Episode #143: Can “Prolotherapy” Make Your Injuries Vanish?

In this podcast can prolotherapy make your injuries vanish? Eating algae oil Increasing testosterone Frankenfoods how to raise HDL Recognizing if your nervous system is overtrained Making a home gym does your brand of fish oil matter? Training for a marathon on a low carb diet does stevia and artificial sweeteners elevate insulin? How to get off a weight loss plateau Compression gear Rotator cuff exercises Is bottled water healthy and is Ironman training bad for you? Foreign. Fitness.com podcast we provide you with free exercise, nutrition, weight loss, triathlon and wellness advice from the top fitness experts in the nation. So whether you're an Ironman triathlete or you're just trying to shed a few pounds, get ready for non run of the mill cutting edge content from BenGreenfieldFitness.com. Hey Ben Greenfield here. As you may have just heard, we do have a jam packed podcast today and our special guest is Dr. David Minkoff. And David has been on the podcast a few times. The guy is amazing. He's a complimentary and alternative medicine physician down in Clearwater, Florida. He's done almost 40 Ironman triathlons. He's been on the show before talking about the three main causes of illness and poor performance, and also did a show called A Peek into the Life of an Ironman Physician. I'll put a link to both of those previous shows that he's done in the show notes to this episode, episode number 143. And he's always just a wealth of interesting content, so you don't want to miss his interview today, which is on something called Prolotherapy. And as I mentioned last week, over the next couple weeks I am responding to more questions during the Q and A session to kind of catch up to the many, many questions that we have in the question database. So let's go ahead and jump right into this week's Content. Listener Q and A. Well, remember, if you have a question for the podcast, you can use the handy Dandy Ask Ben form over at BenGreenfieldFitness.com you can call toll free to 877-209-9439. You can ask your question via Twitter tongreenfield. Or if you happen to be one of the 8,000 people going down to the Wildflower Triathlon this weekend, I'll be down there in the athlete's lounge from 2 to 3 o' clock in the afternoon both days answering your questions Friday and Saturday. So there you go. All right. Army wrote in and army says I had a Question about algae derived DHA and its benefits. One of your podcast guests talked about how fish oil is best, but what about something like Udo's choice dha? Also, have you heard of Astaxanthin? Well, DHA is something that we've talked about on the show before. It is one of the omega 3 fatty acids which not only has, has anti inflammatory properties but is super rich in terms of its brain building capabilities and its ability to lower your risk of degenerative diseases of the nervous system like multiple sclerosis. And it's fantastic for your joints, for your brain, for your body, for your immune system. Ton of different things that DHA has going on in it or for it. And it is part of fish oil. However, you can also get a DHA from algae that produce this DHA and you can get it in like a pill form. So the big problem though is basically the idea of the dosing with dha. So if you go out and get one of these algae oils, the problem is that it typically comes in somewhere around like 200 milligrams of DHA in a capsule. And the issue is that if your essential fatty acid levels like most people's are, are way off base and your omega 6 fatty acids are way up and your omega 3 fatty acids are too low, you're typically looking at needing to take somewhere in the range of 1500-2000 milligrams of DHA EPA blend to get your essential fatty acid levels back up to where they should be. And with 200mg of DHA in most servings of like a, like either an algae based DHA or another source of DHA which is called krill. It's meaning that you got to take a lot of it and buy a lot of it. So you're typically looking at having to spend almost $100 a month on a DHA capsule in order to get enough dha. So I mean it's well absorbed, it is a sustainable source of dha. It's non toxic, this algae oil. But the problem is that it's just very low in DHA or in the amount of DHA that you would actually need. You ask a follow up question about something called astaxanthin and actually it's something that Dr. Richard Cohen recently talked about in the Live seminar that we did called the Shocking Truth About Vitamin D and Fish Oil. Astaxanthin is something that actually complements quite nicely the addition of fish oil to the diet. It's a naturally occurring red pigment it's actually found in the tissue of wild salmon in a lot of crustaceans like lobster and shrimp. Krill is another source of it, and it is an antioxidant and a very rich source of carotenoids, which would be things like vitamin A, vitamin C, vitamin E. And astaxanthin kind of falls into that category. So it gives some really good antioxidant property. It helps to neutralize a lot of the free radicals that can take place when you're exercising or even when you're just, say, digesting food or living. And it's something that tends to complement very nicely the use of a fish oil. The interesting thing about astaxanthin is it also crosses the blood brain barrier. So if you're taking something like a fish oil for your brain health, astaxanthin kind of gives you a 1, 2 combo with that as well. So that's the reason that it's packaged and included with a lot of fish oils. I will put a link to a fish oil astaxanthin kind of 1, 2 combo in the show notes for you, episode number 143. Show notes. It's the same one that Dr. Cohen talked about in the live seminar that we did in case you missed that seminar. So that is the deal with the lg, DHA and the astaxanthin. Graham asks, what are your thoughts on ab wheels, the type where you have a handle on the either side of a single wheel and you roll out to a plank position and then roll back in. Is this good for ab recruitment or a waste of time? I can tell you one thing it's good for. It's good for wanting to punch your friends in the face if they make you laugh the day after you did this, because this thing leaves your abs sore. It's also a great shoulder workout. And if you kind of roll your elbows up and keep your elbows high as you do the exercise, it hits a lot of the lat and swimming type of muscles as well. So it goes by a couple different names. Ab wheel. The other one that I've heard most frequently is a power wheel. And yeah, like Graham says, you hold onto it, you roll your body out. Your entire body is supported between the the wheel and your knees. Then you roll the wheel back in and there's quite a bit of abdominal recruitment that needs to take place in order to roll that wheel in and out. And they actually did a study on this and compared it with a hanging knee up and a reverse crunch, which are also considered to be fairly difficult abdominal exercises. So they hooked up electromyographic patches to assess the muscle activity on the upper and lower abs, on the obliques, on the rectus femoris, on the lats, on the lumbar paraspinal muscles, which are basically your low back muscles. And they compared which of these using the ab wheel, using the hanging knee, up with the straps, using the reverse crunch, elicited the greatest amount of muscle activity in all of these muscles. And there was a huge amount of activity in the ab wheel compared to these other traditional abdominal exercises. And I can personally attest to that, just based off of the fact that my core is in pretty good shape and I still get fairly sore if I do like, say, three sets of 20 repetitions with this ab wheel. The issue is that the electromyographic study also showed that there is a very large amount of hip flexor recruitment when using the ab wheel. And for a lot of people, it's not an issue. But for anybody that has low back pain, one of the issues, one of the primary issues of low back pain, aside from a sacroiliac joint misalignment, is very, very tight hip flexors. And if your hip flexors are super tight and you're doing an exercise that involves a massive contraction of the hip flexors, you are significantly risking your propensity to get low back pain doing the abdominal exercise. So I highly recommend the ab wheel if you've got good, flexible hip flexors and you don't get low back pain frequently. If you do get low back pain frequently, I would make sure that your hip flexors are stretched out first by doing lots of, like, lunging, type of stretch exercises, and then eventually work the ab wheel in your program. All right, Tony says, I read an interesting article about Frankenfoods. How does something like this fall in your morals and teaching? And he put a link to this Frankenfoods article. And the title of the article is Frankenfoods in your natural food. Whole Foods or Whole Hypocrisy? And the idea behind this article is that there are organic grocery stores like Whole Foods selling tons of genetically modified foods in their stores and still advertising themselves as being very, very natural food stores. You know, Whole Foods Trader Joe's is another example. And in the article, there is a quote from one of the guys who stands behind what's called the millions against Monsanto truth in labeling campaign. And for those of you who don't know what Monsanto is, it's one of the primary seed producers in the US that uses genetically modified foods or genetically modified seeds. And what this quote says from this gentleman who directs that strategy behind the Monsanto, the anti Monsanto campaign is it says over 90% of Americans want genetically modified foods labeled. Why? So that we can avoid buying these foods. This is a major reason why millions of us are buying certified organic products which preclude the use of genetically modified ingredients as well as toxic chemicals and animal drugs. Since the politicians in Washington apparently prefer to listen to Monsanto rather than their constituents, we need to put our efforts where we currently have the most power in our local communities, especially at the retail grocery store level where 50 million of us are buying regular or regularly buying certified organic and natural foods or so called natural foods. What most consumers don't understand yet is that most of the so called naturally processed foods and animal products which make up 2/3 of the sales at Whole Foods Markets, we are still buying GMO contaminated. Either they contain genetically modified ingredients like soy, corn, canola, cottonseed oil or sugar beet sweetener, or else the animals have been force fed a steady diet of GMO grains and drugs. We need to clean up our act and walk our talk in the green and natural products sector. We need to tell natural food giants like Whole Foods or Trader Joe's that you can't claim to support GMO labeling and then proceed to sell billions of dollars of unlabeled GMO food in your stores greenwashed as natural. That quote basically sums up what I think about this entire Frankenfoods concept. I agree 100%. We should be told what we are eating. And if a company is going to genetically modify its ingredients, we as consumers have the right to be able to find out about that. And I'm not going to get any more political than that. But I do have to say that I do agree with this idea that you really do need to know what you're eating. Especially if you're walking into a natural food store and expecting that everything you grab is going to be healthy, when in fact it could be heavily genetically modified. Alright, next question is from Don who says my husband was told today by his doctor that his HDL was too low and that he should exercise and take niacin. Anyways, my question is, would more strenuous exercise raise his HDL and what do you think of niacin? Well, first of all, just so we make sure that we're on the same page, the HDL or the high density lipoproteins, they're very good for you. They're Made by your liver. They carry cholesterol and fats from your tissues, from your organs back to your liver, where those tissues can basically be, or where those fats and lipids can be recycled or degraded. And multiple studies have shown that having these high levels of HDL can lower your risk of getting clogged arteries or getting heart disease. So it's basically a fat transport mechanism. And studies have shown that moderate exercise will raise your HDL cholesterol levels, whereas, say, something like smoking would lower your HDL levels. Another thing interesting that can raise your HDL levels is moderate drinking. They had one study that showed that HDL levels would go up significantly when you had about one to two drinks on a daily basis. So one drink, remember being about 12 ounces of beer or 4 ounces of wine. So basically about half as much as what most of us actually consider to be a drink. But drinking alcohol can raise HDL as well. So the answer to your question is yes, moderate exercise can raise hdl. Extensive exercise could actually technically lower hdl, especially if you're eating a low fat, high sugar diet along with a bunch of exercise. So there's kind of a caveat to that. Now, remember, of course, on this show, we believe, or I believe several things. First of all, that cholesterol is not an issue. It's not dangerous by itself. Having high cholesterol could reflect an unhealthy condition, or it could be totally innocent, high blood cholesterol. What they tell you is that it promotes atherosclerosis, that it promotes coronary heart disease. But there have been many, many studies that have shown that just as many people who have high blood cholesterol get heart disease as people who have low blood cholesterol and get heart disease. So your diabetes diet can influence cholesterol. It's not the only thing that can influence cholesterol because your body produces about three to four times more cholesterol than you actually eat. So lowering cholesterol doesn't just come down to diet. It does have a lot to do with your activity levels and the way that you live. And there is zero evidence that animal fat and cholesterol or too much animal fat and cholesterol would promote atherosclerosis or heart attacks. There have been tons of studies that have shown people have a heart attack, haven't eaten more fat of any kind than any other people, and that this high cholesterol or this degree of atherosclerosis rather, is really not related necessarily to a high fat diet, unless that high fat diet is paired with a lot of other unhealthy dietary habits. So I could go on and on, but remember, most physicians are going to just try to go after cholesterol with the shotgun. Bring HDL way up, bring LDL way low, when it could be even healthier to just bring cholesterol as a whole up and just decrease the amount of inflammatory sugars that are being consumed. Now, as far as this niacin goes, niacin really doesn't have many horrible side effects. There could be a little bit of flushing, basically what's called a niacin flush. That comes along with taking niacin in high doses, like taking more than 1,000 milligrams. And it's annoying, but it's not really harmful. What niacin does is it's a B vitamin. It's used by your body to essentially turn carbohydrates into energy. It supports a healthy nervous system, digestive system, good skin, good hair, and it can raise hdl. And as a matter of fact, it can. It can raise HDL by 15, up to over 30%. So Niacin can bring up your HDL levels, and there's. There's not a lot of side effects with it. So it's something that I wouldn't worry about. The only issue is that I would make sure that you're. You're purchasing niacin from a certified good manufacturing practices facility that is somewhat regulated. They're never as regulated as prescription medications, but somewhat regulated so that you know what you're getting. All right, the next question is from Danny, who says, I have been training with weights and I recently lost a lot of muscle weight. I'm not too happy about that. As a result, I have been reading about over training, and this whole cns, or central nervous system response is something that is unfamiliar with me. Do you have a couple minutes to discuss this on an upcoming podcast? How does one know if their CNS is fully recovered, ready for more weight training? Well, this is a really good question because traditionally, over training really isn't considered as big of an issue for the central nervous system compared to what's called the peripheral. The peripheral nervous system. So there's kind of two different types of overtraining. And we've talked about overtraining before in this show, but we haven't talked about the two different types of overtraining. So basically, the first type would be an overtraining of what's called your sympathy sympathetic nervous system. And then there is the type of training that would be considered a Parasympathetic overtraining. So usually what happens is that if somebody's going to be overtrained, endurance athletes typically tend to experience this parasympathetic nervous system over training. And people who are like weight trainers, football players, power athletes, they tend to experience more of this sympathetic nervous system type of overtraining. So for like an endurance athlete, what happens is that when you're always going out and exercising, getting a lot of volume, volume in you work your sympathetic or kind of your fight or flight nervous system quite heavily. And when that happens and that system kind of burns out, your parasympathetic nervous system begins to dominate. And your parasympathetic nervous system would be kind of like your rest and digest part of your nervous system. And so what happens is an overtrained endurance athlete or someone who's, who's overtrained because of a high volume of kind of low intensity exercise would get decreased testosterone levels, decreased testosterone to cortisol ratios, decreased resting, what are called catecholamines, and we'll discuss those in a second. But those are really linked quite highly to the central nervous system and then increased levels of inflammatory markers in the bloodstream, specifically stuff like creatine kinase. And a lot of times they'll be unable to produce as much lactic acid or get to as high of a heart rate during exercise as well. Although a lot of times like post workout, there's kind of a even more rapid drop in the heart rate. So the heart rate is just like always low because your parasympathetic rest and digest type of nervous system is always predominating. And so with anaerobic or with kind of power sprint athletes, as well as with people who tend to just have a lot of like emotional stress, anxiety, you know, whether it be like social stress or school stress or family stress, they tend to get a lot more of this sympathetic type of over training, which is kind of just the opposite, where the parasympathetic nervous system is kind of getting, getting burnt out. And so the sympathetic nervous system is still operating. Okay, but what happens is that you don't see the same type of decrease in testosterone or increasing cortisol, and you don't see a ton of the same effects that you get with parasympathetic nervous system overtraining. But what it comes down to is that either way you define over training, most of the time it's focused on what would be considered your autonomic nervous system and not your central nervous system, which would be like your brain and your spinal cord. But the idea behind the central nervous system is that because your brain and your spinal cord are acted upon by things like neurotransmitters and catecholamines, specifically serotonin and what's called dopamine, what can happen is if there's an imbalance in these neurotransmitters, so a big rise in serotonin or big drop in dopamine levels, that would be considered an example of central nervous system fatigue. And there's been some studies that that suggests that overtraining results in this big spike in serotonin and a big drop in dopamine levels. And that along with some of the other effects that I kind of just described on the, on what's called the autonomic nervous system or the peripheral nervous system would be responsible for kind of this total over training. So typically it's not like central nervous system fatigue or this big rise in serotonin and drop in dopamine is the only thing that happens when, when you're training too much. It's typically like a cluster of symptoms between your peripheral nervous system and your central nervous system. But of course, the most important thing that comes down to is what can you do about it? How do you know when it's okay to go back to training? And really, the only really, really good treatment for overtraining syndrome for like being full blown over trained, Big drop in testosterone, big increase in cortisol, unable to get your heart rate anywhere near where you used to get it, immediate rise in blood lactate levels when you start to exercise, complete drop in motivation to train, loss of sleep, GI distress, ton of other things going on. You got to rest. And the longer you've been over trained, the more you typically have to rest. I knew a bodybuilder who literally was bedridden for a few months, and then he still didn't work out or do much at all other than very, very light activity for almost two years. That's how long it took for his nervous system to completely recover from full blown over training. The good news is that when most of us are feeling kind of down in the dumps and not too motivated to train, and maybe our bodies aren't doing what we want them to. When we go out and exercise, we're technically not over trained. We don't fall into the category of OTS or over training syndrome. We're usually simply overreached. And a couple days of rest or light activity combined with kind of rebuilding ourselves nutritionally is all that it takes but full blown over training can require a lot of things in combination with rest. Doing some nutritional therapies, stepping up the fat in the diet, doing a lot of stress reduction techniques. I mean, it's kind of a discussion for another day what you can do to recover from overtraining. But ultimately what it comes down to is that this idea that a big rise in serotonin, drop in dopamine and effect on the central nervous system system could cause overtraining definitely has something to it. But I don't think that that's the only reason that someone can become overtrained. I think that combined with the cluster of other problems would result in the overtraining syndrome. So hopefully I didn't create more questions than I answered with my response to that. Okay. Kathy says I am an active 46 year old woman who is reasonably fit but working to improve fitness, strength and my running. I wanted to focus more on strength training so I invested in dumbbells to work out at home. However, I'm a little worried or she says, I've decided to invest in some dumbbells. However, I'm a little worried that I might over or under buy. Not to mention some practical space considerations. I've narrowed my choices down to either a 10 to 35 pound set of rubber hex dumbbells with a rack or a set of adjustable dumbbells from 5 to 75 pounds. The difference in price price between these two options is not as big a deal as getting something that I can get maximal use of over the years. What would you recommend? Thanks. You know, I actually don't really see a huge need if you've got a variety of things to work out with, of having more than about three different dumbbell selections. You know, I personally, in my home gym I have a set of 40 pound dumbbells and a set of 10 pound dumbbells and that's it. But I've got other stuff. I've got a yoga mat, I've got a pull up bar. I've got a gym stick which is basically like a couple of elastic bands that are adjustable that attach to this, this kind of aluminum stick that you can do a bunch of different exercises with. I've got some elastic tubes and elastic bands, both the, the short kind and long kind. And what else do I have? I've got a stability ball and what's called a Bosu ball. I've probably got about right around 400, maybe $500 invested in a home gym and that's about it because frankly you tend not to use that entire range of dumbbells when you're lifting weights, if you have access to a bunch of other body weight exercises, elastic tubing exercises, stability ball exercises, and, you know, any other little toys that you may happen to pick up along the way. So rather than getting a huge range of dumbbells and limiting yourself to just doing free weight exercises, I would get fewer dumbbells, you know, and for females, I recommend that you get something like a 10 pound set, a 15 pound set and maybe a 25 pound set. And then you grab yourself a pull up bar or a dip bar, get yourself a stability ball, maybe a Bosu ball for some balance work, get some elastic tubing or a gym stick or both. And that would, that would get you basically equipped with the ability to do lots of different exercises rather than just free weight exercises, which are good, but you know, it's kind of like if you're just going to bodybuild, then free weights would be good. If you want to get total functional fitness, don't limit yourself with just free weights. Get as many different varieties of things as you can that are going to help you do as many different movements as possible. Keep your workouts as fresh and as varied as possible. And that's the direction I would take rather than just focusing on free weights. So for females, for most of the females I'd recommend again, somewhere in the range of like 10 pound dumbbell, 15 pound dumbbells, 25 pound dumbbells, that'll allow you to do a ton of different things. Okay, question from Kim, who says if I can only afford cheap fish oil, should I take that or just not take fish oil? Okay, good question. So I talked a little bit about regular supplements versus expensive supplements or you know, what, what type of fillers go into cheap supplements? And in the case of fish oil, yeah, there's some issues. So when you, when you extract EPA and DHA, which are those two omega 3 fatty acids that you get from fish oil, it involves, or can typically involve, especially when you're getting the, this, the less expensive forms of fish oil, the use of hexane, which is a petrochemical solvent that they use to extract and purify the oil. And that can make the EPA and the DHA very prone to oxidizing. And that's another reason that they'll throw antioxidants in there along with it, like that astaxanthin I mentioned earlier. But a lot of lower quality fish oils, when they use an antioxidant, they use something called Alpha tosopherol, which is really not that great of an antioxidant. Better antioxidants you should be looking for would be like that astaxanthin I mentioned. Another good one would be like a rosemary extract. The gamma tosopherol is a good one. But the type of antioxidant used in the fish oil and the amount of exposure to hexane that occurs in the formation of the fish oil is something that is going to be affected by the actual price of the fish oil. And yeah, you could be getting free radicals, rancid fish oil, subpar oils when you're consuming a fish oil that would be considered just like a cheaper off the shelf version. And although fish oil manufacturers a lot of times will say their products are chemical free, it's unfortunately not always the case. You know, they did that that study that tested like 15% of consumer fish oils and found that all of them were consent were contaminated with PCBs. So you want to look for a fish oil that's been certified free of toxins by independent testers. And then the other thing comes down to the actual type of fats that you're going to get in that fish oil. So fish oil supplements that have the natural triglyceride form of fish oil are going to be way more advantageous than the, than the ethyl ester form in terms of the amount of absorption and utilization in your body. But the ethyl ester form, because it's a lot cheaper to make, is what's used in most of the less expensive fish oils. And there really hasn't even been done a bunch of research on the potential toxicity of the ethyl ester form of the fish oils. So what this comes down to is that to answer your question, I would not take a fish oil unless you're taking a good brand. Just don't go out and buy any fish oil off the shelf because what you're getting may do you more harm than good. Okay, question from Lisa, who says, hi, Ben. I heard that a weight plateau is due to apoptosis of omental body fat. I can't find any references to learn more about this. Do you think cell apoptosis explains why a weight loss stagnates for a short while? Well, apoptosis, for those of you who aren't familiar with that term, is basically cell death. And the omentum that is mentioned here is it's this. Think of it like a drape. You know, it's split into a couple parts, the greater and the Lesser omentum. And it's a layer of fat tissue that drapes off your stomach and hangs down underneath the muscles and kind of partially attaches to the colon. And it serves a bunch of different functions. It supports your organs, it stores visceral fat, which is supplied from your small intestines. It secretes a bunch of immune response factors to, to protect you from infection. It can bind to cortisol, that stress release hormone. It has stem cells in it, so it's got some regeneration properties. It supplies fat to the liver via the portal vein, from the momentum to the liver for energy. And when surgeons do stomach surgeries, they'll even use parts of the omentum to wrap around injuries or incisions. So the omentum is basically a storage depot. When you have excess fat, it has the potential to have a ton of fat globules that swell up to maximum capacity and give you a fat belly. Just because it is that, that abdominal fat depot. And of course, because the liver has direct access to your momentum via the portal vein. That's nice when you need energy, when you need fat based energy to burn. But if you've got a bunch of fat stores coming in and a bunch of fat in your omentum, you're essentially setting yourself up to have some serious liver issues in terms of fat and also to have a great big belly. Now the amentum also has a lot of cortisol receptors in it. And remember that cortisol, it's secreted from our adrenal glands, it's decent, kind of wakes you up in the morning and balances your sleep wake cycle. But when you are chronically stressed or training too much or, you know, basically not taking care of your body, your cortisol levels get elevated and the momentum helps to clear the cortisol by binding to it and uptaking the cortisol. And you know what happens is that it can increase the Momentum's ability to store fat when you get all this cortisol uptake. So we've got stress, we've got increased fat intake, and we got increased belly size. And the momentum is basically part of that process. The amentum can also pull a lot of insulin from the bloodstream, so it can impair some of the ability of your body to get glucose and nutrients stored just because, you know the momentum that, that has a lot of fat in it, will have greater insulin requirements. And of course, you also just get the idea that your organs are, are squished up against the amentum when it becomes full of these fatty globules. And the amentum can secrete a lot of inflammatory chemicals through the abdomen and directly into the liver again via the portal vein. So it can be responsible for part of this systemic inflammation that occurs as well. So it's got some good services the amentum does in moderation in terms of delivering healthy fat energy to your body. But it can also in over fat individual cause belly fat and a lot of other issues. Now you ask if apoptosis or cell death of a mental belly fat could cause a plateau in weight loss. And the only link that I could see between this is because your omentum can serve as a portal from your omentum and your storage belly fat to your liver, for your liver to convert the fat into usable energy. If for some reason there was some type of apoptosis or cell death or malfunction of the omentum, it could inhibit its ability to mobilize belly fat stores and allow you to lose belly fat. And you know, if belly fat is the main weight on your body, could potentially cause a weight loss plateau. However, I haven't seen any research that looks into a link between cell death in the momentum inhibiting delivery of belly fat stores to the liver and thus causing a weight loss plateau. But if it were going to cause something like this, that's basically how it would work, is your liver would not be able to get the fats that it needs to burn via the portal vein and thus you would have a much harder time burning off belly fat or specifically the omental based belly fat that causes that protrusion of the abdomen. So interesting thought, interesting question. The next question comes from, from Jeanette who says, presently I'm reading Art Devaney's new Evolution diet that you recommended. It's a very interesting read. I teach a unit on evolution and nutrition and my degree is in biochemistry. So the book is a nice fit. But of the many interesting things that I came across was the mention of artificial sweeteners elevating insulin levels. Is this true and will stevia have the same effect? Well, you know, the talk kind of goes back and forth about whether artificial sweeteners could induce basically insulin secretion by the pancreas. And so if we look at the different artificial sweeteners, if we take aspartame, they've done some studies on that. And aspartame has really not been shown to have much of an effect at all on insulin levels in the studies that have been done on it. And there's really not much going on at all when it comes to aspartame. As far as saccharin or sweet n low, there have been studies where they had people swish around different taste solutions and then spit them out without swallowing. And the solutions that had sucrose and saccharin did cause an insulin release even without them being swallowed. So by just tasting that artificial sweetener, you could get an insulin release. But there have been other studies where that didn't happen with the, with the swishing and the, and the spitting. And so, you know, it kind of goes back and forth. Acetyl fami, potassium. How does that affect insulin? It does appear to affect insulin levels. They've isolated pancreatic cells that produce insulin and found that artificial sweeteners like acesulfami potassium could cause an insulin response if there was some glucose present. They would basically augment the response or increase the response if glucose was present. So if you have an artificial sweeteners, you know, like a Diet Coke with a meal, you could get a greater insulin release than if you didn't drink the Diet Coke. There was another study that found that in rat pancreas cells that aces ofamin potassium also could cause a little bit of insulin secretion. And direct transfusions of acidosulfamy potassium also cause insulin secretion in rats. And that was basically a study where the more acesulfamine potassium they gave them, the greater the insulin levels would rise. So there was kind of a dose response effect of that. So insulin could be affected by acesulfamine potassium. And then if we look at sucralose, sucralose in most studies hasn't really done much in terms of insulin. There was one study that showed that it may stimulate the release of what's called incretin hormones, and those could increase the secretion of insulin. That's basically kind of like the taste receptor hypothesis that because artificial sweeteners taste sweet, they might actually cause an increase in the production of these gastric hormones, which could stimulate the pancreas to produce insulin. So, you know, it's not like there's hard and fast research on this. There's some suggestive evidence that some artificial sweeteners, specifically, like acesulfamine potassium and sucralose, could affect insulin levels. And then as far as stevia goes, yeah, stevia could definitely have a mild insulin effect. And specifically, that's why it's been used in some cultures to lower blood sugar in people with diabetes, because what it can do is actually cause a little bit of a release of insulin. Which causes your body to store blood glucose as energy. And this kind of comes full circle to the whole issue with this question is that you need to look more at whether or not something has the propensity to cause deleterious health effects than whether it causes a rise in insulin. Because a lot of times it's not the high levels of circulating insulin that are the issue, it's the high levels of circulating glucose that are the issue in terms of causing nerve damage and cell vessel damage. Now, granted, if you're constantly consuming something that's amping up the insulin levels, you're eventually going to become insulin insensitive. And that is an issue because then you always have high levels of glucose, no matter what type of sugars you eat, because the insulin won't be able to take the glucose and put it where it belongs. But artificial sweeteners, elevating insulin isn't necessarily my reason that I would avoid artificial sweeteners. There's a host of other potentially neurotoxic effects of artificial sweeteners and effects on the neural system. And the fact that they're simply chemicals, that's the reason that I personally don't ingest them. I think the insulin effect isn't really much of an issue. And as far as stevia goes, yeah, there is a little bit of an insulin release with that as well, but it's an insulin release that has a blood sugar lowering effect and it's a very mild insulin release. That is not going to be something that would cause insulin insensitivity. Unless, you know, I suppose if you're consuming lots and lots of stevia, you know, on a frequent daily basis, it could be an issue, but ultimately not something that I would worry about too much in terms of insulin insensitivity. So good questions. What this comes down to, in my opinion is if you're going to sweeten something and you want to use a non sugar based sweetener, then use stevia and use it in moderation and stay away from artificial sweeteners. So Andre asks, hi, Ben, what do you think about compression gear? Does it really work? I personally have been using compression gear recently. I've been using something put out by a company called 110% and it is this tight. It gives you this tight compressive effect on your calves. So it's got calf sleeves. They make another ones that are like full body tights. They've got some that are shorts, they've got an upper body. The thing I like about this is they've got ice pockets in them too. So you can literally put these special ice sleeves that come with the compression gear into the compression gear as you're wearing it. And if you're wearing it for recovery, then you get both compression and ice, which can reduce inflammation and speed up recovery. And many studies have shown that compression gear actually works to enhance recovery and decrease soreness. So very good for that. As far as increasing performance, you know, there. There hasn't been a ton of data on whether or not anything could happen with compression socks. There was a study done back in 2007 where they measured max oxygen uptake, heart rate, blood lactate, ventilation, you know, with compression socks versus without. Didn't find any effects. They did another study in 2009. They tried a bunch of stuff. Compression socks, compression tights, full body compression gear. Didn't find any effect on performance. But some people swear by them basically saying that long term, like used over the course of something like an Ironman triathlon, they can decrease the amount of muscle jostling that occurs and thus decrease the amount of muscle damage and improve time to recovery. So for that, they might be good and definitely good in terms of improving recovery performance. Jury's still out on that. But I personally have started using compression socks when I race long distance triathlons, and I use compression gear very frequently for recovery. You'll find me a lot of the time sleeping in compression tights or wearing compression calf sleeves around the house, and a lot of times directly after a workout. Those also have ice in them. And what that does is it puts pressure on the blood vessels, it constricts the blood vessels, forces the blood to flow up to your heart, and basically prevents blood and fluid from pooling in your lower extremities. So, you know, that's how it would decrease soreness, increase the movement of the metabolic byproducts of hard exercise out of your muscles back up to your heart. And you know, I'm a fan for recovery. If it's something that you can include, it will definitely help. As far as performance, you just gotta use yourself as a case study of one and see if it works for you. Okay. Zach says I injured my shoulder doing dumbbell swings improperly. It's healing, but it's a long, slow process. My question is, what are some ways I can speed healing and still get a good, effective upper body workout without putting too much strain on the shoulder? It seems like every good upper body exercises all. Every good upper body exercise, all stress the rotator cuff to one degree or another. Well, the idea is that the reason all of these exercises you mentioned are stressing the rotator cuff is because they are all include a component where you're holding your arm out and away from your body. Anytime your arm is elevated away from your body, or specifically anytime the weight that you're holding is far away from the shoulder, you're going to increase torque on your shoulder. Just like if you're holding a box and you hold it close to your body, you're going to increase torque on the or you're going to decrease torque on the low back. As soon as you hold the box out away from your body, not hug it into your body, you're going to increase torque on the low back. So all muscles kind of work on this concept of torque. And it's the reason that a dumbbell held at your side is a lot easier to hold than a dumbbell held at arm's length. You increase what's called the leverage arm or the moment arm of that weight that you're holding, and it increases torque in the joint that's supporting that weight. So based on that concept, the trick is to choose exercises that work your upper body that do not involve holding a weight far away from the body, which basically, or more specifically would be holding a weight far away from the shoulder. So yeah, there's certainly exercises that you can do that are decent upper body exercises that aren't going to put the same type of stress on the rotator cuff. That would include something like narrow grip pull downs. So when you're pulling, doing a pull down on a cable apparatus, rather than holding a wide grip, which puts the weight farther away from your shoulders, you move that center of rotation closer to the axis of your shoulders and do a narrow grip pull down. Shoulder shrugs would be another example. You're holding the dumbbells close to your body, shrugging your shoulders up and down, not putting a huge torque on the shoulder muscles because again, the weight is held in tightly to the body. When you're doing a shoulder shrug, Bicep curls, where most of the weight occurs around the elbow joint. As long as the upper arm is held stationary, those would be okay. Cable bicep curls or dumbbell bicep curls. Same goes for tricep pushdown. Those again are more of a rotation around the elbow joint. Most of the torque is on the elbow joint, not on the shoulder joint. Partial motion flies. Using something like a fly machine that you sit down in, you can do partial motion of a fly machine basically directly in front of your body and not go through a full range of motion. And those can be great for working the chest without putting a lot of stress on the rotator cuff, keeping most of the stress on the pec. If you're doing lower body work, you know, I mentioned this in a previous podcast episode, but doing something like instead of a barbell squat or a squat where you're holding the weight out away from the body, you do a goblet squat where you take a dumbbell and you just clutch it in towards the chest and you do a squat with a dumbbell or a medicine ball clutched into your chest. And of course, you can do high intensity interval training. You know, cardio interval training that doesn't involve a lot of swinging of the arms like bicycle. You can definitely do lower body work. You can do things like lunges. You can even use machines like leg extensions and leg curls. And there will be some crossover effect up into the upper body. And so, yeah, there's a lot that you could do for your rotator cuff. Just make sure that you aren't holding away, out, away from your body as far as speeding healing of the rotator cuff. Listen into the interview that's coming up here pretty soon with David Minkoff. That'd be one perfect way to do it. All right. Dale asks in part two of the interview with Casey Kreischy, and that's come up a couple times. So I'll put a link to that in the show notes. I'll put a link to everything I talked about. So if you're listening in, you want to follow up on something I talked about, just go to episode number 143@BenGreenfieldFitness.com Casey states that plastic bottles leach chemicals into the water in the bottle. My bottle says it's BPA free. Do I need to throw it out? Well, the idea is that, yeah, plastic bottles do contain harmful chemicals. Those can leak out the contents and they can cause some serious health issues. And there are numbers given to each type of plastic that's used. Excuse me, in soft drink bottles. And some of these plastics are less likely to leach compounds that basically mimic the hormone estrogen. So they can increase your risk of cancer and, and cause some estrogenic effects in your body. Too much estrogen circulating around in your body is not a good thing. So plastics 1, 2 and 4, if you look at a bottle and they all have the numbers on there, all bottles have the numbers on there. It's usually on the bottom. Plastic 1, 2 and 4 are considered relatively safe. They're high density, low density forms of polyethylene. And for example, there's rules that go along with each one. Like a lot of soft drinks and water, they're sold in number one place plastic bottles. Lower levels of estrogen from those generally recognized as safe. I still don't personally use them, but those would be considered like single use bottles. So what research has found is that if you use them more than once, they release dhea, which is a known carcinogen. I play it safe and I just try not to use them at all. Number two, plastic that's used in a lot of different like milk and yogurt and juice containers. It's recyclable. They say you can reuse it. It's called a high density polyethylene. And then number four is like a low density polyethylene. And it's used also in a lot of plastic water bottles. It's considered recyclable as well. The type of plastics that are considered unsafe would be number three, number six, and number seven. And number six would be basically styrofoam. Definitely don't use Styrofoam. You can get away with it. Yes. That means that your take out, that you take out from the restaurant is not something that you should be eating out of or heating with food in it. Keep the food in there for as short a time as possible. Now what KC recommends in his book are several different types of water bottles or bottled water that would be considered safe. And he recommends in his book Mountain Valley Spring Water, which is made from a glass bottle. And it doesn't include this plastic that's considered unsafe. Voss or Voss Artesian Water also comes in a glass bottle and it's sold in a number one clear plastic bottle as well. That would be another one that would minimize the chemicals leaching out from the plastic. Pentawater is another one. Pentawater being something that's highly purified, available in the number one plastic bottles. And ultimately what it comes down to is if you look for that number and you see number one, that's good. Number two is better. Number four, not quite as good. Ultimately I just try not to use plastic at all when I can afford it and I drink out of glasses from a water filter in my own home or take my water bottles where I go. If water bottle says BPA free though, that's really good. You do want to look for the BPA free bottles. So hopefully that helps give you a little bit of direction in terms of checking for your plastic. And what type of plastic would be considered more Dangerous. Okay. These last two questions are very related, so we're going to answer them in kind of one fell swoop. But Josh says, I recently got a ton of tests done from a naturopathic doctor as I was constantly feeling lethargic, having sleep problems, as well as having a noticeable decline in my training performance. Performance. Everything came out great except for my testosterone levels, which is the main reason I got the testing done. I had a hunch they were low, and I also had an excessive amount of enzymes being produced. I'm only 22 years old. I'm currently training for Ironman or for Half Iron man, putting in around 20 hours a week. I'm pretty sure I hit a phase of overreaching or over training, so I took a few days off due to the symptoms I described earlier. My doctor prescribed me to try out coconut oil and flaxseed oil for a few months to see if that would help increase my testosterone and decrease inflammation. I also bought some tribulus to help as well. Is there anything else that you would try if you were in my shoes? P.S. i know you're an advocate of high intensity training, but I have some extra time at the moment, so long sessions work fine for me, and I love lengthy sessions outside. Not really willing to give that up. Ha. Okay, so let's follow that up with this question from Jerry.

Hey, Ben. This is Jerry in Missouri. I was getting caught up on my Ben Greenfield podcast addiction and came across the interview with Art Devaney. And you had mentioned something in that. In that interview that sort of struck me, and I wanted to see if maybe you could help me understand a little bit better about what the point was and maybe clarify something for me. You'd mentioned at the end of the interview that you were a triathlete, an Ironman triathlete, and that you realized that your training and racing was actually taking months or even years off of your life. And it sort of struck me. I'm a triathlete myself, and it caught my attention when you said that I've always realized that training and endurance training and really anything that puts the body through hard training, it has a catabolic effect on the body. But I'd always considered that I could manage it through proper sequencing of training to maybe help balance hormonal disruptions along with supplementation, and that everything would work out okay and my body would recover and. And so forth. And when you made that comment in the interview with Art, it really got my attention because I thought, well, if Ben is acknowledging that he's taking months or even years off of his life, then I certainly am no better than Ben. So it sort of struck me. So I wanted your comments, your clarification, and maybe your thoughts to expand upon that process. Are we, are we triathletes actually destroying our bodies? Are we really taking years off of our life? If that's the case, then it makes me wonder if I need to restructure my priorities. But anyway, I'd appreciate your thoughts and comments. And thanks, Ben.

Well, the reason I chose to answer these questions as kind of one answer is because my main recommendation to Josh would be to significantly cut his hours down to about eight to 10 hours a week from 20. And that is for several reasons, including some of these issues that Jerry brought up about this chronic high level training. Because there's a few things that happen when you're training with the type of training that these ironman athletes or half ironman athletes do. And I just want to go through some issues with you that you may want to think about. So first of all, when you're always training, you're always depleting your body's glycogen or storage carbohydrate levels. And your body, to a certain extent, no matter how much you're eating, it's going to occur. To a certain extent, your body has to cannibalize muscle tissue in order to help make blood sugar. It's a process called gluconeogenesis. And whereas gluconeogenesis in a resting or lightly active individual is not that big of a deal, once you start tearing down muscle, what happens is you get a big release of the adrenal hormone cortisol. And this chronic cortisol release can suppress your immune function. So it opens up the door for you to have lots of infections, lots of sickness, and potentially more serious issues like chronic degenerative diseases or asthma, cancer, heart disease. And this cortisol release also limits the ability of your bones to reuptake calcium. So you get low bone density along with that. That's why a lot of female athletes who train a lot have this issue with, with low bone density. So the other thing that happens that increases cortisol, it's kind of one, two combo with people who are training a lot is that carbohydrates or just meals that are high in calories in general can also cause this bump up in cortisol suppression of the immune system and some of these other issues that I just discussed. So we also can look at the burning of fats, beta oxidation of fats, Is completely healthy. It's how your body metabolizes fats. But beta oxidation of fats also produces free radicals. And the amount of oxidation of fats that has to occur during the amount of training that takes place for ironman creates a ton of oxidative or free radical damage, sometimes 10 to 20 times of what you would normally get if you were just, say, oxidizing fat at rest. So you get all these free radicals circulating around, damaging DNA, damaging protein, damaging cell membranes, and participating in this gradual destruction of a lot of your cells and your body's tissues. And so this, again, can be a huge contributing factor to a lot of diseases that could cut years off your life, like cancer or heart disease or aging. And yes, your body does have antioxidants, and you can take antioxidants, but he can only control this oxidative damage so much. One big correlative factor with your longevity is your amount of lean mass or your lean muscle. So what happens when your organs fail and you die is your organs basically lose their functional capacity, and they lose what's called their organ reserve and their lean tissue. And there's a direct correlation between your drop in organ reserve and your drop in skeletal muscle mass. So if you look at most endurance athletes or ironman athletes, they're pretty dang skinny. They have a lot less muscle mass just because of this gluconeogenesis I mentioned earlier. And even though they're exercising and many of them may appear to be fit, more often than not, you get a lot of very skinny, kind of atrophied endurance athletes. And basically, the amount of muscle that you go into the latter years of your life with is what doing you're stuck with. So if you've cannibalized a lot of that from long training and large amounts of gluconeogenesis, you're really limiting your organ reserve. The benefits of low amounts of physical activity, like, really light physical activity, they're great. So if we look at, like, somebody walking, somebody farming, they're going to be developing all these blood vessels to burn fatty acids to fuel muscles, developing lots of the enzymes responsible for fat burning. So they're not getting, you know, a lot of, a lot of, like, plaque formation. They're improving their cardiac muscle efficiency, improving their cardiac capacity, basically giving the body a lot of benefits. And so we hear about that in the endurance world, and we think, well, I'm doing that, too. It's like, I'm going out and I'm farming, or I'm hunting for, you know, three or four hours a day during my ironman training. Well, the problem is you're nowhere near what farming and walking is. You're putting your body under stress when you're out on a, on a three hour bike ride. You're, you're easily exceeding or doubling up the amount of activity from what would really be considered low level training. And you're doing that over and over and over again. So you're decreasing your muscle mass, you're decreasing your immune system, you're decreasing your testosterone, you're increasing your cortisol, you're amping up the insulin levels, you're just getting a ton of free radical formation. And don't fool yourself into thinking that you're doing the same thing that our farmers or say like our evolutionary paleolithic ancestors did. Very few of them would even go out and do like an endurance hunt. Those things are very stressful. That's why not a lot of tribes really do hunts where they hunt down the animal. You know, it's a lot of it is very easy tracking and then taking the animal down as quickly as possible. So you know, we look at it from like an evolutionary perspective. Now I want you to combine this with episode number 133 where I talked about all of the acute effects, what happens to the body for about one to three weeks after you run a marathon or do an ironman triathlon on and think about what happens if you do 20 to 30 of those in your life. I'm not going to repeat what I said in episode number 133, but I went through a huge laundry list of what happens to you when, when or right after you do a marathon or an ironman jury's out on how well you actually recover from that type of activity. So what this comes down to is number one, there are things that you can do to limit the damage. Yes, you can take a full spectrum antioxidant. Yes, you can get a ton of your dietary intake from things that aren't going to increase the cortisol and the insulin quite as much like Omega 3 fatty acid rich foods, just a high fat, high lean protein fat intake in general. You can monitor your blood levels and monitor your hormone levels and do things like the bioletic testing on a yearly or you know, even if you can't afford that every couple years go out and get things like youryour cortisol and your testosterone levels and your ferritin levels tested and check out what your blood glucose and your insulin is at and you know, maybe go out and look into things like, you know, how saturated your blood is with oxygen, your hematocrit levels. Look at as many things as you can. You know, doing something like the complete athlete profile through something like bioletics. I'm not saying this to be a commercial for them, but you want to.

Track.

And then the other thing that you do want to think about is how much you're going to train and race. I personally, if I really could, I could probably find the time to train about four hours a day. I cut myself short even on the weekends of doing no more than, than two hours right now. Now if I qualify for the Ironman World Championships for Hawaii in October, that will increase to a maximum of four hours on, on a weekend of training and I will max out. The most hours that I'll do in a week will be about 17, 20, 25, 30, 35 hours. Wouldn't even approach it. And I still think that I'm probably doing a little bit of damage to my body, even going out and doing my 10 to 15 hour training week versus doing an easier 6 to 8 hour training week with just some high intensity intervals and stay active and eat healthy. So I guess what this comes down to, and I kind of have to say this in the light of the fact that the physician that we're about to interview has done 37 Ironman triathlons. I guess what it comes down to is if that's what you've chosen to do with your life and you don't mind the fact that there may be some increased oxidative damage and some increased or some decrease in your organ reserves and some other issues that are going on, that's fine. I don't think that we have this moral prerequisite to try and live as long as possible. However, if that is your goal, you are not serving it by doing Ironman triathlon. And don't fool yourself into thinking that you're extending your life through your participation in endurance sports, because that is probably not the fact. The fact is probably quite the opposite. Okay, I did not mean to depress you. Remember, I'm a triathlete. I love to train, love to race. But I will be the first to admit that it is not the healthiest sport that I could be participating in and I am probably taking a couple years off my life by doing it. But again, I don't believe that your goal in life should be to live as long as possible. I think that's grasping at straws. All right, let's go ahead and wrap this up and move on to the interview with Dr. David Minkoff. I'm sure I generate a lot of questions and you can ask them over on the show. Notes for this podcast, podcast number 143, Featured topic. Hey, folks, this is Ben Greenfield. I'm here with Dr. David Minkoff, who you may have heard of before if you're a longtime listener to BenGreenfieldFitness.com he's one of the celebrity physicians that joins us. He himself having finished 39 Ironman triathlons, and he runs a very cutting edge facility down in Clearwater, Florida, and that's called the LifeWorks Wellness Center. And he also owns Body Health, which is basically a really helpful website as well. And he's one of the guys that developed the amino acids that I take on a daily basis, the master amino pattern. And today he's here to talk to us about prolotherapy, which I actually get a lot of questions about. And because I know that Dr. Minkoff actually has a lot of experience with this himself, I figured he'd be the perfect person to ask. So, Dr. Minkoff, first of all, thank you for giving your time and coming onto the show.

It's great to talk to you again, Ben.

Well, tell us about prolotherapy. What is prolotherapy?

Well, the term was coined by a physician in Ohio or Illinois named Hemwall, and he was looking for a way to help people who had chronic body pain, especially joint pain. And he coined this word prolo, was short for the word proliferate, which means to make something grow or expand or increase in number. And so he coined this term prolotherapy, which the idea was, is that you could get soft tissue or connective tissue. Tissue. It's the stuff that holds us together, the ligaments and tendons in the body that hold the structure together, that you could get them to grow and heal when they weren't healing before. And the typical thing that happens to an athlete is either from overuse or injury or malnutrition. They get what occurs in their ligaments and tendons is that they stretch out or they get partially torn. And those are the structures that are supposed to hold joints together and keep them in a very specific range of motion. So let's sample. If you had a knee joint and you stretched the lateral collateral ligament so that the knee joint, now the hinge on the joint isn't holding right? And on the lateral side it's weak. And so the joint is now starting to move a little bit out of the range. That it's supposed to. You will get a wear and tear on the cartilage, which is abnormal. You may or may not get pain, but you will get wearing down of the joint in an abnormal pattern. And it could be after an injury, let's say you twist it or you're tackled by someone, or you make a quick turn on the basketball court, or you're a soccer player and you go one way and a guy tackles you and you get the joint stretched out. You know, the ligament is stretched or partially torn. There may be pain and swelling. There may not be in older folks, there may not be an acute injury. It's just that their nutrition hasn't been good and their connective tissue breaks down. And usually what people do is they do rice. They're supposed to rest it and ice it, compress it and elevate it. And they usually take anti inflammatories like Advil or Motrin or Aspirin. And what occurs is that the healing response gets blocked. And the normal thing that's supposed to happen to heal, that connective tissue gets blocked by the drug because they're anti inflammatories. And the way the body heals an injury is by inflammation. Inflammation means it sends in their white blood cells and little things called fibroblasts, which regrow the connective tissue so that they can heal it up. And for one or another reason, the ligament never quite heals. Or it heals in a condition where it's too long and you end up with a joint that's got too much motion. And when you get too much motion, it wears funny. And then you get, you know, you get pain or you then tear cartilage or the original injury may be a torn cartilage or you get arthritis because now the body is trying to get. It's laying down calcium deposits to try to keep the motion the way it should be. And then since the motion isn't right, the body doesn't like the extra motion that it's got. It's trying to use muscles to hold the joint still. And so you get chronic resting change in the muscle tone, which is too high, that causes painful muscles. And usually the complaint we see from someone is pain. It's either chronic joint pain or chronic muscle pain. And it's an athlete and they need help. And the idea that. And what we do often is prolotherapy. And so the idea of prolotherapy is that if you inject into where the ligament attaches to the bone something that is an irritant that will set off a new inflammatory response. The ligament will shorten and thicken and get stronger and the cartilage in the joint will regrow. And you then can re, you can rehab a joint that before was causing you chronic pain. And once the joint starts, structure is now normal because the ligaments are shortened, the cartilage regrows, the muscles around the joint will relax and the chronic pain will go away.

Okay, so in terms of how it actually works, is it like an injection? Is it something that you, you know, is it like something you smear on top of the joint? How does prolotherapy actually work? When someone goes in, what do they expect?

It's an injection. It's actually multiple injections. So if I'm doing a knee joint, I will inject about 10cc of a mixture of the stuff we call a proliferant. It's the stuff that does it. And for most cases it's a 15% sugar solution with a local anesthetic. With usually I put in some homeopathics which help in the healing response. Something called Tramiel or Zeel. These help joints to heal. And I'll put about 10cc's into the knee joint space and then I'll put another 10cc. I will trace where the ligaments that hold the knee together are. So it's on both sides, it's in the front. And I will inject about a tenth to a quarter of a cc in multiple places around the joint so that the ligament and where I inject it is where the ligaments attach to, to the tibia, which is the lower leg bone, the main lower leg bone and the fibula, the other leg bone and the femur and around the kneecap where all the ligaments attach. And then for about 24 to 48 hours the guy will feel kind of a heatness and maybe a little pain, maybe a little swelling. And then over about three to four weeks, the stimulation of that will cause those ligaments to shorten and thicken and the joint space cartilage to regrow. And during this time, we keep people off of any kind of anti inflammatory medicine. We don't use ice, we use heat. We don't have them doing any kind of ballistic motion because I don't want them to irritate it. So no jumping, no running, no heavy squats. They can do an elliptical, they can ride a stationary bike. But we want to give it a couple of weeks so that it can heal. And then we check them in three weeks and see how they're doing. Usually there is improvement. And most guys, somewhere between one and six treatments, the pain will go away and the joint will rehab and it'll feel really good. And that can be a shoulder, it can be a knee, it can be a, a neck, it can be a low back, it can be an ankle, it can be a chronic plantar fasciitis. It seems to work probably 80% of the time in most people. I've had it done myself a couple of times. It's not a fun treatment because it hurts to get the shots, but it's a very effective treatment for most people. People, because if you compare it to like a guy who has a knee injury and he gets an MRI and there's partially torn ligaments and there's torn cartilage and the orthopedist goes in there with a scope and he wants to clean things up. I would say to most guys, don't do that yet. Come in, do a bunch of prolotherapy treatments, see if it'll rehab by itself because the chances of it working are probably in the 80% range. And they won't need to have somebody go in there with a scope and open it up. There's really no downside other than the pain of the treatment, which lasts about 10 seconds because there's a local anesthetic and it, you know, it takes the pain away. And it's a brilliant treatment. It just really. I love doing it because the success rate is really high. And a lot of people will come. A lot of people will come back and they'll say, you know, man, you fixed me. I'm good. And then I just say, you know, if it hurts again, if you re injure it, if you re overuse it, come back. And I put them on.

Oh, go ahead.

I beef up their nutrition. I put them on MAP Master amino acid pattern because they need extra amino acids to reheal their cartilage. Most guys are vitamin D deficient. I put them on extra vitamin D, I put them on some fish oil. I put them on a multi because they need these extra things because their nutrition hasn't been good. I try to get them off the drug anti inflammatories. And if you've ever, if you've traveled at all. I was flying this weekend and if you look in the airline magazine, there is a picture in there. It's usually an elbow joint. Where they show a guy with an elbow joint before and there's almost no cartilage pad. And then they call it joint rehabilitation. Therapy, it's an advertisement. And then they show the elbow joint. Three or four treatments later, and they show that the cartilage is regrown on the elbow joint. And now they got a good joint. And it's an advertisement for some guys who are doing prolotherapy. That isn't what they call it, but they. That's what they're doing.

That's interesting that you actually can mix other things in with the elements that you're injecting into a joint. Like Traumeel, you mentioned that's something that people would normally put on as a topical anti inflammatory. And you can literally just inject that into a joint, huh?

Yeah. The company that makes it as an injectable homeopathic. So we usually use a combination of Traumeel, which is common, and there's Zeal, which is another one, which is. It rehabs joints, cartilage. So I mixed, I usually throw a vial of that in there. And you know, sometimes on the resistive cases, we might inject some growth hormone into it into a joint to get it to stimulate. You know, sometimes guys need extra other stuff. You know, their testosterone's low or their, you know, they may need other stuff, depending. But for most guys, it's pretty simple. It's the local injection repeated from one to six times. You know, if after one time on the knee joints, most guys one time, sometimes two times, the pain's gone and they're ready to go again. And then they've done it. You know, if they have trouble again, they, they can come back and get another one. I had my groin done. I tore my adductors, which is the muscles that move your leg from outside to in. I got up and I caught my leg on my desk and I tore my adductors. And it was 10 days. I couldn't run. It was painful to walk. I had the prolotherapy done within seven days. I was running. The pain went completely away. It was great. For low backs, it can be terrific. A lot of guys with chronic low back pain, they've got loose ligaments in their low back. They go to the chiropractor, they get adjusted, it feels better for two hours and then they move and it goes out. That is a symptom of ligament laxity. And the ligament laxity, the, the ligaments are not holding the bones in place where they should be. And prolotherapy is the solution to it. Disc surgery isn't. And it can stabilize a low back or can stabilize a pelvis and it can really help. So I love doing it because it's really good. There's a lot of guys around the US who do it. There's a website which is getprolo.com which has a bunch of guys who do it. So you can find somebody in your area who are experienced. And all the theory and all the research, there's been actually quite a lot of literature now on it, scientific literature. It's an orthopedic nightmare because most of them don't like it because it's so effective. It reduces really, the amount of surgery that has to be done because a lot of times it helps. And I've done a lot of pro athletes, like skateboarders, where they'll twist ankles and they've got chronic pain or knees, or baseball players with elbow pain or shoulder pain, or guys with low back pain or chronic neck pain, or sometimes people with chronic headaches. It's muscle spasm in their neck, trying to hold their neck spread that's causing the chronic headaches. And it can help. If that's the right thing, it can help them out.

Wow, interesting. And does insurance cover something like this all the time?

Mostly not. It's not super expensive. Like, to do a knee joint in our office, it's 155 bucks. It's pretty reasonable. And if we do two joints, you know, I think we had 55 bucks for the second joint. So if you need both knees or if you need a knee and a hip, it's, you know, it's not going to break anybody's bank. And if they need a couple of them, it's. It's usually doable.

We don't do insurance like surgery. I mean, that's not bad.

Well, yeah, I mean, you get a scoped knee, it's going to be in the, in the multiple thousands for at least.

Yeah.

So it's a. It's. There's a couple of books that if people want to look at it or even on the website, getprolo.com, there's lots of things that people can educate themselves and, you know, talk to somebody because usually in most of the big cities, there are guys that are doing it. And for athletes, I think it's fantastic because your downtime is short. You know, you don't even really have to be down all the way. So if it's a knee or an ankle or a hip hip, you know, you can still ride. You can do an elliptical. And if one or two treatments, you know, in six weeks, you could be on your feet again. And you could be running. So it's, it's, it won't put you out for a season. And when the pain's gone, you'll just feel a whole lot better. So I really like it.

Got it. So if you're in the Florida area, obviously Dr. Minkoff's life works Wellness center would be the place to go. Otherwise, check out that website that he gave out, getprolo.com this sounds like it could be really, really good for a lot of people who have some of these issues. So, Dr. Minkoff, thanks for your time and for explaining that to us today.

Absolutely, Ben, My pleasure.

Well, folks, that is going to wrap things up. Remember, you can donate a dollar to the podcast to keep this discussion going and keep these podcasts coming to you week after week over@vangreenfieldfitness.com and there are lots of you out there downloading these things, so it gets a little spendy, those hosting fees. So every little bit helps. And then again, if you want to also use a dollar and sign up for a sneak peek into the healthy lifestyle membership website that my wife and I run, that's over@BenGreenfieldFitness.com innercircle can go check it out for a dollar. Now, if you have questions, you know where to go. I always love to hear your comments on these podcasts, and you can do that all over@BenGreenfield Fitness.com until next time, have a healthy week.