Author Archive: Courtney D

About Courtney D

A 20-something year old fitness nerd and medical student trying to spread the truth about health and fitness.

Do you need BCAAs?

BCAAs are a popular supplement currently used for everything from weight loss to muscle soreness and muscle growth. Let’s explore what they are, how they’re used and if they’re needed.

WHAT ARE BCAAs?

BCAA stands for “branched chain amino acid,” which are building blocks of proteins. A chain of amino acids make up a protein. There are two categories (some argue three), which include essential and non-essential amino acids. ESSENTIAL amino acids are not naturally produced by your body and you must supplement them externally. Foods that have all 9 essential amino acids are called “complete” proteins. Complete proteins are usually animal proteins – everything from milk to meat and cheese. Non-animal product complete proteins include quinoa, hempseed, chia, soy, spinach and a few others. Protein sources that don’t have all 9 essential amino acids are called incomplete proteins. NON-ESSENTIAL amino acids are produced naturally by your body and don’t often need supplementation.

WHY DO PEOPLE USE THEM?

There are many claims about what BCAAs do – let’s investigate them.

  • INCREASED MUSCLE PROTEIN SYTHESIS: Mostly, yes! See below
  • HELP WITH MUSCLE SORENESS: no evidence to support this
  • HELPS CARDIOVASCULAR PERFORMANCE: no evidence to support this
  • HELPS WITH WEIGHT LOSS: no evidence to support this
  • DECREASES FATIGUE (MENTAL) DURING EXERCISE: Slightly lower when supplemented >10g during exercise
  • DECREASES FATIGUE (PHYSICAL) DURING EXERCISE: People claim they increase the time to exhaustion in prolonged endurance exercise – but this has only been shown in lightly trained or untrained athletes.
  • INCREASES FAT OXIDATION IN PROLONGED EXERCISE: Some studies show this, but it’s unsure if this is due to glycogen preservation or not
  • Further studies show no effect on cortisol or insulin levels, as well as epinephrine, etc.

MUSCLE PROTEIN SYNTHESIS:

While many of the original claims of the usefulness of BCAAs have been debunked over the last few years, one claim that sticks around is its effect on muscle protein synthesis (MPS). This is the idea that supplementing with BCAAs will increase muscle growth and even be muscle sparing during weight loss.

These claims come from studies around leucine, one of the essential amino acids. This amino acid alone was shown to increase MPS due to its effects on mTOR (mammalian target or rapamycin). Various studies explored how supplementing leucine could be used. When leucine was supplemented alone the results weren’t significant, but when paired with a protein source MPS was higher. This is most likely because it interacts with isoleucine and valine to create the best stimulus. Further studies show that if you add leucine to your post workout protein and carb source you’ll have more MPS than with just protein or just carbs. It also reduced protein breakdown.

HOW MUCH LEUCINE?

Most of these studies advocate for supplementing 2.5 g of leucine per meal, for a total of 8-10g of leucine a day.

HOW MUCH LEUCINE IS IN FOOD VS BCAAS?

  • A scoop of whey protein: 2.5 g of leucine
  • 142g of chicken: 2.5 g leucine
  • 142g of round beef: 2.5 g leucine
  • 4.6 whole large eggs: 2.5g of leucine
  • BCAAs: ~2.5g/serving

IS IT SAFE?

TUI (tolerable upper intake) is 500mg/kg, as it can increase ammonia levels.

WHAT’S THE TAKE AWAY MESSAGE?

  • BCAAs are made up of the building blocks of protein, the most important of these for muscle stimulus is leucine
  • When pairing leucine with protein (and, more specifically, the amino acids valine and isoleucine) you have a higher muscle protein synthesis than just carbs or just protein
  • Complete sources of protein are also high in leucine and can be supplemented if BCAAs are cost prohibitive
  • Vegans/vegetarians/those who dislike animal protein would benefit from supplementing BCAAs to ensure they get all their essential amino acids
  • BCAAs do not decrease muscle soreness, help with weight loss, or effect insulin

REFERENCES:

  1. Blomstrand E, Hassmén P, Newsholme EA Effect of branched-chain amino acid supplementation on mental performance . Acta Physiol Scand. (1991)
  2. Consuming a supplement containing branched-chain amino acids during a resistance-training program increases lean mass, muscle strength and fat loss
  3. Elango R, et al Determination of the tolerable upper intake level of leucine in acute dietary studies in young men . Am J Clin Nutr. (2012)
  4. Liu Z, et al Branched chain amino acids activate messenger ribonucleic acid translation regulatory proteins in human skeletal muscle, and glucocorticoids blunt this action . J Clin Endocrinol Metab. (2001)
  5. Lynch CJ, et al Regulation of amino acid-sensitive TOR signaling by leucine analogues in adipocytes . J Cell Biochem. (2000)
  6. Shimomura Y, et al Effects of squat exercise and branched-chain amino acid supplementation on plasma free amino acid concentrations in young women . J Nutr Sci Vitaminol (Tokyo). (2009)
  7. Shimomura Y, et al Branched-chain amino acid supplementation before squat exercise and delayed-onset muscle soreness . Int J Sport Nutr Exerc Metab. (2010)
  8. van Hall G, et al Ingestion of branched-chain amino acids and tryptophan during sustained exercise in man: failure to affect performance . J Physiol. (1995)

Warm Up and Foam Rolling – is there a point?

Why do we warm up?

“Warming up” is a blanket term used to describe the actions we perform prior to an exercise to allow us to exercise injury free and prime us for ideal performance. During a warm up we increase blood flow to the muscles we plan on using, increase our core temperature, increase range of motion, and get our heart rate elevated. These are all necessary to decrease instances of injury and ensure we have the best performance.

Static stretching vs. dynamic warm ups

When I was in elementary school and took PE I remember warming up with static stretches. This involved grabbing various parts of your body and folding them in ways to stretch the muscles prior to exercise we performed. This mode of warm up is no longer recommended – it’s been replaced with dynamic warm ups.

Dynamic warm ups are not static – it’s movement of the muscle to stimulate it for action. This includes things like lunges, kicks, walking, etc. Any sort of movement that increases blood flow to the muscle. Study (source) after study has shown an increase in acute performance after dynamic warm ups vs. static stretching. This has been confirmed in all sorts of populations, from children (source) to D1 collegiate athletes (Source).

Some dynamic warm up videos:
Katie Anne’s Warm UpMegsquat’s Lower Body and Bench Warm Up

Foam Rolling

Over the last few years’ foam rolling has gained a lot of traction. A foam roller is a long foam device that allows someone to manipulate their muscles without the need of a second person. They come in a lot of different types – plastic, foam, some have rivets on them, etc. While I use “foam rolling” in the rest of this article, you can include using items like lacrosse balls, tennis balls, PVC pipe and massage sticks in this topic.

When I asked friends and family why they foam rolled, by far and away the most common response was “To break up the lactic acid in sore muscles, decreasing DOMS (delayed onset muscle soreness).” This isn’t an accurate point for many reasons. First, lactic acid build up does not cause DOMS. While many theories have been explored – and the exact mechanism isn’t known – the lactic acid theory has been widely rejected and replaced with theories about microtears and inflammatory processes. Second, it gives the idea that the foam roller can cause fascial (tissue/muscle) manipulation at a level to “break up” or “release” anything. Studies have shown that you need somewhere in the neighborhood of 600-900kg of weight to cause meaningful manipulations in fascia (source). In fact, there have been quite a bit of papers debunking the idea that you can “release” fascia without serious force – as stated above.

So why foam roll? Well, there are studies that prove foam rolling increases acute range of motion (source). If you’re foam rolling a “tight” area of your body prior to exercising that area you will find that your range of motion has increased (source). However, this has been noted with any sort of warm up, not just foam rolling. Additionally, the science supports it being just an acute process. If you foam roll on your off days and expect that to carry over to the next day’s exercise you’ll find no improvement. It’s the movements you perform afterwards that are meaningful in long-term increases in flexibility and range of motion.

There’s also been a lot of interesting studies into why foam rolling seems to decrease DOMS (source). There are theories about stimulating pain perception points and even more theories about a placebo effect. Much like the cause of DOMS, the jury is still out on how this can decrease the sensation of soreness.

 

So how should you interpret this data and apply it to your life?

  • If you enjoy foam rolling, keep doing it. Limit it to <10 minutes pre or post workout and include it with other types of warm ups like dynamic stretches and movements.
  • Don’t guilt yourself if you don’t foam roll on your days off. Instead, try other active processes to increase blood flow to your muscles and help with range of motion and flexibility.
  • If foam rolling is not something you enjoy, you don’t have to do it.
  • As always – if it works for you and you feel better before/after you foam roll, keep it up! What works best for you is what YOU should do.

TDEE Calculator

Below is a calculator I developed to help you determine your TDEE, or Total Daily Energy Expenditure. Just plug in the numbers and you’re good to go!

Activity levels

Sedentary 1.2 – You don’t work out and have a desk job
Lightly Active1.375 – You have a desk job, you work out 1-3x a week
Moderate1.55 – You work out 3-5x a week OR you have a job with some manual labor
Heavy1.725 – You work out 5-7x a week OR you have a job with a lot of manual labor
Very Heavy1.9 – 2-a-days, or a job with manual labor and frequent gym use

Orthorexia: Just another buzz word? An eating disorder?

The last 2 years have shown a visible increase in literature on the topic of orthorexia nervosa, despite not actually being in the DSM-5. Does this lack of “true” diagnosis make this condition just another buzz word, or is this the start of a new breed of eating disorders? Furthermore, is the lack of diagnostic criteria ignoring a whole new subset of those with disordered eating under the guise of “health”?

Definitions and Diagnostic Criteria

Orthorexia literally means “proper appetite”, a misleading name given the ramifications of those cited with orthorexia. It was first described in 1997 by Bratman and Knight after Bratman described his own experiences with orthorexia. The symptoms vary from focusing purely on “clean” or “healthy” food to feelings of deep guilt when going “off plan” or eating something “not clean.” Compensatory behaviors that are often found with those who suffer from anorexia nervosa or bulimia are very similar. Orthorexics will exercise compulsively to “make up” for their “mistakes.” They also obsess over nutrition labels and will start to isolate themselves from social events surrounding food for fear of going off their diet. These criteria all shadow behaviors of other eating disorders as well as obsessive compulsive behavior.

Venn Diagram

From “The clinical basis of orthorexia”, a venn diagram showing the overlapping criteria of orthorexia, anorexia and OCD

Orthorexia’s onset can be more insidious than this extreme behavior, though. Often someone starts off wanting to “eat healthier.” They decide to remove a food group from their diet, then another, then another. Before too long they have a very strict set of rules around what they can and cannot eat. These rules and structure make them feel safe and in control, and as long as they abide by them they are eating “healthy”.

One very, very important distinction is that this group has no medical, religious or ethical reason to avoid certain food groups. While those suffering from orthorexia will often claim they are allergic or intolerant to dairy, gluten, etc. they often have never been formally diagnosed. Most of those who suffer from orthorexia have self-diagnosed allergies and intolerances to food groups. Those who do actually suffer from allergies and are intolerant to certain food groups may still fall into other categories of disordered eating, however for the sake of this discussion we will not include them.

One major departure from orthorexia and anorexia (according to research) is the motivation behind the disorder, though I personally disagree. Anorexia’s end motivation may be about weight loss, but there is never “skinny enough” for those with anorexia. They often are unable to see how sick they truly are. I would argue that anorexia is ultimately about control, and here it doesn’t depart too sharply from orthorexia. The suggested criteria for orthorexia points to a need for those to feel “pure” or “clean” by controlling what goes into their body. This mirrors the controlling aspect of anorexia. However, those with orthorexia are quick to flaunt their behaviors, while anorexics are very secretive about theirs. More on this can be read in the paper included at the end of this article.

The Dark Consequences of Orthorexia

Some might argue that orthorexia is a word used by those who “don’t get it” to describe the passionate. Without an official diagnostic criteria this might be true, however it’s impossible to ignore the consequences of unchecked orthorexia. Unchecked orthorexia can mirror a lot of the consequences of anorexia. For example, omitting entire food groups can lead to deficiencies in certain micro and macronutrient groups. Side effects include anemia, osteopenia, bradycardia, hyponatremia, and others.

Other consequences involve the effect it can have on your social life. Food anxiety makes any social outing involving food almost impossible for those with orthorexia. Given the serious overlap between orthorexia and anorexia they’re prone to the same binge-restrict cycles as those with anorexia. Deviations from their diet are met with self loathing and guilt. They spend an inordinate amount of time researching, planning and excluding foods from their diet.

Causes

Since this condition is not officially diagnosed, nor is there outstanding data involving its manifestations and treatment, it’s hard to pin point the specific causes of orthorexia. However, there are some places we can look to understand the obsession around health and purity.

  • Fake trainers or nutritionists: Every celebrity is endorsing some diet these days with very little understanding of the consequences of their support. It’s not hard to find a book, website, or blog touting a certain type of diet or food exclusion as THE way to lose weight or become healthy. In fact, there are entire companies built on the insecurity of the average person, creating groups and “coaches” out of everyday, unqualified people. While some of these people may mean well, they ultimately are unqualified to give advice about diets. This creates and endless cycle of misinformation, usually involving statements like “I saw celebrity name gave up gluten, so I did, and now I feel amazing!” or “I recently started pyramid scheme diet here, and I lost 20 lbs!” While these statements may be innocent in the beginning, they can quickly lead to feelings of guilt when strayed from. Since they focus on excluding food groups they may eventually lead to the same social anxiety described by many with orthorexia.
Examples of misinformation found in popular diets, all which have been discredited but are still touted by popular diets.

Examples of misinformation found in popular diets, all which have been discredited but are still touted by popular diets. Source: The clinical basis of orthorexia.

  • Weight loss/health as a social status: We are often to praise people for losing weight or being healthy without truly understanding what it meant to that individual. “Healthy” and “fit” are a social status that are openly praised. Someone who updates social media with their workout or posts about not indulging in the bagels at work are seen as “strong” and someone to look up to. Diets are often associated with strength and willpower to the point where those who don’t adhere to diets 100% are seen as “weak” and “lack willpower.”
  • Good Food/Bad Food Dichotomy: The minute certain food groups are seen as “bad” or “unhealthy” a dichotomy is created. Labeling food as “good” or “bad” without any true understanding of what it means to an individuals diet or health is unrealistic and unhealthy. Research has shown time and time again that if you tell someone they can’t have a certain food type they will crave it. This can contribute to the food binges experienced by orthorexics when they eat one thing off their “meal plan.”
  • Fad Diets: Researchers have noted that orthorexia patterns of food aversion parallel whichever fad diet is currently circulating.

Where To Go From Here

I have stated many times that this condition lacks an official diagnostic criteria, and is not currently recognized by the DSM-5. However, the National Association for Eating Disorders has been compiling data on the topic and has a page devoted to education on orthorexia. This topic has also been explored by a number of popular websites around health and fitness. While it is not currently an eating disorder it IS a type of disordered eating. It is something that interferes with daily life and disallows enjoyment of life. If you feel that you’ve spent an inordinate amount of time worrying about food, or you feel like you might have orthorexia, it is important to seek the health of a trained professional. Disordered eating can lead to eating disorders, and the associated complications from dietary restrictions are severe enough to warrant intervention in some cases.

If you’d like to learn more about the current research of orthorexia, The clinical basis of orthorexia: emerging perspectives is a great paper to help inform you about orthorexia.