is a nationally acclaimed orthopedic surgeon and sports-medicine doctor who cohosts the popular radio show . Whether you want to know about bunions, better sleep, or running your first marathon without getting hurt, Dr. Cole can offer an expert’s take. Eric Haunschild, his research assistant, also contributes to this column. Have a question? Email AskADoctor@outsideim.com. The doctor is in.

Does apple cider vinegar actually do anything for your body or gut, or is it just something Goop has been selling us? If it is good, how should we be supplementing with it?

Apple cider vinegar (ACV) has been touted as a holistic cure-all for decades, and it’s as popular as ever in the wellness world. Proponents claim the pantry staple has all sorts of positive benefits:Ìý,Ìý, and promotingÌý, to name a few. And in theory, certain properties of ACV suggest that these claims may have some truth to them. For example, ACV contains B-complex vitamins, which Ìýin the body. But the anti-inflammatory propertiesÌýof these vitamins haven’t been studiedÌýin the context of vinegar consumption. That’s the problem with most of the claims people make about ACV—they just haven’t been proven, one way or the other.

ACV also has plentyÌýof antioxidants, and Ìýmay help reduce chronic disease burden as we age. However,Ìýscientific studies on antioxidants have been inconclusive, and there isn’t really any research about ACV’s antioxidants and their effects. When it comes to the gut,Ìýit’s possible that theÌýacetic acid in ACV could aid ourÌýdigestion and thus ease gut issues,Ìýparticularly as we age and produce less of our own stomach acids.ÌýIn theory, adding another acid may help achieve the same thing, but whether it actually works is also, as yet, unproven.

However, there are a few evidence-backed, measurable physiological effects, includingÌýincreased satiety: in a small study from the European Journal of Clinical Nutrition in 2005, participants who supplemented a standard meal with ACV reported feeling more full than those who didn’t. Another randomized controlled trial, in the Journal of Functional Foods from 2018, found that regular supplementation of two tablespoons of ACV daily for three months contributed to modest weight loss of a few pounds when compared to controls. So it seems apple cider might offer a small boost for those interested in weight loss—but that’s not necessarily aÌýhealth benefit, unless you’re working towardÌýa specific goal thatÌýyou and your doctor have agreed would be beneficial for you.

ACV has also been shown to offer a small amount of help modulating blood sugar and insulin levels after you eat a meal, but not soÌýreliably that it could replace traditional treatments and medications.ÌýA recent meta-analysis in theÌýÌýreported that in studies that collectively evaluated over 300 Type 2Ìýdiabetics, ACV supplementation did have beneficial effects on blood-sugar levels. However, most of the individual studies used small sample sizes, and while the results were promising, they were still pretty minimal.

If you’re interested in experimenting with supplementation, it’s safe to take ACV in small doses. Recommendations vary, but an ounce a day diluted in water is a safe place to start. The only notable side effects of overconsumption are an upset stomach and, if you take it undiluted, a sore throat orÌýweaker tooth enamel over time. Just don’t expect a miracle, and remember that if something sounds too good to be true, it probably is.

±õ’m obsessed with my TheragunÌýand generally any type of self-myofascial release, like vibrating foam rollers.ÌýIs it possible to overuse tools like this? The Theragun feels fantastic, but it’s also pretty aggressive.Ìý

From to ,Ìýit seems like everyone (including myself) nowadays is raving about the benefits of self-percussion therapy devices. Manufacturers claim that these devices accelerate recovery and muscle repair, improve blood and lymphatic flow, and relieve stiffness when regularly usedÌýbefore and after exercise. While some of these claims are likely overblown, there is some evidence that theseÌýdevices can alleviate delayed onset muscle soreness—and as long as you aren’t finding that the tool is leaving you achier than you were when you started, you’re probably fine. The key here is to listen to your body, and stop if it starts to feel painful.

Most of the benefits listed aboveÌýare anecdotal; of the above claims, the only one withÌýscientific evidence behind it is that these devicesÌýcanÌýreduce soreness following vigorous exercise. A 2014 study in the examined delayed onset muscle soreness. One group received vibration therapy after exercise, and another group had regular massage therapy. Those who received vibration therapy had a greater reduction in pain 48 hours after an intense workout compared to the massage-therapy group.

When using a percussive device, you can expect to feel some transient, mild soreness over the area being massaged, but you should use common sense. If you are percussing over areas that result in significant and increasing pain of a different character than simple muscle soreness, back off. These devices should only be used on muscle—other sensitive areas, such as an inflamed tendon or bursa, may benefit from a mild manual massage but should not be aggressively percussed. Percussing bone, in addition to being extremely painful, has no benefit. With these considerations in mind, using a Theragun on tired muscles may fast-track your post-workout recovery, and as long as you pay attention to your body, there is no real risk of overuse or injury.

The post Does Apple Cider Vinegar Actually Do Anything? appeared first on ºÚÁϳԹÏÍø Online.

ÌýisÌýa nationally acclaimed orthopedic surgeon and sports-medicine doctor who cohosts the popular radio showÌý.ÌýWhether you want to know about bunions, better sleep, or running your first marathon without getting hurt, Dr. Cole can offer an expert’s take. Eric Haunschild, his research assistant, also contributes to this column.ÌýHave a question? Email AskADoctor@outsideim.com. The doctor is in.

I keep hearing conflicting things about ibuprofen. My doctor prescribed a steady dose—400 milligrams in the morning and 400 in the evening—for tendonitis, but I always thought it was something to take on an as-needed basis for pain. And 800 milligrams a day sounds like a lot! Also, isn’t it bad for my stomach lining? What’s the best, safest way to use ibuprofen?

It sounds like you and your doctor are both right. Ibuprofen can be used to reduce pain and inflammation, but the way you dose depends on which effect you are predominantly trying to achieve. The pain-reducing effects of ibuprofen begin rapidly, usually within 30 minutes of taking a dose, so you can take it as needed, whether you have a headache or an achy knee. To reduce inflammation, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and Aleve need to be taken regularly over days to quiet the body’s inflammation-producing pathways. For persistent relief of joint pain, you should follow your doctor’s instructions and take a regular dose as prescribed, even if you aren’t feeling pain right at that moment.

It’s true that ibuprofen can be bad for your stomach and intestines. This is because the same pathway in your body that generates pain and inflammation also produces the mucus in your stomach that protects it from stomach acid. NSAIDs work by blocking cyclooxygenase enzymes, which play a role in producing a type of lipid called prostaglandins, which in turn act like a hormone throughout the body to initiate myriad biologic processes. In particular, they initiate the sensitization of our nerves to send pain signals to the brain, the generation of inflammation in areas where white blood cells signal them to do so, the inhibition of platelet aggregation needed for blood to clot, and the production of the mucous needed to line the stomach. When you take an NSAID, you alter all of these mechanisms, which can, over long periods of time, lead to stomach ulcers and bleeding. That’s why people with gastrointestinal conditions like peptic ulcer disease or Crohn’s disease, as well as people over the age of 65, shouldn’t take NSAIDs without first talking to a doctor. More commonly, taking ibuprofen can cause a mild upset stomach. If you get queasy, take it with food.

As a rule of thumb, you should opt for smaller, more frequent doses when taking NSAIDs. A usual dose is 200 to 400 milligrams every six to eight hours for no more than two weeks. If you miss a dose, don’t double up on the next one. Just continue dosing as usual. If you have any questions related to the safety or specific use of NSAIDs, you should consult your physician.

I roll my ankles all the time—on the trail, in heels, when ±õ’m just running on the sidewalk. Why? Does this mean I have weak ankles? Are there exercises I can do to make them stronger?ÌýAnd should I be wearing special shoes?

Tweaking your ankle is incredibly common: Americans make more than a million emergency-room visits each year for fractures and sprains of the joint. The ligaments of your ankle are exposed to a lot of stress. They can be torn or strained from a bad ankle roll, but they’re also prone to wear and tear over time with normal movements like walking. Every time you twist your ankle, you contribute to a snowball effect: the ligaments become weaker and more stretched out, which then increases your risk of rolling your ankle again. Without proper treatment, you can develop chronic instability, pain, and degeneration.

Physical therapy that targets and strengthens your ankle stabilizers can go a long way in ensuring your ankle heals correctly. Simple exercises that promote ankle movement in all directions, such as drawing the alphabet in the air with your toes, can help restore range of motion. Calf raises, balancing on one foot, and heel walks can all help strengthen the joint. Once you progress through these exercises, you can further strengthen the ankle with hopping exercises and training with other movements specific to your sport or activity. Find a physical therapist to help you develop your ownÌýpersonalized program.

There aren’t many conclusive studies about the role of shoe selection in reducing the risk of rolling your ankles. High-top shoes are thought to provide more support, but a number of studies comparing ankle sprains in athletes haven’t found a meaningful difference between high-top or low-top shoes. There are a number of Ìýand that can offer supplemental help in stabilizing the ankle. If you feel that additional support helps, there’s no reason not to use it—but remember that strong ankle stabilizers are much more critical in preventing future ankle rolls.

For more expert advice, you can follow Dr. Cole on , , and .

The post Are You Overdosing on Ibuprofen? appeared first on ºÚÁϳԹÏÍø Online.

ÌýisÌýa nationally acclaimed orthopedic surgeon and sports-medicine doctor who cohosts the popular radio showÌý. Whether you want to know about bunions, better sleep, or running your first marathon without getting hurt, Dr. Cole can offer an expert’s take. Eric Haunschild, his research assistant, also contributes to this column.ÌýHave a question? Email AskADoctor@outsideim.com. The doctor is in.

±õ’ve noticed that when ±õ’m stressed out, I get pressure headaches. When it’s really bad, I get chest tightness and feel fatigued—even nine hours of sleep isn’t enough. What does anxiety do to my body, and why?

Stress has long been identified as a trigger for the pressure-like headaches you describe, as well as migraines. People who suffer fromÌýsevere headaches or migraines are three times more likely to report anxiety than those without headaches. Despite this association, the exact reason why stress creates headaches is still unclear. One theory is that muscle tightness in the neck and head, which can reflexively increase with stress, results in dull tension headaches.

In addition to headaches, stress and anxiety can trigger a number of symptoms, including chest tightness and fatigue, abdominal pain, indigestion, dizziness, and nausea. Why we get these symptoms is complicated, but the theory is that they originate in a part of the brain called the amygdala, which coordinates our fight-or-flightÌýresponse. Once activated, the amygdala starts a chain reaction within the brain: it tells the hypothalamus to release something called the corticotropin-releasing hormone (CRH), which then triggers the pituitary gland to release the adrenocorticotropic hormone (ACTH). ACTH enters the bloodstream, where it prompts adrenal glands to release our stress hormone, cortisol. Cortisol produces direct effects across the body that are believed to play a significant role in the symptoms you describe.Ìý

What’s happening inside my muscles when I get a cramp?

Put simply, a cramp is a sudden contraction of a muscle that is involuntary and uncomfortable, and it can last from just a few seconds to minutes. This happens when the nerves responsible for controlling a particular muscle begin firing repeatedly at high rates, resulting in a strong and sustained contraction.

Our central nerves—located in the brain and spinal cord—control the motorÌýnerves that make our muscles engage. To initiate movement, a motor nerve sends electrical impulses to the muscle, releasingÌýcalcium andÌýactivating the proteins that physically result in muscle contraction.Ìý

While the mechanism of a cramp within a muscle is simple, its underlying causes are broad. More common exercise-induced cramps can result from rapid shifts in electrolytes, dehydration, or an accumulation of metabolites (the by-products of our muscles breaking down fuel), all of which happen during strenuous physical activity. Various nutrient deficiencies, neurological diseases, metabolic disorders, medications, and inherited diseases can all cause cramps. The reasons behind certain other cramps—like nocturnal leg cramps—are still a mystery.

Generally, cramps resolve without any need for medical attention. For those with recurring cramps, properly rehydratingÌýwith electrolytes and stretching prior to exercise areÌýusually enough to decrease their rate of occurrence. If you experience recurrent cramping associated with weakness or severe and persistent pain, you should seek medical evaluation to identify and treat the underlying cause.

I can’t help but slouch in front of my computer, but it’s killing my neck and shoulders. Could I be doing permanent damage? What can I do to help correct my posture and alleviate pain?

According to a Nielsen Total Audience Report, the average American spends more than 11 hours a day looking at a screen—which doesn’t leave lot of time for moving around. You’re more prone to poor posture when you’re sitting, because you lose the natural curve of the upper and lower spine when you plop into a chair, and staring down at a phone or a computer doesn’t help, either. ThatÌý strains the neck, spine, hips, and shoulders.Ìý

Usually, poor posture starts with muscular imbalance: your core stabilizing muscles (like the deep muscles of the trunk or the muscles of the pelvic floor) might be too weak, or simply disengaged, which makes you slouch and leads those musclesÌýto further atrophy. In a kyphotic posture, which is associated with a rounded upper back, certain muscles, like your ,Ìýcompensate and shorten,Ìýwhile other muscles,Ìýlike the ones in your back, stretch out and disengage.ÌýIf you’re a chronic sloucher, you’ll find that your mobility gradually decreases and your muscles and joints may ache.

Thankfully, targeted exercise and physical therapy can help improve your posture and alleviate pain. Several trials of regimented exercise programs administered to subjects with demonstrated significant improvements in shoulder, middle, and lower-back pain. There are a number of exercises that target the mobility and strength of the muscles most affectedÌýby poor posture. These exercises, such as squeezing your shoulder blades together (to increase proprioception and strength of theÌýtrapezoidsÌýand rhomboids) or slowly nodding your head up and down (to assist in maintaining range of motion), along with a concerted effort to minimize the time you spend sitting down or in poor posture, are often enough to provide pain relief. You might try setting a recurring alarm on your phone during the workday that reminds you to stop slouching, or opt for a standing desk.ÌýA physical therapist can also help designÌýa postural-strengthening program tailored to your individual needs.

For more expert advice, you can follow Dr. Cole on , , and .

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