Thoughts on the Ultraprocessed Nation

I recently returned from a short caregiving trip in Finland and was catching up on my weekly research digest on the plane. This particular research article caught my eye because of what I had just experienced the cafeteria of my father‘s senior facility.

https://www.amjmed.com/article/S0002-9343(25)00549-2/abstract?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites&utm_term=recent%20study&utm_content=recent%20study&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

In the US, as in some other developed nations, which are unfortunately catching up with US standards in terms of the over abundance of ultra processed foods in that daily plate, ultra processed foods are starting to make up a whopping 70% of our total food consumption. While most people understand on some level that processed food is bad for them, we have a long way to educate people to make them understand what in their grocery basket is a real food versus a highly processed food. And understanding doesn’t necessarily translate into better consistent food choices either.

Moving away from ultra processed foods back to whole foods shouldn’t feel like this insurmountable task. But it takes a lot of communal goodwill, and a lot of structural changes in how a country supports food growing, distribution and pricing. Which would be an entirely different complex and lengthy discussion that is not appropriate for this blog entry.

Back to my trip to the senior care cafeteria. I was having lunch with my family and was so delighted to realize that most of the food offerings were so simple and essentially healthy even in the context of mass production (after 20 years of visiting my father in Helsinki I can assure you this is the norm and not the exception). So much so that I decided to immortalize it with my phone. The soup is a simple chicken and carrot soup in a creamy broth, made from scratch, the main course is ground beef and cabbage, the sides are lingonberry sauce, roasted zucchinis and roasted root vegetables, plain mixed vegetable salad with a dash of sauce and some pickled fish. Totaling close to 90% of unprocessed foods. Pretty tasty too, especially if you are used to eating these sorts of whole foods dishes. The bottom line is that it’s possible, but it’s going to take some personal and collective dedication to reverse the trend and make this cafeteria tray the norm and not the exception.

WHAT IS THORACIC OUTLET SYNDROME

Another overdue blog about a very common problem that lands a lot of people in our office who have often been worked up medically and released with no good explanation or treatment plan.

The term thoracic outlet syndrome is an umbrella term encompassing several clinical syndromes, which all have to do with compression of nerve and/or vascular structures between the neck and shoulder.

Once the cervical nerves exit the inter-vertebral foramen, a.k.a. the space or hole between two adjacent vertebrae, they will join and repackaged themselves in three branches that will then travel downward into the upper arm and give rise to the three major peripheral nerves: radial, median, and ulnar. Shortly after their redistribution from cervical nerve roots into peripheral branches, they are joined by nerves and arteries exiting from the thoracic cavity, to form the neurovascular bundle. You will often see the abbreviation NAV, to describe respectively nerve artery and vein, that travel together. As a result, any of these thoracic outlet compression syndrome subtypes will almost always include a combination of symptoms due to compression or irritation of the nerve as well as compression of vascular structures. As a result, the symptoms can include not only pain, numbness, but also change in blood flow into the upper extremity that can manifest as sensation of cold and discoloration.

The most common causes of thoracic outlet syndrome is that I find myself treating in the today practices are as follow:

– the scalene muscles are really a big player. They respond to cervical injuries by going into spasm, or developing scar tissue from things like hyperextension whiplash injuries. The soft tissue injury to the scalenes will often result in strangling or adhesions to the neurovascular bundle and brachial plexus. It's relatively easily to palpate the problem if you know where to look and how much pressure to apply. If the scalenes are causing the thoracic outlet symptoms, you can reproduce it by lightly compressing the muscle into the neurovascular bundle. A normal interface of the scalenes with the brachial plexus will move out of the way and cause no symptoms with light to moderate pressure.

– Improper alignment of the anterior first rib to the posterior clavicle. This is often the result of upper thoracic sprains and or shoulder girdle sprains, especially a chronic clavicular and sternal clavicular injuries. After the neurovascular bundle and brachial plexus exit the scalenes they have to "dive" posterior and underneath the clavicle to enter the anterior axillary area.

– Deep pectoralis minor and coracoclavicular injuries or repetitive strain injuries. There's a pretty narrow space behind the pectoralis minor for the neurovascular bundle to travel. Most modern humans are very predisposed to compression in that area because of our poor posture, with our shoulders hunched forward and constantly internally rotated. As a result there is not a lot of margin for an additional minor injury to the shoulder such as falls, heavy pushing, and certain athletic injuries from trying to do push-ups or presses. I should say that seatbelt injuries from motor vehicle accidents are notorious for triggering new thoracic outlet symptoms and a lot of patients.

– Last but not least, the subscapularis muscle deep in the anterior superior armpit is also a common culprit. As the largest of the four rotator cuff muscles and a significant shoulder stabilizers, it sits just below and very close to the neurovascular bundle deep in the armpit. It's very easily triggered with falls and throwing injuries, as well as repetitive strain injuries.

Treatment of thoracic outlet syndrome needs to start with specific identification of the area of compression, and the structures causing the compression. For the most part the treatment plan is going to consist of a combination of cervical and thoracic alignments, a lot of very specific soft tissue releases to separate nerves and vascular structures from the compressing soft tissue, and addressing some of the chronic postural distortion patterns that predispose to the compression in the first place. But treating thoracic outlet syndrome can be surprisingly rewarding, since many cases do respond pretty quickly within a few treatments, partially because many of the structures are not usually associated with more complex long-term degenerative changes that are slower to respond to conservative care.

PSOAS 101: what is it, what does it do, when does it hurt ???

Many people are getting familiar with the name of this sometimes hidden and obscure muscle, because of its importance and clinical relevance.

The psoas muscle, or more accurately the iliopsoas muscle group, is part of a broader group of muscle known as the hip flexors. As their name would indicate, their function is to flex the hip. But in reality the iliopsoas muscle group is involved in many more functions and clinical conditions that I would like to briefly highlight below.

– The iliopsoas is a very deep muscle group that is in the anterior part of the lumbar spine. As such it's difficult to palpate part of it. It's also a surprisingly large muscle group. For those among our readers who may be hunters, or butchered their own meat, it's the tenderloin muscle. The circumference of the muscle is larger than that of the spine itself which highlights its importance in the stabilization of the lumbar spine.

– In addition to being a hip flexor, the iliopsoas is a very strong lateral stabilizer of the lumbar spine. Which is why it's important to have a strong healthy and fully lengthened psoas in any persistent lumbar pain.

– The iliopsoas is important for a variety of clinical presentations. We always need to check it in persistent lumbar pain.

– Due to the modern lifestyle associated with frequent and prolonged sitting, the iliopsoas muscle will spend a large amount of daytime in the shortened position. This will create a lot of issues, most notoriously some anterior pelvic tilt of the lumbar spine and compression of the lumbar spine and lumbar discs. It's important if you have a sedentary job to offset this issue with frequent anterior hip extension stretches and gluteal activation.

– The iliopsoas has fascial connections into the thoracic diaphragm, as well as into the quads, and this latter connection can easily influence the function of the quads and normal alignment and tracking of the patella. When people have persistent patella pain, it's worth making sure that the psoas is firing and lengthening normally.

– The psoas influences pelvic tilt, and is an important muscle group to assess when patients have lumbar postural distortion such as a very anterior pelvic tilt.

– Several important peripheral nerves have to make their path through the psoas when exiting the lumbar spine and entering the leg. This would include the main femoral nerve, as well as some continuous nerves which only provides sensory input to the upper thigh such as the lateral femoral cutaneous nerve. Assessing the iliopsoas is absolutely crucial for any anterior leg pain and tingling presentations.

– Manually treating the iliopsoas requires a fair amount of training and experience on behalf of the practitioner due to the location of the muscle group within the abdomen, and close correlation to internal organs as well as traversing nerves.

BAKER'S CYST

It is a question that comes up quite often at the office and I thought I should give it its own blog entry. A Baker's cyst is almost a common household term but it's often very misunderstood.

Most patients think of a cyst as some sort of standalone lesion. A Baker's cyst is actually more so an outpouching of the synovial capsule of the entire knee joint. It is a non-specific finding associated with a variety of mechanical problems with the knee joint: aggravated osteoarthritis, recent sprain, meniscal tear, severe misalignment. All of these will cause some increased fluid production in the joint which will escape in the weakest part of the joint capsule, which happens to be in the back of the knee. Think of it as the "storm pond" of the knee. In some people the outpouching from the increased fluid pressure will result in a distinct round mass that often will extend downward into the upper portion of the posterior calf. It will prevent comfortable flexing of the knee especially.

In addition to the more traditional compression and icing recommendations, sometimes needle draining the Baker's cyst will be performed to relieve an acute situation. It will bring about some much welcome temporary relief, but that will be short-lived. The reason is that a Baker's cyst is caused by something else. It will recur at a high incidence if the reason for the cyst is not recognized and addressed.

In our chiropractic practices, we have found that a Baker's cyst highlights the need to look more closely at what's going on in the knee, and the entire lower extremity. Intrinsic subluxations of the knees, especially misalignment of the lateral tibia posterior, is excessively common especially with osteoarthritis of the lateral compartment of the knee. Something as simple as a posterior adjustment of the tibia can make a big difference in the amount of pressure building up in the posterior knee joint. However we also need to zoom out and look at the bigger picture, looking at the alignment of the lumbar spine, pelvis, foot and ankle, as to how much it's loading up the knee incorrectly, and address that as well.

The bottom line: a posterior swelling in the back of the knee is often categorized as a Baker's cyst, but you need to understand that this nomenclature refers to the end result of a variety of mechanical, postural, muscular imbalance, and alignment issues associated with the entire pelvis and lower extremity that are best understood and treated together.

Iliotibial band cupping

https://www.youtube.com/watch?v=6v6McHqoV08

What this gorgeous fall weather people are putting in their last long runs and marathons before packing their shoes for the winter month. As a result I seen a few more cases of lateral knee pain that are iliotibial band related among our runners and avid walkers. Iliotibial band overload is usually associated with some faulty mechanics in the pelvis and lower extremity as well is some muscular imbalances, so those obviously need to be addressed as the root cause. However once that's all said and done, you still often have to deal with the residual problem of the adhesions between the lateral quad and the distal iliotibial band tendon. One of the most effective ways to do so is using cupping. It has to be done multiple times other two or three day interval for maximal results, so I usually will teach the patient how to do it on themselves. The cupping will allow for the separation of the overlying flat tendinous band from the underlying quads during active flexion and extension range of motion of the quad. It's quite gentle and effective, without the pitfalls of some of the micro bruising and tenderness associated with deep tissue work which is best suited for less superficial structures.

CHIROPRACTIC ADJUSTMENT AND ANTIOXIDANT MARKERS

I recently had a little more time traveling, which has given me the opportunity to catch up on some of my chiropractic research podcasts.

One of the remarkable development of chiropractic research over the last 25 years has been in the basic science department among other places. In particular, while empirically chiropractors and their patients have known for a long time that the manual adjustment is associated with many changes in body chemistry well beyond neuromusculoskeletal markers such as pain reduction and range of motion, trying to document and quantify that has been comparatively lagging behind.

Some of the non-neuromusculoskeletal changes reported by patients often include feeling more energy, sleeping better, feeling less inflamed overall, improved mood and digestion and cognition. While some of those changes are thought to be associated with changes in neurological feedback loops between the brain and the body, this most recent piece of research seems to suggest that there is potentially an additional core biochemical change associated with the chiropractic adjustment, namely the modulation of local free radicals as well as the up regulation of the body's own antioxidant pathways. The research project was unfortunately interrupted by the arrival of the covid pandemic, which did reduce the total sample size of patients, making some of the statistical data a little tough to analyze, however this paper is still a very exciting first step in further investigating how chiropractic care can improve the overall long-term well-being of our patients.

https://pubmed.ncbi.nlm.nih.gov/39966844/

https://pubmed.ncbi.nlm.nih.gov/35760595/

Processed foods and your health: so much worse than we realized

https://www.sciencedirect.com/science/article/pii/S1550413125003602?via%3Dihub=&utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%27s%20Friday%20Favorites&utm_term=new%20randomized%20controlled%20trial&utm_content=new%20randomized%20controlled%20trial&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

In a less overt way than January 1st, many folks are trying to get back on track with a good routine at the beginning of the school year. They're trying to say goodbye to late nights and late mornings, ice cream and fair food. This recently published article in a very solid mainstream medical journal caught my attention in the midst of this process my patients are reporting. Two things primarily caught my eye: the data clearly shows that ultra processed foods are much more harmful than some mainstream reports leads us to believe, that "everything in moderation is okay", and that the effect of ultra processed foods extends way beyond traditional BMI and cardio metabolic health to include depression, thyroid function, fertility, and environmental toxicity markers.

Before we get into further details we should probably briefly review the classification of food according to its level of processing. Depending upon which source you pull up, foods are classified as unprocessed, minimally processed, moderately processed, and ultra processed. (Some classification systems a link minimally processed and moderately processed together). Foods that are minimally processed are things that are cooked, chopped, with very basic added non-chemically manufactured ingredients like salt, water, spices, oil, or fermenting cultures). Think yogurt for example with no sugar added. Or plain cooked canned chickpeas. Foods that ultra processed involve more than one step of basic cooking or fermenting, and the addition of multiple synthetic food additives that are not necessary for processing of food.

https://www.eatrightpro.org/news-center/practice-trends/examining-the-nova-food-classification-system-and-healthfulness-of-ultra-processed-foods

What's quite surprising to a lot of people is how many foods they eat commonly fall into the ultra processed category, foods that they assume are benign or maybe even healthy. High on my hit list are things like crackers, granola bars, breakfast cereals, most commercial breads, and even things like commercial smoothies. Those things are chemical junk bombs, with the list of ingredients more or less unrecognizable past the first one. (Which often is sugar). Beyond that you go into the more traditional ultra processed foods that most people realize they shouldn't be eating, things that come in a box, in a can, but even things like a commercial pastry is an ultra processed food. And it's very clear that unless you go to some sort of farm to table restaurant, pretty much anything you're going to eat out at a restaurant is going to be ultra processed.

Back to the study itself. Most people have a basic understanding that eating ultra processed food can lead to weight gain, and some of the more commonly recognized downstream effects such as cardiac disease. However we would be lucky if the problem stopped there. What was really stunning about the study is that among the various control groups were people who ate an ultra processed dominant diet but with a caloric intake that was very appropriate for their height and weight. Even at a normal caloric intake, people exhibited significant abnormal health markers, indicating that the type of food and the level of processing were a huge part of the problem. Beyond cardio metabolic disease, the study showed a statistically significant change in thyroid levels, (a lot of obese blamed their thyroid function when in reality the type of foods they are eating our causing abnormal thyroid function), significant elevated phthalates (a common chemical byproduct of food packaging, which is much more prevalent and ultra processed food than unprocessed foods obviously), significant changes in testosterone levels in men, sperm count, and FSH in women (a hormone associated with ovulation and fertility).

The bottom line: one of the best things you can do with your diet is to keep you nutrition simple by not trying to buy designer foods, but look at foods in their original format, with one or two ingredients. This does not mean that you cannot take simple hacks that will save you time, such as buying plain precut vegetables or squash, but that ultimately most of your diet needs to come from food in the form that nature provides.

Harmon's first massage blog

Hello! I’m happy to be able to share things I’ve learned about Massage Therapy with you through my first blog ever. I thought a good place to start would be some of the most common questions I get asked by clients. So here we go!

What is a knot in a muscle?

A knot is defined as “a bundle or cluster of muscle fibers or sarcomeres that are contracted and will not release their contraction.”

A sarcomere is the smallest unit of a muscle and is where the “contraction” happens. Clusters (they look like a honeycomb or a hexagonal structure) of these make myofibrils, which make muscle fibers, which make fascicles, which make a muscle “belly”. These bundles or clusters seal themselves off from blood and oxygen in your circulation system and prevents them from releasing.

So why won’t they release their contraction?

The area that has become the knot has used up all the oxygen and energy (ATP) in that region. The pH (acid to base scale 1-14) drops from a neutral pH of 7 or 7.5 to 4 or 4.5 (more acidic) in the surrounding fluid. This acidic state dismantles the neurotransmitter called Acetylcholinesterase which would stop Acetylcholine from stimulating the muscle.

In a less wordy way to explain it - the muscle doesn’t release because it is being told not to. It is being told the opposite and the instructions to stop that command do not arrive.

I’m going to keep these short and digestible for modern day attention spans. I hope you like these and I would love to hear feedback from you. Peace!