Articles

Book Reviews: “The Cure for Everything” and “Which comes first, cardio or weights?”

Do you have any skeptical blind spots? I’ve had a skeptical perspective for a long time (my teenage cynicism wasn’t just a phase) but the framework for my thinking has developed over years. Professionally, the blind spot that the pharmacy profession has towards supplements and alternatives to medicine was only clear after I spent some time working in a pharmacy with thriving homeopathy sales. In looking for some credible evidence to guide my recommendations, I discovered there was quite literally nothing to homeopathy. Once I discovered blogs like Respectful Insolence, the critical thinking process, and scientific skepticism, took off.

While my critical thinking about medicine is now pretty sharp, I’m discovering that I’ve had blinders one when it comes to the science of health and fitness. For context, I am regular runner and swimmer and work out several times per week. For a time, I considered myself to be a triathlete, and even managed to complete an Ironman triathlon. Now I exercise because I like it. (Plus I have an unreasonable fear of cardiovascular disease.) But my exercise practices developed through a combination of expert opinion, personal experimentation and anecdotes from others. Judging by conversations with others, I suspect this isn’t uncommon. So I run with Gatorade, stretch after my workouts, and sometimes have a protein shake after my weekly long run. Science-based? I rarely paused to ask. Here I sound like a CAM advocate: It worked for me.
The superstitions of top athletes are well known, but what’s less well known is the extent to which the conventional knowledge about diet, fitness, and nutrition also lack good scientific evidence. We’ve covered the occasional focused topic here at SBM, but blog posts don’t tend to offer the general overview and analytic framework that can guide the new reader. I also recognize that blogs are not a primary source of information to many people, so any credible sources in other formats that I can refer to are always welcomed.

I’ve found two excellent references to recommend. The first is Timothy Caulfield’s “The Cure For Everything”. Caulfield is a professor in the Faculty of Law and School of Public Health at the University of Alberta. His book is an accessible, engaging read into the world of health, fitness, and alternative medicine. The book’s subtitle is “Untangling Twisted Messages about Health, Fitness and Happiness” and that’s exactly what Caulfield does – with a personal perspective. While an academic by training, Caulfield doesn’t just regurgitate the evidence. In fact, he really tries to understand different perspectives, and does this by immersing himself fully into his topics. Caulfield is a strong advocate for the use of science to guide decision-making:

At a time when scientific information has never been more important, it is being subjected to an unprecedented number of perverting influences. Not that this should come as a surprise. As science becomes more central to our lives, the stakes grow higher the incentives to twist the scientific message multiply.

Tim also zeroes in on an important point in how we teach people to make better scientific decisions:

May scientists believe that if people just knew more about science or understood the facts, they would be more rational about their health decisions. This view, which has been called the deficit model, is faulty. Research has shown that learning bout science can have a dramatic impact on a person’s views about health issues – as I optimistically and perhaps naively hope this book will- but that this is not the norm. Supplying individuals with facts rarely alters beliefs. People see, select and interpret information about health (and many other topics) through individual and largely self-constructed lenses of preconceived beliefs, values, and fears.

Tim’s approach to this is to treat each topic with a mix of personal anecdotes and contrast it with what the scientific evidence actually says. Like the SBM blog, the book doesn’t just focus on CAM – his exploration includes the spin of both the pharmaceutical industry and the direct-to-consumer genetic testing industry, show that the twisting of science for marketing purposes is hardly the exclusive domain of the CAM advocate.
Caulfield’s chapter on fitness is where I personally learned the most. He contrasts the marketing of fitness (all about sex appeal and 6-pack abs) with the unequivocal health benefits conferred – despite the fact that dramatically changing our appearance due to exercise alone is near-impossible. That’s because exercise is spectacularly bad at producing weight loss. Caulfield attributes much of the inaccurate messaging about diet and exercise to the food industry, which tends to portray inactivity as a driver of obesity, rather than suggesting the avoidance of calorie-dense, nutritionally-poor foods.

While it’s an evidence-based book, Caulfield’s personal experience make the book read more of a personal odyssey. You’re never left wondering what the science says, but it’s distilled with his own particular perspective. Caulfield gleefully debunks is the idea that stretching is both necessary and good.  (Raise your hand if you spent hours in gym class doing static stretching.) The evidence actually shows that there’s little data to support routine stretching for preventing injuries. And stretching may impair, rather than benefit, a range of athletic activities.

Caulfield argues that the importance of strength (resistance) training for people of all ages and fitness levels has been under-emphasized, and uses this to recommend approaches to maximize your gains. He drives home the evidence demonstrating a clear dose-response to exercise – so intensity is key. Public health messages that advocate “moderate” exercise (which make sense when targeting a largely sedentary population) have obscured the reality that it is the intensity of exercise that drives health gains. For this reason, he is critical of yoga, which is far less effective than most other forms of exercise at building strength or cardiovascular benefits. Again, it’s the marketing of yoga (a multi-billion dollar industry now) that creates the perception of the health value of yoga, which is largely unsubstantiated.
The section on diet starts with some simple questions: “What, when and how much should I eat?” that he poses to a panel of diet experts he assembles – and then follows their science-based advice for three months. Without spoiling the surprise, Caulfield describes the impact of his own experiment while weaving in what the evidence says – and has some remarkable results along the way – all without miracle pills, supplements, and gimmicks.
The chapter on the alternative health industry will be the most familiar to SBM readers. Caulfield is a strong science-based medicine advocate (and even mentions this blog) and he understands and explains how CAM advocates spin evidence and market themselves in ways to adopt the veneer of science, without the substance. As part of his research, he even visits a naturopath, describing the visit as “the most pleasant clinical experience I have ever had.” The naturopath’s prescription to prevent motion sickness? Deep breathing, supplements, acupuncture, and homeopathy. Caulfield actually has his session with the acupuncturist, and takes his homeopathic nostrums as directed on an Alaskan cruise, with expected results. He goes on to a deep dive into naturopathy, and his evisceration of the premise and evidence base for naturopathy would make Kimball Atwood proud. He notes that naturopaths can offer reasonable and scientifically sound advice – but argues that this is only when they happen to align with naturopathic philosophies – not because they have been evaluated by naturopaths from a scientific perspective. Caulfield emphasizes that naturopaths crave mainstream legitimacy, yet refuse to renounce the magical (and debunked) framework that guides naturopathic practices:

If people want to go to alternative practitioners because they enjoy the personal attention (and I sure did), because they  appreciate the holistic approach to health, because they are attracted to the underlying philosophy and are comfortable with the lack of evidence, then I say go for it. But if the field claims to be scientifically informed, as is the case with modern naturopathic practice, then it must follow the principles of science, And practitioners should not deceive patients about what the evidence says.

Homeopathy is an easy target, for sure. It is universally accepted by those within the scientific community that it’s a crock. But that is why it serves as such a damning example of the twisting power of an overriding ideological framework. If naturopathy was really evidence based, would naturopaths provide homeopathy as a primary treatment? Is the use of homeopathy supported by “voluminous research” as claimed by the head of the British Columbia naturopaths’ association? Or do naturopaths hold on to a belief in this therapy because it is part of the naturopathic tradition and accords closely with the foundational (and unscientific) principles of the field? The answers to these questions are patently obvious.

Because of Caulfield’s work in area, he’s been widely quoted in the past weeks as the Province of Alberta has announced plans to register and regulate naturopathy. So much for evidence-based health policy. For anyone that needs an introduction to SBM and the importance of making health decisions based on good scientific evidence, Caulfield’s book is an excellent introduction.

Which comes first, cardio or weights?
The second book which I’m just as excited about is Alex Hutchinson’s “Which comes first, cardio or weights? I became aware of Alex’s work through regular columns in the Globe and Mail which stood out from the usually health and fitness tripe in that they were strongly evidence-based. A journalist with a PhD in physics, Alex is excellent writer plus an accomplished distance runner. (A combination I aspire to, but fail on both counts).  Hutchinson brings a mix of pragmatism and science to his blog at Runner’s World, which is also reflected in his new book, which answers dozens of pertinent health and fitness questions, such as:

  • Are elliptical trainers useful?
  • Is “barefoot running” all it’s touted to be?
  • Is there really a “fat burning zone” for my heart, and should I target it?
  • What should I eat or drink before, during, and after workouts?
  • Does listening to music help or hurt my workout?
  • What athletic shoes do I really need?
  • How does exercise affect my immunity?
  • Will running ruin my knees?
  • Can you change your running style? Should you?
  • Should I stretch? (Depends on why you want to do so – it doesn’t help performance)
  • Do compression garments help performance or recover?
  • Is it lactic acid buildup that’s causing muscle fatigue?
  • What is an exercise “stitch” and how do I prevent them?
  • Are those maximum heart rate charts in the gym accurate?

Well referenced and grounded in the evidence, I have little to critique about the book. I don’t want to spoil the read for you – I learned a tremendous amount about my own blind spots of exercise, which is going to help not only my own fitness habits, but also the advice I offer to others.  Compared to Caulfield’s book, this is a much “deeper dive” into the specifics of exercise, but it’s an excellent read for anyone interested in maximizing the gains from exercise.  Both books are exceptional in the way they cut through the noise we’re exposed to everyday when it comes to diet, health and fitness advice.

Great science-based references that are accessible to a general audience are hard to come by. I am happy to recommend “The Cure for Everything” and “Which comes first, cardio or weights?” unequivocally.

Posted in: Book & movie reviews, Naturopathy

Leave a Comment (18) ↓

18 thoughts on “Book Reviews: “The Cure for Everything” and “Which comes first, cardio or weights?”

  1. BillyJoe says:

    “Caulfield gleefully debunks is the idea that stretching is both necessary and good. (Raise your hand if you spent hours in gym class doing static stretching.) The evidence actually shows that there’s little data to support routine stretching for preventing injuries. And stretching may impair, rather than benefit, a range of athletic activities.”

    What about dynamic stretching?
    It is pleasant, quick, and easily mastered.
    It is possible to stretch every muscle in the body in ten minutes.

    http://en.wikipedia.org/wiki/Dynamic_stretching

    In the past, whenever I read that stretching does not prevent injury or improve performance, I tried saving time by dropping the stretches from my schedule and, every time, I ended up with muscle pain, cramping, and the resulting decrease in performance which I promptly corrected with the re-introduction of stretching. I decided that if the pronouncements about stretching were true, they could not be universally true because it helped dramatically in my own case.

    Many years later, I discovered that those studies were referring to what I now know as static stretches. I’d often seen others holding their stretches, but I couldn’t see any rationale for doing so. I actually invented dynamic stretching for myself. Certainly I’d never seen anyone else using this form of stretching before I developed the technique. I found I could dynamically stretch every muscle in my body in the time it took others to statically stretch jusy one muscle group. I just didn’t know it already had a name.

  2. Alia says:

    Personally, I treat those 5 minutes of stretching after a fitness class as a way to slow breathing and pulse, so that I do not need to go out all red in the face and panting.

  3. egrrrl11 says:

    Thanks for the reviews, just put holds on both books at the library!

  4. Janet Camp says:

    Thanks for exposing yoga. The popularity of this particular pastime have become so pervasive that it is now considered to be a method for actually achieving fitness and “well-being”–all without really doing much at all for most people. It just makes them feel better to sit in a “position” rather than on the couch.

    Some of the claims I hear for yoga are right up there with all the rest of the altie fads, yet none of the middle aged women I know who “practice” yoga regularly have gained any measurable benefit (other than psychological–placebo?); that is, they have not lost weight, gained strength, changed their health status or even seem more “relaxed”.

    I realize this is just my own observation, and if there is data to the contrary, I’d love to see it. I am more than capable of changing my mind.

    Thanks for the reviews; both books sound well worth reading.

  5. Angora Rabbit says:

    “That’s because exercise is spectacularly bad at producing weight loss.”

    I did a double-take at this sentence until I realize what was left out. Unfortunately the sentence as it stands run the risk of being as equally misinformed as the topics the book critiques.

    It should read “Aerobic exercise is bad at producing weight loss in the absence of altered eating habits.” Yes, there’s a hill of studies showing that exercise alone only creates small weight changes, on the order of a few kg. This is because people eat more to compensate for the calories burned, plus the modest muscle replacing fat is denser so weights more. Exercise-alone IS very effective in improving metabolic health.

    However, exercise PLUS being aware of what one eats, and making healthy nutrition choices as a result, IS effective at weight loss. And has even greater benefit to metabolic health. I think you allude to this later in mentioning the nutrition consult.

    I just wanted this correction out there because someone will doubtless cite it to support an incorrect view.

  6. mousethatroared says:

    Sound like an interesting book. Thanks for the review.

    I am particularily interested in reading his take on stretching and yoga. Maybe I am peculiar, but I when I danced as a youngster and when I took marital arts, I found stretching (after warmed up) to be very beneficial to increase flexibility, which helps in both of those pasttimes. I also find it to be helpful with muscle tension.

    Personally I enjoy Vinyasa (Flow) yoga, when I can do it. It is mentally challenging enough to keep me from getting bored, the poses flow into each other for what feels like a reasonably good light aerobic/weight bearing exercise combo. It’s nice on alternate days to more challenging workouts.

    But then again, I am not athletic. I tend to set the bar quite low, i will count anything that I have the patience to maintain for a 1/2 hour or more, increases my heart rate, makes me sweat and doesn’t cause some sort of joint or tendon pain as “good exercise”.

  7. Alia says:

    @Angora Rabbit – I’m a very good example of what you’re writing about. About six years ago I took up exercise. Not very intensive, an hour of aerobic twice a week. And while I started feeling better, for example I wouldn’t be out of breath after climbing to my flat, which is on fourth floor, I didn’t lose any weight. In fact, I got fatter – because I had this feeling “you exercise, you burn calories, so why limit what you eat?”. And then, three years ago I also changed my diet. And I lost 50lb, which so far haven’t returned. Anecdata, I know, but I see quite a lot of women at my fitness club who do not lose any weight, even though they exercise regularly.

  8. Angora Rabbit says:

    Alia, congratulations! That’s wonderful! I didn’t get to mention earlier that the lack of an exercise-only effect on weight is greater (worse?) in women than in men, and once the women changed their diets, then the weight benefits accrued. Anecdote ain’t data, but but you are definitely within one SD of the mean. :)

    Congrats again!

  9. michaelSkiCoach says:

    Thank god for this article – I am planning on buying both of these books. I’m married to a yoga instructor and I’m always made to feel guilty when I avoid both after exercise stretching and yoga. I also go into hiding when I see her fetching the mats and straps.

    Having said that I must confess that maintaining basic flexibility is a requirement for most sports. I find that when I avoid stretching altogether then I have knee tracking issues running and biking. Of course that equally may have to do with being over fifty !

    Having been a volunteer fitness instructor and coach for many years I can affirm that the fitness industry puts alt. medicine to shame when it comes to new fads and completely unsubstantiated claims. Fortunately most current fads come in a full circle and so my twenty years out of date perspective is now in vogue.

    Thanks for this blog.

    p.s (I don’t really hate yoga – I just prefer beer!)

  10. Bulk says:

    I’d love to know about what amount of protein he found was recommended. I’ve seen as many different recommendations as I’ve seen sites. The only consensus seem to be that one should eat more protein than feels natural.

  11. Lytrigian says:

    A bit anecdotal, but when I was regularly running about 7 miles a day and developed ITBS, stretching was the only thing that worked for it.

  12. niftyblogger says:

    I had a WTF moment a few days ago. I work as a technician in a lab, and my boss is a well respected late-career scientist who build her career on multidisciplinary infectious disease research. She obviously has incredible scientific prowess and has both a medical degree and a PhD. She is constantly encouraging me to develop good scientific questions and clear methods to answer those questions and to look at my data objectively rather than emotionally. Almost like a mentor character in a movie.

    Except, the other day, when I told her I’d been having trouble finding medication for my anxiety and was quitting the drug rollercoaster in lieu of exercise and a diet change, she praised my decision to go a more “natural” route to remedying my anxiety and also started recommending acupuncture and naturopathy to me as a better alternative to conventional medication. i was pretty shocked to hear that coming out of her mouth. Has she never thought to question those claims seeing as how extensive her science training is?

    I guess belief is stronger than any training. She’s a cyclist and general outdoorsy person. She rides her bicycle 30 miles to work and 30 miles back each day and she is ~60 years old. She’s a vegan. She is very fit due in part to starting out that way in life. Alternative medicine and alt-med fitness loons believe that stuff “works” because they are already healthy and find it convenient to attribute it to their altie lifestyle rather than good genetic luck.

  13. WilliamLawrenceUtridge says:

    I’ve long thought that CAM is little more than a combination of emotion-focused coping and health-focused discount psychotherapy. I personally think most people would benefit from a visit to CAM practitioners so long as they spent most of the time talking about their symptoms and how they felt about them, and ignored any recommendations.

  14. Mike.Gayner says:

    Went to buy these books – neither of them are available on Kindle in my region. Guess I’ll have to pirate them. Ugh, why don’t these authors get it yet?

  15. Janet Camp says:

    @AngoraRabbit

    I know it’s a bit late, but I just saw your comment re exercise and weight loss–which also misinforms. As far as anecdotes go, I lost 45 lbs, six years ago and have kept it off. I did not change my exercise habits at all. I walk, a mile or so most days. I am active but don’t do any formal routines.

    That’s just an anecdote, but the point is–and I think you made it yourself in a way–is that exercise has little to do with weight loss, on any level. It’s about what goes in. Eat less, lose weight. Exercise is good, in and of itself, but weight control is mostly about the “what goes in” part. Food companies would like you to think otherwise so that they can make you feel that it is your own fault you are fat, rather than the food abundance culture we live in. I’m not denying personal responsibility, just putting it in perspective, especially where children are concerned.

    There was some recent reporting in the NYTimes about the weight loss/exercise connection that confirms what I am talking about and I’ll look for a link. Marion Nestle also talks about this in her blog (foodpolitics.com) and in her writings.

  16. jhawk says:

    Janet Camp/AngoraRabbit,

    I think you have either misunderstood Angora or Angora is off base IMO. (or maybe I have misunderstood Angora!).

    It is all about Calories in vs. Calories out. You can lose weight (I prefer fat loss, more in a sec) by 1) exercise alone as long as you don’t increase your Caloric intake 2) restricting your Caloric intake 3) combo of both. It’s not that exercise alone doesn’t create weight loss, it is the increase in Caloric intake that keeps one from weight loss. I prefer fat loss because, as Angora said, muscle is more dense than fat and with increased exercise can make it seem in the beginning that one is not losing “weight” but this increase in muscle mass is the perfect recipe for sustained “weight” loss as it helps you burn Calories more efficiently. Obviously (and as Angora stated), exercise plus Caloric restriction and sound nutrition is the best way to proceed for “weight” loss.

    Thoughts?

  17. Pingback: mlsp review

Comments are closed.