

When making the active ingredients, different manufacturers may employ different processes and chemicals. This can lead to different kinds and amounts of impurities being left in the final product. Manufacturers check to make sure these impurities are within safe limits for human consumption. Even so, a small number of people may be more sensitive to the impurities in one manufacturer’s product than another’s and develop unwanted side effects.

Similarly, the chemical compounds used to formulate the pills, capsules, and syrups can also differ between manufacturers. Just look at the variety of colors and flavors that medications come in. While most of these chemicals are relatively inert inside the human body, some people may react to them, leading to side effects.

Finally, manufacturers test their medications to make sure that the active ingredients are released and absorbed as designed. But in some people, they don’t work exactly as expected. This can lead to the medication having a stronger or weaker effect.

Now you know the about the differences between brand name and generic versions of the same drug. But before you tell your doctor or pharmacist to keep your medication manufacturer the same, keep in mind that these differences generally affect very few people. So far, I have only come across a handful of patients in which staying with one manufacturer’s medication was clinically significant. If the medications you are taking are working as your doctor intended, there’s no need to worry. But, if you notice your medications are no longer working as well or you are having new side effects, talk to your doctor or pharmacist. They will be able to help you figure out what’s going on.

Friday, May 8, 2015

How to Fix "Weak" Wrists

People often ask me what to do about “weak” wrists. They usually complain of discomfort or even pain in the wrist area when supporting their body weight on their hands, such as during planks, push-ups, and gardening, and other similar palm-pushing activities. As a result, they shy away from those exercises and lose out on their benefits. While you can wear wrist supports or modify the techniques so that they put less strain on the joint, the best thing to do is to increase wrist flexibility and strengthen the muscles that support it.

While it may seem simple, the wrist joint is actually quite complicated. It consists of the 5 proximal ends of the metacarpal bones in the hand, 8 small bones in the base of the hand, the distal ends of the 2 long bones in the forearm, ligaments, and joints between all of the bones. As you can imagine, without strong support from the ligaments and muscles, it will be really hard to keep them moving appropriately relative to each other. When you have weak supporting muscles, bending the wrist and placing it under weight can easily move the bones out of alignment, making them hit each other and cause pain. Similarly, if your wrist isn’t flexible enough, the bones will be crushed against each other when placed in stressed positions.

Before we go over how to strengthen these important muscles, let’s cover the correct way to push with your wrists extended, such as in a push-up. Contrary to common practice, the hand and wrist should not be relaxed when pushing with your palm. Doing so will allow weight to move your wrist bones out of alignment. It will also concentrate the stress onto fewer joints, increasing the chances of injuring them. Rather, constantly press and flex the entire hand into the ground, distributing the force throughout the palm, bases of the fingers, and the finger tips. This engages your wrist and finger flexor muscles, stabilizing the wrist joint.

Left: Pushing down with only the base of the palm provides less stability and concentrates stress into a smaller area.
Right: Pushing down with all parts of the hand and fingers increase stability and better distributes the stress. Note the pressure from the fingers indenting the carpet.
This technique also improves the stability of your support. Maintaining tension throughout your hand enables you to sense changes and react quickly. This is something I struggled with for a long time when learning the handstand. I used to do them with my hands relaxed, which made it difficult to adjust my balance. In addition, the weight of my body quickly made my wrists hurt. Once I tightened my hand and fingers, improvement quickly followed and the pain went away.

Now that you know how to properly push with your palms, you can start strengthening your wrists. It’s as simple as using the proper pushing technique whenever you do planks, push-ups, sit presses, or any other pushing exercises. There's no need to do separate wrist curls with weights. If your wrists are too weak to support that much body weight right now, try doing easier versions of those exercises. For example, you can do push-ups or planks against the wall. Move your legs back and your hands down the wall until you feel enough pressure on your wrists. As you get stronger, you’ll be able to move your hands further down the wall. Alternatively, you can rest your knees on the ground to reduce weight. As your wrists gain strength, move your knees back to increase the difficulty.

Don’t forget to stretch your wrists regularly throughout the day. Use one hand to bend the other wrist in all different directions, to the point of tension but not pain. With consistent effort, you’ll notice an increased range of motion and wrist stability. Before long, your “weak” wrists will be a thing of the past.