Why Is It So Hard To Control Our Appetites? A Doctor’s Struggles With Giving Up Sugar

We’ve become convinced that if we can eat more healthily, we will be morally better people. But where does this idea come from? Near the end of the hellish first year of the coronavirus pandemic, I was possessed by the desire to eliminate sugar – all refined sugar – from my diet. In retrospect, it probably wasn’t the best time to add a new challenge to my life. My wife and I had been struggling to remote-school three young kids with no childcare. My elderly parents lived out of state and seemed to need a surprising number of reminders that pandemic restrictions were not lifted for Diwali parties or new Bollywood movie releases.

Like many people in those early days, we were looking around for masks and trying to make sense of shifting government guidelines about when to wear them. In addition, as a doctor, I was seeing patients in clinic at a time dominated by medical uncertainty, when personal protective equipment was scarce, and my hospital, facing staff shortages, was providing training videos and “how-to” tip sheets to specialists like me who hadn’t practised in an emergency room for years, in case we were needed as backup.

It would have been enough to focus on avoiding the virus and managing all this without putting more on my plate. But cutting processed sugar seemed like an opportunity to reassert some measure of order to the daily scrum, or at least to the body that entered the fray each day.

My former physique was behind me and the stress of clinical practice during the pandemic was taking its toll. Maybe it was all the pandemic death in the air, but I started feeling like I was what the narrator in Arundhati Roy’s novel The God of Small Things calls “Not old. Not young. But a viable die-able age.” Maybe doing away with sugar could slow things down? More tantalisingly, maybe it could even take me back to a fresher time, the days in college when I had actually gone sugar-free for a while.

My friends offered condolences on what they called my soon-to-be joyless lifestyle. But I was set, compelled by literature about the deleterious, even toxin-like effects of added sugar. I had my doubts about being able to pull something like this off again, though, so I decided – as doctors often do – to tackle the problem by studying it.

That year, in what was arguably an act of masochism, I began the coursework required to sit for a medical-board exam on dietetics, metabolism and appetite. By earning another qualification, I thought, I would credential my way to realising my goal. After shifts at work, during breaks or once the kids were asleep, I would attend virtual lectures and pore over board-review books in a quest to understand the body’s metabolism.

I immersed myself in the physiology of exercise, the thermodynamics of nutrition, and the neuroendocrine regulation of appetite. But this knowledge didn’t break my pandemic eating habits. Cupcakes and ice cream and cookies didn’t call to me any less. And big food corporations were winning the bet that Lay’s potato chips first made back in the 1960s with its “Betcha can’t just eat one” ad campaign. So, I found myself reaching for Double Stuf Oreos while flipping through my medical textbooks and scarfing chocolate bars even as I correctly answered my practice-exam questions.

My body refused to be disciplined by my intellectual mastery of its operations. I passed the board examination, but my appetite for sugar didn’t change. I was left with more questions than I had when I started. Was sugar really a problem? Or had I internalised hangups about desire from the culture at large? Why did my soul feel so inexplicably sick – so unsatisfied – with the outcome of my first effort to quit that I tried it all again? And what does my “success” – I’ve been sugar-free for a year now – even mean?

I turned to Plato – a man occupied by appetite – for some answers. In his body map of the soul, the stomach was the dwelling place of desire. Reason, of course, resided in the head, while courage rested in the chest. In this tripartite architecture, it was up to reason – with the help of courage – to subjugate appetite and elevate the individual. The thinking went that if we could just rule our stomachs, we might be able to hold our heads up high and our chests out wide. For the Greeks, the right moral posture was key to the good life, or eudaimonia.

Early medical science in the west borrowed heavily from Plato, beginning with Aristotle, who practiced and taught medicine throughout his life. Aristotle agreed that eudaimonia could be realized by moderating the visceral and sensual appetites. He saw the heart as the vessel of intelligence, and arguably the most virtuous of organs. In his hypothesis, the heart occupied – physically and figuratively – a central place in the body, controlling other organs. The brain and lungs played supporting roles, merely cooling and cushioning the heart. The heart was, for Aristotle, where reason flowed.

Five hundred years later, the Greek anatomist and surgeon Galen challenged the centrality of the heart but still adhered closely to Plato’s triadic notion of the soul. Galen’s treatises, foundational to the development of modern medicine, are suffused with Platonic assumptions, and he painstakingly tried to stitch the divided parts of the soul – the rational, the spirited and the appetitive – on to specific organs in the human body.

In a striking display of topographical certitude, Galen writes in On the Doctrines of Hippocrates and Plato: “I do claim to have proofs that the forms of the soul are more than one, that they are located in three different places … and further, that one of these parts [rational] is situated in the brain, one [spirited] in the heart, and one [appetitive] in the liver. These facts can be demonstrated scientifically.”

The Harvard classicist Mark Schiefsky writes that, in Galenic physiology, equilibrium is understood “as a balance of strength between the three parts; the best state is when reason is in charge, the spirited part is strong and obedient, and the appetitive part is weak”.

Should we be sceptical of this aspiration to tame appetite? Sigmund Freud doubted whether desire could ever be so readily controlled. In tossing Plato’s map aside, Freud erased the “soul” and instead sketched a three-part atlas of the “self” and its ratio of desires and repressions – endlessly fractured, negotiating between order (superego), consciousness (ego) and appetite (id). For Freud, appetites could not be overcome but only better managed. Perfect harmony and permanent equilibrium were nowhere in sight. Rather, in Freud’s idea of the self, anxiety for order loomed above the ego, with desire buried beneath it. Appetite was the subterranean tether that consciousness could never escape, but only sublimate.

There was something talismanic about my focus on sugar. So often, liberty is conceived of as the ability to say yes to things. To make affirmative choices: to open this door or that window. But there is also a flipside to that freedom: the power to say no. To refuse. Increasingly during the pandemic, I felt like I was powerless in the face of my cravings. If there was a knock at the door of appetite, a tap on the window of impulse, I had to answer it. And this felt shameful. Why couldn’t I say no? And why was realizing this so painful?

I don’t pretend to anything approaching total understanding of my motivations. But there were a few loosely detected currents worth illuminating here. For one thing, not being able to say no to sugar sometimes felt like a form of bondage to the demands of the body, the very body that I was eager to assert power over, particularly during a global health crisis that was damaging bodies everywhere.

If I couldn’t control this plague, could I not at the very least control myself? I wonder now if this insistence on regulating appetite was my sublimated response to the coronavirus’s immense death toll – a way of denying mortality in the midst of its excess. In this respect, perhaps there was not as much separating me from other kinds of pandemic deniers as I would like to believe. Were we all just coping with the inexorability of our decay – laid painfully bare by Covid-19 – in different ways?

Maybe. But there was something beyond the exigencies of the pandemic on my mind as well. The inability to resist sugar cravings – to break the habit – seemed like a victory of the past over the present. It felt like the triumph of the mere memory of pleasure over real satisfaction in the moment. Saying no to that memory – the neurological underpinning of craving – became important, because it felt like the only way to say yes to imagination. “I am free only to the extent that I can disengage myself,” the philosopher Simone Weil wrote.

Detachment from an indulgence, however small, felt like a way to stop being beholden to an old storehouse of desires (and aversions and beliefs). Developing the ability to refuse to reach for the cookie was also a way to break free from the impulse to reach for patterns of the past, from the compulsion of replicating yesterday at the expense of tomorrow. It’s the trick of habit to convince us that we are reaching forward, even as we are stepping back. Or, as the British scholar of asceticism Gavin Flood elegantly summarizes: “The less we are able to refuse, the more automated we become.”

If Freud dismantled the soul, modern medicine mechanized what he left of the self. But where Freud’s psychoanalytic theory allowed for a pinch of poetry, materialist models hold comparatively dry sway today. A look at the biomedical literature on appetite reveals a tortuous mix of neural circuits and endocrine pathways. What’s clear is that if there was a moral aspect of appetite for ancient philosophers and physicians, it’s not readily discernible in the language of contemporary scientific literature.

There are upsides to this development. In the modern era, medicine’s tradition-bound framing of appetite as a moral problem has been demoralizing for patients, who often felt – and still feel – objectified, policed and discriminated against by institutions that sermonize about it. The stigmatisation of appetite remains pervasive in the culture, in and out of medicine. The loss of at least an explicit moral charge in the scientific literature is a welcome shift.

In the century or so since Freud’s conjectures, appetite has been atomised by medicine into a problem of eating, or more specifically, of fighting the body’s tendency toward “disordered” eating. In the pursuit of better and longer lives, maladies of appetite – of eating too much, too little, or not the right kinds of food – have been studied and treated with varying degrees of success. The empirical study of digestion and appetite in the laboratory moved hunger from the moral arena into a biochemical one. Still, in both experimental physiology and clinical medicine, the ancient impulse to locate the appetite persisted: was it in the body or in the mind? Lines were drawn – and defended – between diseases of the stomach and diseases of the psyche.

What was at stake in the difference? Pinning down the appetite – claiming it belonged to the gut or the brain – was arguably the first in a series of steps leading to its regulation. Understood this way, medicine’s mission to uncover the mechanisms of appetite, despite the erasure of the soul from scientific databases, cannot escape Plato’s legacy. Whether we’re trying to improve or curtail appetite, we seem unable to resist the desire to control it.

It would have been different – I wouldn’t have felt the need to go all-or-nothing with sugar – if I could have simply walked away after a few bites. But increasingly during the pandemic, I wouldn’t stop even after I was full. What started off as pleasure would morph into painful excess. Sure, there’s pleasure in abundance, in overdoing a thing. But I found myself barrelling past that threshold.

While studying for the board exam in my first, failed attempt at going sugar-free, I was also using various apps and devices to keep track of my body. I had long used a smart watch to log my steps and workouts. I was also using a calorie-tracking app, studiously punching in numbers for every meal and scheming how much I could eat and still remain under the calorie limit. But all that logging and calculating felt joyless and anxiety-ridden. Sometimes, at a meal, in the middle of tallying up numbers like an accountant, I’d explain to impatient friends and family that “I’m just entering my data”. It was a lot of data.

I grew weary of all the inputting, and so I switched to an app with more of a behavioural focus. This app still had me tracking calories, but also came with recipes, a personal coach and “psychology-based” courses, as part of what the company calls your “journey”. The courses were a welcome shift from the myopic focus of calorie counting, and chatting with a coach added an opportunity to get some clarity about my goals.

The coach would share chipper motivational advice and provide tips to overcome obstacles. I diligently went through the app’s courses, answered its behavioural questions and followed its nudges. There were a few weeks where I was able to go sugar-free, but after a couple of months, the coaching advice seemed more and more generic, and the courses too simplistic when I was already spending so much time studying for my upcoming exam. I lost interest and reverted to simply recording calories.

I eventually passed that exam without much to show for it in terms of changes to my nutritional habits. I needed something different, a way to hold myself accountable and mean it. I stumbled upon another app that described itself as being “on a mission to disrupt diet culture and make our relationship with food, nutrition – and ourselves – healthier for good”. It promised live coaching calls with a certified nutritionist, shared recipes, and even offered to tailor my coaching with a vegetarian dietician. It did not ask you to track calories or enter food items from a database. All it wanted was for you to send pictures … of your food. It felt radically different than tapping numbers into a screen: someone else would see this.

The app’s slogan was “100% accountability and “0% judgment”. But, to be clear, it was the judgment that I came for. The simple fact that my nutritionist wouldn’t just know but also actually see what I was eating was the killer feature. I answered a questionnaire about my dietary habits and goals. I made it clear that I wanted to go sugar-free, and repeated as much to my nutritionist during a preliminary call.

She didn’t exactly endorse this goal, but rather acknowledged it as something that was important to me and gently marked it as a topic we would come back to, adding that she hoped I would get to the point where a more balanced approach would suffice. I told her we’d see. I made a promise to take a photo of every meal, good or bad. She kindly reminded me there are not “good” and “bad” foods, and we were on our way.

It’s been a year since I downloaded the app. Every day since then, I have taken a photo of every morsel of food I’ve eaten, whether it’s a handful of pistachios, a salad or a veggie burger. In every one of those pics, every day, I have been sugar-free. I’ve eaten more vegetables and greens and fruits than I’ve probably ever eaten in my life. My plates look balanced (I make sure of it). I take care to snap pictures that look nice for my nutritionist. Though she never judges me negatively, I look forward to the raising-hands emoji and approving words she sends if she sees a salad with asparagus and garlic balsamic drizzle and avocado up front.

Like an influencer on Instagram, I’ll take another shot if the lighting isn’t quite right, or if the framing is off. It’s been satisfying to upload a cache of sugar-free images, all beautifully arranged on the app’s user interface. Even more satisfying has been avoiding feeling like the guy who said he’d go sugar-free only to end up sending in pictures of donuts and cookies. Compared to calorie logs and food diaries, the prospect of someone else seeing photos of what I’m eating has made the potential pain of falling short feel more proximate than the pleasure of eating sweets. So I just stopped eating sugar. And it’s still working. Was this all it took?

Perhaps the persistent effort to control appetite, replicated across many cultures and times, reveals just how vigorously it resists that very control. The seemingly endless proliferation of constraints on appetite – from the disciplinary to the pharmacological – underscores its untamable quality. And yet the training of appetite – both as physiological fact and, more abstractly, as desire – can function as an ascetic practice. In this paradigm, as religion scholars such as Flood argue, the negation of desire amplifies the subjectivity of the individual.

Depriving the body paradoxically accentuates the conscious subject, because hunger unsatiated allows the pangs of the self to be felt more acutely, and renders being more vivid. In other words, appetite unfulfilled creates the conditions for expanding self-awareness. This is seen in the Bhagavad Gita in the figure of the ascetic, one who has renounced the pull of appetite and “attains extinction in the absolute” – in seeming contradiction, gaining infinity through loss.

If philosophy is after theoretical victories, science aims more concretely to hack, or at least short-circuit, a physiological truth. Take, for example, gastric bypass surgery, an operation that cuts the stomach into two parts (leaving one functional thumb-size pouch alongside a larger remnant) and radically reconstructs separate intestinal systems for each segment to restrict the amount of food that can be eaten. By shrinking the stomach to fool the mind into feeling satisfied with less, this surgery builds on growing recognition that the long-embraced brain-gut divide is far more porous than previously thought.

Recipients of the surgery generally do well in the short term, with reduced appetite, marked weight loss, better control of diabetes and improved health markers. But the percentage of patients who “fail” in the long-term after bariatric surgery (ie achieve less than half of excess weight loss) is reportedly as high as 35%. During that first post-op year, studies suggest, an influx of appetite-reducing intestinal hormones decreases patients’ urge to eat. Crucially, however, there are questions about the duration of those salutary hormonal changes and their effectiveness in controlling appetite as post-surgical days add up.

For a significant proportion of patients, even surgically shrinking the stomach – the historical seat of hunger – doesn’t offer complete freedom from unchecked appetite. This fact is not entirely surprising, given what is now known about the multiple neuroendocrine nodes that govern appetite, but it poses a conundrum for medical science: can appetite, as Freud asked in his own way, ever be fully controlled? And if not, is it a wonder that patients turn back to more personal strategies to pursue the work that prescriptions and sutures leave undone?

I can’t say I fully understand why teaming up with a nutritionist on an app worked so well, so fast. Would sharing pics of my food with friends and family in a group chat or a Facebook page have been as effective? Probably not. The issue seemed to be one of epistemology. My friends and family wouldn’t have been as suitable an audience, since they don’t just know me as I am, but also as I was. That knowledge of what’s bygone necessarily shapes the stories we can tell and believe about one another.

But with my nutritionist reviewing pictures of my meals from god knows what timezone, the app created an epistemological gap into which both of us could step. It was within this gap that my future self – the self I aspired to be, still unrealised and therefore unknown – could intercede in the present with slightly less inertia from the past. The app provided an illusion that daily life could not, offering a space for the dormant commitments of the future to come to fruition in the present. A space for imagination to overcome memory.

As my sugar-free streak extended, I began to wonder about the future of this illusion. Was it a rare example of tech living up to its glitteringly naive promise of liberation? Or was this an instance of the digital panopticon yet again determining our ability to imagine ourselves, revealing just how far-reaching its gaze is? And, more practically, I began thinking about how long I needed to keep eating this way. The cravings that had knocked so loudly at my door at the start of the pandemic now softly shuffled from leg to leg right outside it. I could still hear their shoes creaking at the threshold, but they couldn’t force their way in anymore. Things seemed quiet, maybe a little too quiet.

Whereas the Greeks soughtto regulate appetite in pursuit of the good life, perhaps what is sought after today is a facsimile of it: a corporatised eudaimonia-lite, where the goal isn’t virtue but efficiency; not equanimity, but productivity. In this view, it’s not a better way to live we’re seeking, just a less painful way to work and die – all while “looking good”. A more charitable and poetic possibility is that the constraint of appetite continues to appeal because it provides the same sense of structure to selfhood that metre does to a poem: a limit against which to construct narrative unity of the psyche.

As fascinating as it is to think about this question, even more essential ones – about the links between appetite, scarcity and loss – loom in the writings of Toni Morrison, a writer who provides a necessary counterbalance to the obsession with appetite restriction in societies glutted with luxury. In particular, I’m thinking of Beloved, which tells the story of human beings struggling for survival and wholeness in the face of slavery’s horrors. In portraying this struggle, Morrison uses the language of food and appetite to unfurl narratives saturated with the metaphysics of hunger: the difficulty of sating the self; the confusion between hunger, history and hurt.

I was struck by this unexpected resonance while rereading the book in the middle of my bid to quit sugar. Morrison’s characters think about what it would mean to satisfy what the narrator calls their “original hunger” – and whether doing so is even possible. They imagine getting to a place “beyond appetite”, but are also compelled by history to contemplate the price of doing so.

In my reading of the book, the denial of hunger risks becoming a costly exercise in self-abnegation – a severing of self from history, of self from self – whose consequences Plato doesn’t seem to fully consider, but which Morrison is deeply wary of. I think Morrison is, like Freud, skeptical of the metaphysicians who would have us render hunger subordinate. But where Freud is an anti-idealist, Morrison appears willing to reach for hunger, perilous though it may be. Straddling both the risk of self-destruction posed by contact with the original hunger, and the anguish of self-denial created by leaving it unrecognised, Morrison casts her faith in the human ability to embrace the beautiful, blood-hued predicament of incarnation.

About 10 months into my sugar-free life, a scent from the pantry hit me like it hadn’t for a while. My wife had just baked chocolate-chip cookies for our kids as a treat. By then, I was unfazed by sweets around the house. They might as well have been made of stone. But, at the end of a long day, I found myself unexpectedly at the pantry door. Minutes passed. After a while, I opened the plastic container and inhaled. My mouth began to water. I could almost taste the cookies.

I remembered the delightful way the chocolate melted at the back of the tongue. I remembered the satisfaction of soaking a warm cookie in milk. A part of my brain was humming, eager to replicate the memory of sugar, butter and dough on the cortex. Another part was already dreading the pain of not being able to stop. I picked up the cookie and, having built nearly a year’s worth of muscle memory, simultaneously opened the app on my phone. I centred the cookie in the glowing frame and was about to press send when, looking at the screen, it hit me: what would my nutritionist think?

As of this writing, my streak remains unbroken, despite a few close calls. In many ways the story seems to be going the way I intended: I am eating well balanced, sugar-free meals and haven’t counted a calorie in more than a year. The cravings that were troubling me aren’t gone, but the future version of me – the unsweetened aspirant – grows closer with each picture I snap. I feel the spiritual and physical acuity that comes with ascetic practice.

But I also feel some qualms about neglecting Morrison’s original hunger, with all its attendant risks and possibilities. I think about how I have sacrificed memory at the altar of imagination, recognising the chance that imagination ends up being overrated and memory proves to be the last storehouse of joy. But then I remind myself that visions like Morrison’s may be too large, too untimely for us to inhabit. They come from a place we haven’t arrived at. At least not yet.

By

Source: Why is it so hard to control our appetites? A doctor’s struggles with giving up sugar | Health & wellbeing | The Guardian

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How To Move With Migraines

Migraines are the most common form of headache that can cause severe throbbing pain – usually on one side of the head – and severely affect quality of life. A migraine attack can last hours or days and often comes with nausea, vomiting and extreme sensitivity to light and sound.

According to a 2018 Deloitte Access Economics Report, almost 5 million people in Australia live with migraine, with 7.6% of them – around 400,000 people – experiencing chronic migraine, which means more than 15 migraine days per month.

Migraines are much more common in women than men and more prevalent in working-age people.

“During a flare, all people want to do is lie in a cold dark room and not do anything,” says Adnan Asger Ali, a physiotherapist and the deputy national chair at Musculoskeletal Physiotherapy Australia. But research shows regular exercise may have a preventive effect in reducing the number and intensity of migraines. One of the main reasons physical activity may help relieve migraines, says Ali, is that the body releases endorphins (natural painkillers) during exercise.

“Physical therapy can complement the pharmacological management of migraines,” he says. “It might mean that they take two Panadol instead of two codeine, and that’s still going to be a win because they’re not taking the hard stuff.”

A proper physical assessment is necessary to tailor a treatment plan to the individual, and individuals should consult with a health professional before embarking on a new exercise regime, but here are some suggestions on physical exercise that might help manage migraine.

The class: yoga and tai chi

Ali says slow movements, meditation and relaxation have significant beneficial effects on people who suffer from migraines. That includes activities such as yoga and tai chi.

In a recent randomized clinical trial that involved 114 patients aged 18 to 50 years with a diagnosis of episodic migraine, researchers found that people who practised yoga as an add-on therapy had less frequent and less intense migraines than those who received medical treatment alone.

Tai chi can also serve as a preventive measure for migraines. In a 2018 randomised controlled trial of 82 Chinese women with episodic migraines, researchers found that after 12 weeks of tai chi training, the women experienced significantly fewer migraine attacks.

The move: chin tuck

Neck stiffness and postural issues can be a driver for migraines, says Ali. He suggests the chin tuck, or cervical retraction, exercise to strengthen neck muscles and improve mobility.

The chin tuck exercise can be performed standing or sitting. Begin by sitting upright and looking straight ahead, keeping your neck and shoulders relaxed. Place a finger on your chin and gently glide your chin down – tuck your chin to your neck. Don’t hold your breath, move your head up or down or bend your neck forward.

You might feel a gentle pull at the base of the head and top of the neck. Hold the position for about five seconds and repeat the exercise 10 times – as long as it doesn’t cause any pain.

The activity: walking, jogging, running and cycling

Aerobic exercises such as walking, jogging, running and cycling might help mitigate migraine.

A systematic review of studies on exercise and migraine published in The Journal of Headache and Pain in 2019 found that moderate-intensity exercise – physical activities that elevate your heart rate and cause you to breathe harder but still allow you to carry on a conversation – can decrease the number of migraine days.

“Any activity that people will do consistently and that they enjoy will be good for them,” says Ali.

The hard pass: high-intensity interval training

Ali warns against HIIT workouts, which alternate short bursts of intense cardio exercise with rest or lower-intensity exercise. “Very high-intensity exercise is discouraged if it triggers your migraine,” he says.

In some people, high-intensity exercise can trigger a migraine attack. But research has shown that regular HIIT workouts might be more beneficial than moderate exercise for others, highlighting the importance of a personalized exercise plan.

By: Manuela Callari

Source: How to move: with migraines | Life and style | The Guardian

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Definition:

The main symptom of a migraine is usually an intense headache on 1 side of the head. The pain is usually a moderate or severe throbbing sensation that gets worse when you move and prevents you carrying out normal activities. In some cases, the pain can occur on both sides of your head and may affect your face or neck.

Additional symptoms

Other symptoms commonly associated with a migraine include:

  • feeling sick
  • being sick
  • increased sensitivity to light and sound, which is why many people with a migraine want to rest in a quiet, dark room

Some people also occasionally experience other symptoms, including:

Not everyone with a migraine experiences these additional symptoms and some people may experience them without having a headache. The symptoms of a migraine usually last between 4 hours and 3 days, although you may feel very tired for up to a week afterwards.

Symptoms of aura

About 1 in 3 people with migraines have temporary warning symptoms, known as aura, before a migraine.

These include:

  • visual problems – such as seeing flashing lights, zig-zag patterns or blind spots
  • numbness or a tingling sensation like pins and needles – which usually starts in 1 hand and moves up your arm before affecting your face, lips and tongue
  • feeling dizzy or off balance
  • difficulty speaking
  • loss of consciousness – although this is unusual

Aura symptoms typically develop over the course of about 5 minutes and last for up to an hour. Some people may experience aura followed by only a mild headache or no headache at all.

When to get medical advice

You should see a GP if you have frequent or severe migraine symptoms that cannot be managed with occasional use of over-the-counter painkillers, such as paracetamol. Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines (on more than 5 days a month), even if they can be controlled with medicine, as you may benefit from preventative treatment. You should call 999 for an ambulance immediately if you or someone you’re with experiences:

References:

  • Paralysis or weakness in 1 or both arms or 1 side of the face
  • stroke or meningitis, and should be assessed by a doctor as soon as possible.

 

The Facts About Fat Burning and Running

If you’re reading this while sitting down, congratulations—you’re primarily burning fat. However, if you get up and start moving around your home, you won’t burn as much fat. And if you felt really active and broke into a sprint outside, you’ll be burning almost no fat.

While everything we just said is true, it doesn’t mean all you have to do is sit tight and watch your fat stores melt away. The common presentation of how to exercise to lose fat—presented in admittedly exaggerated form above—is misleading.

There’s no special “fat-burning zone” that’s key to getting lean. Here’s what you need to know about burning fat through exercise.

What Fuels Your Running?

Look at wall charts or cardio equipment in the gym, or listen to many personal trainers, and you’ll encounter the fat-burning zone. The standard advice for getting in this zone is to work out at about 60 percent of your maximum heart rate.

That level of exertion is relatively low-intensity. Runners can usually talk in complete sentences at this effort, which is an easy pace like you might run the day before a race or the day after a hard interval workout. Working in this zone, it’s said, will burn more fat, and therefore result in greater long-term weight loss, than doing the same exercise at higher intensities.

On the surface, there’s some substance to part of this claim, according to decades of research. At all times, your body fuels itself primarily by burning a mix of fat and glycogen (the stored form of carbohydrate in your muscles). The less active you are at a given moment, the greater the percentage of that fuel mix comes from fat. At rest, fat constitutes as much as 85 percent of calories burned. That figure shifts to about 70 percent at an easy walking pace. If you transition to a moderate-effort run, the mix becomes about 50 percent fat and 50 percent carbohydrate, and moves increasingly toward carbohydrate the faster you go.

One reason your body goes through this shift is because your brain runs almost entirely on carbohydrates, and it wants to preserve its limited carbohydrate stores. Although burning fat requires a lot more oxygen than does burning carbohydrate, there’s plenty of oxygen available when you’re at rest or working at a low intensity. As you start exercising harder, however, your body needs fuel more quickly, and turns more to carbohydrates.

This change in the fuel-burned ratio is why you might hit “The Wall” when trying to run a marathon as fast as possible, but you might not during an ultramarathon. A marathon run at faster than your normal training pace can use up all of the glycogen stored in your muscles. When that happens—usually in the final 10K—your muscles turn to fat to fuel your stubborn insistence on reaching the finish line. But burning fat requires a lot more oxygen than burning carbohydrate, so to meet that demand for more oxygen, you have to slow considerably, usually by a minute per mile or more.

In contrast, if you’ve ever run an ultramarathon, it was likely at a much lower intensity, probably slower than your normal easy pace. The percentage of each mile that’s fueled by fat is higher than at the faster pace of racing a marathon. So even though you might be running longer in an ultra, you’re less likely to have that sensation of having to suddenly slow significantly because of depleted glycogen stores. Even the leanest runners have enough body fat to fuel hundreds of miles at a leisurely pace.

There’s Burning Fat, and There’s Losing Weight

So, it’s true that at some workout intensities you’re burning a higher percentage of fat than at other intensities. But running a certain pace so that you burn a higher percentage of fat doesn’t magically melt fat away. And even if it did, the difference in total fat burned in running three miles slowly and doing the same distance faster is perhaps a couple dozen calories. That’s negligible in the grand scheme of things, given that burning a pound of fat entails burning about 3,500 calories.

More important, as Asker Jeukendrup, Ph.D., a leading sport nutrition researcher, puts it, fat burning and weight loss aren’t synonymous. Weight control is a matter of calories in and calories out. Burn more calories than you consume, and you’ll eventually lose weight. Do the opposite, and you’ll eventually gain weight. “If you burn more fat, but you eat more calories than the calories you burn in total, you will not lose weight,” Jeukendrup has written.

Because total calories burned is what matters, perhaps you can see another flaw with the “fat-burning zone” line of thinking: You could spend an hour walking three miles; of the roughly 300 calories you’d burn, a higher percentage would be from fat than if you ran three miles. But in that hour, you might run six miles, burning about twice as many calories.

If you want to get all geeky, the math in the following example (and in the graphic) argues against the fat-burning zone.

Walk three miles in an hour, and of the roughly 300 calories you’ll burn, about 210 of them (70 percent) will be fueled by fat. Run 10-minute miles for that hour, and of the roughly 600 calories you’ll burn, about 300 (50 percent) of them will be fueled by fat. Also, your metabolism stays revved up longer after vigorous workouts than it does after low-intensity exercise. While this postrun burn is likely only a few dozen additional calories, or less than the amount in a banana, every bit helps if weight loss is one of your goals.

The Real Reason to Consider Fat Burning as a Runner

Running at the gentle effort of around 60 percent of your maximum heart rate isn’t the key to weight loss, but there are still many reasons to regularly run at this pace.

Easy runs help you recover before and after harder workouts, they provide great cardiovascular and mental health benefits, and they’re simply enjoyable. Easy running also allows you to accumulate lots of mileage, and thereby burn more calories, if doing so is one of your motivations to run.

As for fat burning and running, perhaps the most important reason to care about the topic has to do with training performance, not weight loss. As we noted above, at sustained higher-effort levels, such as half marathon to marathon pace, your running is fueled by a higher percentage of carbohydrates than at slower paces. Run far enough at these paces, and you’ll start to deplete your muscle’s glycogen stores, and you’ll have to slow.

One of the main goals of marathon training is to become more efficient at burning fat when running these faster paces. If you can train your muscles to burn a little more fat per mile when running at marathon pace, then your glycogen stores will last longer, and your chances of holding a strong pace to the finish will increase.

The best way to accomplish that is by running not at a gentle jog, but at close to your marathon pace, with wiggle room of about 5 percent per mile faster or slower. For example, if your marathon race pace is 8:00 per mile, then run between roughly 7:36 and 8:24 per mile.

You can do these runs as stand-alone workouts, such as 6 to 10 miles at marathon pace after a 1- or 2-mile warm-up. You can also incorporate them into the latter part of your long runs, such as running easy for an hour and then running another hour at around marathon pace. When done a few times a month, sustained runs at these effort levels will improve your muscle’s fat-burning efficiency.

Starting some medium-length to long runs on an empty stomach, such as soon after waking up, and taking in no fuel during those runs, can also train your body to burn more fat at a given pace. It’s best to save these “fasted” runs for easy to medium-effort sessions. (Learn more about the good and bad of fasted cardio workouts here.)

All of this might seem like a lot to remember about fat burning. The key takeaway: Ignore claims you’ll lose more weight by running in a special “fat-burning zone.” Follow a good training plan, eat a well-balanced diet, and stay healthy enough to run the amount you want to, and you’ll likely settle at what for you is a good running weight.

By: Runner’s World / Runner’s World Editors

Source: The Facts About Fat Burning and Running

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References

  1. Shira Tsvi. Personal Trainer & Fitness Instructor. Expert Interview. 7 January 2020.
  2. http://www.active.com/running/articles/3-ways-to-burn-fat-effectively-while-running
  3. http://www.runnersworld.com/run-nonstop/how-and-why-you-should-warm-up-before-a-run
  4. http://www.fitbodyhq.com/cardio/running-tips-to-boost-fat-loss/
  5. http://www.runnersworld.com/ask-coach-jenny/three-mind-games-to-get-you-through-tough-runs
  6. http://www.active.com/articles/running-for-weight-loss-prepare-to-be-patient
  7. http://www.runnersworld.com/running-tips/your-perfect-running-pace
  8. https://www.runtastic.com/blog/en/veras-viewpoint/how-to-burn-fat-while-running/
  9. http://www.runnersworld.com/hydration-dehydration/prevent-dehydration-while-running
  10. 1 Running Distances for Fat Burning
  11. 2 Incorporating Alternative Components to Boost Fat Burning

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How To Harness The Pain Blocking Effects of Exercise

Athletes have a very complicated relationship with pain. For endurance athletes in particular, pain is an absolutely non-negotiable element of their competitive experience. You fear it, but you also embrace it. And then you try to understand it.

But pain isn’t like heart rate or lactate levels—things you can measure and meaningfully compare from one session to the next. Every painful experience is different, and the factors that contribute to those differences seem to be endless. A recent study in the Journal of Sports Sciences, from researchers in Iraq, Australia, and Britain, adds a new one to the list: viewing images of athletes in pain right before a cycling test led to higher pain ratings and worse performance than viewing images of athletes enjoying themselves.

That finding is reminiscent of a result I wrote about last year, in which subjects who were told that exercise increases pain perception experienced greater pain, while those told that exercise decreases pain perception experienced less pain. In that case, the researchers were studying pain perception after exercise rather than during it, trying to understand a phenomenon called exercise-induced hypoalgesia (which just means that you experience less pain after exercise).

This phenomenon has been studied for more than 40 years: one of the first attempts to unravel it was published in 1979 under the title “The Painlessness of the Long Distance Runner,” in which an Australian researcher named Garry Egger did a series of 15 runs over six months after being injected with either an opioid blocker called naloxone or a placebo. Running did indeed increase his pain threshold, but naloxone didn’t seem to make any difference, suggesting that endorphins—the body’s own opioids—weren’t responsible for the effect. (Subsequent research has been plentiful but not very conclusive, and it’s currently thought that both opioid and other mechanisms are responsible.)

But the very nature of pain—the fact that seeing an image of pain or being told that something will be painful can alter the pain you feel—makes it extremely tricky to study. If you put someone through a painful experiment twice, their experience the first time will inevitably color their perceptions the second time.

As a result, according to the authors of another new study, the only results you can really trust are from randomized trials in which the effects of exercise on pain are compared to the results of the same sequence of tests with no exercise—a standard that excludes much of the existing research.

The new study, published in the Journal of Pain by Michael Wewege and Matthew Jones of the University of New South Wales, is a meta-analysis that sets out to determine whether exercise-induced hypoalgesia is a real thing, and if so, what sorts of exercise induce it, and in whom. While there have been several previous meta-analyses on this topic, this one was restricted to randomized controlled trials, which meant that just 13 studies from the initial pool of 350 were included.

The good news is that, in healthy subjects, aerobic exercise did indeed seem to cause a large increase in pain threshold. Here’s a forest plot, in which dots to the left of the line indicate that an individual study saw increased pain tolerance after aerobic exercise, while dots to the right indicate that pain tolerance worsened. 

The big diamond at the bottom is the overall combination of the data from those studies. It’s interesting to look at a few of the individual studies. The first dot at the top, for example, saw basically no change from a six-minute walk. The second and third dots, with the most positive results, involved 30 minutes of cycling and 40 minutes of treadmill running, respectively. The dosage probably matters, but there’s not enough data to draw definitive conclusions.

After that, things get a little tricker. Dynamic resistance exercise (standard weight-room stuff, for the most part) seems to have a small positive effect, but that’s based on just two studies. Isometric exercises (i.e. pushing or pulling without moving, or holding a static position), based on three studies, have no clear effect.

There are also three studies that look at subjects with chronic pain. This is where researchers are really hoping to see effects, because it’s very challenging to find ways of managing ongoing pain, especially now that the downsides of long-term opioid use are better understood. In this case, the subjects had knee osteoarthritis, plantar fasciitis, or tennis elbow, and neither dynamic nor isometric exercises seemed to help. There were no studies—or at least none that met the criteria for this analysis—that tried aerobic exercise for patients with chronic pain.

The main takeaway, for me, is how little we really know for sure about the relationship between exercise and pain perception. It seems likely that the feeling of dulled pain that follows a good run is real (and thus that you shouldn’t conclude that your minor injury has really been healed just because it feels okay when you finish).

Exactly why this happens, what’s required to trigger it, and who can benefit from it remains unclear. But if you’ve got a race or a big workout coming up, based on the study with pain imagery, I’d suggest not thinking about it too much. Hat tip to Chris Yates for additional research. For more Sweat Science, join me on Twitter and Facebook, sign up for the email newsletter, and check out my book Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance.

By: Alex Hutchinson

Source: How to Harness the Pain-Blocking Effects of Exercise | Outside Online

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Critics:

Exercise-associated muscle cramps (EAMC) are defined as cramping (painful muscle spasms) during or immediately following exercise. Muscle cramps during exercise are very common, even in elite athletes. EAMC are a common condition that occurs during or after exercise, often during endurance events such as a triathlon or marathon.

Although EAMC are extremely common among athletes, the cause is still not fully understood because muscle cramping can occur as a result of many underlying conditions. Elite athletes experience cramping due to paces at higher intensities.The cause of exercise-associated muscle cramps is hypothesized to be due to altered neuromuscular control, dehydration, or electrolyte depletion.

It is widely believed that excessive sweating due to strenuous exercise can lead to muscle cramps. Deficiency of sodium and other electrolytes may lead to contracted interstitial fluid compartments, which may exacerbate the muscle cramping. According to this theory, the increased blood plasma osmolality from sweating sodium losses causes a fluid shift from the interstitial space to the intervascular space, which causes the interstitial fluid compartment to deform and contributes to muscle hyperexcitability and risk of spontaneous muscle activity.

The second hypothesis is altered neuromuscular control. In this hypothesis, it is suggested that cramping is due to altered neuromuscular activity. The proposed underlying cause of the altered neuromuscular control is due to fatigue. There are several disturbances, at various levels of the central and peripheral nervous system, and the skeletal muscle that contribute to cramping.

These disturbances can be described by a series of several key events. First and foremost, repetitive muscle exercise can lead to the development of fatigue due to one or more of the following: inadequate conditioning, hot and or humid environments, increased intensity, increased duration, and decreased supply of energy. Muscle fatigue itself causes increased excitatory afferent activity within the muscle spindles and decreased inhibitory afferent activity within the Golgi tendon.

The coupling of these events leads to altered neuromuscular control from the spinal cord. A cascade of events follow the altered neuromuscular control; this includes increased alpha-motor neuron activity in the spinal cord, which overloads the lower motor neurons, and increased muscle cell membrane activity. Thus, the resultant of this cascade is a muscle cramp.

See also

How The COVID Vaccine and Regular Exercise May Increase Effectiveness

And while we’re still waiting for similar studies with COVID-19 vaccines, there’s good reason to believe the same effects would apply, says University of Sydney associate professor of exercise science Kate Edwards, who has extensively researched the links between vaccines and exercise.

Exercise and your immune system

First, it’s important to understand the profound effects of exercise on the immune system. One, Edwards says, is that it puts more immune cells – which kill infected cells and produce antibodies to destroy viral and bacterial antigens – on patrol in the body’s blood circulation. Also, when you work out, your muscles release signalling molecules, called myokines, that help put our body’s defences on high alert. Over the long-term, regular exercise means having a stronger, more responsive immune system.

And this has had repercussions during the pandemic. A US study, published this week in the British Journal of Sports Medicine, examined almost 50,000 patients and concluded that aside from old age or a past organ transplant, physical inactivity was the biggest risk factor for severe symptoms. People who didn’t exercise were more than twice as likely to be hospitalised compared to those who clocked up at least 150 minutes of activity every week. They were also 2.5 times more likely to die of the infection.

The effects of exercise on vaccines

Given all this, it’s perhaps unsurprising that exercise has been shown to improve the efficacy of vaccines. “We see that regular exercise over the course of weeks or months makes vaccine responses stronger and that likely then means you are more protected from the disease,” Edwards says.

A study published last year found that elite athletes had significantly more anti-influenza immune cells after a flu shot compared to other healthy adults. This echoed a 2019 study finding that older adults who trained regularly had a much higher antibody response to healthy adults who didn’t exercise. Consistent exercise after a vaccine is also thought to prolong enhanced protection.

“Vaccination does cause an immune response but because we have more of these immune cells [when we exercise], it’s a much more powerful response,” says Rob Newton, professor of exercise medicine at Edith Cowan University.

Interestingly, exercising on the day of a vaccine has also shown benefits. There’s less evidence for this, Edwards says, but her research suggests it may lead to a stronger immune response, particularly from doing arm movements in the hours before injection.

“You are likely to get more immune cells moving to pick up the vaccine … but also by exercising the muscles where you’ll get the vaccine means you release those immune signals and so it may draw the cells to that location as well.”

“The key is that exercise has no downsides. It gives benefits regardless and the evidence is so strong in a range of other vaccines.”

Professor Rob Newton

What’s even more startling is that being active close to the time of a vaccination – such as flu or HPV – has been found to reduce the risk of suffering from adverse reactions to the jab. Edwards says the effects were observed simply with 15 minutes of moderate resistance band exercise, probably because the immune system was primed and ready for a challenge.

“I would expect exercise in the hour before vaccination and the short period after would have the same effect,” Edwards says. This may be particularly valuable for people who are compromised through age or illness, Newton says.

Preparing for your COVID-19 vaccine

Of course, while this is all compelling evidence, Newton says we can’t be sure the same will apply to COVID-19 vaccines, particularly those that use new mRNA technology, such as Pfizer. “But those pathways still require the involvement of the immune system and the activation of immune cells,” Newton says. “[And] exercise distributes immune factors through the body.”

Newton is frank when he explains how he’ll approach his own COVID-19 vaccine: “I’m already exercising regularly and when it’s my turn to get a vaccination I can tell you I’ll be exercising before I head off to the medical clinic.” He suggests people follow his lead: “The key is that exercise has no downsides. It gives benefits regardless and the evidence is so strong in a range of other vaccines.”

“If you’re particularly worried about a vaccine working well, then exercise is a really good thing to do, but remember it’s important for … all sorts of things.”

Associate Professor Kate Edwards

Edwards agrees: “Certainly what we’ve never seen is exercise making anything worse: immune response or side-effects.” Edwards says because researchers are still exploring why some people are experiencing COVID-19 vaccine side-effects, she recommends not drastically changing your exercise routine on the day of your shot. But if you typically go for a run or do yoga, go for it.

She says it may help to do some light arm exercises close to the time of injection – for example a few sets of wall push-ups, shoulder presses and bicep curls. “Then you might want to consider having a rest day the day after the vaccination because reactions are sometimes being seen 24-48 hours after.”

And while you wait for the rollout to reach you, it’s worth ensuring you have a training routine in place. Australia’s physical activity guidelines for adults aged 18-64 are to have at least 150 minutes of moderate exercise each week, and two resistance training sessions – the latter of which Edwards particularly recommends for promoting immune function.

The bottom line, though, is working out is good for everybody, for myriad reasons. “If you’re particularly worried about a vaccine working well, then exercise is a really good thing to do, but remember it’s important for chronic disease, mental health, socialisation, all sorts of things,” Edwards says.

Newton says people shouldn’t worry that vigorous exercise will stress their bodies. “Unless you’re an elite athlete it’s very difficult to exercise to excess and compromise your immune system.” He recommends older Australians or people with chronic illness set up an exercise program with the guidance of an accredited exercise physiologist.

Sophie Aubrey

 

By: Sophie Aubrey

Source: How the COVID vaccine and regular exercise may increase effectiveness

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Related Links:

Common Ground: a pandemic influenza simulation exercise for the European Union, 23-24 November 2005

R Kaiser, M Ciotti, G Thinus… – Weekly releases (1997 …, 2005 – eurosurveillance.org
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Exercising in isolation? The role of telehealth in exercise oncology during the COVID-19 pandemic and beyond

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Combating physical inactivity during the COVID-19 pandemic

AJ Pinto, DW Dunstan, N Owen, E Bonfá… – Nature Reviews …, 2020 – nature.com
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home-based exercise programmes are feasible and can be effective in promoting health benefits
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Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic

M Leonardi, AW Horne, K Vincent… – Human …, 2020 – academic.oup.com
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sleep hygiene, low-intensity physical activity (including pelvic exercises, yoga), dietary …

The impact of the COVID-19 pandemic on Parkinson’s disease: hidden sorrows and emerging opportunities

RC Helmich, BR Bloem – Journal of Parkinson’s disease, 2020 – ncbi.nlm.nih.gov
… Nevertheless, a loss of aerobic exercise during the COVID-19 pandemic may well … Furthermore,
reduced physical exercise may contribute to increased psychological stress, thereby further …
Promoting home-based and adequately dosed exercises, such as cycling on a stationary …

Loneliness and social isolation in older adults during the Covid-19 pandemic: Implications for gerontological social work

M Berg-Weger, JE Morley – 2020 – Springer
… Having had to quickly respond during the pandemic necessitated the use of technology … delivery
option, traditional interventions can similarly be offered (eg, exercise, dementia care … eg, interactive
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General practice and pandemic influenza: a framework for planning and comparison of plans in five countries

MS Patel, CB Phillips, C Pearce, M Kljakovic… – PloS one, 2008 – journals.plos.org
… Tools [54], [55] and desktop simulation exercises [19] are available to help GPs plan … This aspect
of preparedness was enhanced after the Exercise Winter Willow simulation in … or impede effective
functioning of general practice services during a pandemic, including adaptation of …

Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries

P Hanvoravongchai, W Adisasmito… – BMC public …, 2010 – bmcpublichealth.biomedcentral.com
… Open Access; Published: 08 June 2010. Pandemic influenza preparedness and health
systems challenges in Asia: results from rapid analyses in 6 Asian countries … PDR in
2006. Pandemic preparedness programme. All countries in …

Have a heart during the COVID-19 crisis: Making the case for cardiac rehabilitation in the face of an ongoing pandemic

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Table 1), to ensure that patients keep themselves healthy during the pandemic and do … With
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… opportunities for the inclusion of all stakeholders in decision making, mock community‐wide
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