Most people are aware of the worldwide epidemics of diabetes and obesity. The World Health Organization definition of overweight is a body mass index (BMI) equal to or greater than 25. Obesity is defined as a BMI equal to or greater than 30.¹ Worldwide obesity has doubled since 1980. In 2008, 35% of adults aged 20 and older throughout the world were overweight and an additional 11% were obese. Further, more than 347 million people worldwide have diabetes.² In other worlds, one out of every 20 persons has diabetes.

What's going on? Why be concerned? These conditions do not exist by themselves. Both contribute to additional severe health issues. Obesity is the leading cause of pediatric high blood pressure and increases the risk of coronary heart disease. Uncontrolled diabetes, over time, can lead to kidney disease, heart disease, disorders of the nerve system, and blindness.

In the face of these life-threatening epidemics it's important to look for any good news. The good news is that both obesity and diabetes can be addressed with lifestyle-related changes. A suboptimal diet and lack of exercise are causes of both conditions. This is well-known. It is also well-known that maintaining a healthy diet and getting regular exercise prevents obesity and prevents or delays the most common type diabetes (type 2 diabetes).

A healthy diet consists of regularly consuming food from all major food groups and consistently eating only that amount of food necessary for your daily energy requirements. If you're interested in losing weight and then maintaining the best weight for your body, a daily calorie intake between 1800 and 2100 calories is good for most men, and a daily calorie intake between 1700 and 1800 calories is good for most women.³ There is a third component of healthy eating that regulates how your body uses the food you eat. This additional component is known as food combining.

Food combining involves combining protein and complex carbohydrates at each meal. This important step is the key to a healthy, optimally functioning metabolism. When your metabolic processes are working efficiently, you’re burning carbohydrates for energy. Your blood insulin levels are steady throughout the day. In contrast, without food combining, your digestive processes send unregulated amounts of glucose into the blood stream every time you eat a meal. The result is frequent swings in insulin levels and storage of these glucose molecules (broken-down carbohydrates) as fat. Long-term, over months and years, such eating patterns can lead to being overweight, obesity, and diabetes.

Putting the dietary principle of food combining into practice is easy. All that's required is paying attention to meal planning. The result of this simple series of steps is better health for you and your family, now and in the future.

¹WHO Fact Sheet No. 311 (March 2013): http://www.who.int/mediacentre/factsheets/fs311/en/

²Danaei G, et al: National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980. Systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 378(9785):31–40. 2011

³Campbell KL, et al: J Clin Oncol Reduced-Calorie Dietary Weight Loss, Exercise, and Sex Hormones in Postmenopausal Women: Randomized Controlled Trial. J Clin Oncol 30(19):2314-2326, 2012

Core strength is critical for everyday activities such as placing heavy grocery bags into the trunk of your automobile, carrying a gallon jug of milk from the refrigerator to the dining room table, and even walking to the mailbox. When your core strength is diminished, even bending over to pick up a pencil may result in a serious spinal injury. Weakened core musculature causes simple, daily physical activities to be problematic. When standing up from a seated position or getting into a car causes you to experience twinges in your back, you may be sure your core muscles are not working in the manner for which they were designed.

Your core muscles consist of the four abdominal muscles – the transversus abdominis, internal obliques, external obliques, and rectus abdominis – and back muscles such as the erector spinae, longissimus thoracis, and multifidi. The most important core muscle may be the transversus abdominis, a sheet of horizontally oriented muscle that lies underneath the other abdominal muscles and provides deep mechanical support to the low back and pelvis. Similarly important are the multifidi, a group of small, powerful, deep spinal muscles that interconnect pairs and series of vertebras.

In times past, when the concept of work meant actual physical labor, there was no need to pay attention to training the core. In those days, your core muscles were being trained all day long by lifting, carrying, pushing, and pulling loads with heavy resistances and/or bending, digging, hoeing, planting, and raking. Working on a farm or in a factory provided more than sufficient exercise for the core. But in today's developed world, farming and manufacturing jobs have been greatly reduced and the large majority of work is done in the so-called service sector. In the 21st century, people living in developed nations spend the largest portion of their day sitting at a desk. In such circumstances the core musculature will weaken drastically, unless specific attention is paid to training these muscles.^1,2

The good news is that a wide variety of exercises are available for training the core. Most of them require no equipment. Many of them may be done at home and do not even require a gym membership. For example, yoga provides thorough and complete exercise for core muscles. Self-motivated persons might only need a yoga DVD and a yoga mat, minimizing financial cost and doing their yoga training at home. For others, taking yoga classes at a gym or yoga center might be more appropriate. But yoga is only one possible solution. Numerous highly efficient core exercises may be done on a physioball. Dynamic exercises such as the plank provide substantial core benefit and the only equipment requirement is a mat. Other dynamic exercises include squats, gluteus bridge, lunges, jumping jacks, and the grapevine.

When you spend the time to make sure your core musculature is strong, daily physical activities begin to be done with ease and grace. Back pain and other mechanical aches and injuries fade into memory.³ The overall result is a body that works efficiently and optimally. Thus, a strong core helps provide for a lifetime of health and well-being.

¹Kumar T, et al: Efficacy of core muscle strengthening exercise in chronic low back pain patients. J Back Musculoskel Rehabil 2014 Dec 2. [Epub ahead of print]
²Granacher U, et al: Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology 59(2):105-113, 2013
³Huxel Bliven KC, Anderson BE: Core stability training for injury prevention. Sports Health 5(6):514-522, 2013

Many adults begin to develop shoulder pain, even though they may not have sustained a specific injury. It's important to pay attention to such shoulder issues, as a healthy shoulder joint is the key to full function of the upper extremities. We all know at least one person whose ability to perform normal activities of daily living has been significantly compromised by chronic shoulder pain. Conservative treatment may be of benefit, but the key, as always, is to prevent these problems before they occur. The primary prophylactic intervention, as is the case for most musculoskeletal conditions, is exercise.

We all agree that the human body's design is magnificent. Every component has a purpose, down to the smallest cell. Every system is deeply interconnected with every other. Miraculously, the whole is much greater than the sum of the parts. And yet, there are a few "gotchas" built-in to this ingenious design. With respect to the shoulder, the "gotcha" relates to the shoulder joint's extraordinary mobility. The shoulder joint has the greatest range of motion of all the joints in your body. But this extreme mobility comes at a price, that is, the shoulder joint is not a particularly stable joint. For example, shoulder dislocations comprise approximately 50% of all such injuries.

Shoulder pain in the absence of a specific injury often represents damage to the rotator cuff. Again, the design of the shoulder joint and surrounding soft tissues is implicated in these rotator cuff problems. The blood supply to the bones, muscles, ligaments, and tendons of the shoulder is consistently compromised during normal motion of the shoulder above 90º, as in placing an object on or taking an object down from the top shelf in a kitchen cabinet. If much of your day is spent with your arm elevated above 90º to the front or to the side, over time you may develop nagging shoulder pain. Worse, with persistent repetitive motion above 90º, nagging shoulder pain may become chronic pain that restricts activities.

The best approach to shoulder problems is to become aware of the rotator cuff's well-known tendency to develop degenerative changes. We can be proactive by doing strength-training exercises for the shoulder and incorporating these exercises in our weekly exercise program as soon as possible.^1,2 Beginning such exercises in the teenage years would be ideal. For those of us who are older, the right time to begin shoulder strength training is now. Shoulder exercises stimulate growth of new muscle fibers, increase the size of muscle fibers already in existence, and stimulate growth of nerve fibers bringing information to and from all shoulder girdle structures.

Shoulder exercises should be done once or twice a week as part of your overall fitness program. As with all exercise that's new to you, start slowly and gradually increase the level of difficulty over time.³ The result of all this activity is a dramatically improved blood supply to the shoulder region and a dramatically reduced tendency for rotator cuff degeneration and injury.

¹Choi SH, Lee BH: Clinical Usefulness of Shoulder Stability Exercises for Middle-aged Women. J Phys Ther Sci 25(10):1243-1246, 2013
²Saltychev M, et al: Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disabil Rehabil 37(1):1-8, 2015
Another example of a common issues
³Daenen L, et al: Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain 31(2):108-114, 2015

Most of us have experienced a painful bout of low back pain brought on by a seemingly innocuous movement such as bending over to pick up a pencil or a dropped set of keys. These painful episodes may last a couple of days or be more severe and last more than a week. We're left wondering, "What exactly happened?" After all, we weren't trying to pick up a 100-pound crate. When our chiropractor asks what caused the problem we say, "I don't know. I didn't do anything." For the patient, the mystery often remains unsolved. But it's important to know there is an answer. The deep background to these unexpected, troublesome back problems is loss of viscoelasticity.

Viscoelasticity is a physical property of both materials and soft tissues. When these structures undergo deformation, they exhibit properties of viscosity and elasticity. Materials and soft tissues that demonstrate viscoelasticity resist shearing forces when a stress is applied (viscosity) and strain when stretched or compressed and quickly return to their initial state after removal of a transient load (elasticity). For viscoelastic structures, the relationship between strain and stress depends on the factor of time.

In terms of spinal biomechanics, viscoelastic structures include joint cartilage (for example, intervertebral discs), ligaments, and tendons.¹ If a substantial load is placed on the low back when viscoelastic properties of intervertebral discs and spinal ligaments have not returned to optimum, injury to low back muscles and ligaments may result.² For example, if you've been sitting for more than 15 minutes the soft tissue structures of your low back have been compressed for that length of time. Standing up and bending over to retrieve something causes your low back to attempt to support all the weight of your torso and head. If you haven't prepared your low back to receive this substantial burden, that is, restored viscoelasticity, you will likely suffer an injury that may be not only very painful but also inconvenient in terms of time and resources spent on recovery.

Injury prevention in these circumstances largely depends upon understanding.³ Being aware of the requirements for maintaining viscoelasticity will help you remember to "wake up" the soft tissues of your low back prior to any load-bearing activities such as bending over or twisting and turning. A simple way to restore viscoelasticity is to pause before suddenly changing a position you've been in for a while, such as getting out of a chair after working at your desk for 30 minutes, and gently rotating your torso from side to side eight or ten times. These rotational movements immediately restore viscoelastic properties to baseline and increase circulation to intervertebral discs, muscles, and ligaments. The result is a spine that is ready for action and prepared for the demands of new physical work. As always, proper preparation and attention help prevent injury.

1Troyer KL, Puttlitz CM: Nonlinear viscoelasticity plays an essential role in the functional behavior of spinal ligaments. J Biomech 45(4):684-691, 2012
²Freddolini M, et al: Stiffness properties of the trunk in people with low back pain. Hum Mov Sci 36:70-79, 2014
³Mörl F, Bradl I: Lumbar posture and muscular activity while sitting during office work. J Electromyogr Kinesiol 23(2):362-368, 2013

"There I am," a very fit patient is saying, "out on my five-mile run, motoring my way up a steep incline. Suddenly, I feel a throbbing pain in the middle of my right shin. Oh, no, I think, not again."

As things turned out, the patient recovered from the shin splints¹ quickly, but he knew he'd dodged a bullet. "Why did I get hurt?" he wanted to know. "I wasn't doing anything wrong.…What can I do to make sure this doesn't happen again?"
All very good questions. One answer is - basically − we need a plan for exercise. A powerful strategy that helps us train smart and train safe. When you're working this way − training smart and safe − then you can also train hard.

Training safe and smart means paying attention to what's happening in your body as you do your workout. "Paying attention" is a learned skill. It requires focus and repetition. Visualization is an important part of focus ─ and, if you're working on visualization, you're definitely paying attention!

You can visualize when you're running, too.
• Visualize an erect, fluid spine and strong abdominal muscles.
• Your head is upright, you're looking forward and slightly down, and your chest is open.
• Your arms are active yet relaxed, and your shoulders sit comfortably on your rib cage.
• Visualize a long stride, a soft landing, and a strong pushoff, with your leg kicking straight behind you.

Training smart means trusting your instincts, rather than listening to your ego. This is a tough one. At the time, it seems so important to do that last rep. Now, you can do that last rep if you maintain your form. Form is everything. If you have to sacrifice form in order to do those last few reps, you may get an unexpected, unwelcome result.

Likewise in running. When your form breaks down, that's a signal to slow down and recover your good mechanics. If your training is done with attention to proper, effective form, you'll be more likely, when the time comes, to run a good race at a good pace.

And, of course, we want to do these things to be healthy and well. The American College of Sports Medicine² states, "Resistance training, particularly when incorporated into a comprehensive fitness program, reduces the risk factors associated with coronary heart disease and non-insulin-dependent diabetes, prevents osteoporosis, promotes weight loss and maintenance, improves dynamic stability and preserves functional capacity, and fosters psychological well-being."

As in much of life, there's a fine line between training hard and overtraining. Remember, the benefit of training is for the long term.

¹Couture CJ, Karlson KA: Tibial Stress Injuries: Decisive Diagnosis and Treatment of "Shin Splints". Physician and Sportsmedicine 36(6):29-36, 2002
²Kraemer WJ, et al: Progression Models in Resistance Training for Healthy Adults. Med Sci Sports Exercise 34(2):364-380, 2002

You're driving to work and stop for a red light. You're minding your own business and - bam! - your car rocks forward and backward, slammed in the rear by another car driven by some guy yakking on his cell phone. Or you're a passenger in a New York City taxi. The driver's cruising down Fifth Avenue when a teenager suddenly dashes into the intersection, running across the street against the light. The cabbie slams on the brakes and your head rocks forcefully backward and forward.

Or for reasons known only to yourself you decide it's a good idea to go bungee jumping. You dive into space, the cord extends, and finally the cord is fully played out. Significant physical forces blast through your body as you helplessly bounce back and forth, dangling in the air like a gaffed flying fish.
The result of each of these demonstrations of Isaac Newton's First Law of Motion? Later that day, or possibly within several days, you begin to experience neck pain. You might also have shoulder pain, headache, nausea, dizziness, and pain or numbness traveling down one or both arms. You have whiplash - a traumatic injury to the muscles, ligaments, and spinal joints of your neck and upper back.^1,2

If you're lucky you'll get better in a few days. If the injuries are moderate or severe the various complaints will linger and may even get worse. As with any injury or illness, if you're not getting better right away you need to see your doctor. As you've suffered an injury to your head and neck, it may be a good idea to see your doctor as soon as you can, in any case, even if you think the injury is mild.

Your chiropractor is an excellent choice for examination and evaluation of injuries due to whiplash. She will be able to determine the nature and extent of the damage to muscle, ligament, and bone. Taking an x-ray series is a very important part of the evaluation of whiplash, as even seemingly modest forces can result in fracture of one or more vertebras in your neck. Evaluation of nerve function, including both spinal nerves and cranial nerves, is critically important. Pain and/or numbness radiating into one or both arms suggests injury to a cervical nerve root and needs to be thoroughly assessed.

If no fractures have been identified, chiropractic treatment can begin immediately. Over time, chiropractic treatment helps reduce inflammation of injured muscles and ligaments. Over time, chiropractic treatment helps restore normal ranges of motion to your neck and upper back. With this natural form of healing you begin to make incremental, steady progress, recovering the ability to participate in all your daily activities with reduced levels of pain and discomfort.

Chiropractic treatment provides optimal therapy for whiplash injuries, allowing your body to recover and return to normal by utilizing its own restorative powers.³

¹Kasch H, et al: Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. Eur J Neurol 15(11):1222-1230, 2008
²Chen HB, et al: Biomechanics of whiplash injury. Chin J Traumatol 12(5):305-314, 2009
³Michaleff ZA, et al: A randomised clinical trial of a comprehensive exercise program for chronic whiplash: trial protocol. BMC Musculoskeletal Disord 10:149, 2009 (12/2/09)

It has long been known that over evolutionary time the human organism developed in tandem with a vast host of microbial fellow travelers. The 100 trillion microorganisms inhabiting our gastrointestinal tracts assist in numerous physiological processes critical to our health and well being. The intestinal microbiome (commensal microorganisms) helps maintain the integrity and function of the lining of the small intestine, helps us digest our food properly, and assists in training our immune systems to appropriately recognize friends and foes.^1,2 Alterations in composition of the intestinal microbiome (dysbiosis) lead to many disorders and diseases, including celiac disease, osteoporosis, autoimmune diseases such as rheumatoid arthritis, and diabetes. Thus, dysbiosis needs to be considered in the evaluation and treatment of many common conditions. Fortunately, many forms of conservative management are available for dysbiosis, including use of probiotics and prebiotics.

Probiotics are formulations of live microorganisms that contain large numbers of colony-forming units, primarily lactobacilli and bifidobacteria.³ Taken as dietary supplements, probiotics persist in the gastrointestinal tract for several days and compete successfully with resident microorganisms. Probiotic bacteria help repair damaged linings of the small intestine, enhance nutrition, and suppress inflammatory intestinal reactions. Importantly, probiotic bacteria ferment undigested carbohydrates in the large intestine and produce nutrients for "good" microorganisms, helping restore the normal composition of commensal microorganisms.

Prebiotics are selectively fermented ingredients (foods) that target specific microorganisms and help restore balance in the intestinal microbiome. The primary targets are bifidobacteria and lactobacilli. By providing dietary substrates, prebiotics stimulate growth of specific bacteria and act to restore a more healthful composition of the intestinal microbiome. Many prebiotics are found naturally in foods such as garlic, onions, asparagus, and leeks. However, an effective means of obtaining prebiotics is to add prebiotic ingredients to bread, yoghurt, and drinks. In order to obtain full benefit, prebiotics and probiotics must be consumed regularly.

Dysbiosis is frequently the result of intolerance to gluten, a class of proteins found in wheat, barley, and rye. Chronic immune and inflammatory reactions to gluten peptides often lead to disturbances in intestinal microorganism homeostasis. Other conditions such as acute intestinal infection disrupt the intestinal epithelial barrier and lead to dysbiosis. The good news is that alterations in composition of the intestinal microbiome are usually correctable by supplementation with probiotics and prebiotics. The key to effective management is knowledge and awareness of the possibility of dysbiosis and access to appropriate methods of natural supplementation.

¹Chistiakov DA, et al: Role of gut microbiota in the modulation of atherosclerosis-associated immune response. Front Microbiol 2015 Jun 30;6:671. doi: 10.3389/fmicb.2015.00671. eCollection 2015

²Purchiaroni F, et al: The role of intestinal microbiota and the immune system. Eur Rev Med Pharmacol Sci 17(3):323-333, 2013

³Hajela N, et al: Gut microbiome, gut function, and probiotics: Implications for health. Indian J Gastroenterol 34(2):93-107, 2015

In recent years, media pundits around the world have proclaimed the extraordinary value of so-called super foods. Blueberries, broccoli, and especially kale have been described as possessing remarkable, almost magical, properties. What is it about these foods that makes them so good for you?

From a basic perspective, adding fresh fruits and vegetables of all types to your daily diet is a very smart way to help improve your current levels of health and well-being. Fresh fruits and vegetables are so important that many national agencies and organizations have promoted the "five to stay alive" rule - these groups recommend eating at least five portions of fruits and vegetables each day.¹

Fresh fruits and vegetables provide numerous health benefits, many of which are based upon the actions of biochemicals known as phytonutrients. Certain of these formerly mysterious compounds stimulate enzyme activity and others have actions similar to those of hormones. Many phytonutrients are powerful antioxidants that circulate throughout the body, scooping up and neutralizing free radicals. Free radicals are a normal byproduct of cellular metabolism, but too many of them will cause a lot of problems. Excess free radicals have, for example, been linked to development of chronic diseases such as heart disease, diabetes, and even cancer.^2,3 Blueberries, broccoli, and kale are categorized as "super foods" owing to the abundance of phytonutrients they contain and make available to those who consume them.

The takeaway is not to load up on kale, broccoli, and blueberries in an attempt to make up for years of less-than-optimal dietary choices. Rather, the goal is to begin, today, to implement a healthful, balanced food plan. Diets lacking fresh fruits and vegetables in general, and lacking super foods in particular, will not provide you and your family with the resources needed to enjoy productive, energy-filled days. Resolving to follow the "five-to-stay-alive" plan will add literally missing ingredients to your daily health regime. As you upgrade your nutrition, you're automatically upgrading the functioning of all your body's systems.

With sufficient dietary phytonutrients, you can help prevent chronic disease, strengthen the immune system, combat the effects of obesity, and obtain numerous anti-aging benefits.

The vast array of advantages that will likely ensue include more restful sleep; enhanced skin tone and muscle tone; increased reserves of energy throughout the day; and improved ability to focus and complete tasks successfully. Improved peace of mind will naturally occur as a consequence of these benefits, and an untapped reservoir of creativity may be revealed. Super foods truly provide super benefits.

¹Liu RH: Health-promoting components of fruits and vegetables in the diet. Adv Nutr 4(3):384S-392S, 2013

²Wu TY, et al: Pharmacogenetics, pharmacogenomics and epigenetics of nrf2-regulated xenobioticmetabolizing enzymes and transporters by dietary phytochemical and cancer chemoprevention. Curr Drug Metab 14(6):688-694, 2013

³Pasko P, et al: Rutabaga (Brassica napus L. var. napobrassica) seeds, roots, and sprouts: a novel kind of food with antioxidant properties and proapoptotic potential in Hep G2 hepatoma cell line. J Med Food 16(8):749-759, 2013

People often wonder about taking vitamins. Should I bother? Are they worth the money? Which ones should I take? In order, the answers are yes, yes, and ask your chiropractor to recommend the brand best for you.

Why take vitamins at all? The purpose of supplementation is to cover all bases -- to make sure they're covered. How can you be sure your diet contains all the cofactors and trace minerals needed to make your metabolism work correctly? And what about all the antioxidants that fight free radical formation and the phyt­onutrients that seem to have so much benefit in cancer prevention?

Likewise, it would take a lot of effort to be certain that your diet contained sufficient iodine, magnesium, selenium, chromium, folate, and vitamins B1 (thiamin), B2 (riboflavin), B3 (niacin), B6 (pyridoxine), and B12 (cyanocobalamin).Taking a supplement guarantees that these requirements have been met. It's simple, safe, and efficient in terms of both time and cost.

Which brand of supplementation is best? There's no right answer here, it's more of a practical decision. You'll know if a specific brand is right if you feel healthier and more energetic after taking it regularly for four to six weeks. You chiropractor will assist you by providing expert information and recommendations. There are no peer-reviewed, hard statistical data suggesting that one brand is superior. "Results" here are qualitative, not quantitative. The important point is that vitamin/mineral supplementation is necessary to ensure optimal metabolic functioning and physical well-being.

What about using specific supplements for specific things, such as taking calcium supplements after a bone-density study has revealed loss of bone mass (osteoporosis)? Is this an effective therapy? Well, in the postmenopausal setting1, if you're not exercising, the calcium you take will simply be excreted. Completely useless. On the other hand, if you are exercising or begin an exercise program, the additional calcium will be useful in providing raw material for stronger bones, built in response to the stress of exercise.

What about calcium supplementation for younger women? Again, exercise is the key to forestalling osteoporosis2. Of course, this includes taking sufficient daily calcium. The recommended daily requirement for calcium is 1000-1200 mg. So, a vitamin/mineral supplement supplies 500 mg. A cup of yogurt adds another 250 mg. A glass of skim milk or a piece of low-fat cheese adds another 250 mg. Non-dairy sources of calcium include calcium-fortified orange juice, spinach, turnips, and sardines (with the bones). So, dietary sources plus your vitamin/mineral supplements provide close to the recommended dose.

Additional calcium tablets or pills can make up the difference.

Vitamin/mineral supplements are important for busy people. Supplementation ensures a consistent, optimal dose of necessary nutrients. Balanced nutrition, in combination with regular exercise, will help provide vibrant, glowing good health3.

1Rosen CJ: Clinical practice. Postmenopausall osteoporosis. N Engl J Med 353(6):595-603, 2005
2Swanenburg J, et al: Effects of exercise and nutrition on postural balance and risk of falling in elderly people. Clin Rehabil 21(6):523-34, 2007
3Speckerr B, Vukovich M: Evidence for an interaction between exercise and nutrition for improved bone health during growth. Med Sport Sci 51:50-63, 2007