Back pain & obesity Part 1 - metabolism · Weight control is a matter of creating an energy...

Previously,wehaveexaminedtheeffectofpostureonbackpainandwehavealsobrieflydiscussedsomeexercisesandstretchesthatcanbeperformedtoalleviatetheeffectsofbadposture.Inthisseriesofthreearticles,wewilllookattheeffectofobesityonbackproblemsandthenexplorethevariouswaysofhelpingyoutoshedweighteffectively.Thespineisdesignedtocarrythebody’sweightanddistributetheloadsencounteredduringrestandactivity.Whenexcessweightiscarried,thespineisforcedtoassimilatetheburden,whichmayleadtostructuralcompromiseanddamage.Oneregionofthespinethatismostvulnerabletotheeffectsofobesityisthelowerbackandlumbarspine.Sittingforprolongedperiodsoftimecanleadtomuscularimbalance,predisposingtobackproblems.Workingforlonghoursandalackofphysicalactivitycausesweightgain,especiallyabdominalobesity,whichshiftsthecentreofgravityforward.Thisinturnleadstoanincreasedchanceofposturaldeviation,suchasanexcessivelordoticlumbarcurveandanteriorpelvictilt.Suchadeviationalsoleadstofaultyloadingpatterns,whichincreasethestrainonthespineandsurroundingjointstructures.Thosewithanexcessivelumbarlordosis(hyperlordosis)oftenhaveareducedrangeoflumbarflexionandrestrictedmobility,therebyincreasingtheriskofdiscprotrusionorherniationwhichcancausenervestobepressedonorpinched,resultinginpainandinsomecasessciatica.Areyouoverweightorobese?Ifyouareoverweightorobese,therearemanywaysoflosingweightandmaintainingahealthierbodycomposition.Togetstarted,talkwithyourdoctororafitnessprofessionaltoestablishyourultimategoalsandhowtosafelybeginasustainableweightlossprogramme.Thisisimportantbecauseifyousufferfrombackpain,yourexerciseprogrammeislikelytobedifferentfromsomeonewithoutsuchproblems.Remember,notwopeoplearethesameandobtainingprofessionalhelpisthebestinitialstep.

Doescardiovascularexercisehelpyoutoloseweightorcanitevenmakeyoufatter?Whilstphysicalactivityisusefulinreducingtheriskofcertaindiseases,itdoesnotnecessarilypromoteweightloss.Apersonwhoexercisestendstocanceloutthecaloriestheyhaveburnedbyeatingmore,generallyasaformofself-reward.Inordertounderstandthephysiologyofweightloss,weneedtounderstandtherelationshipsbetweendiet,metabolismandthecircumstancesunderwhichthebodybeginstoburnfatasfuel.Metabolism–energyexpenditure

Metabolismisthesumofallthebiochemicalprocessesthatoccurinthebody,including:• Anabolism–theformationoflargermolecules,and• Catabolism–thebreakdownoflargermoleculesintosmallerones.

Exerciseandweightloss–Part1–Obesity&backpain;metabolism

DrJamesTang,CES,MBA,BDS,LDSRCSNASMCorrectiveExerciseSpecialist,Level3PersonalTrainer(REPregistrationnoR1045463),SportsNutritionist&Level3SportsMassageTherapist,withspecialinterestinposturaldysfunctionandlowerbackproblems,GDP

Thebody’srateofenergyexpenditureisthemetabolicrate,andthetotalcaloricexpenditureistheproductofanumberofinteractingfactors:

• Basalmetabolicrate(BMR)isthetotalsumofallthereactionsthatoccurinthebodywhenatcompleterestwithnodigestionoccurring.Thisisusuallyexpressedasthenumberofcaloriesneededtosustainbasicfunctioning.

• Thermiceffectoffood–theamountofenergyexpendedbythebodythroughtheingestion,digestion,absorption,utilisationandstorageoffood.Thisaccountsfor6–10%ofdailyenergyexpenditureformenand6–7%forwomen(Poehlman,1989).

• Thermiceffectofactivity–theamountofenergyrequiredforplannedandunplannedlevelsofphysicalactivities.Thisisthemostvariablecomponentofenergyexpenditureanditaccountsforapproximately20–40%oftotalenergyexpenditure.

Metabolicrate=BMR+thermiceffectoffood+thermiceffectofactivity

1gofthesedifferentfoodcomponentsproducesthefollowingenergyvalues:

• Carbohydrate4kcal• Fat9kcal• Protein4kcal• Alcohol7kcal

Weightcontrolissimplyamatterofcreatinganenergyimbalancewhichforcesyourbodytoburnfatstoresforenergy.Theenergybalanceequationrequiresconsiderationofbothenergyintake(foodanddrink)andenergyexpenditure(basalmetabolicrate,thermiceffectoffoodandphysicalactivity).Insimpleterms,ifyouconsumemorecaloriesthanyourtotalcaloricexpenditure,youputonweight.Ifyouexpendmorethanyouconsume,youloseweight.Forthepurposeofweightloss,onlymacronutrients(carbohydrates,proteinsandfats),whichareusedtofuelbodyactivities,willbeconsideredhere.Itisimportantthatyoumaintainabalanceddietwhichincludestherecommendedlevelsofmicronutrients(vitamins,minerals)aswell.

Theeatwellplatehighlightsthedifferenttypesoffoodthatmakeupourdietandshowstheproportionsweshouldeatthemintohaveahealthy,balanceddiet.

Source–Gov.uk

It’sagoodideatotrytogetthisbalancerighteveryday,butyoudon’tneedtodoitateverymeal.Youmayfinditeasiertogetthebalancerightoveralongerperiod,aweekforexample.Wheneverpossible,trytochooseoptionsthatarelowerinsalt.

EnergyIntake

Carbohydratesarestoredasglycogeninthemusclesandliver.Thereisapproximatelythreetimesmoreglycogenstoredinthemusclesthanintheliver.Increasingyourmusclemasswillalsoincreaseyourstoragecapacityforglycogen.Onaverage,thetotalstoreofglycogenisabout500g,equivalentto1600–2000kcal,enoughtolastadayifyouweretoeatnothing.Thisiswhyalow-carbohydratediettendstomakepeoplelosequitealotofweightinthefirstfewdaysandthisweightlossisalmostentirelyduetothelossofglycogenandwater.Onaverage,youhaveenoughintramuscularglycogentofuel90–180minutesofenduranceactivity;thehighertheintensity,thefasteryourmuscleglycogenstoreswillbedepleted.Thegreateryourpre-exercisemuscleglycogenstore,thelongeryouwillbeabletomaintainyourexerciseintensityanddelaytheonsetoffatigue.However,otherfactors,includingariseinconcentrationofthebrainchemicalserotonin,willcauseyoutofatigue.TheGlycaemicIndex(GI)isthespeedatwhichyoudigestfoodandconvertitintoglucose.Glucosehasaglycaemicindexof100.Ifyouneededtogetcarbohydrateintoyourbloodstreamandmusclecellsrapidly,e.g.,immediatelyafterexercisetoreplenishyourglycogen,youwouldchoosehighGIfood.Itis,however,notadvisabletoeathighGIfoodbeforeexercise.Whenglucoselevelsarehigh,largeamountsofinsulinareproduced,whichshuntstheexcessglucoseintofatcells,leadingtotransienthypoglycaemia.ThesafeststrategyistoconsumelowGIfoodpre-exerciseandthentopupwithhighGIcarbohydrateduringexercise.Tooptimiseglycogenstorageandminimisefatstorage,aimtoachieveasmallormoderateglycaemicload–eatlittleandoften,andavoidoverloadingoncarbohydrates.Thereis,however,noneedtocutouthighglycaemicfoods.Thekeyistoeatthemwithproteinand/oralittlehealthyfatwhichputsabrakeonthedigestiveprocess,slowingdownthereleaseofglucose.

Apples(despitecontainingsimplecarbohydrates)produceasmallandprolongedriseinbloodsugar.Agreatdealofstarch-richfood(complexcarbohydrates),suchaspotatoesandbread,isdigestedandabsorbedveryquicklyandcausesarapidriseinbloodsugar.Ifyoutrytoloseweightbycombiningalow-caloriedietwithalengthycardioworkout,youareheadingfordisaster.Thisisbecausenotonlydoesyourbodyadaptsoyouhavetodomoretogetthesameresult,butaslow-caloriedietstendtobelowincarbohydrate,onceyouhaveusedupyourintramuscularglycogen,thebodystartstometaboliseproteinforenergy.So,notonlyareyounotlosingfat,youarealsolosingmusclemass.Thisisbadnewsbecausewhilstwethinkthatweexpendmostofourcalorieswhenweareexercising,mostofourenergyisusedupjustexisting–evenifyoudonothingfor24hours,youwouldstillbeburningnearly1,700caloriesinaday(basalmetabolicrate),andthemoremusclemasswehave,themorecaloriesweburn.

Fatisstoredasadiposetissueinalmosteveryregionofthebody.Asmallamountoffat,about300–400g,isstoredinmusclesasintramuscularfat.Themajorityisstoredaroundtheorgansandbeneaththeskin.Peoplewhostorefatmostlyaroundtheirabdomens(theclassicpot-bellyshape)areknowntohaveahigherriskofheartdiseasethanthosewhostorefatmostlyaroundtheirhipsandthighs(pearshape).Youcannotdoanythingaboutthewayyourbodydistributesfat,butyoucanchangetheamountoffatthatisstored.Femalehormonestendtofavourfatstoragearoundthehipsandthighswhilstmalehormonesencouragefatstoragearoundthemiddle.Thereisnoexercisethatcan,onitsown,removeyourabdominalfatanditisamisconceptionthatabdominalcrunchesandsit-upswilleradicateyourabdominalfat.

Proteinismainlyusedasabuildingmaterialratherthanasanenergystore.Proteins,however,canbebrokendowntoreleaseenergyifneedbe.Proteinisonlyusedduringveryprolonged(usuallyexercisesthatlastinexcessofanhour)orveryintenseboutsofexercise,whenglycogenstoresbecomedepleted.Somepeoplethinkthatiftheydepletetheirglycogenstoresbyfollowingalow-carbohydratediet,theywillforcetheirbodytobreakdownmorefatandloseweight.Thisisnotalwaysthecase,aswehavementionedabove,asyourisklosingmuscleaswellasfat.Exercisetriggerstheactivationofanenzymethatoxidiseskeyaminoacidsinthemuscle,whicharethenusedasafuelsource.Thegreatertheexerciseintensityandthelongeritsduration,themoreproteinisbrokendownforfuel.Therefore,ifyouarefollowingaweightlossprogramme,donotreduceyourcarbohydratetoodrastically;otherwise,proteinwillbeusedasanenergysourcemakingitunavailablefortissuegrowth.Ahigherproteinintakecanoffsetsomeoftheassociatedmuscle-wastingeffects.SoyproteinisolatehasthehighestconcentrationofthekeyaminoacidsthatareimportantformusclegrowthBCAAs(leucine,valineandisoleucine),glutamineandarginine.Thebioavailabilityofaparticularproteinisoftenmeasuredbyitsbiologicalvalue(BV)andanegghasaBVof100.Wheyproteinsareextractedfromcurdledmilk.TheyhaveaBVofupto159,whichisconsiderablyhigherthananegg.

SummaryWeightcontrolisamatterofcreatinganenergyimbalance,i.e.,ifyouconsumemorecaloriesthanyourtotalcaloricexpenditure,youputonweight.Ifyouexpendmorethanyouconsume,youloseweight.Inthenextpart,wewilltakealookatthephysiologyofhowthebodyburnsfatasafuelandhowwecanoptimisefatburninginaholisticweightlossprogramme.

Ifyouhaveanyquestions,pleasedonothesitatetogetintouchinfo@healthaddiction.co.uk