By: Alex McDonald, MD
Acupuncture has it’s origins in ancient China. For thousands of years practitioners of Eastern medicine have developed acupuncture skills and techniques that have been refined and re-refined into a very effective and precise medical art. However, it is still in many ways an art and can differ greatly from one practitioner to another. Within recent decades acupuncture has gain broad acceptance within Western medicine and has been scientifically show to have great benefit in many different medical and health circumstances. One of many specific uses for acupuncture that has been closely examined is it’s effect on athletic performance. Athlete’s have been shown to be more willing to engage in Complementary and Alternative Medicine (CAM), 56%, as compared to the general population, 36%. So is there an actual benefit to acupuncture on athletics? After a brief literature review, the answer is a resounding yes. Keep in mind, that there are many additional benefits of acupuncture, which are beyond the scope of this article.
It should be noted that there are several different methods of “acupuncture” all of which utilize a complex map of meridians and points on the body. Some of the more common types of treatment include; Needling, where a tiny needle is inserted into/thru the skin; Acupressure, where the skin is not penetrated; Transcutaneous electrical acupoint stimulation (TEAS), where an electrical stimulus is applied at specific acupuncture points by an electrode placed on the skin; Lastly, when an electrical stimulus is applied through a needle inserted into/thru the skin. All of these various modalities have been show to be beneficial to athletic performance.
There have been several studies, which point toward improved athletic performance with the use of acupuncture. Although there are certainly several different pathways involved, the major factors are most likely, reduced tension in the muscle, increased blood flow, increased oxygen utilization, and psychological effects.
Endurance athletics is particularly attuned to the effect of oxygen consumption and utilization and acupuncture has been shown to increase VO2 max. In one study by Lin et al. 3 groups of athlete’s were run to exhaustion. The control group had no treatment, the acupuncture group had auricular acupuncture treatment, and the third group had auricular acupressure treatment (no needle). The group that had received acupuncture treatment had a statistically significant higher measured VO2 max at exhaustion.
Muscular force production and recovery has also been shown to improve with acupuncture . In one study by So et al., participants completed 3 successive days of isokinetic knee exercises. The treatment group received TEAS right after exercise for 15min, where electrodes and current was applied to specific acupuncture points. A second, control group received pseudo-TEAS for 15min right after exercise, where electrodes where placed on points which were not established acupuncture points. Maximal muscular force was measured before and after exercise, as well as at 5min increments during the 15 minutes of TEAS or pseudo-TEAS treatment. The results showed that the group treated with TEAS had significantly improved recovery time and were able to generate greater maximal force and create it sooner than the pseudo-TEAS group. There have been additional studies, which demonstrate improved recovery after endurance exercise with acupuncture treatment, showing lower heart rate and lactic acid levels (lin).
In addition to allowing for higher muscle force production after acupuncture, studies have also demonstrated reduced muscle tension (de Sousa). Muscle fibers have an optimal length at which state they function best. If the muscle is stretched to long then contraction will be sub maximal, additionally, if the muscle is pre-contracted and too short then, again, contraction will be sub maximal. Part of the theory behind why muscular forces are greater after acupuncture is that the muscle is better able to relax to it’s optimal length. Acupuncture likely achieves this through two methods. First, it functions to relax the muscle itself. Secondly, it release tension in the fascia surrounding the muscle. Connective tissue, known as fascia is continuous and contiguous throughout the entire body form the bottom of the feet to the top of the head. This is one reason why treatment to one specific area, such as the leg can positively impact distance structure such as the shoulder. In one anecdotal, albeit uncommon situation, a woman with knee pain experienced symptom relief after acupuncture releasing tight fascia in her jaw.
Acupuncture has been shown to increased blood supply throughout the body, particularly to the muscle during and after acupuncture treatment (Ohkubo). This is one probable reason for why VO2 max has been shown to increase with acupuncture treatment. The act of microtrauma to muscle seems to create a healing response form the body without actually cause notable trauma. When an injury occurs there is a highly sophisticated response of hormonal, neural and metabolic intermediates that stimulate the healing response. Most notably in this situation, increased blood flow and resultant increased oxygen flow. Although slightly out of the scope of this article, acupuncture has been show to be beneficial during injury rehabilitation for many of the same reasons. Injured structures require blood flow to provide nutrients and metabolites to repair damaged tissue, as well as carry away waste products. Acupuncture has been show to be particularly helpful to increase blood flow to tendon injuries which typically have a very low blood flow, such as the achilles (Kubo).
Lastly, acupuncture has been show to decrease pain. The application of acupuncture has been show to have potential analgesic effect through the activation of endogenous opioid system within the body (Ma). That is to say, that acupuncture causes the release of substances naturally found in the body, known as endorphins, which act on the same neural pathways where medicines such as morphine and codeine. We have all experienced this sense of invincibility, or “no pain” during moments of emergency.
The Placebo Effect:
There have been some case studies, which describe immediate and significant improvement in athletic performance after commencing a regular acupuncture program. . For example, Kaada reported a mean improvement of 2.3 s in 800 m track racing and 4.3 s in 1000m road racing (Usichenco). The points for acupuncture were based on specific complaints by the athlete, for example, stomach pain, arm fatigue, stiffness of the shoulder and excitement and tremor of specific muscles. It is very difficult to explain these benefits based solely on physiology. As a result other causes of the benefits have been proposed, especially the placebo effect. The placebo effect being the benefits are psychological and due to the athlete’s belief that a treatment is helping and it becomes a self fulfilling prophecy. Some researchers argue that placebo, in addition to physiological effects, may constitute 30–50% of the entire clinical effect of acupuncture (Lundenburg) although, this cannot be confirmed. However, the placebo effect alone has been shown to produce the same performance improvement in trained athletes, as could be achieved using various pharmacological agents—caffeine and sodium bicarbonate in cyclists and anabolic steroids in weight lifting, thus even challenging the specific effect of these drugs (Usichenco). As a result, if a treatment helps an athlete believe that they will perform better, regardless of any physiologic base, than so be it!
There is a significant about information that indicates acupuncture can and does improve athletic performance. These benefits are mediated thru numerous physiologic and psycho logic pathways. There are certainly other benefits to acupuncture which have not been touched upon in this article. As a result it may be something that an athlete might utilize to take their training and racing to the next level.
Alex M. McDonald, MD is a professional triathlete, First Endurance Research Board Member, and endurance coach at Fast Forward Triathlon. Alex’s professional interests lie in coaching endurance athletes, sports medicine and exercise physiology. He obtained his MD degree from the University of Vermont. Prior to medical school, Alex graduated from Connecticut College with an emphasis on both the biological and social sciences. He currently trains and lives, with is wife and daughter, in Durham, NC.
Contact information:
Alex M. McDonald, MD
Professional Triathlete
www.alexmmtri.com
alexmmtri@gmail.com
919.699.6593
References:
Improved performance in endurance sports through acupuncture].
Benner S, Benner K. Sportverletz Sportschaden. 2010 Sep;24(3):140-3. Epub 2010 Sep 15. German.
Local increase in trapezius muscle oxygenation during and after acupuncture.
Ohkubo M, Hamaoka T, Niwayama M, Murase N, Osada T, Kime R, Kurosawa Y, Sakamoto A, Katsumura T. Dyn Med. 2009 Mar 16;8:2.
Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial. Hübscher M, Vogt L, Ziebart T, Banzer W.
Eur J Appl Physiol. 2010 Sep;110(2):353-8. Epub 2010 May 25.
Ergogenic effect of acupuncture in sport and exercise: a brief review.
Ahmedov S. J Strength Cond Res. 2010 May;24(5):1421-7. Review.
Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Eur J Appl Physiol. 2010 Jun;109(3):545-50. Epub 2010 Feb 6.
Lundeberg T, Lund I, Sing A, Näslund J. Is placebo acupuncture what it is intended to be? eCAM ( 2009;) doi:10.1093/ecam/nep049.
Goal-directed Acupuncture in Sports--Placebo or Doping?
Usichenko TI, Gizhko V, Wendt M. Evid Based Complement Alternat Med. . [Epub ahead of print]
So RC, Ng JK, Ng GY. Effect of transcutaneous electrical acupoint stimulation on fatigue recovery of the quadriceps. Eur J Appl Physiol ( 2007;) 100:: 693–700.
Nichols AW, Harrigan R. Complementary and alternative medicine usage by intercollegiate athletes. Clin J Sport Med ( 2006;) 16:: 232–237.
Ma SX. Neurobiology of acupuncture: toward CAM. eCAM ( 2004;) 1:: 41–47
Lin ZP, Wang CY, Jang TR, Ma TC, Chia F, Lin JG, et al. Effect of auricular acupuncture on oxygen consumption of boxing athletes. Chin Med J ( 2009;) 122:: 1587–1590.
Effects of acupuncture stimulation on recovery ability of male elite basketball athletes. Lin ZP, Lan LW, He TY, Lin SP, Lin JG, Jang TR, Ho TJ. Am J Chin Med. 2009;37(3):471-81.
Electromyographic evaluation of the masseter and temporal muscles activity in volunteers submitted to acupuncture. de Sousa RA, Semprini M, Vitti M, Borsatto MC, Hallak Regalo SC. Electromyogr Clin Neurophysiol. 2007 Jul;47(4-5):243-50.
The Science of Cholesterol
Acupuncture Today
December, 2010, Vol. 11, Issue 12
Big Fat Lies
By Marlene Merritt, DOM, LAc, ACN
One of the most important aspects about being a good practitioner/citizen/general person is to not believe everything you read or hear. It's not so much being skeptical as questioning the source of your information, wondering about the agenda behind the information, and just generally checking up on the facts.
And one of the biggest lies perpetrated on people today is the paradigm of low fat -- that eating low fat is healthy for you and will prevent heart attacks and lengthen your life. Nothing could be further from the truth.
Heart Studies
Did you know that high cholesterol levels in women of all ages and in the elderly is associated with a longer lifespan? In fact, for women and the elderly, no appreciable difference in cardiovascular heart disease (CHD) rate is seen for ANY level of cholesterol. The scientific publication Circulation (Circulation 1992 86:3) in 1992 said, "Many studies have shown that all-cause deaths, especially deaths from cancer, are higher for individuals with cholesterol levels lower than 180." How about this one? "Those individuals with a low serum cholesterol maintained over a 20-year period will have the worst outlook for all-cause mortality." (Lancet, 2001 358:351-55.) You probably hadn't heard that, had you? What about the French? They have the highest saturated fat intake of the entire European Union, but have the lowest rates of heart disease (European CVD statistics, 2005). How did we end up with a national stance that is so anathema to what is actually healthy?
Between 1930 and 1960, the number of deaths from heart attacks went from 3,000 to 500,000. Today, 650,000 to 700,000 people die from a myocardial infarction every year. Researchers started looking into this and saw some trends. They pointed out that they were using a lot more vegetable oils and fewer animal fats. We were especially consuming liquid oils hardened by a process called partial hydrogenation such as margarine and shortening in baked goods. These researchers suggested the solution to the new health problem was to return to traditional foods and stop using these vegetable oils -- a very logical suggestion.
However, other scientists proposed a different theory -- the "diet/heart theory" or the "lipid hypothesis." This hypothesis was based on experiments with vegetarian rats who were fed huge amounts of purified, oxidized cholesterol, which caused them to develop what seemed like atherogenic plaque in their arteries leading to blockages and heart disease.
According to the diet/heart theory, the cause of heart disease was a "bad diet," containing too much cholesterol and saturated fat, which led to us having elevated levels of cholesterol in the blood, which in turn, led to the build-up of plaque in the arteries. The overall conclusion was that this bad, indulgent diet of butter and bacon was the cause of heart disease.
So, the first of many studies was done. In 1957, the Anti-Coronary Club was a study done with men eating a "Prudent Diet," substituting corn oil and margarine for butter, cold breakfast cereal for eggs and chicken and fish for beef. Nine years later, the "Prudent Dieters" had cholesterol levels 30 points less than the control (220 vs. 250), but had had eight deaths in their group versus none in the control.
Studies were done comparing countries around the world (Ancel Keys' Six Country Study is one of the most famous) but again and again, when looking at the full data, it cannot be seen that reducing saturated fat improves your health. The Six Country study is quoted repeatedly as one of the basic studies showing high fat intake equals high CHD, but in actuality, it's a 22-country study. And when you see the graph for all 22 countries absolutely no correlation between saturated fat intake and heart disease occurs. This is a great example of cherry-picked statistics.
The majority of your patients (and probably yourself) have heard again and again, in advertising, in headlines, in everyday conversation, that it's advisable to lower their cholesterol, reduce their intake of saturated fats and eat "healthy" vegetable oils. If you're interested in your own health, as well as the health of your patients, you might consider challenging those long-standing notions you think are correct.
The Skinny on Fats
There are books written on this topic (try Mary Enig's book, Know Your Fats) but the basics are this: all fats, saturated and unsaturated, are actually a combination of both. You need the characteristics and attributes of both. You NEED both saturated and unsaturated fats. And, like other processed foods, the more processed a fat is, the more dangerous it is to the body.
Without going into the chemical structure of fats (I could, but who wants to read that?), unsaturated fats include polyunsaturated and monounsaturated. A example of a polyunsaturated fat is flax oil or fish oil -- those are very unstable oils and go rancid very easily, which is why they have to be in containers that are dark and stored in refrigerators and packed with nitrogen because light, heat and oxygen all damage those fragile oils. You've heard you should have a lot of Omega 3's versus Omega 6's, right? The ratio is supposed to be 1:2 or up to 1:4, but for most people, the ratio is a very unhealthy 1:25 because they're eating so many oils that have Omega 6's. Where are they getting those oils?
Vegetable oils, that's where - there are healthy sources of Omega 6's like Black Currant Seed Oil, or Evening Primrose, but that's not what people are typically ingesting. We've heard we should be eating vegetable oils like corn, soy, safflower, canola, etc. and yes, they're technically polyunsaturated fats, but they're heavily processed. They are NOT fresh oils. Basically, to produce them, they have to heat the ingredients to such a high temperature it causes the oil to go rancid. You'd smell that rancidity, so then they undergo a chemical process to deodorize them and when you ingest those oils, an enormous amount of free radicals are introduced into your system, causing huge amounts of damage. It's distinctly possible the vegetable oil industry has had an influence on the U.S. food policy -- corn IS our biggest crop, after all, with soy running a close second.
Monounsaturated fats are like olive oil or avocados. Lard is actually a monounsaturated fat as well. Olive oil is best if it's cold-pressed, obviously (when it's fresh, since it will otherwise be damaged by heat) and there are schools of thought that think it's not healthy to cook with it -- hence the reason it's so often used on salads.
But for being all-around healthy, it's not enough to live only on olive oil. The types of fats you eat are what are used in cell membranes -- if you eat a lot of unstable, damaged oils like vegetable oils, your cells are more prone to damage and faster aging. People think that saturated fats are unhealthy, but if this was true, why are the plaques found in arteries 74 percent unsaturated fats? What about life expectancy? A study already back in 1965 showed this conclusively: patients who already had had a heart attack were divided into three groups, and after two years, the corn oil group had 30 percent lower cholesterol, but only 52 percent of them were still alive. The olive oil group had 57 percent still alive and the animal fat group had 75 percent still alive (British Medical Journal, 1965 1:1531-33).
Yes, the quality of fat is very important. You DEFINITELY don't want to be eating animal fats filled with pesticides or hormones (farmers markets often have the cleanest sources). That being said, your body desperately needs nutrients found in animal fats. Have you noticed the uproar about vitamin D in the news? The food sources of vitamin D are cod liver oil and lard - that's how people kept from getting vitamin D deficient in the winter. Vitamins A, D, K, and K2 are all found in animal fats -- even your vegetarian patients could gain an advantage by ingesting coconut oil, butter, eggs, whole milk and cheese. Studies show that choline from egg yolks and liver help the brain make critical connections and protect against neurotoxins; animal studies suggest that if choline is abundant during developmental years, the individual is protected for life from developmental decline. The best way to get that is 4-5 egg yolks per day, but with our incorrect information, people get freaked out about the cholesterol in eggs, which is, as I pointed out earlier completely unfounded.
It's a challenge to find studies discussing the nutritional benefits of fats (government health policy dictates to a large degree where the research funds are allotted), but they are there. "In studies conducted over 20 years, the Harvard School of Public Health showed that total fat intake bore no significant relation to Coronary Artery Disease risk. . . Four epidemiological studies have shown no evidence that men who eat less fat live longer or have fewer myocardial infarctions (MIs)" (Circulation 2003; 107:10). As acupuncturists, you challenge the conventional wisdom regarding the body's ability to heal itself; as nutritionists, continuing to learn and reading critically and between the lines, you will have a huge health impact on your patients and on yourself.
you can view the origional article here:
http://www.acupuncturetoday.com/mpacms/at/article.php?id=32321
December, 2010, Vol. 11, Issue 12
Big Fat Lies
By Marlene Merritt, DOM, LAc, ACN
One of the most important aspects about being a good practitioner/citizen/general person is to not believe everything you read or hear. It's not so much being skeptical as questioning the source of your information, wondering about the agenda behind the information, and just generally checking up on the facts.
And one of the biggest lies perpetrated on people today is the paradigm of low fat -- that eating low fat is healthy for you and will prevent heart attacks and lengthen your life. Nothing could be further from the truth.
Heart Studies
Did you know that high cholesterol levels in women of all ages and in the elderly is associated with a longer lifespan? In fact, for women and the elderly, no appreciable difference in cardiovascular heart disease (CHD) rate is seen for ANY level of cholesterol. The scientific publication Circulation (Circulation 1992 86:3) in 1992 said, "Many studies have shown that all-cause deaths, especially deaths from cancer, are higher for individuals with cholesterol levels lower than 180." How about this one? "Those individuals with a low serum cholesterol maintained over a 20-year period will have the worst outlook for all-cause mortality." (Lancet, 2001 358:351-55.) You probably hadn't heard that, had you? What about the French? They have the highest saturated fat intake of the entire European Union, but have the lowest rates of heart disease (European CVD statistics, 2005). How did we end up with a national stance that is so anathema to what is actually healthy?
Between 1930 and 1960, the number of deaths from heart attacks went from 3,000 to 500,000. Today, 650,000 to 700,000 people die from a myocardial infarction every year. Researchers started looking into this and saw some trends. They pointed out that they were using a lot more vegetable oils and fewer animal fats. We were especially consuming liquid oils hardened by a process called partial hydrogenation such as margarine and shortening in baked goods. These researchers suggested the solution to the new health problem was to return to traditional foods and stop using these vegetable oils -- a very logical suggestion.
However, other scientists proposed a different theory -- the "diet/heart theory" or the "lipid hypothesis." This hypothesis was based on experiments with vegetarian rats who were fed huge amounts of purified, oxidized cholesterol, which caused them to develop what seemed like atherogenic plaque in their arteries leading to blockages and heart disease.
According to the diet/heart theory, the cause of heart disease was a "bad diet," containing too much cholesterol and saturated fat, which led to us having elevated levels of cholesterol in the blood, which in turn, led to the build-up of plaque in the arteries. The overall conclusion was that this bad, indulgent diet of butter and bacon was the cause of heart disease.
So, the first of many studies was done. In 1957, the Anti-Coronary Club was a study done with men eating a "Prudent Diet," substituting corn oil and margarine for butter, cold breakfast cereal for eggs and chicken and fish for beef. Nine years later, the "Prudent Dieters" had cholesterol levels 30 points less than the control (220 vs. 250), but had had eight deaths in their group versus none in the control.
Studies were done comparing countries around the world (Ancel Keys' Six Country Study is one of the most famous) but again and again, when looking at the full data, it cannot be seen that reducing saturated fat improves your health. The Six Country study is quoted repeatedly as one of the basic studies showing high fat intake equals high CHD, but in actuality, it's a 22-country study. And when you see the graph for all 22 countries absolutely no correlation between saturated fat intake and heart disease occurs. This is a great example of cherry-picked statistics.
The majority of your patients (and probably yourself) have heard again and again, in advertising, in headlines, in everyday conversation, that it's advisable to lower their cholesterol, reduce their intake of saturated fats and eat "healthy" vegetable oils. If you're interested in your own health, as well as the health of your patients, you might consider challenging those long-standing notions you think are correct.
The Skinny on Fats
There are books written on this topic (try Mary Enig's book, Know Your Fats) but the basics are this: all fats, saturated and unsaturated, are actually a combination of both. You need the characteristics and attributes of both. You NEED both saturated and unsaturated fats. And, like other processed foods, the more processed a fat is, the more dangerous it is to the body.
Without going into the chemical structure of fats (I could, but who wants to read that?), unsaturated fats include polyunsaturated and monounsaturated. A example of a polyunsaturated fat is flax oil or fish oil -- those are very unstable oils and go rancid very easily, which is why they have to be in containers that are dark and stored in refrigerators and packed with nitrogen because light, heat and oxygen all damage those fragile oils. You've heard you should have a lot of Omega 3's versus Omega 6's, right? The ratio is supposed to be 1:2 or up to 1:4, but for most people, the ratio is a very unhealthy 1:25 because they're eating so many oils that have Omega 6's. Where are they getting those oils?
Vegetable oils, that's where - there are healthy sources of Omega 6's like Black Currant Seed Oil, or Evening Primrose, but that's not what people are typically ingesting. We've heard we should be eating vegetable oils like corn, soy, safflower, canola, etc. and yes, they're technically polyunsaturated fats, but they're heavily processed. They are NOT fresh oils. Basically, to produce them, they have to heat the ingredients to such a high temperature it causes the oil to go rancid. You'd smell that rancidity, so then they undergo a chemical process to deodorize them and when you ingest those oils, an enormous amount of free radicals are introduced into your system, causing huge amounts of damage. It's distinctly possible the vegetable oil industry has had an influence on the U.S. food policy -- corn IS our biggest crop, after all, with soy running a close second.
Monounsaturated fats are like olive oil or avocados. Lard is actually a monounsaturated fat as well. Olive oil is best if it's cold-pressed, obviously (when it's fresh, since it will otherwise be damaged by heat) and there are schools of thought that think it's not healthy to cook with it -- hence the reason it's so often used on salads.
But for being all-around healthy, it's not enough to live only on olive oil. The types of fats you eat are what are used in cell membranes -- if you eat a lot of unstable, damaged oils like vegetable oils, your cells are more prone to damage and faster aging. People think that saturated fats are unhealthy, but if this was true, why are the plaques found in arteries 74 percent unsaturated fats? What about life expectancy? A study already back in 1965 showed this conclusively: patients who already had had a heart attack were divided into three groups, and after two years, the corn oil group had 30 percent lower cholesterol, but only 52 percent of them were still alive. The olive oil group had 57 percent still alive and the animal fat group had 75 percent still alive (British Medical Journal, 1965 1:1531-33).
Yes, the quality of fat is very important. You DEFINITELY don't want to be eating animal fats filled with pesticides or hormones (farmers markets often have the cleanest sources). That being said, your body desperately needs nutrients found in animal fats. Have you noticed the uproar about vitamin D in the news? The food sources of vitamin D are cod liver oil and lard - that's how people kept from getting vitamin D deficient in the winter. Vitamins A, D, K, and K2 are all found in animal fats -- even your vegetarian patients could gain an advantage by ingesting coconut oil, butter, eggs, whole milk and cheese. Studies show that choline from egg yolks and liver help the brain make critical connections and protect against neurotoxins; animal studies suggest that if choline is abundant during developmental years, the individual is protected for life from developmental decline. The best way to get that is 4-5 egg yolks per day, but with our incorrect information, people get freaked out about the cholesterol in eggs, which is, as I pointed out earlier completely unfounded.
It's a challenge to find studies discussing the nutritional benefits of fats (government health policy dictates to a large degree where the research funds are allotted), but they are there. "In studies conducted over 20 years, the Harvard School of Public Health showed that total fat intake bore no significant relation to Coronary Artery Disease risk. . . Four epidemiological studies have shown no evidence that men who eat less fat live longer or have fewer myocardial infarctions (MIs)" (Circulation 2003; 107:10). As acupuncturists, you challenge the conventional wisdom regarding the body's ability to heal itself; as nutritionists, continuing to learn and reading critically and between the lines, you will have a huge health impact on your patients and on yourself.
you can view the origional article here:
http://www.acupuncturetoday.com/mpacms/at/article.php?id=32321
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