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I get questions about using ice (or heat) almost daily. Lately, it’s been increasing due to the popularity of full-body cryotherapy centers that have popped up everywhere. Joe Rogan has apparently been taking daily ice baths to start his day and talking about it on social media.

All the above, and the fact that everyone’s been icing injuries for as long as I can remember, have led to many questions about our old frosty friend.

Here’s the bottom line: icing injuries delays healing, mainly because ice pushes blood flow away from the injured tissue.

In 1978, Dr. Gabe Mirkin coined the term “RICE,” the acronym for “Rest, Ice, Compress, Elevate.” RICE became the mantra for all of us who treat athletic injuries and is still used across the land on sports teams from high schools to the pros. But Dr. Mirkin recanted on the use of ice way back in 2015. By then, I had been in practice for a while, but I missed the memo. Still, I had found that heat seemed to get way better results with patients, and I never used ice.

So–what should you use in an acute pain situation? Is ice always out? Typically, movement is the answer. Gently loading the injured tissue will lead to much better outcomes than avoiding movement while simultaneously limiting blood flow, which will only prolong the misery.

But what about reducing swelling? I’ve been telling people that reducing painful swelling is the only acceptable time to ice an injury. But in doing my research for this article, I stumbled upon this paper, which states the following:

“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability. As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics in the wrong direction, increasing the amount of local swelling and pressure and potentially contributing to greater pain.”

In other words, ice can worsen swelling and intensify pain instead of reducing it. Now we both know.

So what should you do in an acute pain situation? The rest of the RICE acronym (rest, compress, and elevate) is still wise in the initial 24 hours after an injury, but it’s good to start lightly loading the tissue as soon as possible. The adage of “walking it off” might be wiser than we thought.

Using heat can help improve blood flow to injured tissue. And since the one thing ice does well is numb pain, which can allow you to function if your pain is intractable, it’s not going to be the end of the world if you use ice to numb it out–just know that you need to get it moving as quickly as possible.

So, instead of diving into sub-zero temperatures to get your week started, maybe get a massage instead.

And, just as I was getting ready to hit the publish button, the following video came up in my Youtube feed:

Recently, we talked about healthspan–how long you live well within your lifespan, and the importance of muscular strength to increase your health span to match your lifespan. 

If you’ve never heard of healthspan before–you will. It’s now in the dictionary, and since my last email on the subject, the software I use to write these things now recognizes it as one word instead of two. 

I also made the case that there are six pillars of healthspan:

1. Muscular strength
2. Cardiac endurance
3. Mobility where you should be mobile.
4. Stability where you should be stable
5. body composition
6. A sense of community

Today I want to talk about mobility (we’ll get back to cardiac endurance later). In particular, the hips, shoulders, and the entire upper two-thirds of your spine.

First up: hips.

Your ability to squat has a massive effect on your quality of life at every stage, from infancy to your twilight years. For example, babies learn to squat as a precursor to walking. And when you’re in your eighties, being a master of the squat means maintaining independence. As long as you can get on and off the toilet independently, you can keep living without assistance. And you need mobile hips to squat well.

Not every hip is built the same, however. People of Irish, Scottish, English, and French descent are more likely to have deeper, more stable hip sockets, which limits squat depth but increases stability. People of Asian, and Eastern European descent, as well as most of the continent of Africa, tend to have shallower hip sockets which make them better squatters but with more problems with hip dysplasia. These facts help explain cultural differences when it comes to the way people sit to eat and socialize.

Having mobile shoulders is also important–you have to reach that stuff on the top shelf, after all. And therein lies the problem: we rarely put our shoulders in positions other than straight out in front where the keyboard, phone, or steering wheel are. 

I’ve had my share of shoulder mobility issues, primarily because I work with my hands in front of me all day, just like everyone else. However, the thing that made the most remarkable difference has been to hang from a pullup bar and do rowing-type exercises routinely. There’s an entire book devoted to hanging from a bar that explains in detail how it works. And for me, it worked.

Finally, the spinal joints of your upper back and neck are supposed to be pretty mobile. However, your lumbar spine resists movement. We’ll get to the stability part of the research in another newsletter. But if you can’t get the full range of motion in your neck and upper back, you’ll likely develop issues in the lower back and hips because of the tendency for those areas to compensate. That’s the area where I can help you the most.

I’ve written about this before, but to stay functional, you need mobility to pass the Sitting Rising test, which is precisely what it sounds like: you sit down and rise back up. But without using your hands. If you can pull off a perfect ten, your next ten years are pretty much guaranteed unless you have an accident of some sort. Here’s a video of mine a couple of years ago on my birthday. Again, you need that hip and upper back mobility to pull this off.

Here’s an article about the Sitting Rising Test in case you want to know more.

I’m as Texan as they come–I love barbeque and chili and Tex-Mex (and chicken fried steak, and on and on). But when we finally crawled out of 2020, I was 10 pounds heavier and needed a break from the usual rotation.

My last book, The Fad Proof Diet, is all about not doing anything extreme but instead taking an accurate inventory of your intake and making adjustments based on your preferred food choices.

So, it’s with astounding hypocrisy that I went vegan for a month. But I wanted to see how a few things went, and my wife was happy to go along for the ride and help out with the cooking. Here’s what happened.

First off, I easily lost 10 pounds in four weeks. As I say in the book, vegetation is very low calorie but high volume, so eating more plants can fill you up without packing on the pounds. I ate quite a bit of almond butter, which is calorie-dense, but when one isn’t eating the afore-mentioned Tex-Mex, a little almond butter is the least of your worries.

Next, I lost some muscle. I’ve been lifting weights with my son on the weekends, and we had been maxing out on bench press several weeks in a row leading up to the new year. Over the month, my max dropped about 10%.

That’s a bummer. But not a surprise–protein is the building block of muscle, and I wasn’t eating nearly as much of it as usual.

Overall, I enjoyed the experience of being a little uncomfortable for a month. We tried new recipes, and there were plenty of meals we made I’ll happily eat again.

But I did miss the Tex-Mex. 

In the future, I’m trying to focus my attention on leaner meats but keeping plenty of vegetation on my plate. And if you happen to be carb-phobic, you’ll be interested to hear that there were plenty of nights when I ate a big pile of roasted potatoes with some herbs and olive oil, and the weight still came off by the day. 

I could tell from the way my belt fit from one day to the next that I was dropping inches, and from one week to the next, I lost a little over three pounds.

Again, I don’t advise going full-on vegan (or any other diet that’s not sustainable for you–and going vegan wouldn’t be my long-term preference). But since I went for it, I thought I’d write about it here.

My biggest regret is that I didn’t do before/after bloodwork to see what happened with my cholesterol numbers. Maybe next time.

I have to admit that I was skeptical when I started noticing collagen supplements taking up Costco’s entire aisle. Still, since I’m in the business of knowing about this stuff and all, I did a deep dive into the reviews on collagen supplementation. It turns out, I may have been skeptical out of a knee jerk response because the evidence is mounting that collagen supplements can be helpful in several categories: osteoporosis, osteoarthritis, and dermatological effects. Let’s have a look at each type.

First up is osteoporosis and osteoarthritis (which is the most common form of arthritis—generally considered the “wear and tear of aging” and can lead to back and neck pain). A recent study by Porfirio and Fanaro concluded that “hydrolyzed collagen has a positive therapeutic effect on osteoarthritis and osteoporosis with a potential increase in bone mineral density, a protective effect on articular cartilage, and especially in the symptomatic relief of pain.”

They reviewed nine studies and found that 8 grams per day increased glycine and proline levels (amino acids that can lead to some of the positive effects mentioned above). They found that 12 grams a day was the magic number that resulted in significant improvements in osteoarthritis and osteoporosis symptoms. Pretty cool.

Next, in the same review, 10 grams a day was found to alleviate joint pain compared to placebo. That study included 147 subjects for 24 weeks, a decent number of participants for that long time. Right around the time of publication, another study by Kumar et al. showed that 10 grams per day had a significant impact on relieving knee pain due to osteoarthritis. This was a placebo-controlled study, and the placebo showed no benefit. Again—good news for the aging athletes among us (and at 49, I’m one of them).

Another study reports that 5 gram a day improved the clinical benefits of an Achilles tendon rehab program. The participants were using calf exercises to strengthen their Achilles, and the supplementation accelerated the rate of tissue repair for the tendon.

This stuff sounds awesome, right? Is there anything it’s not good for? In fact, there is—muscle building. A recent study (May of 2019) looked at collagen protein as a supplement for muscle building and found it lacking. This is because the protein in collagen is missing leucine, which is the amino acid your muscles like the most when repairing and rebuilding itself. Fortunately, leucine is readily available in whey protein, the perennial favorite protein source for gym rats (including me).

My solution? I use both. I want the collagen to keep father time at bay, and the whey to help support muscle retention and growth.

If you’re interested in the brand I use, I have a store set up here.

In the interest of science (and practicing what I preach in my book), I recently finished one full year of tracking every single bite of food I ate and every sip of liquid calories I drank. I learned quite a bit about myself during that time, and now I’ll share the most salient stuff with you. Because I care.

Because I wrote a book on the subject of weight loss, and because of my station in life in general, nearly everyone who comes in my office who has lost a considerable amount of weight, and then maintained that loss, tells me about it. They all have one thing in common.

After my year of tracking, I saw how true this one thing is.

That one thing? Being honest with one’s self.

Before I started tracking, I had gained some weight while trying to get stronger in the gym. Muscle needs fuel to grow, and for most of 2014 I went after it hard in the gym seeking to hit the elusive thousand pound total–that is, between one rep of a squat, a deadlift, and a bench press, the total amount lifted would equal one thousand pounds.

For some power lifters, that number is laughably small, but for your average 40-something dude like myself, it’s no small feat. In the process, I gained quite a bit of weight. So, when all the gym abuse was over, I started following my program to shed the extra fat I had picked up in the process.

In the book, I encourage people to track their intake for one month to develop caloric awareness. I tend to take things to the extreme, so I can tell you about it here. Hence the full year.
The results? I didn’t do anything different outside of simple diet observation for several weeks. Predictably, nothing changed.

I did get a good look at where the problem was, though. Shockingly, I was eating too much. Can you believe it?

Specifically, I was eating too much at night in the form of crackers and cheese and nuts and such. This type of eating paired with the liquid calories that accompanied it in the form of red wine was the obstacle. So, in the name of science (and looking better), I stopped drinking altogether for about ten weeks, and since then I only indulge on rare occasions.

Once I stopped the majority (but not all) of the late night snacking the needle started dropping fast on the scale. I went from the mid 180’s to the mid 160’s over the course of the ten weeks. I decided that was a little too light for doing what I do in the office all day (a little extra oomph helps with the low back move I have to do 20 times a day). Also, my strength numbers were dropping in the gym. I expected that to happen but was pleasantly surprised how much strength I could retain at a much lower body weight. Staying strong at a lighter weight is the sweet spot–I was losing mostly fat and keeping the muscle I worked so hard to put on the year before. As a matter of fact, just last Sunday I set my all-time bench press record at a much lower body weight than I was at in 2014.

So if you want to lose some weight, my suggestion is that you so some tracking, find the weak link in your daily habits, and find some reasonable workarounds to get you through that part of the day without overindulging.

My go-to evening snack was to mix up some chocolate PB2 (it’s peanut butter with the fat removed that comes in a powder. Mix with water to get the desired consistency, and you’re off to the races). I’d then spread it over a low carb (which equals high fiber, nothing against carbs) tortilla that I’d get crispy in the oven. Sweet, salty and crunchy all at the same time and the whole snack is only around 160 calories. That one strategy helped me shave a good 400 calories a day off my total, and the dropping of weight came quickly as a result.

Now that I’ve finally finished the year I’m enjoying the freedom of not tracking anymore. I’ve learned how to approximate how much I’m eating, and I feel like I’ve become sufficiently calorically aware. But if I catch the needle moving up again I can always “recalibrate” my brain with a quick week of tracking.

The bottom line is we all have to find the balance between enjoying our food and not letting our enjoyment get the best of us. Keeping track of intake for a short (or even really long as in my case), can help you get your mind right about what’s really going on.