Filed under: Op-Ed
We’ve seen all the recent news and reports about energy drinks and the concern about the amount of caffeine in these products. Now a new wave of products is gaining attention, aimed at helping us relax, reducing our anxiety, and helping us sleep. These “relaxation beverages,” or “anti-energy drinks,” contain ingredients such as melatonin, valerian root, kava, St. John’s Wort, L-theanine, rose hips, and chamomile. A great number of relaxation beverages have been introduced into the market over the last three years, with names such as “Dream Water,” “iChill,” “Vacation in a Bottle,” and “Unwind.” Consumers of any age can buy these drinks in convenience stores, college campuses, and online.
Part of the problem with these relaxation drinks is that some of their ingredients, particularly melatonin, have not gone through the Food and Drug Administration’s (FDA) approval process required for all food ingredients to be designated as safe or GRAS (“generally recognized as safe”). Melatonin is a hormone made by the body, but it is also available as a supplement and is often used to treat sleep disorders and jet lag. The FDA sent a warning letter last year to the manufacturers of the “Drank” beverage saying, “there is no food additive regulation in effect that provides for the safe use of melatonin…Likewise, we are not aware of any basis to conclude that melatonin is GRAS for use in conventional foods.” The manufacturers of “Drank” want their product to be classified as a dietary supplement, not as a beverage, since the FDA scrutinizes foods and beverages much more closely than dietary supplements.
People who have liver problems, liver disease, or are taking prescription drugs should be cautious about using the herb kava, an ingredient found in some of these relaxation drinks. Kava has been linked to severe liver injury, and the FDA issued a consumer advisory in 2002 with a warning that kava-containing dietary supplement products have been associated with liver-related injuries, including hepatitis, cirrhosis, and liver failure. Valerian root, a medicinal herb, is used to treat sleep disorders as well as anxiety. Although some research has been conducted on the effects of valerian on insomnia, the data are mixed, and no studies have tested the safety and effectiveness of the combination of ingredients found in relaxation beverages.
The marketing of relaxation drinks is also of concern, as it is geared toward a younger crowd, with bottles resembling the look of popular energy drinks and shots. The concern is that young adults will think nothing of having more than one of these a day. Some of these beverages have warnings on their labels stating that users should not consume them before operating/driving machinery or if pregnant or nursing.
What’s the bottom line? Buyers beware! There’s no magic pill, and there’s no magic beverage. Try to determine the causes of your stress and/or insomnia, address those issues, and then work towards establishing a healthy lifestyle overall.
The amount of the time spent sleeping is decreasing: the average amount of sleep reported for middle-aged people in the late 1050s—around eight to nine hours—has decreased in recent times to about seven or eight hours. And the number of individuals who sleep less than six hours each night has significantly increased. These changes in sleep patterns may be indicative of sleep deprivation in society at large. This is not surprising, as the modern society seems to offer twice as much work (on the job, at home, etc.) and half as much time to complete it. Consequently, we are awake for extended periods of time, thus reducing the amount of time we spend sleeping.
However, we all know that sleep is essential! Sleep is vital to restore and renew many body systems; and sleep deprivation may result in poor performance, increased sleepiness, reduced alertness, delayed response time, difficulty maintaining attention, decreased positive mood, and increased long-term health risks. Some research studies have even shown that sleep deprivation is associated with increased risk of death.
So adequate sleep is vital for everyone to optimally perform the activities of daily living. But you may wonder, “How can I determine how much sleep I need to function at my best?” Dr. Michael Bonnet, director of the Sleep Laboratory at the Dayton. Ohio, Department of Veterans Affairs Medical Center provides a very simple but practical test you can use to determine how much sleep you need. According to him, if you need an alarm clock to wake up, try going to bed a little earlier the following night (e.g., 15 minutes earlier). If you still need an alarm clock to wake up the next morning, push your bedtime a little earlier again (i.e., another 15 minutes). Continue doing this until you no longer need an alarm to wake up.
I actually tried this test and found out I was not the “night owl” I thought I was. It looks like I function at my best if I retire for the night a couple of hours earlier than I used to. Sleep is important! It significantly affects your performance, health, and quality of life. And it is especially important to Warfighters, who can rarely get enough when deployed. So in addition to a healthy diet and regular exercise, try to get enough sleep each night whenever your situation makes it possible.
Source: National Sleep Foundation
Being in stressful situations activates the body’s physiologic stress response, which is what allows Warfighters the ability to respond to any threat at any time. In the sports world, the stress response is associated with the adrenaline rush that pumps athletes up during competitions, and gives them the edge to win.
Unlike athletes, however, Warfighters are a select group who operate in stressful situations day in and day out. Prolonged exposure to stressful situations has been found to be harmful both physically and psychologically, unless one learns how to successfully manage one’s internal response. To that end, there are programs throughout the uniformed services that teach Warfighters combat stress management techniques. Many use a stoplight system—utlizing the colors green, yellow, and red—to teach Warfighters how to calm the stress response and bring the body back into balance, in order to give it a reprieve. Successful warfighters learn these skills and apply them in theater.
These same skills, which allow one to calm the body’s physiologic response to stress, can also be applied to other areas—most notably, in one’s relationships. The stress response triggered by external threats is the same stress response that is activated during emotionally-charged conflicts with someone you care about (although the degree of stress is different). Conflict between two people creates the same internal stress, coupled with a flood of negative emotions. The techniques learned to manage combat stress are techniques that can also help Warfighters in their personal relationships.
A recent study examined 149 couples in a 15-minute discussion about a marital conflict found that positive emotions helped couples regulate, or calm, their physiologic responses after the conversation. Interestingly, how happy the individual was with their relationship did not impact this finding. This indicates that positive emotions seem to have the ability to “undo” the physiologic arousal of conflict.
The next time you get in a fight with someone you care about, try this: stop, take yourself out of the situation, and start thinking positive thoughts—either about yourself, something else, or your partner. Notice whether you feel calmer, if your body temperature decreased, if your heart rate slowed down, and if your body moved less (we tend to move more when we are upset). You might find this to be an excellent addition not only to your combat stress strategies, but also to your positive relationship strategies.
Source: Yuan, J., McCarthy, M., Holley, S. & Levenson, R. (2010). Physiologic down-regulation and positive emotion in marital interaction. Emotion, 10(4), 467-474.
Have you ever been tempted to try the exercise equipment advertised on late-night infomercials—the products that promise to enhance various body parts or provide a great workout for a low, low price? Most of it isn’t necessary to get into the shape you want. Some of the most effective workouts can be done at home—with only your own body weight. It’s not that equipment is bad—correct use of weights and some machines can be very effective—but it isn’t necessary, nor is it an excuse to prevent you from getting in a good workout when equipment isn’t available.
There are some clear benefits to exercising at home without the use of equipment, including saving time and money that you would spend at a gym. Most importantly, exercising by using your body weight provides you with the ability to exercise anytime and anywhere—you aren’t restricted only to the times when you have access to the piece of equipment or device. Also, there are a variety of ways to go about a home-based program, ranging from workouts on DVD to a workout you create for yourself. Those already familiar with online workouts may know that YouTube has been afire with videos of extraordinarily fit people demonstrating their workouts done with minimal equipment in their homes, backyards, or local parks. Always proceed with caution—these videos are impressive and can be useful, but realize that they come with a risk of serious injury. Before you begin any home workout, consult your physician and/or an exercise professional to determine what is safe, and best for you.
We list some examples below of fitness moves that can be performed at home without equipment. These moves should be performed properly and at the right intensity level for them to be effective and safe. The American Council on Exercise (ACE) provides an Exercise Library that displays the proper form for many exercises.
Squats (Single Leg)
For a complete workout, visit ACE’s At Home (Without Equipment) Workout.
The Federal Trade Commission (FTC) recently filed a complaint against POM Wonderful products due to deceptive advertising. POM Wonderful has claimed that its products will reduce (or treat) heart disease, prostate cancer and erectile dysfunction. The FTC says that these claims are not supported by scientific research.
So, what’s a health claim and what’s considered acceptable advertising as such?
A health claim statement has to have a food substance, food, or dietary ingredient, and a health condition or disease. The Food and Drug Administration (FDA) has approved certain health claims that, based on scientific evidence, show a link between a food or supplement and a health condition or disease. Health claims cannot state that a food product or supplement can treat or cure a disease. It may claim to minimize a disease risk; for example, a product advertised as low sodium can state the approved claim that “diets low in sodium may reduce the risk of high blood pressure, a disease associated with many factors.”
Health claims shouldn’t be confused with structure/function claims. These claims do not have to be approved and reviewed by the FDA, yet they must be truthful in stating that a substance maintains structures and/or functions of the body. We see these claims on many fiber-rich products, like “fiber maintains bowel regularity,” or a dairy product stating that “calcium builds strong bones.” Unlike health claims, structure/function claims cannot be linked to a health-related condition or disease. Also, an important point to keep in mind: if a dietary supplement label makes a structure/function claim, it must also state this disclaimer: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”
There are also nutrient content claims. These describe the amount of a nutrient in a product. Descriptions such as free, low, high, and rich in are used, or other terms that describe the nutrient content to that of the content in another product, such as reduced, lite, less, or more.
Manufacturing companies want consumers to buy their products. We, as consumers, must be savvy as we try to choose products that are healthy for our families and us. False health claims are used on food products as well as dietary supplements. They claim to help us lose weight, cure diseases, and prevent memory loss. The FDA has not approved claims that focus on the treatment of diseases. They have, however, set forth regulations to authorize health claims after the scientific evidence has been presented and reviewed.
Are PRTs still accurate assessments of physical fitness levels? The days of calisthenics and running several miles for exercise are gone. Comfort Zones and gyms on- or off-base are filled with exercise toys such as cable cross machines, Roman benches, kettlebells, and miles of cardiovascular equipment. Most military personnel are exercising with the latest technology, or at least with free weights. Shouldn’t PRTs utilize the most current knowledge of functional exercise and movement?
“Functional movement” is defined as real-world biomechanics of body movement. Sit-ups and push-ups are not functional; they show strength and/or flexibility, but not true overall fitness.
Gray Cook’s Functional Movement Screening (FMS), however, assesses the quality of seven functional movements to determine a persons’ symmetry, grading each movement (21 being a perfect score). FMS might be a better assessment in terms of a person’s total fitness level. Most studies using FMS have evaluated the prediction of injury rates based on the level of symmetry (for example: Military Joe shows rotary stability in the left shoulder but not in the right – the asymmetry of his shoulders most likely predicts injury when climbing walls in theater).
An unpublished study by COL Francis O’Connor, MD on injury prediction in Marine Corps Officer candidates (MC) found that those who scored 14 or higher (out of 21) had a lower injury rate. A study on NFL players also had similar findings.
Should the military re-evaluate its PRTs in terms of functional movement or should it stay with its current program? Contact us here at the HPRC if you have thoughts to share.
In 2008, the Journal of Medical Internet Research published an article titled Medicine 2.0: Social Networking,Collaboration, Participation, Apomediation, and Openness, in which the term “Web 2.0” is used. Web 2.0 refers to web applications that support collaboration and interactive information sharing online, a large part of which are the social media applications for blogging, wikis, and video streaming. The Journal article talks about the idea of a “Medicine 2.0” for web-based health and medical information, geared towards healthcare consumers, caregivers, patients, health professionals, and researchers.
Interestingly, all of this has given rise to a “Fitness 2.0” trend, allowing users to go beyond just the factual, static health information that exists and find more interactive information. It turns out that the internet can be a great resource for boosting one’s fitness level! YouTube, for example, has thousands of clips on exercise – proper techniques, expert advice – everything from the proper dead-lift technique to nutrition tips for weight loss.
These types of social media can also track fitness levels and goals of users by allowing them to enter in numbers and monitor their progress. Applications like Virtual Weight Loss, health networks like FitDay, and iPhone apps like “My Weight Loss Coach” are great ways to accomplish this. For an even simpler tracking method, use Twitter updates with a hash tag (i.e. #weightloss and #twit2fit) – a great way to get support while keeping a daily or weekly report of progress.
Another area where social media provides a bridge for exchanging health/medical information are online support/social communities. The sharing of experiences and struggles can help when things get tough or when motivation lags. With this level of personal interaction, users don't have to get healthy their own. Sites like Google Groups or DailyBurn, are easy ways to compare and discuss results with a community. When researching a health-related topic, however, keep in mind that blogs, videos, and social networks should not be primary sources of information. Look up multiple sources – no one source of information is ever perfect, so reduce the risk of bad information.
Social media is about creating connections and information, and healthy living is about consistency and knowledge. Together, they can be a great match. Social media can bring a lot of useful information and support to people looking to improve their health or fitness levels, and provides many innovative ways to stay motivated and well-informed.
Research from the Harvard School of Public Health showed many years ago that individuals who exercise regularly die less from all causes. Although vigorous exercise, like running, produces greater gains, all that’s needed for good health is regular exercise. Regular physical activity has a positive effect on all of your body systems – it improves your mood and decreases anxiety, improves cognitive function, makes you stronger, and reduces your risk for many diseases like stroke, cardiovascular disease, many types of cancer, and adult onset diabetes. Even so, public health data from the Centers for Disease Control still shows that obesity and physical inactivity among adults in our country is high.
We at the Human Performance Resource Center are not only concerned with the total fitness of our Warfighters, but of all Americans. And like in many offices across the country, we work at desks, and fitness is something we have to carve out time for. But still, we do, as one of our staff members reports.
A few weeks ago, I went running with my super-tough Airborne Army son, a jumpmaster and SSG who’s been deployed many months over the last four years. When we last ran several years ago prior to his initial boot camp experience, I could outdistance him. Fortunately, that didn’t last long – six years and many runs later, this is no longer the case. The stories abound, and are hilarious. Like when he returned from his first 15-month deployment to Iraq: I had been running a lot and wanted to impress him with what good shape I was in. We hadn’t even made it out of my neighborhood, or hit the hills yet, and I was sucking wind. At that point he looked over and said, “Hey, Ma…we walkin’ or runnin’ today?” Fast forward to our five-mile run a few weeks ago in the midday July heat. I straggled back, having taken only a couple of one-minute walk breaks to catch my breath. Of course, he beat me back, and his greeting was, “Ma, you can do better than that!” But I know that underneath the teasing, he’s proud that his 50-year old mother is out that running with him, eating his dust. My response is, “Why aren’t there more mothers, sisters, brothers, fathers, sons, and daughters out here running with their Warfighter?”
So I challenge you: if we expect our Warfighters to be in optimal condition because their role, protecting our country, demands it – don’t we also have a responsibility to ourselves, our loved ones, and our country, to improve our health and reduce our healthcare costs? It doesn’t matter what you do to stay fit, only that you do something. Walk the dog, play outside with the kids, join an adult sports league, or go for a run – the possibilities are endless.
Despite widespread access to internet-based healthcare information, there’s almost a complete lack of evidence showing any effects all this information may have on health outcomes. According to a study published in Health Expectations, this indicates that there’s a disparity between the health information we find online and our ability to use it properly.
So, with as much information as there is on the internet, how can we, as consumers, find reputable sources for our health questions? The internet can be a great resource when you want to learn about a specific disease or health condition. You can also find tips on staying healthy. But among the millions of websites that offer health-related information, many present myths and half-truths as if they are facts.
To avoid unreliable health information when you’re surfing the internet, use these tips to find reliable information:
- Keep in mind that anyone can publish anything they want on the internet, regardless of the facts. Ultimately, it’s up to the consumer to determine which information source is credible.
- In order to determine a trusted, verified source for credible and objective information, stick with well-respected health websites. A good starting point is healthfinder.gov, which provides a “Health A to Z” topic listing (http://www.healthfinder.gov/HealthAtoZ/ ) of over 1,600 health topics from the most trusted sources.
- Newspapers always use more than one source for verifying factual information. The same should hold true for health information. When searching a topic, it’s important to find at least a second reference to confirm your findings. Find a third reference, too, if possible. When several sources report similar information on a topic, it’s more likely to be accurate and up-to-date. In general, if you can't find the information duplicated in more than two or three references, then the information is questionable at best.
- Become skilled at separating facts from opinions. This can sometimes be difficult, as the evidence that exists may be minimal. It's important that you know the difference between fact and opinion, especially when you're researching treatment alternatives.
- Testimonials and personal stories tend to focus on a patient’s subjective point of view. If you find a website that quotes patients about the effectiveness of a treatment or therapy, this information is biased and cannot be trusted as a reliable source. However, there is information to be learned from the experiences of patients by using other sources (for example, through blogs and wikis, and support group message board forums). In those situations, refer back to point 1 (above) as your first line of review.
- Make sure the information you find is the most current available. Often, you will find that research and studies conflict with one another, or that newer information trumps older information.
Finally, information that you find on a website does not replace your doctor's advice. Your doctor is the best person to answer questions about your personal health. If you read something on the internet that doesn't concur with what your doctor has told you, make a point to speak with him or her about it.
The book Born to Run by Christopher McDougall has been a primary catalyst for the rapid expansion of the population of “barefoot runners” over the past year. Most barefoot running advocates are in reality minimalist runners – they wear as little on their feet as possible. In most cases they wear just enough to provide a little cushion on concrete or other hard surfaces or to provide a thin layer of protection from glass or other sharp objects. Minimalist footwear is referred to as “barefoot technology,” which, at some level, seems to be an oxymoron. The cynical side of me says the term was coined by those expecting to make money off a new trend.
It is important to first note that there is no evidence-based information to support either side of the debate on the efficacy of being either shod or unshod. The most interesting research pointing toward the possible advantages of the minimalist approach is outlined by a Harvard professor and his colleagues in a January 2010 edition of the journal “Nature.” A counter to the assertion that barefoot running is beneficial can be found on a website titled “Barefoot Running is Bad.” The pro barefoot running community points to initial research that indicates there is more force absorbed by the body by a runner wearing shoes than by barefoot runners. The greatest difference is that barefoot runners have a forefoot strike, while runners wearing modern running shoes tend to have a heel strike. The opposition community points to anecdotal information that there has been a rapid rise in the incidence of stress fractures in the feet of barefoot or minimalist runners.
For me, the jury is still out. I find the concept that we should allow our feet to function as designed intriguing. My advice to those in the military interested in transitioning to a barefoot regimen is to first consult their local provider for advice. In addition, anyone starting a barefoot running program should increase the barefoot component of their normal workout routine gradually. A good rule of thumb is to increase the barefoot part of the program by no more than 10 percent each week. Barefoot adherents should also listen to their bodies and stop any activity that leads to joint or soft tissue pain.
My closing concern: warriors, regardless of where they are assigned, will spend a considerable amount of time in some sort of boot technology while training or deployed. As the sports medicine community debates the value of being barefoot in contrast to lacing up the latest Nike technology, we need to determine if there is any advantage for warriors adopting a partial or full barefoot workout program. This research should include an assessment of the positive or negative effects of frequently transitioning between minimalist footwear and boots. As more warriors get the minimalist footwear bug, it is important that we provide them the best evidence-based information that supports or argues against the practice.