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.

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.

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.

Feel Younger by Staying Flexible

 Many of us lose flexibility as we age, which makes us feel even older than we really are. Simple tasks like bending down and tying shoelaces or reaching for a bag in the back seat of the car become harder. Recreational activities grow more daunting as our range of motion and strength decrease. With an increasing fear of injury as we age, many of us shrink away from these health-maintaining activities.

Is losing flexibility with age inevitable? No. In fact, there are elderly people who can still do leg splits and other feats of flexibility that even contortionists would find enviable! While most of us won’t need that degree of flexibility, I think everyone would like to keep moving easily and freely even as the years go on.

Why do some people stay flexible while others get stiffer with time? While some people are naturally more flexible, the key lies in habits. Just like strength, if you don’t use it, you lose it. Flexibility is largely dependent on the stretchiness of your muscles. Like a rubber band, if you use it regularly, it stays pliable. Let it sit around and it becomes stiff, breaking the next time you stretch it. That’s how you end up with an injury.

On the microscopic level, muscles contain bundles of contractile fibers. They slide back and forth, enabling the muscle to stretch and shorten. When used regularly, these fibers slide readily. Through inactivity, these fibers get stuck to each other, reducing the amount the muscle can stretch as a whole. As more fibers get stuck, the less flexible you become. If enough fibers become stuck, you can end up with an immovable contracture.

When we were kids, we moved and played a lot, keeping us flexible. Now that we’re older, studying and working take up more of our time. These often stationary activities leech flexibility from our bodies. Stretching helps recondition our muscles and restore flexibility. But if you’re like most people, stretching a couple times a week at the gym fails to undo the damage from countless hours of inactivity. This exceedingly common experience is why people often think the loss of flexibility with age is unavoidable.

The best way to counter this kind of damage caused by daily inactivity is to stretch every day. Now, this doesn’t mean you need to do deep stretching sessions every day, which may paradoxically reduce your flexibility. Rather, stretch lightly many times throughout the day, focusing on a different body part each time. Each light stretch helps counter the stiffness that has accumulated since the last stretch. If you sit a lot, stretch standing up. If you stand for most of the day, do some floor and squatting stretches.

If you keep forgetting to stretch regularly, try incorporating it into common actions. For example, instead of spinning your office chair around to get the phone, carefully twist and reach to stretch your neck, back, and shoulders. When walking through a doorway, take a second and hold onto both sides of the door frame. Then lean forward to stretch your chest muscles or lean back to stretch your upper back muscles. When you tie your shoelaces or pick up a light object, stretch your hamstrings by bending over slowly with your knees straight or just bent enough to feel a light stretch.

Do these little stretches consistently and remember to push your limits slightly each time. This will gradually improve your flexibility. Before you know it, you’ll be moving better and feeling younger.

Should You Eat Less Carbs and More Fat?

If you’ve been following the health news recently, you’ve undoubtedly seen articles saying that carbs are evil and fats are no longer considered bad for you. They might even cite a study or two that suggests the notion. Considering how tasty fatty foods are, it is understandable for people to want to see these studies as a green light to eat as much fat as they want. Unfortunately, throwing caution to the wind is not wise in this case. To understand why, we’ll have to take a historical look at our diet.

Decades ago, dietary guidelines that encouraged eating more carbohydrates and less fat were published in an attempt to reduce the rate of heart attacks and heart disease. At that time, it was believed we were eating too much fat. As a result, we started to eat more carbs and fewer fat calories. However, this didn’t do much to improve heart disease and seemed to have caused other problems such as obesity and diabetes to grow in size.

Now, current studies show that the high-carb low-fat diet wasn’t such a great idea after all. Their results suggest that we should eat fewer carbs and more fats compared to that diet. But, they don’t show in absolute terms how much more fat and how much less carbs is healthy. They also don’t prove that a low-carb high-fat diet is good for you.

So yes, we should eat fewer carbohydrate calories than before. Yes, we can probably eat more fat than we were told to before. But no, that doesn’t mean we can safely eat as many fat calories as we want.

If you think about it, this shouldn’t be surprising. Considering that our bodies need fats, carbs, and proteins to function normally, it doesn’t make sense to deprive it of any one nutrient. Carbohydrates are not inherently bad for us. They are the easiest nutrient for our bodies to extract energy from. In fact, our brains run almost exclusively on glucose, a carbohydrate, for energy. Similarly, fats are not necessarily bad. They are an excellent way for our bodies to store energy and they also provide many other important functions throughout the body. Proteins serve as building blocks and also as a source of energy.

On the flip side, too much of anything, nutrient or otherwise, is bad for our bodies. The body can only process so much of any substance at a time. Get too much of it and it becomes toxic. Even absolute essentials such as oxygen and water can hurt and kill us if we get too much of either!

We’ve already seen the effects of high-fat and high-carb diets over the long term. Currently, I’m seeing a trend in articles about high-protein diets since people are avoiding carbs and fat. If these high-protein diets become wide-spread for long enough, I wouldn’t be surprised to see future studies showing deleterious effects. At that point, with strikes against carbs, fats and proteins, I wonder what direction the next trend will take. Perhaps then, people will remember that balance is the key to much of life and health.

As for now, the next time you see an article about a health food trend, skip the hype and take a step back. Look at the context from which the recommendation is being made and see if it makes sense. If a study is cited, consider looking at the actual publication and seeing what it actually says. It may be quite different from what articles about the study say.

Why Your Ergonomic Workstation Won’t Fix Your Pain

You’re at work sitting in front of the computer and your back or shoulder is hurting. This has been going on for longer than you care to remember so you think it’s time to improve your workspace. Maybe you’ll get an ergonomic chair or one of those standing desks. Unfortunately, after you spend all that money, it’s likely that you’ll still have pains, just in different parts of your body.

While ergonomic furniture may help, it’s not the true solution to the problem. Why? The problem isn’t your work space, but rather your habits. It’s not just that you’re sitting or standing poorly, but that you’re in the same position for too long. Even if you sit in an uncomfortable chair, you can actually avoid pain if you reposition yourself in your chair and stand up frequently enough. Ergonomically friendly furniture can help you stay in one position longer before developing symptoms, but then that also means you are being inactive that much longer.

We’re not meant to be stationary beings. Even when we sleep, we move around quite a bit. And there’s a good reason for this. Our bodies need to redistribute body weight so that pressure points don’t stay on any part of the body for too long. Pressure reduces blood flow to affected body tissue which causes damage over time. If this continues long enough, your tissues actually break down and you’ll develop open wounds called pressure sores. This is what happens to immobile people such as the critically patients in hospitals.

To prevent this, our bodies warn us far in advance by sending pain signals and motivating us to reposition ourselves. Don’t ignore those signals and keep working through the pain. Listen to what your body is telling you and move.

Some people, such as stroke patients and those with severe Type 2 diabetics, can’t feel the pain and are at high risk of developing these dangerous sores. If you have one of these conditions, you need to be even more vigilant and proactive about changing your position frequently.

Positional pain can also come from your muscles and joints. Muscles help maintain posture, both good and bad. When we stay in a position too long, muscles get tired and the weight it was working against is dumped onto your joints. Your joints are not meant to handle this kind of load for long periods of time and become damaged, leading to pain. In addition to joint pain, your muscles can also become stiff, causing the common muscle tightness and cramping between the shoulders and lower back.

Ergonomic furniture helps reduce the stresses on your body by distributing your weight better and supporting your posture to reduce the tension on your muscles. However, no matter how much the furniture helps, the fact remains that there is pressure and tension on your body. The only way to prevent positional pain is to move.

So, the next time you start feeling your leg go numb or your shoulders tighten up, stand up (or sit down if you’re standing)! Move around, take a few steps, or even do some light stretching or some exercises, such as those from The One Minute Workout. This will not only resolve your symptoms, but help you perform better by increasing blood flow throughout your body. As a bonus, physical activity will also help your brain change states, which may help you figure out a problem you’ve been stuck on!

Why Pull-Ups Shouldn’t Stop at Your Chin

I remember first learning about pull-ups during the physical fitness tests back in grade school. A repetition only counted if your chin went above the bar so there was lot of neck craning and leg kicking during those gym class pull-ups. When scrawny kids are only trying to beat their friends, they don’t care about form or the benefits of exercise.

As adults, pull-ups are no longer a mandatory activity (unless you’re in the military), and are a great way to build strength and functionality. Despite the change in goals, we often stick to doing them the way we first learned them, stopping with the chin just above the bar. While still effective, I would argue that this isn’t the most effective use of your time and effort.

Instead of artificially stopping with the chin just above bar-level, why not keep going? A chin-level pull-up is actually less than half of the range of motion that our arms are capable of. You can actually keep pulling higher until your lower chest is at bar-level. As you can imagine, this is even more difficult, which means a better workout for your muscles, and more bang for your workout time.

But it doesn’t stop there. If you keep going up, the movement transitions from mostly pulling to a pushing movement. That means you can work on even more muscle groups with the same exercise! At the very top, you’ll be supporting your body weight on the bar with your arms straight down, just like the top of a dip. This combined pull-push movement is called a muscle-up. When done in a controlled manner (little swinging or momentum), you can develop great strength throughout the entire range of motion with this exercise alone.

I emphasize the importance of relying on momentum as little as possible since that works your target muscles maximally and imparts the most strength building benefit. Just as in grade school, going quickly, kicking, or kipping like you often see in CrossFit may help you notch a couple more reps but that doesn’t maximize the strength-building benefits for your time spent.

Besides looking cool and being more time efficient, muscle-up training imparts more functionality. Training this combined pull-push movement erases the strength gap that most people have when they are transitioning between pulling and pushing. This means better performance for many sports. For those of you who like more extreme sports, it’s also quite handy if you ever find yourself hanging off a building or cliff and need to climb up.

So, the next time you do pull-ups, don’t stop at the chin. Keep going up as high as you can. You may not be able to do as many repetitions this way but you’ll gain more benefit in less workout time.

For the best muscle-up I've seen to date, check out the video of Olympic gymnast Andreas Aguilar below. The applause is definitely well-deserved!