Unboxing 5HTP

Exercise Intensity

CoachRic's guide to advancing your activity:

1-Determine your Base-everyone starts at a different level of fitness, age, experience, limiting disease.  Expectation is to improve endurance, strength and speed over a period of time.  Rest should also be calculated into your exercise planning.  (there should be a fail safe duration of time in case of "push and crash"-see last paragraph)

-Assessment of TARGET HEART RATE (sometimes known as lactic acid threshold)

(calculate Maximal Heart Rate-MHR = 220-age)

Blue zone for warm up and recovery ................50-60% of MHR

Green zone for fundamental endurance ............60-70% of MHR

Yellow zone for active endurance.  ...................70-80% of MHR

Orange zone for resistance.  ..............................80-90% of MHR

Red zone heavy resistance. .............................90-100% of MHR (difficult to measure)

-Rate of Perceived Exertion can also be used
1   rest
2   very light
3   light
4   fairly light
5   somewhat hard
6
7   hard
8   extremely hard
9   very hard
10 maximum exhertion
(note RPE is a bit harder to dial in as it is very subjective BUT it serves as being directional to advance effort)

2-Determine fitness goals, calendar deadlines and health outcome goals. Advance in a linear or cyclic approach to pushing to the point of "uncomfortable muscle pain" and holding for a preset amount of time then rest.  Not regarding repetitions or sets... this is just the sessions per week.  Ultimate goal is to drive enough muscle work to stimulate mitochondrial bio genesis WITHOUT hitting the wall and crashing.  Avoiding the injury of hitting the wall will keep a time efficient plan to get to summit.  For Chicagoans, I expect to take advantage of spring summer and early fall and get as close to goals then stabilize and hold through out winter months until the plan for next year.  

GOALS:

-Build Muscle

-Lose Weight

-Improve Performance (get around a plateau)

-Balance/Reverse Disease

3-Overload / Adapt / Progress within each Phase

(even with no desire to add resistance, cardio training itself can lead to overuse injury)

Phase 1-work on deficiency of endurance, strength, flexibility, imbalance

-steady linear progression during this phase finding proper rest, nutrition, exercise type

Phase 2-work on undulating progression of cardio/endurance/overload 

-more specific for end goal / summit

-adjust load, tempo, volume, rest time and weekly order of exercise

Phase 3-testing efficacy of training in mock end goal / summit 

-care for co morbid conditions of obese, age, prior injury and medical disease

The Saguil Approach is to push skeletal muscle / cardiovascular fitness / immune system to its limit.

In some cases disease symptoms must be controlled first with aggressive medical management.  Often before starting with Phase 1, 

-Physical therapy will have to be called in to help balance skeletal alignment and regional dyskinesia.  -Psychological therapy will be just as crucial to maximize morale and endure the trials of work and sacrifice 

-Nutritional therapy would be a crucial asset during Phase 2 as we find balance with attaining maximal heart rate and building muscle while staving off pain and not adding to central fat.

I feel when the heart brain and muscle are fine tuned to maximize on cellular / metabolic flexibly, the immune system will be reset and autophagy will clean up misfiring cells and inflammation.

-Coaches will be hand picked, I act as Captain and the team is there to guide you to success.

Gonna make you sweat...

                                 SWEAT

With a recent interview during patient hours, I had gone through my usual Q&A to develop a picture of the 2nd person in the room.  One of my pillars to a balanced antiinflammatory lifestyle change is activity.  EVERYONE HAS TO MOVE....in the US we conceptualize walking as a chore thinking there is status in not having to walk so far from the front door or being at the back of the line or being able to watch 200 channels after a huge dinner, paying for your pre-made food instead of having to make it or chop veggies or cook from scratch.
My patient said he goes to the gym for 60-75 min about 3 x weekly.  NICE!!! Then I ask what are the activities he relies on (thinking I may be able to change or rearrange his routine to get the most his time in the gym).  He said 15minutes is spent in the sauna, another 15 spent in the whirlpool...then he gets on the treadmill or uses machines.   So you are thinking, 30minutes getting warm, then the rest of the time expending energy on the gym floor.  Fits into the AHA's recommendations of 30min 3-5 days a week.  BUT...this is a business owner that has 2 jobs and works around 60-70 hours a week and shoots for 6-8 hours of sleep nightly.  Even with his enjoyment of heat and concept of relating sweating as a form of exercise....this is where the life coach in me says to better utilize total hours per week, cut out the heat and try to condition the cardiovascular system to tolerate HIIT, (driving the heart rate high in a short amount of time and sustaining it for 30min -DONE!)...save time in the gym, get sweaty and with the 90minutes of "freed up time" per week, we can dive into a mindful practice development or enjoy a walk or family time.

(So I like using the American Heart Associations saying of minimum activity is 3-5 days a week of 30min of moderate intensity exercise weekly. )

So speaking of the cardiovascular system, when the heart beats faster than resting state, it is a muscle and muscle generates heat.  The reason the heart beats fast is to supply freshly oxygenated blood to muscles that are moving.  All this muscle heat has to be offloaded for fear that the brain will heat up to high temps - and result in a seizure.  One way to neutralize temp, SWEAT.  Perspiration moves water to skin layer and evaporation is cooling.  Some proponents of detoxing say a lot of toxins will leave the body with sweat but ....regarding weight.  NO overall change when you reload the fluid you sweat out in the gym over the course of the next 12 hours.

1-sweating ok (unless you are on a water pill at which point you can drop blood volume too fast)
2-perceived exertion of sweating should be associated with breath and pulse rate
3-walk when ever you can, stand instead of sit, feel the body high of moving fast for short times
4-tie in healthy eating to healthy activity to healthy mindful practice (stillness in silence )
5-HIRE a COACH if you are stagnant with what you do / bored / plateaued on benefits

Hormones like a teenager

In my prime-I was a muscle head.  Lived in Wildwood New Jersey.  Had 3 roommates (1 bartender and 2 bouncers).  Worked out at Atilis Gym in 1982, that summer the gym owners asked me to compete in a Mr East Coast and Mr Natural New Jersey.  I was 18 and didn't give a sh*t so I joined and won both (teenage divisions).  I lifted weights with some Venice beach-like-male-airheads and refined my "Muscle and Fitness magazine" body building movements.  (Joe Weider's publication was a bible back then)

I seemed to develop a lot of muscle mass with what I was taught so I took it with me to college and later.  I believe when we adapt a "routine" that: works, doesn't cause injury and gives size gains.....that becomes religion for the remainder of our exercise lives (at least for guys).  The lucky ones can still continue with the "usual" exercises no matter what age (maybe tailoring the routine to help with weight gain).  The not so lucky end up in physical therapy for some age related ache and are given a 3-6 week sentence with a physical therapist.  From that point on, free time limitations and achey reminders keep the "new routine" fresh.    

I stumbled upon alternative and complementary therapies when I tried to avoid rotator cuff surgery from a rock climbing injury in my 40's.  I did my own rehab and kept it to bare essential movements to maximize time in the gym and still get a "pump".  (can't let go of the feeling to muscle fiber with targeted movements with weights!!)  I beat the knife but it took a few years; I also dived into marathon running, yoga and more recently hiking.  Still can't stay away from trying to chisel a little muscle definition-so I have been doing this truncated weight/cardio work out (called peripheral heart action or circuit weight training before there was cross fit) guys do and getting by to work the heart and keep fit.

I started a new chapter in my life by signing a contract to go back to running a primary care office like I did in the 90's.  (worked in family medicine and carved a niche with my sports medicine clinic in Wheaton).  This week I decided to go back to using cables to work my shoulders.   [In a gym there are free weights, Nautilus-type machines to isolate body parts, universal cable machines for some restricted movement then Smith Machines for universal bars and big plates (wagon wheels).  So there I was.....pushing the envelope with repetitions, grunting from pain (had my bluetooth headsets on) and since it was empty-running between 3 stations back to back like a college crew teams would do.  As I finish my last of 3 giant sets, I feel a great pump to delts and traps....no ache...good heart rate....well targeted and I'm done!!  It just hit me, I was so used to the bare basics of quick power lifting movements that I forgot my old techniques of fine muscle tuning.  The feeling brought me right back to days at the gym in Wildwood NJ!!  Then I look up and see:

LOL!!!!

Lose weight; change your life; don't get hurt.

Spring is here and most people are scrambling to start dieting.  If you are like everyone else playing catch up, don't expect to do things the same way this year.  The 2014 snow season kept most runners in, most drivers delayed, most exercisers bundled up.  The usual dietary reflex in the deepest cold is to seek nutrient dense comfort foods.  In other words, the bears are coming out of the den with an extra padding of fat this year.  It just so happens  there are also 2 drugs that are building up steam as part of the "cheat-code" for initiating weight loss.  Qsymia and Belviq were released in mid to late 2013 (and so far no deaths!!).  Of course the most important impact anyone can have to lasting weight control is total lifestyle change.
I maintain my patients seek to address 3 components of life:

Thinking

Eating

Activity

(see my video)

The eating part everyone says "I know what to do, I just have to do it".  I disagree 100%!!!  If adopting a nutritional change was as easy as shopping the periphery of the grocery and choosing labels of low fat, our nation would be lean and healthy.  The World Health Organization published a controversial ranking of health throughout the world in 2000 and the US was 37th out of 190 countries (but we spent the most money per person in the world).  Seems out of proportion but just look at the check out line and notice how many people look overweight (1 in 3).  I just came back from an indoor water park and it was disappointing to see out of shape kids (waiting a few minutes I would see the inspirational out of shape parent float by) but then I thought this was job security for me.  However I refuse to just prescribe medicines and watch people become behaviorally addicted to weight loss drugs.  Anyone that goes to see me out of network knows if you want meds like phentermine, I must hear from your team of coaches to make sure I agree you are a "responsible adult".  When I hear the catch phrase above, it usually leads my brain to image how this person will look in 10 years.  (It's always the same-10 pounds heavier with 3 new medicines and 1 new surgical disease diagnostic procedure).  It takes more than just reading a few chapters from an author and experiencing 10 pounds of fat burning in 2 weeks back in college days to say you know what works for you.  In my short 20+ years of medicine, I have learned that community can overcome disease but disease can overcome the individual.  We have all the answers on how humans work (down the the DNA sequence) but a patient requires the knowledge to be applied in an individual designed lifestyle plan.  There is alot of great reproducible evidence out there (pubmed, google scholar) but I find myself "piece mealing" snippets of plans together to initiate, modify and maintain the routines people come in to see me for.  And it usually has to be reformulated in stages.  The "giving spirit" in me tries to keep people from spending their hard earned money on me and rather on nutrition, exercise and meditation coaches.  Infallibly, the plan works for a while but has to be reformulated as the goal was achieved and the next pinnacle has to be planned. I guess this is where most people throw the towel in, they hit a plateau, don't see further gains and just regress back to previous life/weight with disappointment.  So they tasted victory but lost the focus to maintain it, and the picture of summiting Mt Everest sticks in the memory more so than the pain of losing all your fingers and toes.

"I know what to do".   I believe most people with guidance can daisy chain small bursts of change to ultimately get to a goal that is healthy and rewarding.  It takes the right tweek from the right specialist to hit the next pinnacle.  I dont mean a medical specialist, this is more of a makeover specialist-the specific trained coach that can overcome the specific obstacle we run into.  (...could be flexibility, nutrition, self esteem, spouse issues, injury, food allergy....we are multifaceted and complex and problem solving requires a community of healers).  Currently, my best vaccine for the disease of weight gain is listening.  I don't mean you sit on a couch and regurgitate all frustrations to me-that would be a waste of my time and your money. Quid pro quo interviewing is the best way to get me started in creating a template for change.  Unfortunately this takes an average of 60-90 minutes for me while medical insurance has been chipping away at the proverbial office visit (13 minutes total to break even).  Those basic areas of change do require some trust.  When people say they know what to do - I translate that to mean they are not willing to change.  Experimentation is hard because it requires a step into the unknown but if I can summon the help of Jim Fixx, Linus Pauling, Atkins, Benson, Ornish, Weil, Chopra......there will be a wealth of knowledge to help catch you when you fall; (everyone falls!!)

When I hear "I know I need help", the creativity of my right brain takes the logic from my left brain a beautiful painting is created.  

To experience the Saguil Approach to lifestyle change, sign up for the April lecture at Advocate Sherman Hospital in Elgin (Randall Rd and 90)  Link to Event Tickets

Back pain from Shoveling

The last 10 days has been a massive winter "dump".  The snow fall seems un-ending and I have been getting alot of great outdoor time.  I love the clean look of a driveway after shoveling but hate that one crack in the sidewalk that catches my shovel tip just as I am going full speed with a big avalanche.  Well I also noted when my fingertips were painful, throbbing, I didn't realize my back was telling me "take a break!!!".  My mind was saying oh, just finish the last part of your driveway and it will stay dry magically forever.  Pain is usually delayed like whiplash....the next morning as the eyes open and the first step of the day is met with "whoa....did I sleep wrong?....oh....I shoveled yesterday!"  Then the realization is that it's still snowing so you have to do it again.
Muscle spasm if the activity is aggressive and blunt, will be felt accordingly at the time.  If activity is long and repetitive, the pain and inflammation is delayed up to 2-3 days.  It doesn't have to be an ache in one spot, pain can be a flare up of an old pinched nerve/bulging disc type pain.
The way the back is made is skin to outer layer, muscle covering (epimysium), muscle, fascia and bone.  The muscle is built to contract repetitively for life (think of the heart that beats every second for your entire life)  The problem our back muscles come into is the brain gets "superman strength" when reasoning about taking a break vs getting the job done now and going onto another chore.  With fatigue the muscle can still be stimulated to contract and do the job but lactic acid will accumulate, energy (ATP) will be used up, and some tendon fibers will tear (microscopically) and imbibe blood/edema slowly (versus a skin cut where blood comes out fast).  With a slow leak throughout broad low back muscle, swelling and stiffness will occur after about 12-24 hours.  Usually felt next morning.....same concept as whip lash.  With my previous post on whip last, there can always be pinched nerves, broken back bones, herniated discs....but those are usually sudden onset.  (only way to tell is to see a professional)
My best advise is to
1-do no further harm, lay off further shoveling, no exercise for 3 days, take brakes if you have a sitting job.
2-start with antiinflammatories immediately, that could be supplements like turmeric/magnesium, topicals like helicrysium/capsaisin/wintergreen, or prescription medicines/muscle relaxers/NSAIDS/narcotic pain relief.
3-get hands on healing, your choice of chiropractor, massage therapist, physical therapist, a relative with strong hands
4-raise the flag and see an MD/DO if urine or bowel incontinence occurs, pain doesn't allow sleep, numbness or tingling start, cant get out of bed, symptoms longer than 3 days

Shoulder Pain

I turned 40 in 2002 and as I approached that age, I was involved with a lot of x-games sports.  I remember rock climbing and attempting a "dyno".  (this is when you grab onto the ledges, pump up and down building up momentum and launch up to grab a hand hold somewhere above you .....Tom Cruise in MI 1) and missed.  It resulted in a year of not being able to bench press, lift overhead, and catching of my shoulder with any movement.  Some of my old patients may remember when I was working with a huge ice pack on my shoulder for 3 weeks.  I had seen my physical therapist who specialized in throwers, I took some of the best prescription medicines available, even got ready for arthroscopic surgery after the 6th month of not being able to exercise.

At that point, I had stumbled on alternative healing.  While an employee of CDH, one of the stipulations in my contract was to have my CMEpaid for, I chose a seminar in California with some guy that was teaching acupuncture to pain medicine doctors.  I planned on signing my name on the roster, blowing off the lecture and hanging out at the beach.  The keynote was made by Dr Joesph Helms and I remember sitting in the front row in a room of 800 doctors and with my long hair (midlife crisis) challenging him with questions on acupuncture in sports medicine, acupuncture in pediatrics, acupuncture for medical diseases.  But this guy nailed all my questions with very intelligent answers!  Then when he asked for a volunteer, I gave him my body (very skeptical and anxious to get to the beach).  Remember my shoulder was still painful and limited with range of motion from the rock climbing injury earlier in the year.  He place 3 needles into my shoulder and within 10 minutes, I had pain free, range of motion just like my pre-injury state!   I was sold on this weird 2500 year old concept of healing.  Thus began my journey into alternative and complementary medicine.
Note that I still had to do my rotator cuff exercises, my scapular stability exercises, take glucosamine sulfate, and have acupuncture 2-3 times a week for a few months.....but I avoided surgery and now have regained full range, better strength than before and can do hand stands in yoga at 51 years of age.  (the acupuncture isnt just a passive treatment, it helps the body heal so anyone with injury or disease still has to put in the sweat equity and maintain the building blocks to health and healing (see my Anti-inflammatory Lifestyle video here).