By: Eric Cressey

We’re back with another interview this week – and it certainly won’t disappoint.  Those of you who haven’t heard of Julia Ladewski need to seek out everything she writes, as she’s one of the brightest young stars in the strength and conditioning community.  Keep an eye out for great things from her in the months and years to come!

EC: Hi Julia; thanks for being with us today.  For our readers who don’t know you, could you please fill them in a bit on your background and what you’re doing now? JL:  Currently, I’m a Strength Coach at the University at Buffalo, in Buffalo, NY.  I graduated from Ball State with a degree in Exercise Science where I also spent time working with the varsity athletes (baseball, volleyball, gymnastics, track & field).  From there, I spent a summer at Athletes’ Performance in Tempe, AZ where I continued to work with college athletes, as well as youth and professional.   After that I came out to Buffalo, where I’m going on my fifth year as Assistant Strength Coach. I am also a competitive drug-free powerlifter, squatting 463, benching 240, and deadlifting 424 in the 132-pound weight class.   And in my “free” time, my husband and I train high school kids of various sports.

EC: Now, you started out at Ball State, which is well known for producing some outstanding lifters and coaches.  What is it about Ball State?  Something in the water?  And, how the hell did that schmuck Robertson manage to get in?  I heard his father teaches there, so that must have had something to do with it.  But I digress…the floor is yours! JL:  Ball State, first of all, has one of the top Biomechanics labs in the country, formerly headed by Dr. Robert Newton.  Dr. William Kramer also used to be there, so it has a tradition of serious biomechanics research, which in turn breeds super smart students, who become awesome strength coaches.  I have no idea how Robertson ended up there.  I had the unfortunate “privilege” of being on the powerlifting team with him while I was there.   And I can say this about that team… Other than it being good ol’ Mid-Western, Indiana water, it was started by Justin Cecil, who himself was a great lifter and coached many of us to National Championships.  His intensity and desire to be the strongest team was imbedded in us whenever we trained.  It’s like Westside Barbell… strong breeds strong.  And that’s what we were…. STRONG! EC: You’re a highly successful female in a sport that has traditionally been dominated by males.  How has your path to success in powerlifting been different in light of your gender? JL:  First of all, I owe it all to the females before me that paved the way.  Once I fell in love with the sport, I wanted to be the best, to be #1.  It’s about stepping out of your comfort zone and surrounding yourself with people who are strong and supportive.  Most of those people are males.  If you’re fortunate enough, you’ll have some other females to train with.  (I have only 1 female training partner.)  So it’s setting standards higher than the public sees.  Most people think women are supposed to lift 5 pound dumbbells and run on the treadmill all day.  But stepping out of that stereo type has not only allowed me to be successful in powerlifting, but also make me a successful strength coach.  For me, it’s motivating to know that there’s only a handful of women in the history of the sport that have done what I’ve done.  And being a part of that history keeps me wanting to lift more and more. EC: Thus far, we’ve focused primarily on you as a lifter, but you’re also a strength and conditioning coach at the University at Buffalo.  How has your experience as a lifter made you a better coach? JL:  Eric, powerlifting is a huge part of my coaching career.  Here’s why… Strong breeds strong.  Ok, so my athletes don’t need to be ‘powerlifter’ strong, but they do need to get stronger.  Being a strong female has allowed me to gain the respect of the athletes I work with, especially males.   They listen to me when I help them squat because they know I have had success in that.  It has also allowed me to be proficient in exercise technique and program design.  If I could give advice to someone wanting to be a strength coach, or how to get better in your field, it would be to workout and get stronger. EC: I know you and I have discussed the problems we encounter with female athletes at length; why don’t you fill the readers in on the problems you face as a coach in this regard? JL:  The problems are so extensive that I could write an entire book on it.  But to keep it simple, here are the most prominent issues. 1. Knock-knees – females knees buckle in severely when squatting, jumping, landing, lunging, etc.  It has to do with the Q angle of their hips and (the thing that can be corrected) weak glutes. 2. Over-dominant quads – females tend to use more quads, less hamstring and glutes for all activities.  This leads to patella femoral problems.  So, strengthening the hamstrings and glutes has to be a staple of their program. 3. Not wanting to get “bulky” – I hate that word, Eric.  It’s so stupid.  I’ve been lifting consistently (heavy) for 10 years and I have yet to “bulk up”.  Without going into too much detail, as women, it’s going to be extremely difficult for you to grow man muscles due to your low testosterone levels.  So with my athletes, after they have been lifting for a year or so, and I’ve instilled some confidence in them that they won’t get “bulky”, then they really start to buy into the program, they get really strong and their athletic performance takes off! (Note from EC: Julia and I are actually going to be publishing an e-book together on this very topic in light of our extensive experience with training female athletes at all levels.) EC: How about ordinary female weekend warriors? JL:  As I mentioned above, most female recreational lifters, who are lifting just to stay healthy and ward off the body fat, don’t want to get big.  So they use light weight, high reps and they use the same exercises over and over and over again.  And they wonder why their progress stalls!  You must constantly use new exercises to provide a stimulus for the muscles to grow.  And hopefully we all know by now that muscle burns fat, so it’s ok to build muscle!   Weekend warriors have the same knee problems that athletes have, more so the weak glutes part.  They can’t use their glutes effectively when, for example, picking up something around the house, so they use their back muscles and they end up with back pain.  The list goes on, but those are the main things. EC: What are some exercises that you think all women (assuming they're healthy) need to be doing? JL: I think all women should be doing squats and deadlifts.  They are great total-body exercises that give you the most bang for your buck – especially for most women who are in a time crunch when it comes to working out.  You could knock out some squats and deads and get what you need lower body-wise from those two exercises.  Of course I always recommend doing single leg exercises as well.  But those two are the Granddaddy of 'em all! EC: Who has had the biggest influence on you as a lifter and a coach? JL:  Well, I would say that my husband, Matt, has had the most influence on me as a lifter and coach together.  If it weren’t for him, I wouldn’t have began or stuck with the sport of powerlifting.  He also supported me when I decided to change majors and pursue a career that I loved, where he challenges me daily to learn more and more. But independently from Matt, I would say Louie Simmons (and Westside) have had the biggest influence on me as a lifter.  When we lived closer to Columbus, we traveled out there quite often to learn from the best.  Remember, strong breeds strong! As a coach, I can’t say that I can narrow it down to one person.  Most importantly, the people that I have worked with and under have shaped me the most.  Mark Verstegen, Cheyenne Pietri and Buddy Morris have all had impacts in my coaching career.  Most of all, I have learned how to develop my own coaching style and each of these men have brought something to the table. EC: On a semi-related note, let’s go with a word association game; what’s the first thing that comes to mind when I say: Buddy Morris JL:  I gotta keep this short, huh?  ;)  Ok, ok.  Buddy has forgotten more things thant most people will ever learn.  He’s been in the business for 25 years.  Love working with him. EC: Louie Simmons JL:  Powerlifting icon.  He’s taught me so much and is willing to help ANYONE! EC: Curves JL:  Need I comment?  Fine…  Curves is ruining the women’s fitness industry.  Don’t get me wrong, those women working out are at least doing something.  But if they only knew… EC:  Buffalo Winters JL:  Not as bad as you think.  Everyone thinks of the couple years they got 8 feet of snow in a week.  It’s not like that every year. EC: The Chicago Cubs JL:  ROCK!!!  I know, we have a good season every once in a blue moon, but I love ‘em!  (I’m a Chicago native.) EC: Last but not least, what are some of your top resources (books, manuals, DVDs) that you feel all lifters and coaches should have: JL: 1. Supertraining by Mel Siff 2. Magnificent Mobility DVD – Eric Cressey & Mike Robertson 3. Science and Practice of Strength Training: 2nd Ed. – Zatsiorsky and Kraemer 4. Any Russian Manual – Verkhoshansky (among others) 5. High Low Sequences of Programming and Organizing Training – James Smith 6. The Ultimate Off-Season Training Manual – Eric Cressey This is by no means a complete list, but they are items I refer to most often. EC: Thanks for taking the time to be with us today, Julia.  Where can our readers find out more about you? JL:  Check out the new website at www.LadewskiStrength.com.  I have a free newsletter for which you can sign up, articles, products, and other stuff.  You can email me directly at julia@ladewskistrength.com.   Thanks, Eric!  We’ll have to do this again sometime!

By: Eric Cressey

By: Eric Cressey

For those of you who aren’t familiar with Jay Floyd, I would highly recommend searching around for some of his stuff and familiarizing yourself with his name.  In addition to being one of the most accomplished lifters and knowledgeable and passionate coaches around, Jay is a rare breed in the strength and conditioning world: a genuinely good guy.  He understands that he’s developing people as much as he’s developing athletes, and he’ll always take the time to help out up-and-coming lifters.  I know because three years ago, I was one of those lifters.  I was on the fence about whether or not to get into powerlifting, and my discussions with Jay were a huge deciding factor in me making the jump into competitive lifting.  He made me realize that I couldn’t ever be the coach that I wanted to be unless I was doing my best to walk a mile in my athletes’ shoes, and to do so, I needed to get back the competitive mindset I had when I was involved in athletics as I grew up.  Simply stated, I owe him a lot.

EC: Hi Jay; thanks for taking the time to be with us today.  We’ve interacted a lot over the years, but I’m not a lot of our readers are familiar with you and your accomplishments.  By all means, bring them up to speed by taking a few paragraphs to brag about yourself!

JF: Well I played football, baseball, and threw the shot put in track in high school, and I have always loved lifting weights.  I started lifting in my room when I was 12 years old; I would crank up “Too Legit To Quit” and lift like crazy.  My dedication to lifting really paid off early for me, as I was able to start at tight end as a sophomore in the toughest classification in Georgia. I went on to be a three-year starter on the football team, was Team Captain, Best Offensive Lineman, Weight Champ, and all those things. I even got to play in the Georgia Dome my senior year.

After high school, I only had a couple of walk-on opportunities because of my height (6ft.), so I decided to just go to school and not play football.  While in school, I got a degree in Exercise Science and immersed myself in learning as much as I could about strength and conditioning.  During this time I also started powerlifting; now, my current best lifts are an 845 squat, 535 bench, 640 deadlift and 2000 total in the 275lb class.

EC: Great stuff, Jay; what are you up to now?

JF: I am now the Strength and Conditioning and Offensive Line Coach at Alexander High School in Douglasville, GA.

When I got here less than two years ago, we only had three 400-pound squatters, zero 300-pound bench pressers, and two over 250 pounds in the power clean. At our last high school powerlifting meet, we ended up with nine 400-pound squatters, three 500-pound squatters, six 300-pound benchers, one 400-pound bencher, and six over 250 in the power clean.  My best lifter did an APC meet last weekend and squatted 650, benched 451, and deadlifted 551 at age 18 at body weight of 260.  All these lifts were done in old single-ply gear; the squat suit he used was my four-year old Metal IPF squatter, which is actually loose on me at 285!

I have written articles for Bodybuilding.com, Athletes.com, and Elitefts.com.  I am also in the works with Landon Evans on something in football that should be interesting and I have developed some exercises with bands that should change the way I coach my offensive lineman in football.

EC: I can speak from experience that coaching entire teams isn’t an easy thing to do, so I’ve got a ton of respect for what you do with your high school kids.  What are the challenges you face on a daily basis in this setting, and how do you overcome them?

JF: Without a doubt, the biggest challenge is lack of support from the other coaches and administration.  Because the school day is so full, the only time you can work with athletes is during a weight training class.  Unfortunately, our administration is not committed to putting our athletes in those classes; this lack of support is actually one of the reasons that I will not be back at this school next year.

We also face problems with the coaches of other sports. Many are ignorant to conditioning and this makes my job very difficult.  They do not stress the importance of lifting and getting stronger to the kids and that makes it tough for me to sell the program to their kids.  For most football players, it isn’t a problem, but basketball and baseball are different stories, though.  The overspecialization is killing the athletes in this country, but no one wants to see it.  A lot of really bright coaches have beaten this horse to death, so I won’t go into it any further.

Another problem I have is more is my fault entirely.  Because I compete in powerlifting, some coaches believe that this is the way we I train my kids year-round.  Although we do have elements of a traditional Westside Barbell program, their training looks nothing like mine.  However, for people who do not know the difference, it looks the same.

EC: What does a typical day in the life of Jay Floyd look like?

JF: I wake up between 5:30 and 6AM, and eat right away.  I will go to the gym and train fellow coaches, football players, and powerlifters until 8AM.  At about 8:15AM, I will start the movements from your Magnificent Mobility DVD and start to lift around 8:45AM.  I am usually done by 10:00AM, but I may do accessories throughout the day when I find the time.  I am in classes from 10:20AM until 3:30PM. If it is football season, practice starts at 4PM and I am there until about 7-7:30PM.  If it’s not football season, I hang around for a bit and then go home.  I just got married, so now the afternoons are reserved for my wife.

EC: I’m sure that - like all of us – you’ve made some mistakes along the way.  What were a few of those mistakes, and how did you turn them into positive learning experiences that benefited your athletes and you as a lifter?

JF: The biggest mistake I have made is not paying attention to mobility.  I am stuck playing catch-up now and it is much more difficult to backtrack than it is to build it in the first place and then maintain it.  I stress this heavily with my athletes now; we do mobility work of some sort every single day.

In my own training, going overboard with bands really hurt my strength.  I neglected my straight weight and raw work for too long my squat and deadlift really suffered. In fact, I just wrote an article called "Starting Strength" for EliteFTS.com about this very subject.

EC: Along those same lines, who in the industry has helped to make you the lifter and coach that you are today?  To whom have you looked for inspiration?

JF: A guy in this field is a liar if he doesn’t say that Louie Simmons has been the one of his biggest influences; I would not be where I am today if not for Louie Simmons, Dave Tate, Jim Wendler, and the rest of the guys at Westside Barbell and Elite Fitness Systems.  I only know Jim personally, but they have all helped me and been more than generous with their time and money.  Also, guys like you, Landon Evans, Steve Coppola, Jared Bruff, Donnie Thompson, Marc Bartley, and the other guys at the Compound in South Carolina have helped me tremendously with my powerlifting technigue and gear. Your Mobility DVD has been unbelievable for me.  Landon Evans is always there with brilliant ideas, and Steve Coppola and Jesse Burdick are the same way.  Jared Bruff has been a great friend to me over the past four years, as we’ve done many meets together and he has been my handler at most of them; I would not have done as well as I have if not for him.  Joe DeFranco has probably influenced my program design the most; I have done variations of his programs with my kids with great results.  I also have tons of respect for James Smith, and Jason Ferruggia has been great to me as well.  Those are the kind of people that make this business so great.

And I would be a terrible person if I did not mention my training partners for the past two years.  Clay Livingston, Joey Strickland, and Rich Fendley have pulled more bars off of me than I can count.  I especially want to thank Clay; he has been my constant training partner for the last two years. Of course, I have to thank my wife, too; she has pushed me in powerlifting more than anybody.  It is great to have that kind of support and love at home for what you do.  The best hug I ever received was when she came to the back to hug me after I totaled Elite for the first time; I think she was happier than I was!

EC: How about “book smarts?”  We also all our interviewees what their top ten book and DVD choices are; if you had to pick ten, what would they be?

JF: I think reading and constantly learning is extremely important. If you learn one thing that can help you, then it has been worth it.  I read more articles than I do books.  Books tend to be out-of-date very quickly, while articles are more current.  I do think it is somewhat important to be knowledgeable about the human body and its functions; this knowledge enables you to see through many gimmicks right away.  For instance, I had one guy tell me that he heard squats were great because they release acids that are stored in your glutes; I am not kidding.  Now, this is an otherwise very smart guy, but this makes absolutely no sense whatsoever.  Anybody with any fundamental appreciation of how the human body works knows that this is completely insane.  This basic knowledge also allows you to see through most supplements and save money.

My favorite books and videos?  That’s a tough one.  I read a ton of books that have nothing to do with strength and conditioning, so I might put a couple of those in there as well.

EC: No problem; we’re all about variety around here.  If it helped you, it’s sure to help someone else.  Shoot.

JF: In no particular order:

1. The Case for a Creator by Lee Strobel
2. The Case for Christ by Lee Strobel
3. The Case for Faith by Lee Strobel
4. High/Low Sequences of Programming and Organizing of Training by James Smith
5. The Westside Seminar DVDs
6. Magnificent Mobility by Eric Cressey and Mike Robertson
7. The Parisi DVDs
8. The Elite Fitness Exercise Index DVDs
9. The Fair Tax Book by Neil Boortz
10. The Terrible Truth About Liberals by Neil Boortz

EC: Some interesting stuff in there, Jay.  Not many guys can please Billy Graham, Bob Doyle, and Dave Tate in the same breath, but I’d say that you passed the test with flying colors!  Thanks again for taking the time; where can our readers find out more about you?

I am extremely fortunate to not only have a loyal group of newsletter subscribers, but also a very knowledgeable and passionate group of individuals who come from unique backgrounds.  Collectively, you subscribers give me a ton of outstanding feedback that makes me better at what I do.

After Newsletter 95, I received a great email response from Dr. Jason Hodges:

Needless to say, that “etc.” at the end of the last sentence got me intrigued, so I asked Dr. Hodges if he would be willing to do an interview for our subscribers.  I think you’ll find it very enlightening – and forward-thinking.

EC: Thanks for joining us this week, Dr. Hodges.  Could you please tell us a bit about both your professional background and health and human performance interests?

JH: Thanks for the opportunity, Eric. I did my undergrad at University of Kansas with a BA in biochemistry graduating in 1991, and received my MD degree from U. of Kansas School of Medicine in 1995. I finished my Radiology residency at U. of Missouri in 1999 and received my American Board of Radiology certification the same year. I am currently an executive partner in S and D Medical LLP in NYC. My interest in fitness really lies outside my professional duties although there is obviously some overlap. My Radiology training is not specific to fitness.

EC:  In your reply to my newsletter last week, you not only confirmed some of the things I noted about MRI results in what we think are healthy lower backs, but also had some other very interesting experiences to share.  Would you please fill our readers in?

JH: Often imaging findings do not correlate with clinical findings. Older patients often have very degenerative spines without symptoms. Whereas younger patients can have small bulging discs or herniated discs and have debilitating pain. The human body has a great reserve capacity. I see many “normal” kidneys that are in chronic renal failure

Medical imaging generally deals with anatomy: how organs “look”, not so much how they function. Obviously, they are linked, but function can decline long before anatomic changes occur. Symptoms can occur without imaging abnormalities. This leads doctors to conclude that nothing is wrong because the x-ray/CT scan/MRI looks normal. This is simply not the case.

Medical imaging is simply one piece of the clinical puzzle. An analogy can be made with astronomy. You can image the universe at visible light, x-ray, ultraviolet, infrared, etc. Each modality provides a vital, but incomplete picture of the universe. You have to put it all together to get the big picture.

EC: How about the knees?  I know a lot of people are walking around with chronic ACL tears that aren’t symptomatic, but what else do you see?

JH: It is often easier to see acute injuries better than chronic images. We often see the secondary finding, such as edema or fluid collections rather than the direct injury itself. An acute ACL tear may show a gap in or fraying of the ACL, surrounding edema and joint effusion. A chronic ACL tear may show only a wavy appearance or abnormal signal as scar tissue has partially healed the injury. But it is important to recognize the chronic ACL tear because it alters the biomechanics of the knee, stressing other parts of the knee. This can lead to a higher risk of meniscal tear or premature arthritis. A common cluster of findings in acute knee injury is ACL tear, medial meniscal tear and medial collateral ligament sprain/tear and a joint effusion.

EC:  Shoulders?

JH: The most common finding I see is tendinopathy of the supraspinatus tendon. It is the most likely to be impinged under the acromion and clavicle. The shape of the acromial hook can predispose to impingement, as can arthritic changes of the acromioclavicular joint. In radiology, we tend to use the term “tendinopathy” rather than “tendonitis”. “Tendonitis” implies white blood cell inflammation, which we cannot confirm on MRI. So we use the imaging term of “tendinopathy” which can certainly include tendonitis.

EC:  So, what’s your take?  Are we too heavily reliant on MRIs as a society?  Certainly, it takes a lot more resources to get a MRI than x-rays, yet many people seem to request these at a moment’s notice to gain some peace of mind.  What kind of accuracy are we talking?

JH: As I said, MRI is just a piece of the big picture. Some of the limitations include the fact that we image the joints in a static state, in one position. We image the lumbar spine with the patient lying down which is a whole different loading scheme than standing up. The tracking of the patella during extension is really best assessed by physical exam, not by MRI. It is a matter of putting too many eggs in the imaging basket, so to speak. MRI is the best imaging modality for the soft tissues, but it is not all-seeing/all-knowing.

EC: Let’s talk about lifters.  What are you seeing in terms of chronic adaptations to lifting heavy stuff?

JH: To be honest, we don’t image many lifters except in the setting of acute injury. Lifters tend to be younger and healthier. Certainly, lifters have better bone density and have a lower risk of osteoporosis. Larger muscles and lower bodyfat are obviously the case.

EC: Aside from lifting, what other lifestyle habits have you found lead to less-than-stellar diagnostic imaging?  Alcohol?  Certain occupations?

JH: By far, the biggest limitation is obesity. All of the imaging modalities are limited by it, mostly for technical reasons. An ultrasound beam can only penetrate so far into the soft tissues. X-rays and CT scans are degraded by scattered radiation, which leads to a higher radiation dose and grainy images. Also, the time it takes to do the study increases, which gives a higher incidence of motion blur.

EC: So diagnostic imaging is less accurate with obese patients?  One more reason to not get fat in the first place!

We often talk about how the best doctors are the ones who meet the lay population halfway.  In other words, they’re the ones who can tell an injured patient what he CAN do, and not just what he CAN’T do.  My experience has been that the best trainers and coaches are the ones that can meet the doctors halfway, and it’s something to which I attribute a lot of my success.

To that end, what resources would you recommend to trainers, coaches, and everyday weekend warriors looking to learn more in the direction of the clinical realm?

JH: Frankly, the mainstream media is not a great source of information. It is incumbent on us radiologists to let the primary care doctors know what we can image and, more importantly, what we can’t. Orthopedic surgeons tend to be the most knowledgeable regarding the musculoskeletal system, but don’t discount chiropractors. I am pretty open-minded to alternative medicine, unlike many of my fellow MDs. My chiropractor does a great job using ART on my trigger points in my traps. Also, never be afraid to get a second opinion.

My advice to all practitioners – be they doctors, chiropractors or trainers – is to learn as much as possible. Be confident in your knowledge and abilities, but don’t think that any one practitioner has all the answers. Medical knowledge is too vast for anyone to know everything about everything. I know my medical school training regarding fitness and nutrition was paltry. Sure, I learned about muscle fiber composition and the biochemistry of vitamins and minerals. But, most doctors just parrot the standard dogma of low-fat, high-carb diet, walk 20 minutes three times a week, etc. You and I both know that won’t lead to any significant body composition changes.

EC: Agreed.  I actually know several doctors who have “seen the light” when they’ve started to read more of Dr. John Berardi’s work – not to mention the latest research of carbohydrate-restricted diets from the likes of Jeff Volek and Cassandra Forsythe.  What else?

JH: Seek out those practitioners who aren’t afraid of the cutting edge. Just as you wouldn’t want a trainer who is a glorified rep counter, you don’t want a doctor who is simply going to give you the same old tired, old-school nutrition and fitness “advice,” if you can even call it that. That advice may promote health, but it won’t give the body composition changes most of your readers seek.

In addition to being confident in their abilities, practitioners need to know when to refer to other people. Some things need to be treated medically or surgically. They can’t be fixed in the gym or at the training table. Health and wellness should be a team effort with everybody working in their areas of expertise and not outside of it. Underconfidence and overconfidence in your abilities are equally bad for your client/patient.

Unfortunately, Western style medicine is very disease-oriented and body-part-oriented, often losing the big picture, especially regarding the whole kinetic chain of the musculoskeletal system. My opinion is that this is where trainers and chiropractors shine. I wish my fellow doctors would be more amenable to referring patients to trainers/chiropractors for problems that don’t need medical or surgical treatment. The human body has great ability to adapt and heal itself, if you give it a chance.

EC: Thanks again for taking the time to be with us!

JH: My pleasure. Thank you for inviting me. My kind gratitude to my colleague D. Dillon, RN, BSN for her assistance.

by Eric Cressey

Of all the lousy things that can happen, this has to be one of the worst. Imagine...You've just completed the most successful bulking cycle of your life, adding twenty pounds of mass; you're on top of the world. Now, all you have to do is train properly and eat plentifully in order to solidify your gains. With your knowledge of diet and training, it should be a snap. Then everything hits the fan... Your girlfriend is so proud of you for making such great gains and transforming your physique that she can't keep her hands off of you. The day before, she had shared a soda with a friend who had just come from the gym. That friend had taken a sip from the water fountain at the gym and accidentally touched her lips to the spout. Ten minutes earlier, that skanky "human sweat gland" guy who spends five hours on the elliptical cross trainer each day had just made out with that same water fountain. That morning, he had kissed his wife goodbye before leaving for his job at the DMV. That wife is the teacher of a kindergarten class. Incidentally, that class happened to be riddled with the flu, and some kid had blown chunks all over her nice new blouse the day before. Sure she cleaned it up, but she still wound up with the flu. Thanks to this incredibly unlikely downward spiral, you are now home sick from work, pitying yourself as you watch the same episode of Sportscenter eight times in a row. All the while, you're thinking about how you would much rather be deadlifting like a madman and showing off your gains at the gym! Unfortunately, you cannot go back in time to prevent yourself from coming down with the flu. Although it may be beneficial to look back and figure out if there was anything you could have done to strengthen your immune system (avoiding overtraining, paying attention to post-workout nutrition, taking certain supplements, getting plenty of sleep, etc.), you need to focus on the task at hand: beating the flu! You see, bodybuilders, powerlifters, and other athletes have to take into account how sickness affects performance and physical appearance, whereas normal folks just worry about "getting rid of their sniffles." Before we get to the specifics, though, I should mention that the term "flu" that we so often use is short for influenza. Influenza (also known as Grippe or Grip) is really only one of several common kinds of viral respiratory infections. Also including on this list are the common cold (upper respiratory infection or acute coryza), pharyngitis, laryngitis, tracheobronchitis, and viral pneumonia (1). Regardless of the clear differences in the nuts and bolts of each infection, they are generally all lumped together and called the flu by the general public. While this oversimplification is erroneous, the human immune system must be strong to prevent and in many cases overcome any type of infection. And, if you're anything like me, you detest the idea of getting loaded up on medications, sugary cough syrups, and lozenges just because your nose is running faster than a sprinter with a rocket up his butt. All that being said, let's get to work on finding a universal approach to maintaining your gains and getting back to optimal health as soon as possible. Diet Proper diet seems like a no-brainer, right? One would think so, but I'm constantly amazed at how people vehemently adhere to this primitive urge that tells them to stuff themselves full of crap foods just because they feel like crap! These crap foods are usually "comfort" foods: Mom's cookies, white toast with cinnamon, sugar, and butter, hot chocolate, a whole gallon of ice cream?. These foods may have made you feel better as a kid when they were used to take your mind off the "boo-boo" on your knee, but they'll only make thing worse when you are a sick adult. They might make you feel all warm and toasty on the inside, but they'll quickly make you soft and fluffy on the outside if you overindulge. So what should you eat and what should you avoid? For starters, remember that total calories are of foremost importance. Don't fall into the trap of dropping calories too low out of fear of gaining fat while "on the shelf." Instead, it's important to assume the mindset of maintaining the status quo physique-wise while bringing the immune system up to par. If you gain a little fat, don't sweat it. Remember, it's a lot easier to shed a little fat than it is to regain a few pounds of lost muscle. In reaching your daily caloric goal, as usual, spread your intake out over six smaller meals. Maintenance caloric intake is highly variable, so rather than multiplying your body weight by a certain number to find your target, base your intake on slightly below (100-150 calories) what you would take in on a normal rest day. This decrease should account for the extra time spent on the couch or in bed. Specific macronutrient recommendations are also of little value in this instance due to individual variations in terms of carb tolerance. As such, adhere to your typical macronutrient ratios with the only exception being a slight reduction in carb intake to compensate for the diminutive calorie reduction and reduced training effect. Furthermore, make sure that you keep protein high (1-1.5g/lb lean body mass) in order to remain in positive nitrogen balance and stop muscle protein catabolism in its tracks. From all our cutting cycles, we're all well aware that protein needs increase during times of stress, and sickness is certainly one of those times. In a study of critically ill children in hypermetabolic and catabolic states, researchers found that a higher protein intake was associated with positive nitrogen balance, whereas a low intake (with total calories held constant) led to a continued state of negative nitrogen balance and muscle protein catabolism (2). A big steak probably won't sound too appealing when you're sick, though, so low carb protein powders (such as Xtreme Ultra Peptide), cottage cheese, omelets, and other "easy to get down" protein sources might turn out to be your best friends. Next, only consume low-glycemic carbs. When you're sick, your body isn't primed for sucking up simple sugars like it is when you've just completed a training session. So, the typical bodybuilding "no-no" foods should be even more off-limits than usual. Your best bet is to focus carb intake early in the day when muscle cells are most receptive to storing glycogen. Keep fats (especially healthy fats) up as well - possibly at the expense of carbohydrates. In the aforementioned study of critically ill children, fat was used preferentially for oxidation. Meanwhile, a high carbohydrate intake was associated with lipogenesis (fat formation) and decreased fat oxidation (2). Thirty percent of total calories is a good figure in order to support endogenous testosterone and overall energy levels (as fat is the primary source of energy at rest). Your body will be forming plenty of new immune cells as you fight off sickness, and fatty acids constitute an important component of each new cell membrane. Therefore, in order to give the body the best raw materials available, make sure that you're getting plenty of omega-3 fatty acids. However, don't fall into the trap of overdoing the omega-3s or fat in general; very high fat diets are associated with impaired lymphocyte (one of the five kinds of leukocytes, or white blood cells) function (3). Furthermore, while fish oil has proven effective in enhancing immune function in certain clinical situations (e.g. rheumatoid arthritis, ulcerative colitis) and in animals, studies of healthy humans are yet to yield consistently favorable results to substantiate the claim that omega-3s enhance immunity (4). As such, there does not appear to be any greater benefit (at least not yet) to increasing omega-3 PUFA intake during times of sickness. Simply stick to your normal intake levels, relying on healthy sources such as fish oil and flaxseed oil for your supplemental fat intake. The last dietary concern that warrants mention is water intake. You might think that because you aren't training, you don't need to worry much about pushing the H2O- big mistake. The body loses a significant amount of fluids each day independent of training. We're constantly losing water as we dissipate heat through our skin and in our breathing without even knowing it. Factor in increased mucus production, the sweating that may be associated with a fever, the fact that your body is constantly constructing new cells (especially during sickness), not to mention your higher protein intake, and you can begin to realize the importance of really emphasizing water intake. Shoot for at least one gallon (preferably more) of water daily. Supplementation First and foremost, be sure to get a flu shot each fall. The optimal time to do so is mid-September through November, as it takes at least a week for the shot to really kick into protective-mode. If you need proof that the influenza vaccine is worth the fee (if you even have to pay for it), look no further than a study conducted on a Brazilian airline company's employees. As I'm sure you can imagine, flight attendants and those in related roles are a population segment that is extremely susceptible to the flu due to their interactions with so many customers (often in confined spaces). Prior to flu season, each of 813 employees received either an influenza vaccination or a placebo. Seven months later, the employees who had received the vaccines showed 39.5% fewer episodes of flu-like illness than the placebo. Additionally, the vaccine group was absent from work due to sickness 26% less often than the placebo group (5). From a weight-training standpoint, that 26% corresponds to a lot of missed training sessions. In addition to the flu shot and your regular multivitamin, you should definitely include the following: Vitamin C Vitamin C (ascorbic acid) is the first immune-booster that comes to mind. A vital component of every cell in the human body, ascorbic acid is perhaps most notably found in high concentrations in leukocytes (white blood cells). The leukocytes are constantly being produced in the bone marrow as safeguards against bad stuff like cottage cheese gone sour, reruns of those obnoxious Subway commercials with Jared, curling in the squat rack, and, oh yeah, infections. During infection, in order to prevent oxidative damage, the vitamin C within the leukocytes is used up faster than a post-training shaker bottle full of Relentless (4)! Thus, it should come as no surprise that reduced leukocyte vitamin C levels are associated with less than optimal immune function. (6) In the worst vitamin C deficit scenario, scurvy, the immune response is entirely inadequate (and sometimes nonexistent) in each of the many components of the immune system. In fact, overall vitamin C status is often measured via an assessment of levels in the leukocytes (4). In terms of preventative supplementation, a true consensus has not yet been met regarding the efficacy of vitamin C in reducing the occurrence of common colds. Several respected studies have found that Vitamin C supplementation is of little value in preventing the common cold (7), whereas others have reported decreased incidences of reported common cold infection among individuals who received large doses of a vitamin C supplement (8,9). However, other studies have verified the assertions that supplementation with vitamin C improves several aspects of the human immune response, effecting positive changes in proliferation and/or function of in three of the five types of leukocytes: lymphocytes, neutrophils, and monocytes (10-16). Adequate vitamin C status is often defined as "a circulating pool of 1500mg" (7). Due to the fact that water-soluble vitamins like vitamin C are not stored by the body as well as fat-soluble vitamins, ascorbic acid must be continuously replenished through diet and supplementation. Doses of up to 10g per day have been used in numerous studies without serious toxicity symptoms. The side effects of such high consumption may include diarrhea and, in serious cases, kidney stones or urate crystals (due to increased uric acid release in the urine). Antonio and Stout state that these risks have "been greatly overstated" (7). Based on the available literature, I recommend 2-2.5g of supplemental vitamin C daily during normal training conditions and 4-5g daily during flu-like symptoms and times increased of training stress. Also, be sure to spread your intake throughout the day in 500mg doses. Dosages of 500mg are proven to increase cellular ascorbic acid absorption by up to 40%, whereas dosages greater do not increase this absorption (17). Vitamin E Perhaps as important as vitamin C is Vitamin E, which works synergistically with selenium in tissues to reduce lipid membrane damage by reactive oxygen species (ROS) during infections (4). Vitamin E has proven effective in improving various parameters of the immune function, including enhanced lymphocyte production, improved antibody response to vaccine, reduced pulmonary viral titers (a measure of virus prevalence in respiratory infections), and "preventing an influenza-mediated decrease in food intake and weight loss" (18-20). No decrease in food intake? Maybe that steak won't sound so bad after all! All that being said, even the slightest deficiency in vitamin E can easily compromise one's immune response. And, the current RDA of 30 IU is barely adequate in preventing deficiency in sedentary, normally healthy individuals, let alone in athletes, the elderly, and the sick and diseased. Granted, one may derive a considerable amount of vitamin E from diet alone, but in order to receive sufficient vitamin E to attain an enhanced immune benefit, one must supplement in excess of the RDA (especially on low-fat diets). Vitamin E is recognized as one of the least toxic vitamins, although one may experience some minor symptoms (nausea, diarrhea, muscle weakness) with very high dosages (7,21). As such, 800-1200 IU throughout the year (regardless of whether you're sick or healthy) is an optimal approach. Glutamine Glutamine is well known as the most abundant amino acid in the human body (including both the plasma and tissue pool). In fact, the intramuscular free amino acid pool is more than 60% glutamine, and the glutamine in skeletal muscle accounts for about 90% of the body's total glutamine pool. Although over 40% of the body's glutamine is devoted to fueling the GI tract, this amino acid also plays a role in the functioning of many other parts of the body, including the liver, brain, muscles (duh!), hair follicles, kidneys, and - you guessed it - the immune system (7,22-24). Adequate levels of glutamine are necessary to ensure optimal proliferation and function of lymphocytes, macrophages, and neutrophils (25,26). Traditionally, because the body can synthesize glutamine endogenously (mostly in the muscle tissue), it has been classified as a nonessential amino acid. However, this classification is made under the assumption that the body is not enduring a stressful physiologic trauma such as sickness (23). Many researchers have now begun to classify glutamine as a conditionally essential amino acid during times of sickness, infection, and malnutrition. Because glutamine is a crucial substrate for a variety of metabolic processes, it is only logical that the body requires increased amounts of the amino acid during infection in order to "bolster" the immune system while maintaining normal physiological functioning (24,26). Unfortunately, as you can see in many cancer patients, the body's response to infection, injury, and stress is protein catabolism. Initially, plasma glutamine levels are depleted. Next, in order to sustain its metabolic processes and replenish plasma glutamine levels, the body takes glutamine from skeletal muscle. Normally, this isn't a problem, as skeletal muscle glutamine synthesis matches glutamine release. However, during times of stress, there is a problem: numerous organs, including the liver and bowel, show marked increases in glutamine uptake during infection. These increases, in combination with the needs of the immune system, GI tract, and the regular metabolic processes, cause glutamine release from skeletal muscle to exceed glutamine synthesis. In fact, skeletal muscle glutamine release may double during infection (23,27). In summary, during infection: 1. Glutamine use increases 2. Glutamine supply decreases 3. A concentration gradient across the muscle cell membrane cannot be reached (23) 4. Your beloved quad sweep becomes fuel for your GI tract and, essentially, your body's lunch. Think about it for a second: when you're sick, is your body going to care more about ensuring appropriate internal organ functioning or maintaining sleeve-splitting biceps? Luckily, numerous studies have proven that exogenous glutamine can help to: maintain positive nitrogen balance (and glutamine levels in skeletal muscle), increase plasma glutamine levels, prevent decreases in ribosomal concentrations, improve muscle protein synthesis rates, and enhance immune function (through such mechanisms as encouraged lymphocyte proliferation) (7, 28-32). Also, let's not forget that glutamine?s "immunoenhancing" effects make it an effective year-round, recovery-promoting supplement (albeit in smaller doses) for hard training athletes who are more susceptible to infection, especially during and shortly after periods of intensive training (7,33,34). Glutamine supplementation is also associated with increased plasma GH concentration, which may also assist in immunity (7,35). During illness, shoot for 0.35-0.4g glutamine per kg body weight, and spread your intake out throughout the day in 3-5g doses. Based on the published clinical studies and for absorbability reasons, I recommend glutamine peptides. L-glutamine (free form), however, tastes better, generally costs less, and will also yield favorable results. Personally, I'll stick with peptides, but it's your call; just make sure to get it in you in some form! Zinc Although most people primarily associate zinc with growth and development, this trace mineral also plays a crucial role in proper immune function. A deficiency of zinc relates to diminished immune response, including low T- and B-cell (the two broad categories of lymphocytes) counts in bone marrow due to decreased proliferation, and reduced antibody production (just to name a few). In some mice, only thirty days of inadequate zinc intake caused an 80% reduction in immune capacity. As such, it should come as no surprise that zinc deficiencies are prevalent in numerous immune system-stressing chronic illnesses, including HIV, renal disease, and alcoholism (4,36). While the complications of zinc deficiency are well established, studies on the benefits of zinc supplementation in enhancing immune function have yielded mixed, but mostly favorable results. Numerous studies have found that zinc supplementation initiated upon the onset of a cold or upper respiratory tract infection decreases the sickness' duration and severity (7,37-39). In a study of twenty burn victims, fewer pulmonary infection rates and shorter hospital stays were observed in patients who received a trace mineral supplement that included zinc (40). Meanwhile, zinc supplementation in long distance runners prevented the typical increase in reactive oxidative species normally seen with endurance activity (41). In terms of preventative supplementation, researchers found that of 609 school children that were given either a zinc supplement or a placebo, those who supplemented with zinc had 45% fewer acute lower respiratory infections over the 120-day study (42). If you take nothing else from all these studies, at least walk away from this article cognizant of how important sufficient intake is, especially for athletes (who are more likely to be deficient than the general population). While high-dose supplementation can actually lead to immunosuppression, moderate supplementation throughout the year with slightly increased dosages beginning at the onset of flu- or cold-like symptoms is an effective and safe supplementation approach (7). During sickness, take at least 25mg zinc (but not more than 100mg) per day. An optimal approach would be to get this supplemental intake in the form of a ZMA supplement, as it will enable you to meet your zinc needs while increasing anabolic hormone levels, improving recovery, and promoting deep, restful sleep. Miscellaneous: the other stuff Here are a few other supplements that are often thrown into the immunity discussion, but will probably not be worthwhile additions to your immune effort: Vitamin A (preformed vitamin A is known as beta-carotene): Although vitamin A is of unquestionable importance to proper immune functioning, there is no definitive evidence to suggest that supplemental vitamin A offers additional benefits over normal dietary intake, especially in those with already adequate status. Excessive vitamin A intakes have been associated with suppression of T- and B-cell function, thus causing a greater susceptibility to infection. Toxicity can also become an issue with higher intakes. Vitamin A deficiency is very uncommon in wealthier nations. As such, if you feel that you need to get more beta-carotene than you diet alone provides, make sure to select a multivitamin with at least 5000 micrograms (4,7). Echinacea: Although a few studies have emerged that show slightly (and relatively insignificantly) shorter respiratory tract infection durations in patients treated with echinacea, most have demonstrated that the herbal product has little or no effect on preventing and treating sickness. This uncertainty is complicated by the fact that there are nine species of the plant, different parts (leaves, stem, roots, flowers) of the plant can be used, and different forms are available (e.g. powder, liquid extract, capsule). Essentially, even if echinacea was definitively proven effective, an argument would still exist over which species, form, and delivery produces the best results. At this point, there is not enough evidence to recommend echinacea as a worthy supplement (7,43-45). Arginine: This nonessential amino acid has shown promise in improving immune response and wound healing via improved lymphocyte production in individuals with compromised health status. Other studies, however, have shown that arginine supplementation is of no benefit in attempting to enhance the immune response, especially in healthy individuals (7). Given that some clinical trials use upwards of 20g L-arginine per day (mostly without appreciable immunity-related results), forty capsules per day seems like far too risky an investment even if you enjoy being a human guinea pig. Then again, even if you do decide to give arginine a try, be careful; excessive intakes can actually blunt the immune response (46). Lifestyle/Training An adequate amount of sleep during sickness is of the utmost importance. The old "8-hours at night" recommendation still holds true...as a minimum. You should also be shooting for a nap or two during the day. It seems like a no-brainer to say that you shouldn't be training when you're sick, but I'm constantly amazed at how many people still go the gym in spite of their wheezing, sore throats, and aches. Before you stumble off the couch and over to your local gym, ask yourself if your body could really recover from a heavy training session if it hasn't even recovered from the flu. The answer should be a resounding "NO!" If it isn't, maybe it will help to think about how your decision to go train will impact others; you'll probably make half the people in the gym sick just like the "human sweat gland" did to you. Stay home, if not for your own sake, then for the sake of everyone else who enjoys his or her health and visits to the gym. Get over the flu and then get back to the gym! Conclusion There you have it: a comprehensive approach to getting back to the gym as soon as possible. To recap: 1. No comfort foods 2. Maintenance calories (factoring in reduced activity level) 3. Normal protein intake 4. Slightly reduced carb intake, consisting of low GI carbs only 5. Normal healthy fat intake 6. Regular Multivitamin 7. 4-5g vitamin C in 500mg doses throughout the day 8. 800-1200 IU vitamin E in 400 IU doses throughout the day 9. 0.35-0.4g glutamine peptides/kg body weight in 3-5g doses throughout the day 10. ZMA supplement (or zinc equivalent providing 25-100mg/day) 11. No training until symptoms are gone 12. R&R It might not sound as appetizing or heart-warming as a bowl of chicken soup, but it beats Nyquil... References 1. The Merck Manual of Diagnosis and Therapy. http://www.merck.com/pubs/mmanual/section13/chapter162/162b.htm; 1995 accessed Sept 2002. 2. Coss-Bu JA et al. Energy metabolism, nitrogen balance, and substrate utilization in critically ill children. Am J Clin Nutr 2001 Nov;74(5):664-9. 3. Calder PC et al. Fatty acids and lymphocyte functions. Br J Nutr 2002 Jan;87 Suppl 1:S31-48. 4. Field C. et al. Nutrients and their role in host resistance to infection. J Leukoc Biol 2002 Jan;71(1):16-32. 5. Mixeu MA et al. Impact of influenza vaccination on civilian aircrew illness and absenteeism. Aviat Space Environ Med 2002 Sep;73(9):876-80 6. Schwager, J. et al. Modulation of interleukin production by ascorbic acid. Vet Immunol Immunopathol. 1998 Jun 30;64(1):45-57. 7. Antonio, J., & Stout, J. Sports Supplements. Lippincott Williams & Wilkins, 2001. 8. Hemila, H. Vitamin C and common cold incidence: a review of studies with subjects under heavy physical stress. Int J Sports Med 1996 Jul;17(5):379-83. 9. Hemila, H. Vitamin C and acute respiratory infections. Int J Tuberc Lung Dis 1999 Sep;3(9):756-61. 10. Kennes, B. et al. Effect of vitamin C supplements on cell-mediated immunity in old people. Gerontology 1983;29(5):305-10. 11. Penn, ND. et al. The effect of dietary supplementation with vitamins A, C and E on cell-mediated immune function in elderly long-stay patients: a randomized controlled trial. Age Ageing 1991 May;20(3):169-74. 12. Shilotri PG, & Bhat KS. Effect of mega doses of vitamin C on bactericidal ativity [sic] of leukocytes. Am J Clin Nutr 1977 Jul;30(7):1077-81 13. de la Fuente, M. et al. Immune function in aged women is improved by ingestion of vitamins C and E. Can J Physiol Pharmacol 1998 Apr;76(4):373-80. 14. Patrone, F. et al. Effects of ascorbic acid on neutrophil function. Studies on normal and chronic granulomatous disease neutrophils. Acta Vitaminol Enzymol 1982;4(1-2):163-8. 15. Prinz, W. The effect of ascorbic acid supplementation on some parameters of the human immunological defense system. Int J Vit Nutr Res 1977; 47:248-57. 16. Woollard, KJ. et al. Effects of oral vitamin C on monocyte: endothelial cell adhesion in healthy subjects. Biochem Biophys Res Commun 2002 Jun 28;294(5):1161-8. 17. Voldani, A. et al. New evidence for antioxidant properties of vitamin C. Cancer Detect Prev. 2000;24(6):508-23. 18. Meydani, SN et al. Vitamin E supplementation enhances cell-mediated immunity in healthy elderly subjects. Am J Clin Nutr. 1990 Sep;52(3):557-63. 19. Meydani, SN et al. Vitamin E supplementation and in vivo immune response in healthy elderly subjects. A randomized controlled trial. JAMA. 1997 May 7; 277(17):1380-6. 20. Han, SN et al. Effect of long-term dietary antioxidant supplementation on influenza virus infection. J Gerontol A Biol Sci Med Sci 2000 Oct;55(10):B496-503. 21. Beharka A. et al. Vitamin E status and immune function. Methods Enzymol 1997;282:247-63 22. Yeh, SL et al. Effects of glutamine-supplemented total parenteral nutrition on cytokine production and T cell population in septic rats. JPEN J Parenter Enteral Nutr. 2001 Sep-Oct;25(5):269-74. 23. van Acker, BA et al. Glutamine: the pivot of our nitrogen economy? JPEN J Parenter Enteral Nutr. 1999 Sep-Oct;23(5 Suppl):S45-8. Review. 24. Newsholme, P. Why is L-glutamine metabolism important to cells of the immune system in health, postinjury, surgery or infection? J Nutr. 2001 Sep;131(9 Suppl):2515S-22S; discussion 2523S-4S. Review. 25. Saito, H. et al. Glutamine as an immunoenhancing nutrient. JPEN J Parenter Enteral Nutr. 1999 Sep-Oct;23(5 Suppl):S59-61. Review. 26. Ziegler, TR. Glutamine supplementation in cancer patients receiving bone marrow transplantation and high dose chemotherapy. J Nutr. 2001 Sep;131(9 Suppl):2578S-84S; discussion 2590S. Review. 27. Karinch AM. et al. Glutamine metabolism in sepsis and infection. J Nutr 2001 Sep;131(9 Suppl):2535S-8S; discussion 2550S-1S. 28. Wilmore, DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J Nutr. 2001 Sep;131(9 Suppl):2543S-9S; discussion 2550S-1S. Review. 29. Boelens PG. et al. Glutamine alimentation in catabolic state. J Nutr. 2001 Sep;131(9 Suppl):2569S-77S; discussion 2590S. Review. 30. Yoshida, S. et al. Effects of glutamine supplements and radiochemotherapy on systemic immune and gut barrier function in patients with advanced esophageal cancer. Ann Surg. 1998 Apr;227(4):485-91. 31. Valencia, E. et al. Impact of oral L-glutamine on glutathione, glutamine, and glutamate blood levels in volunteers. Nutrition. 2002 May;18(5):367-70. 32. Yoshida, S. et al. Glutamine supplementation in cancer patients. Nutrition. 2001 Sep;17(9):766-8. 33. Castell LM., & Newsholme EA. The effects of oral glutamine supplementation on athletes after prolonged, exhaustive exercise. Nutrition 1997 Jul-Aug;13(7-8): 738-42. 34. Rosene, MF. et al. Glutamine supplementation may maintain nitrogen balance in wrestlers during a weight reduction program. Med Sci Sports Exerc 1999;31(5): S123. 35. Welbourne, TC. Increased plasma bicarbonate and growth hormone after an oral glutamine load. Am J Clin Nutr. 1995 May;61(5):1058-61. 36. Fraker, PJ. et al. The dynamic link between the integrity of the immune system and zinc status. J Nutr 2000 May;130(5S Suppl):1399S-406S. 37. Prasad AS. et al. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2000 Aug 15;133(4):245-52. 38. Al-Nakib, W. et al. Prophylaxis and treatment of rhinovirus colds with zinc gluconate lozenges. J Antimicrob Chemother. 1987 Dec;20(6):893-901. 39. Mossad, SB. et al. Zinc gluconate lozenges for treating the common cold. A randomized, double-blind, placebo-controlled study. Ann Intern Med. 1996 Jul 15;125(2):81-8. 40. Berger MM. et al. Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial. Am J Clin Nutr. 1998 Aug;68(2):365-71. 41. Singh A. et al. Exercise-induced changes in immune function: effects of zinc supplementation. J Appl Physiol 1994 Jun;76(6):2298-303. 42. Sazawal S. et al. Zinc supplementation reduces the incidence of acute lower respiratory infections in infants and preschool children: a double-blind, controlled trial. Pediatrics. 1998 Jul;102(1 Pt 1):1-5. 43. Gunning, K. Echinacea in the treatment and prevention of upper respiratory tract infections. West J Med. 1999 Sep;171(3):198-200. 44. Brinkeborn RM. et al. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine. 1999 Mar;6(1):1-6. 45. Grimm, W, & Muller, HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med. 1999 Feb;106(2):138-43. 46. Wiebke EA. et al. Effects of L-arginine supplementation on human lymphocyte proliferation in response to nonspecific and alloantigenic stimulation. J Surg Res 1997 Jun;70(1):89-94.

By Eric Cressey

Although each of the four muscles of the rotator cuff contributes to humeral motion, their primary function is stabilization of the humeral head in the glenoid fossa of the scapula during this humeral motion. Ligaments provide the static restraints to excessive movement, while the rotator cuff provides the dynamic restraint. It's important to note, however, that even if your rotator cuff is completely healthy and functioning optimally, you may experience scapular dyskinesis, shoulder, upper back, and neck problems because of inadequate strength and poor tonus of the muscles that stabilize the scapula. After all, how can the rotator cuff be effective at stabilizing the humeral head when its foundation (the scapula) isn't stable itself? Therefore, if you're looking to eliminate weak links at the shoulder girdle, your best bet is to perform both rotator cuff and scapular stabilizer specific work. In my experience, the ideal means of ensuring long-term rotator cuff health is to incorporate two external rotation movements per week to strengthen the infraspinatus and teres minor (and the posterior deltoid, another external rotator that isn't a part of the rotator cuff). On one movement, the humerus should be abducted (e.g. elbow supported DB external rotations, Cuban presses) and on the other, the humerus should be adducted (e.g. low pulley external rotations, side-lying external rotations). Granted, these movements are quite basic, but they'll do the job if injury prevention is all you seek. Then again, I like to integrate the movements into more complex schemes (some of which are based on PNF patterns) to keep things interesting and get a little more sport-specific by involving more of the kinetic chain (i.e. leg, hip, and trunk movement). On this front, reverse cable crossovers (single-arm, usually) and dumbbell swings are good choices. Lastly, for some individuals, direct internal rotation training for the subscapularis is warranted, as it's a commonly injured muscle in bench press fanatics. Over time, the subscapularis will often become dormant – and therefore less effective as a stabilizer of the humeral head - due to all the abuse it takes.

By Eric Cressey

It's time to pick up where I left off last month in Part I.  To "reset" the stage, I'll just say that fish oil is good because it helps with:

• Belluzzi et al (1996) found that 2.7 g of fish oil per day for one-year significantly reduced the incidence of relapse in Crohn's patients in remission. Thirty-nine of the patients received the fish oil, while 39 others received a placebo; the relapse rate was 41% lower in the former group. Regression analysis indicated that the positive effects of fish oil were independent of patient age, sex, previous surgery history, disease duration, and smoking status (34).

• Barbosa et al (2003) hypothesized that omega-3 fatty acids from fish oil tend to exert their anti-inflammatory effects in ulcerative colitis via decreases in plasma oxidative stress, acting as free radical scavengers (35).
• In a study of eighteen patients with active ulcerative colitis (characterized by diarrhea and rectal inflammation; ain't that a pretty picture?), four months of 5.4 g combined EPA and DHA supplementation (vs. placebo) led to significantly "reductions in rectal dialysate leukotriene B4 levels, improvements in histologic findings, and weight gain (36)." English translation: their rectums looked, felt, and performed better.

• Nagakura et al (2000) found that ten months of EPA and DHA supplementation lessened asthma symptoms and acetylcholine sensitivity in 29 children with severe bronchial asthma (in collaboration with a controlled environment and diet) (37).
• Three weeks of 5.4 g combined EPA and DHA markedly blunted exercise-induced asthma in ten elite athletes and improved post-exercise pulmonary function significantly (38).

• In a study of thirty cystic fibrosis patients that received EPA and DHA supplementation as 1.3% of their total calories for eight months, researchers noted significant decreases in markers of inflammation. Subtle improvements in forced expiratory volume (a measure of pulmonary function) were noted as well. Furthermore, in comparison with the previous eight-month period, the patients (collectively) required much fewer days (392 vs. 721) of antibiotic therapy during the eight months on EPA and DHA (39).

• Shahar et al (1994) examined the relationship between dietary omega-3 fatty acid intake and COPD in 8,960 smokers, finding that combined EPA and DHA intake was "inversely related to the risk of COPD in a quantity-dependent fashion (40)." In other words, if you're going to smoke, you might as well complement that metallic cough with some fish breath; it'll probably protect you from COPD down the road.
• Romieu and Trenga (2001) observed that "data also suggest that omega-3 fatty acids may have a potentially protective effect against airway hyperreactivity and lung function decrements" in both children and adults (41).

• In patients with sickle cell disease, omega-3 fatty acid supplementation at 0.1 g/kg per day "reduced the frequency of pain episodes requiring presentation to the hospital from 7.8 events during the preceding year to 3.8 events/year." Conversely, subjects receiving dietary olive oil (the control group) experienced 7.1 pain events/year, only slightly less than the 7.6 event average from the previous year. This reduction in pain episodes was likely attributable to the effects of EPA and DHA on reducing prothrombotic activity (42).
• A study of Nigerian children found that omega-3 fatty acid concentrations were 40-50% lower in the phospholipid membranes of children with sickle cell disease than in those of healthy children. The researchers noted that "the phospholipids of the children with SCD are less fluid relative to those of their healthy counterparts. (43)"

• In a Danish study, low intakes of omega-3 fatty acids were correlated with more severe menstrual symptoms. Dysmenorrhea correlations were also observed in low omega-3: omega-6 ratios and vitamin B12 deficiencies. The body utilizes omega-3s to create type-3 prostaglandins that are less "aggressive" than those formed from other fatty acids. The net result of utilizing omega-3s as raw materials appears to be milder symptoms. Prostaglandins act like hormones, controlling uterine contractions and pains (44).

• Ninety days of DHA with vitamins E and B significantly improved computerized visual field (CVF) and retinal contrast sensitivity in thirty chronic glaucoma patients. The researchers concluded that such a supplement merits inclusion in an intervention to prevent the progression of glaucoma-related damage (45).

• Cunnane et al (1989) found that in comparison with their healthy counterparts, MS patients had lower omega-3 fatty acids in their plasma (46).
• As a follow-up, Gallai and colleagues (1995) found that omega-3 supplementation in MS patients led to decreases in proinflammatory eicosanoids, indicating potential for fish oil in modulating some immune function decrements associated with MS (47).

• Supplementation with DHA between the 24th and 28th week of pregnancy significantly increased (by roughly six days on average) the duration of gestation. Birth weight, length, and head circumference all increased slightly as well (48).
• A study of Norwegian children found that "use of cod liver oil in the first year of life was associated with a significantly lower risk of type 1 diabetes." Regression analysis implied that this effect was independent of the oil's vitamin D content, and was likely due to the omega-3 fatty acids in the oil (49).
• Malcolm et al (2003) noted an association between "the DHA status of infants at term and early postnatal development of the pattern-reversal VEP [visual evoked potential], indicating that DHA status itself may influence maturation of the central visual pathways" in infants. These assertions were based on results seen in a trial of one hundred women that received either fish oil capsules or a placebo (50).
• Uauy and colleagues (2003) found not only that long chain polyunsaturated fatty acid supplementation in newborns improved visual acuity at four months, but also there was "a significant relation between the total DHA equivalents provided and effectiveness (51)." In other words, more was better (to a certain point, of course). This effect is likely due to effects on physical properties of the membranes, neurotransmitters, and modulation of gene expression in the retina and brain (52).
• Because of the crucial role of essential fatty acids as structural components of all cell membranes, profound implications can be seen at the "brain, retina and other neural tissues are particularly rich in long-chain polyunsaturated fatty acids (LC-PUFA) (52)."
• Uauy et al (2001) asserted that "light sensitivity of retinal rod photoreceptors is significantly reduced in newborns with n-3 fatty acid deficiency, and that docosahexaenoic acid (DHA) significantly enhances visual acuity maturation and cognitive functions (52)." Furthermore, "DHA also has significant effects on photoreceptor membranes and neurotransmitters involved in the signal transduction process; rhodopsin activation, rod and cone development, neuronal dendritic connectivity, and functional maturation of the central nervous system (52)." It beats feeding potato chips to your kids, doesn't it?
• Data from Dunstan et al (2003) suggests that there may be a role for omega-3 fatty acids in the prevention of allergic disease. In a study of 83 atopic pregnant women receiving fish oil or placebo, the researchers noted that infants from the fish oil group had significantly less severe atopic dermatitis at age one, although no difference in the frequency of the disease was apparent between groups (53).
• Williams and colleagues (1995) described preeclampsia (affecting pregnant women) as "a systemic disease characterized by diffuse endothelial dysfunction, increased peripheral vascular resistance, coagulation abnormalities, antioxidant deficiency, persistent elevations of maternal leukocyte-derived cytokines, and hyperlipidemia (54)." These researchers conducted a study to examine the relationship between omega-3 fatty acid intake and preeclampsia. Women with the lowest omega-3 levels were 7.6 times more likely than those with the highest levels to have preeclampsia-related complications during their pregnancies. Moreover, "a 15% increase in the ratio of omega-3 to omega-6 fatty acids was associated with a 46% reduction in risk of preeclampsia (54)."

• Psoriatic lesions are characterized by increased concentrations of arachidonic acid. EPA exerts an anti-inflammatory effect that likely works to counteract the pro-inflammatory effects of arachidonic acid and its metabolites. In a study of 83 patients with chronic plaque-type psoriasis, researchers found that omega-3 fatty acid infusions were superior to omega-6 infusions (the placebo) "with respect to change in severity of psoriasis per body area, change in overall erythema, overall scaling and overall infiltration, as well as change in overall assessment by the investigator and self-assessment by the patient (55)."
• Grimminger et al (1993) observed that high dose intravenous omega-3 fatty acid supplementation exerted a rapid beneficial effect on inflammatory skin lesions in twenty patients hospitalized with acute guttate psoriasis. These effects were most likely mediated through eicosanoid metabolism regulation (56).

• Hydroa vacciniforme ?also known as photosensitivity ? is a serious skin disorder characterized by blistering (especially on the face) after even the slightest amount of sun exposure; it affects primarily children. In a small study, Rhodes and White reported that three months of fish oil supplementation reduced erythemal sensitivity to UVA and UVB (two types of ultraviolet radiation), and yielded modest improvements in overall symptoms (57).

• Increased oxidative stress is a hallmark of type 2 diabetes. Jain et al (2002) sought to determine the effects of very low dose omega-3 fatty acid supplementation (0.6 g combined EPA and DHA) on type 2 diabetics. Even at such a low dose, they found that the patients in the omega-3 group exhibited significantly greater improvements in glycemic status, blood pressure, lipid profiles, and reductions in markers of oxidative stress as compared to a placebo group of type 2 diabetics (58).
• It's well established that the various types of fatty acids are clearly involved in the onset of chronic conditions (such as insulin resistance and obesity) characterized by inflammation. In overweight subjects, higher concentrations of saturated fats and omega-6 and lower concentrations of omega-3 fatty acids are significantly associated with higher concentrations of circulating interleukin-6 (IL-6), a marker of inflammation. Interestingly, though, these associations are not apparent in lean subjects (59).
• In a 14-year study of 84,204 female nurses ages 34-59, the risk of type 2 diabetes was significantly positively associated with high consumptions of trans fatty acids and cholesterol, whereas the condition was negatively associated with omega-3 and omega-6 polyunsaturated fatty acids. The investigators estimated that "replacing 2% of energy from trans fatty acids isoenergetically with polyunsaturated fat would lead to a 40% lower risk" of type 2 diabetes (60). I guess it's time to replace the doughnuts in the nurses' lounge with canned salmon. Or, you could contact Krispy Kreme about introducing the chocolate frosted sardine filled doughnut!
• Chicco et al (1996) found that low-dose fish oil supplementation in rats led to significant reductions in blood lipids and plasma insulin levels without changes in glucose tolerance. The investigators hypothesized that because no changes in pancreatic insulin content were apparent, the lower insulin levels may have been due to improvements in peripheral insulin sensitivity (61).
• Unfortunately, studies attempting to demonstrate these effects in humans have been less impressive (62-64). In spite of the fact that omega-3 consumption in the form of fish increased HDL cholesterol and improved overall dyslipidemia in overweight patients, Mori et al (1999) found no independent effect of fish consumption on glucose or insulin (62). Others have come to similar conclusions with actual fish oil supplementation (63,64).

• Eric Noreen has done extensive work examining the effect of fish oil on resting metabolic rate (RMR). At the 2003 American College of Sports Medicine Annual Conference, Noreen presented the results of a study that compared RMR in subjects supplemented with 9g of safflower oil (predominately omega-6), 3, 6, or 9g of 60% concentrated fish oil. The fish oil groups saw daily RMR increases of 141 to 448 calories, whereas the safflower group's RMR actually decreased. As an added bonus, the fish oil group also lost a little bit of fat mass while gaining some lean body mass. (65)

• Leptin is a hormone released by adipocytes that has a great impact on body fat levels. In simple terms, the amount of leptin present in one's body serves as feedback to the brain about whether one is okay as far as nutritional status is concerned. As you get leaner, leptin levels drop; as you get pudgier, they go up. These are important responses, as high leptin concentrations are associated with decreased hunger and food intake and increased energy expenditure, all of which are important factors in getting and staying lean.
• Unfortunately, as you get leaner, leptin levels drop as your body essentially senses starvation-like conditions; this decrease makes it difficult to get and stay lean. Fish oil may be able to help with this problem, as rats fed high omega-3 diets demonstrate up-regulation in plasma leptin concentrations significantly above what is predicted based on body fat levels (66,67).
• In an overfeeding study of rats with 42% of their energy intakes as fish oil, safflower oil, olive oil, or beef tallow, the fish oil group had the greater lean body mass gains and the lowest fat mass gains (68). In other words, if you're going to stuff yourself, be sure to include some fish oil in the feast.

• Maes et al (1999) observed that there is a significant deficiency in omega-3 fatty acids serum phospholipids and red blood cell membranes in major depression. Furthermore, the deficiency is likely a result of abnormal omega-3 metabolism in depressed patients and may continue in spite of treatment with antidepressants (69). As such, fish oil treatment may serve as an important adjunct to ? or even a replacement for - traditional antidepressant therapy
• Hibbeln and Salem (1995) proposed that low concentrations of polyunsaturated fatty acids may be related to increased risks of suicide, depression, alcoholism, and post-partum depression (70).
• Four out of five trials of EPA in the treatment of schizophrenia have demonstrated significant reduction in patient episodes of severe mania and depression following supplementation (71).
• In an eight-week study of 28 clinically depressed patients receiving either 9.6 g omega-3 fatty acids per day or a placebo, there were significant decreases in scores on the Hamilton Rating Scale for Depression, an evaluative tool on which high scores indicate more severe feelings of depression (72).
• Zanarini and Frankenburg (2003) studied the effects of 1 g/day ethyl-EPA (or placebo) on thirty females with borderline personality disorder. The ethyl-EPA supplement proved "to be superior to placebo in diminishing aggression as well as the severity of depressive symptoms (73)."
• Attention-deficit/hyperactivity disorder (ADHD) may be related to an abnormality in polyunsaturated fatty acid metabolism. As such, both Richardson and Puri (2000) and Kidd (2000) have proposed that omega-3 fatty acid supplementation may have merits in the treatment of this condition, although more research is warranted in this regard (74,75).

• Here's one for the Type A folks out there. Delarue et al (2003) studied seven subjects on two occasions separated by three weeks. In the first session, these seven individuals were subjected to mental stress in the form of mental arithmetic and the Stroop task, and measures of sympathoadrenal activation (plasma cortisol, catecholamines, energy expenditure, and adipose tissue lipolysis) were taken thirty minutes after the stress. After this mental stress challenge, each subject supplemented with 7.2 g fish oil/day for three weeks, at which point they took the battery of tests again. In this second session, plasma epinephrine, cortisol, energy expenditure, and plasma non-esterified fatty acids concentrations, were all significantly lower than in the initial session. The investigators therefore concluded that omega-3 fatty acid supplementation "inhibits the adrenal activation elicited by a mental stress, presumably through effects exerted at the level of the central nervous system (76)." It appears that omega-3 fatty acids are able to partially inhibit the pro-inflammatory response to psychological stress (77). Ever get a racing heart or high blood pressure before a test, presentation, or job interview? Fish oil may be just what you need to get mellow!

• In a study of 27 adolescents with chronic migraines, supplementation with fish oil led to reductions of 87% in headache frequency, 74% in headache duration, and 78% in headache severity compared to a period prior to the study. Interestingly, olive oil (the placebo) produced similar results, although they were not quite as favorable (78).

• Many anticonvulsant medications for epileptics have highly undesirable side effects. In light of the profound roles of omega-3 fatty acids in immune and nervous system activities, Rabinovitz and colleagues (2004) compared the effects of carbamazepine (CBZ) and SR-3, a compound with a 1:4 omega-3: omega-6 ratio, on seizure control efficiency, and protection against cognitive impairment and cortisol elevation in rats. While the two treatments were equally effective in controlling seizures, SR-3 proved to be superior on the latter two measures (79). Treating epilepsy with omega-3 compounds is certainly a new frontier, so more research is warranted (especially in human subjects) to determine its true efficacy.

• The exact cause of CFS remains to be determined, but there is speculation that it could involve abnormalities at the immune, neuroendocrine, and autonomic levels. Because fish oil inhibits the production of certain pro-inflammatory substances, many experts believe that it holds great potential in the treatment of CFS. Research is ongoing (80).

• Several experts predict a role for omega-3 fatty acids in the treatment of fibromyalgia; anecdotal evidence supports this assertion, and further research is certainly warranted on this front (81).

• In chronic liver disease, widespread inflammation can cause the liver to become fibrotic. In light of the known anti-inflammatory benefits of omega-3 fatty acids, Hayashi et al (1999) studied the effect of EPA and DHA supplementation on four patients with hepatitis B infection, one with hepatitis C virus cirrhosis, and one with alcohol-related cirrhosis. Subtle reductions were observed in globulin (a marker of liver pathology) with simultaneous increases in HDL cholesterol and various apolipoproteins (protective agents against hepatitis-related liver disease) (82).

If you aren't taking fish oil, you're an idiot. Seriously. Okay, I'll leave you with a bit more practical wisdom instead. The typical fish oil capsule you'll encounter is 1000 mg fish oil; we, however, are more concerned with the EPA and DHA content of that 1000 mg. In most cases, you'll find 180 mg EPA and 120 mg DHA per capsule. A good rule of thumb (especially based on the results of the clinical trials) is to consume 3-6 g combined EPA and DHA per day; at this capsule size, you'd need 10-20 capsules per day. For this reason, liquid fish oil is a great alternative.

By Eric Cressey

If you're even remotely up-to-date on your nutrition-for-health reading, you're well aware of the benefits of fish oil. Moreover, if you're anything like me, you've also gone to great lengths--often to no avail--to convince people that they should be taking it even if it does sound "icky." In an effort to save you and I a lot of future time and energy, I've compiled the following for you to share with your relatives, mailman, proctologist, lunchlady, and anyone else with whom you associate that isn't currently "on da fish." Based on undeniable scientific evidence and anecdotal evidence, I strongly encourage you to incorporate into your diet two specific omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), commonly referred to as fish oils. EPA and DHA deficiencies have been linked to problems that include, but are certainly not limited to heart disease, hypertension, arthritis, cancer, immune disorders, chronic intestinal disorders, growth retardation, liver disorders, skin lesions, reproductive failure, visual problems, kidney disorders, and neurological disorders (1). Dietary alpha-linolenic acid can be converted to EPA and DHA in the body for utilization as important raw materials in healthy cell membranes. Significant amounts of alpha-linolenic acid can be found in the following oils: flaxseed, soybean, hempseed, pumpkinseed, canola, wheat germ and walnut. Products such as margarine and shortening that are derived from these oils also contain modest amounts of alpha-linolenic acid. Some nuts and seeds-- butternuts, walnuts, pumpkinseeds, and flaxseeds-- and vegetables (soybeans) are good sources as well (1). However, the conversion of alpha-linolenic acid to EPA and DHA is quite inefficient; estimates place the conversion rates at less than 5-10% for EPA and 2-5% for DHA (2). Lifestyle factors can also negatively influence these conversions. There is also evidence to suggest that females are more efficient at converting linolenic acid than men; this is likely due to increased demands for EPA and DHA during pregnancy and lactation (3). Even if you eat plenty of the aforementioned foods regularly, you still might come up short on EPA and DHA because the fatty acid quality is often degraded due to the typical overprocessing that occurs in commercial production (4). As such, it is best to get your EPA and DHA directly whenever possible. EPA and DHA are commonly referred to as fish oils because coldwater fish are by far the best sources. Although the terms EPA/DHA and fish oils are substituted for one another in writing and conversation, EPA and DHA are actually just two kinds of fatty acids contained in fish oils (5). These fish include, but are not limited to: salmon, mackerel, bluefish, tuna, mullet, herring, anchovy, and sardines. Infants receive plenty of EPA and DHA from their mothers' milk (1). Certainly, eating fish every day isn't appetizing for most people, and drinking human milk after the age of one is neither feasible nor socially acceptable! Plus, the typical vegetarian diet is extremely low in alpha-linolenic acid, so even if conversion was efficient, these individuals would still be coming up short (clinical studies have proven that vegetarians have insufficient levels of EPA and DHA) (2). Luckily, fish oil supplements in both liquid and softgel form are widely available to ensure that EPA and DHA requirements can be met easily. EPA and DHA exert their most powerful effects in an anti-inflammatory role. Arachidonic acid, which is created out of the omega-6 fatty acids in our diets, serves as the building block for certain eicosanoids that control the synthesis of cytokines that are pro-inflammatory and immunoregulatory; when these cytokines are overproduced, chronic inflammatory diseases (and even septic shock) can result. Omega-3 fatty acids, on the other hand, inhibit the production of arachidonic acid--thus preventing the production of certain mediators of inflammation--and serve as the raw materials for a healthier class of eicosanoids with anti-inflammatory properties (6). Given how out-of-whack the typical diet is in terms of the omega-6: omega-3 ratio, it should come as no surprise that the world is as unhealthy as it is! Here is some pretty impressive data on a variety of fronts: Cardiovascular Health/Atherosclerosis/Hyperlipidemia/Hypertension:

• An eleven year study of 20,557 male U.S. physicians showed that those who consumed fatty fish at least once per week were 52% less likely to suffer a sudden cardiac death than those who only ate it once per month or less (5).
• The typical Greenland Eskimo diet is devoid of fruits and vegetables and very high in fats from animal sources: not your traditional "heart healthy diet." However, the Eskimos had far lower instances of coronary heart disease (CHD) than a Denmark population of nearly identical ethnical composition (same ancestors). The Eskimo and Danish diets both consisted of a high percentage of calories from fat (39% and 42%, respectively), so why didn't the Eskimos suffer from such CHD like the Danes and everyone else? The secret lay with the types of fat that the Eskimos were eating. The typical Danish diet consisted of 22% of total calories from saturated fat and less than 1% from omega-3 polyunsaturated fatty acids (PUFAs). Meanwhile, only 9% of total calories in the Eskimo diet came from saturated fat. Perhaps more importantly, 4.2% of the Eskimos' total calories came from omega-3 PUFAs (5). Similar trends are readily apparent in coastal villages of Korea and Japan and throughout Scandinavian countries. Not surprisingly, they all rely extensively on coldwater fish in their everyday lives. Need further proof? A recent comparison of two Japanese villages: one fishing, one farming, found that the farming village had eight times more atherosclerotic plaques than their fishing counterparts (7).
• In a study of 59 patients with diagnosed heart disease, Durrington et al (2001) monitored the effects of 2 g daily of Omacor, a pharmaceutical grade fish oil concentrate. The researchers found that "there was a sustained significant decrease in serum triglycerides by 20-30% and in very low density lipoprotein (VLDL) cholesterol by 30-40% in patients receiving active Omacor at three, six, and 12 months compared either to baseline or placebo (8)."
• Not only do fish oils lower serum triglycerides and, in high dosages and combination with dietary modifications, low density lipoprotein (LDL) cholesterol, but they also decrease arterial platelet collection, which can lead to dangerous clots (5).
• Harper and Jacobsen (2001) reported that randomized clinical trials with fish oils "have demonstrated reductions in risk that compare favorably with those seen in landmark secondary prevention trials with lipid-lowering drugs (5)."
• Following coronary artery bypass surgery with venous grafts, patients that receive 4 g per day of omega-3 fatty acids have a significantly lower risk of graft occlusion (obstruction/closure) (9).

Hypertension:

• There are like 80 bizillion studies out there proving that fish oil reduces blood pressure (although you'll obviously derive greater benefits if you eat right and exercise, too). That said, 4 g omega-3 fatty acids per day is the minimum you'll need to see an improvement (9). You can expect not only reduced blood pressure, but also decreased vascular wall thickness (10). I've included a few more references (11-13) for those of you that either don't believe me or have a lot of time on your hands for extra reading.

Cardiac Arrhythmias:

• There is significant backing for the assertion that fish oils' antiarrhymthic capacity is the most important. Without sufficient EFAs, the body is forced to make cell membranes out of saturated fatty acids, which yield membranes that are far less elastic. When cardiac cells are made from EFAs (and are thus appropriately elastic), the heart has an easier time returning to a resting state. However, the rigid cell membranes made from saturated fatty acids can cause arrhythmias and alter the cardiac muscle cell contraction (5).

Inflammatory Diseases of Joints and Connective Tissues:

• In patients with degenerative and inflammatory joint diseases, supplementation with omega-3 fatty acids decreases both the "degradative and inflammatory aspects of chondrocyte metabolism, whilst having no effect on the normal tissue homeostasis (14)."
• Chondrocytes are the building blocks of articular cartilage and work with the extracellular matrix of collagen and proteoglycans to dissipate forces. If the cartilage is constantly eroding due to chondrocyte degradation, the structure tends to soften as its water content increases. Interventions with omega-3 fatty acids are effective in reducing these negative trends and their related symptoms in most patients with osteoarthritis (15,16).
• In more than two dozen studies, researchers have found that fish oil supplementation reduces fatigue and stiffness in rheumatoid arthritis (RA) afflicted individuals. In fact, some studies found the effects to be dramatic enough to allow for substantial decreases in nonsteroidal anti-inflammatory drug (NSAID) dosages (16-18). Generally speaking, in trials of 3 g combined EPA and DHA (the minimum recommended dose for RA patients), the benefits of fish oil supplementation were not noticeable until the 12-week mark, so be patient! On a microscopic level, the omega-3 supplementation tended to limit the release of leukotrien B(4) and interleukin 1 from neutrophils and monocytes. In plain English, this means that two inflammation-causing factors were present in lesser quantities (17).
• RA patients that supplemented with Vitamin E and fish oil showed an even greater decrease in NSAID requirements, indicating a synergistic effect between the two (18).
• Raynaud's Phenomenon is a vascular disorder that falls under the inflammatory diseases of joints and connective tissues. In this condition, tiny blood vessels that feed the skin periodically contract (called a "vasospasm"), limiting blood flow to the skin. As oxygen deprivation sets in, the skin--especially in the hands and feet--turns white and eventually blue. There is speculation that this phenomenon is due to the body's overreaction to cold, as the body excessively vasoconstricts these arteries to conserve heat. However, while cold atmospheres are most likely to cause a vasospasm, emotional stress can be a causative factor as well. Because omega-3 fatty acids "induce a favorable response to vascular ischemia," they have been investigated as a potential treatment for Raynaud's. DiGiacomo et al (1989) found that fish oil supplementation improved cold exposure tolerance and significantly delayed the onset of vasospasm in Raynaud's patients. Furthermore, this cold tolerance improvement was associated with a significantly increased digital systolic blood pressure in a cold atmosphere (20).
• Systemic lupus erythematosus (SLE) -- better known simply as lupus - is a chronic, autoimmune rheumatic disease with a wide variety of symptoms. Typically, this disease affects women of childbearing age (21). Symptoms include arthritis, skin rash, vascular inflammation, and profound effects on the central nervous, renal and cardiopulmonary systems (22). Mohan and Das (1997) found that concentrations of EPA and DHA were low in the plasma phospholipids of SLE patients; this supported pre-existing data that EPA and DHA supplementation could lead to clinical remission without side effects (22).
• In cases of pediatric SLE, dyslipoproteinemia -- essentially high triglycerides, low HDL, and high LDL - is often present. Provision of fish oil supplements has proven effective in significantly improving blood lipid profiles (decreased serum triglycerides concentrations) in these patients beyond dietary intervention alone (24).

Osteoporosis:

• Two short-term studies have found that a lower omega-6 to omega-3 fatty acid ratio (achieved via omega-3 supplementation) attenuates bone loss in patients with osteoporosis. These effects are likely due to decreases in the production of Prostaglandin E2 (PGE2), an eicosanoid widely implicated in bone resorption (25). Overall eicosanoid balance is largely dependent on fatty acid intake; so it's important to consider both the quantity of omega-3s and omega-6s present.

Kidney Disease/Renal Failure:

• Researchers at the Mayo Nephrology Collaborative Clinic found that fish oils slowed the progression of immunoglobin A nephropathy in patients at a high risk for kidney disease (26).
• Omega-3s have shown promise in reducing urinary calcium levels in kidney stone patients and preventing blood clots in hemodialysis patients (26).
• Hemodialysis patients given fish oil required 16% less erythropoietin while experiencing a 3.6% increase in serum albumin levels in comparison to a placebo group (27).
• The side effects (such as skin lesions and hyperlipidemia) of cyclosporine, a medication often prescribed for kidney transplant patients, are noticeably less significant when patients supplement with fish oil (28)

Prostate Cancer:

• A longitudinal study of 6,272 Swedish men showed that those who regularly consumed fish were approximately 50% less likely to be diagnosed with prostate cancer and roughly 70% less likely to die from it than those who avoided fish. Three servings per week appeared to be the minimum amount needed to attain such benefits (29).
• Augustsson et al (2003) validated the Swedish study with a larger sample size of 47,882, and noted that the strongest association also existed between fish consumption and metastatic cancer (meaning that it's extensive and spreads to other parts of the body via the blood vessels or lymphatic system). Those men that ate fish more than three times per week were 24% less likely to be diagnosed with metastatic cancer (30).

Colon Cancer:

• Collett et al noted that incidences of colon cancer in rats were reduced significantly with DHA supplementation in the form of fish oil (31).

Breast Cancer:

• In a five-year prospective study of 35,298 Singapore Chinese women ages 45-74, high levels of dietary omega-3 fatty acids (mostly from shellfish) were associated with a significantly reduced (26% lower) risk of breast cancer (32).

Skin Cancer:

• In animals, omega-3 fatty acids have been proven effective as protection against photocarcinogenesis, likely due to the fatty acids' ability to combat oxidative stress. Rhodes et al studied the effect of 4 g/day EPA supplementation "on a range of indicators of ultraviolet radiation (UVR)-induced DNA damage in humans, and assessed effect on basal and post-UVR oxidative status" in 42 healthy subjects. The control group received oleic acid, a monounsaturated fatty acid, for the three-month study. Sunburn sensitivity was reduced in the EPA group only; likewise, other early markers of skin cancer diminished significantly with EPA supplementation. These results imply that there was protection against acute UVR-induced damage by dietary EPA; the researchers hypothesized that "longer-term supplementation might reduce skin cancer in humans (33)."

That concludes part one; hopefully, you've picked up some valuable information. Next month, I'll besiege you with another 8,471 references supporting my argument on a variety of different fronts. Stay tuned! References 1. Whitney, E.N. & Rolfes, S.R. Understanding Nutrition: (8th ed.). Belmont, CA: Wadsworth Publishing Company, 1999. 2. Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr. 2003 Sep;78(3 Suppl):640S-646S. 3. Burdge GC, Wootton SA. Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Br J Nutr. 2002 Oct;88(4):411-20. 4. Colgan, M. Optimum Sports Nutrition. New York: Advanced Research Press, 1993. 5. Harper CR, Jacobson TA. The fats of life: the role of omega-3 fatty acids in the prevention of coronary heart disease. Arch Intern Med. 2001 Oct 8;161(18):2185-92. 6. Calder PC. n-3 polyunsaturated fatty acids and cytokine production in health and disease. Ann Nutr Metab. 1997;41(4):203-34. 7. Yamada T, Strong JP, Ishii T, Ueno T, Koyama M, Wagayama H, Shimizu A, Sakai T, Malcom GT, Guzman MA. Atherosclerosis and omega-3 fatty acids in the populations of a fishing village and a farming village in Japan. Atherosclerosis. 2000 Dec;153(2):469-81. 8. Durrington PN, Bhatnagar D, Mackness MI, Morgan J, Julier K, Khan MA, France M. An omega-3 polyunsaturated fatty acid concentrate administered for one year decreased triglycerides in simvastatin treated patients with coronary heart disease and persisting hypertriglyceridaemia. Heart. 2001 May;85(5):544-8. 9. Nordoy A, Marchioli R, Arnesen H, Videbaek J. n-3 polyunsaturated fatty acids and cardiovascular diseases. Lipids. 2001;36 Suppl:S127-9. 10. Engler MM, Engler MB, Pierson DM, Molteni LB, Molteni A Effects of docosahexaenoic acid on vascular pathology and reactivity in hypertension. Exp Biol Med (Maywood). 2003 Mar;228(3):299-307. 11. Passfall J, Philipp T, Woermann F, Quass P, Thiede M, Haller H. Different effects of eicosapentaenoic acid and olive oil on blood pressure, intracellular free platelet calcium, and plasma lipids in patients with essential hypertension. Clin Investig. 1993 Aug;71(8):628-33. 12. Bhatnagar D, Durrington PN.Omega-3 fatty acids: their role in the prevention and treatment of atherosclerosis related risk factors and complications. Int J Clin Pract. 2003 May;57(4):305-14 13. Holm T, Andreassen AK, Aukrust P, Andersen K, Geiran OR, Kjekshus J, Simonsen S, Gullestad L. Omega-3 fatty acids improve blood pressure control and preserve renal function in hypertensive heart transplant recipients. Eur Heart J. 2001 Mar;22(5):428-36. 14. Curtis CL, Rees SG, Cramp J, Flannery CR, Hughes CE, Little CB, Williams R, Wilson C, Dent CM, Harwood JL, Caterson B. Effects of n-3 fatty acids on cartilage metabolism. Proc Nutr Soc. 2002 Aug;61(3):381-9. 15. Curtis CL, Rees SG, Little CB, Flannery CR, Hughes CE, Wilson C, Dent CM, Otterness IG, Harwood JL, Caterson B. Pathologic indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids. Arthritis Rheum. 2002 Jun;46(6):1544-53. 16. Cho SH, Jung YB, Seong SC, Park HB, Byun KY, Lee DC, Song EK, Son JH. Clinical efficacy and safety of Lyprinol, a patented extract from New Zealand green-lipped mussel (Perna Canaliculus) in patients with osteoarthritis of the hip and knee: a multicenter 2-month clinical trial. Allerg Immunol (Paris). 2003 Jun;35(6):212-6. 17. Kremer JM. n-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000 Jan;71(1 Suppl):349S-51S 18. Tidow-Kebritchi S, Mobarhan S. Effects of diets containing fish oil and vitamin E on rheumatoid arthritis. Nutr Rev. 2001 Oct;59(10):335-8. 19. Rennie KL, Hughes J, Lang R, Jebb SA. Nutritional management of rheumatoid arthritis: a review of the evidence. J Hum Nutr Diet. 2003 Apr;16(2):97-109. 20. DiGiacomo RA, Kremer JM, Shah DM. Fish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study. Am J Med. 1989 Feb;86(2):158-64. 21. Ioannou Y, Isenberg DA. Current concepts for the management of systemic lupus erythematosus in adults: a therapeutic challenge. Postgrad Med J. 2002 Oct;78(924):599-606. 22. Das UN. Beneficial effect of eicosapentaenoic and docosahexaenoic acids in the management of systemic lupus erythematosus and its relationship to the cytokine network. Prostaglandins Leukot Essent Fatty Acids. 1994 Sep;51(3):207-13. 23. Mohan IK, Das UN. Oxidant stress, anti-oxidants and essential fatty acids in systemic lupus erythematosus. Prostaglandins Leukot Essent Fatty Acids. 1997 Mar;56(3):193-8. 24. Ilowite NT, Copperman N, Leicht T, Kwong T, Jacobson MS. 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Craig Ballantyne is one of the most widely published and successful guys in our industry – and for a good reason: he gets results. His Turbulence Training protocols have helped thousand of people get lean over the past few years, and with summer upon us, I figured it would be a great time to track Craig down for an interview.

EC: Let’s be honest: every Average Joe trainer under the sun has an e-book or 5-minute guide to sucker misinformed housewives into shelling out hundreds of dollars to learn the “hidden secret” of fat loss. Frankly, I’ve had hundreds of products along these lines cross my path in the past few years, and the only two that have withstood the test of time – and yielded outstanding results time-and-time again are yours and Cosgrove’s. I know about your programming, but let’s enlighten our readers a bit about what makes Turbulence Training so effective.

CB: I think there are a lot of other good ideas and programs out there; not a day goes by that I don't get a good idea from another trainer.  Maybe Alwyn and I just claimed the catchiest names - or maybe it’s the Scottish last name.

What I've done over the years is take my experience in research, and in training athletes, and in working with busy people with minimal equipment, and rolled that up into a program that meets the needs of my readers.

I've adapted the program quite a bit over the years because users have demanded changes. For example, in the past, it used to focus on barbell exercises, but now includes only dumbbell and body weight training exercises (with the exception of my more advanced "Fusion and Synergy" fat loss programs).

The principles remain the same, though. We use more intense strength training than traditional programs (lower reps, not as low as a powerlifter, but lower than 99% of fat loss programs recommended in the past - although this is changing as the approach becomes more popular).

Each workout uses supersets. This gets the workout done faster. I also use what I call "non-competing" supersets, basically referring to supersetting two exercises that don't use the same muscles - including grip strength.

So, a dumbbell split squat and a dumbbell chest press would be non-competing. A dumbbell reverse lunge and a dumbbell row would be competing, because they both demand intense grip work. So, I'd avoid the lunge-row combo.

And then we finish up each workout with interval training. This, too, has evolved over the years. I used to recommend basic 30-second intervals, with 60-second recovery, done on a bike or treadmill (or sprints outside). Now I'm using bodyweight circuits in place of intervals, or sometimes barbell complexes, or sometimes even high-rep dumbbell work.

These changes have all been based on feedback from users. For example, a lot of Turbulence TrainingSo, we use body weight training circuits instead. These are great and can be adapted for any fitness level. readers work out at home with nothing but dumbbells and a bench; they don't have a machine for cardio.

For the interval type circuits, I like to use six total bodyweight exercises, three lower body and three upper body. Then just alternate between upper and lower in a 6-exercise circuit.

So bottom line, a Turbulence Training workout will run like this:

5-minute body weight warm-up

20-minutes superset strength training

18-minutes interval training

7-minutes stretching or mobility work

We do three hard workouts per week, yet I emphasize that everyday is an exercise day (that is, on the four days you don't do a hard Turbulence Training workout, you must still get 30 minutes of activity - preferably something you enjoy and enables you to spend time with family or friends).

EC: Along these same lines, where are most fat loss programs falling short? Where are people missing the boat?

CB: Mostly in nutrition, to be frank.

But as for the workout component, relying solely on long, slow cardio exercise to build the body of your dreams is only going to lead to pain and frustration from a lack of results.

It is simply not an efficient way to exercise for fat loss. If you only have 45 minutes to exercise, and you spend 40 of those minutes on a cardio machine, then you have no hope of building the body you want.

The cardio mindset is all about breaking down the body, burning calories, and looking negatively at food (i.e. how much exercise can I do to punish myself for eating this brownie?). It's that 1980s aerobic-high carbohydrate mentality that has literally ruined people's lives by leading them down the wrong physical path.

The Turbulence Training fat loss mindset is positive, and is focused on building the body, boosting the metabolism, and developing positive nutrition rituals that fuel your body for mental and physical performance.

Another mistake of fat loss programs is focusing on the "calories burned". Just like the nutrition industry is slowly starting to recognize that a "calorie isn't always a calorie", we need to accept that the number of calories burned in a workout is not the main determinant of fat loss success.

First, machine calorie counters are notoriously inaccurate. Second, you can wipe out all the calories you just burned in about 30 seconds with a Starbucks summer drink. And finally, we need to look at the bigger question - and that is how does your workout affect your daily metabolism?

I believe a high-intensity workout - like Turbulence Training - leads to better results because it focuses on boosting your metabolism. So while you won't burn as many calories during the workout - according to the machine - you end up burning more fat over the course of the day and week. And that's the bottom line.

EC: Memorial Day weekend was the unofficial start to summer, meaning that millions of people are scrambling to get as lean as possible as fast as possible. If you had to give them three bits of advice, what would they be?

CB: First, your nutrition is going to give you the majority of your results. Find a time when you can go to the grocery store and prepare your meals for the week. Stick to that. Give yourself a little reward each week, but don't go overboard.

Find out how many calories you eat now. Then cut back on your calories AND try to improve the quality of your nutrition. Take baby steps, and don't move too quickly. For example, tomorrow, make sure you eat one additional fruit. The day after, add one extra serving of vegetables. The third day, cut out all sugary beverages. And so on.

Second, get social support. Whether you find kindred fat loss spirits on the Internet, at work, in the gym, or at home with a family member, make sure you have someone that you can be accountable to (get a trainer once a week), and that will support you (if your family isn't supportive, find someone on a good internet forum or a buddy at work).

Social support will keep you out of the wrong eating situations and will always be there to help you hit new personal bests in your workouts. Don't underestimate what a helping hand can do for your fat loss.

Third, if you really want to succeed, then be prepared to suck it up for a few weeks. After all, what's eight weeks of discipline over the course of a lifetime? It's nothing. Just think about the last eight weeks of your life...doesn't it seem like that time just flew by?

So, if you get serious about your nutrition and consistent with an intense program of strength training and interval training, you can make dramatic changes in four weeks, eight weeks, or whatever is left this summer.

Find a time when you know you can stick to your workout. Don't let anything get in the way.

And after eight weeks of consistent effort, you'll have a better body, and this is where it gets good...

You'll find its much easier to maintain a great body, AND you'll have built so many healthy habits in those eight weeks that you won't feel like going back to the old way of living where you ate - and felt - like crap all the time. Plus, you'll have a consistent exercise habit. It's a win-win situation to put yourself through an eight-week intensive regimen.

EC: Tell us about Turbulence Training; what’s the scoop?

CB: This is the one-year anniversary of my program at TurbulenceTraining.com. Over the past year, we've helped thousands of people lose fat in less time than ever, and we want to help even more this year.

So I twisted a few arms and rounded up some excellent bonuses that include...

1) Meal Plans for Men & Women by Dr. Chris Mohr (Value $99)

2) How to Measure Your Body Fat by Dr. John Berardi (Value $29.97)

3) High-Octane, Fat Burning Recipes by Mike Roussell (Value $19.99)

4) How Hormones Affect Your Fat Loss: A Special Report from Dr. Holly Lucille & Jon Benson (Value $19.99)

5) A One-Month Bonus Trial at Global-Fitness (Value $9.95)

6) The Turbulence Training Hardcore Fat Loss 4-Week Program by Craig Ballantyne (Value $19.99)

7) A Three-Month Basic Level Membership to the Turbulence Training Discussion Forums & Other Exclusive Fat Loss Info (Value $59.85)

If readers are curious, they can check them out at TurbulenceTraining.com.