New to 2010 is Dr Oughtred’s annual health assessment: a comprehensive health assessment that includes a medical assessment, a physical therapy type of assessment, and a fitness and lifestyle assessment. Patients will receive a 15 page booklet outlining and explaining their results, and it comes complete with a comprehensive plan that includes dietary recommendations, supplement and medication recommendations, exercise programs and tips, stretching advice, or recommendations for physical therapies or other hands on techniques.

The center piece of your assessment is the summary page, which quickly displays and colour codes your results alongside your recommended goals for the following year. This page gives you a comprehensive, yet simple ‘snapshot’ of your current state of health and fitness, and can act as a great motivator for the future.

For those of you who have extended medical insurance, your coverage will likely cover you for all, if not part of the assessment.

Assessment overview:

• Review and assessment of your current and past health concerns
• Relevant physical examination
• Orthopedic Assessment (Joint Alignment, Range of Motion, Posture, Strength, Stability)
• Fitness Assessment (Everything from grip strength and body fat to cardiorespiratory fitness and lactate threshold testing)
• Nutritional and Lifestyle Assessment
• Disease Risk Assessment (Framingham score, diet, biometrics, other)
• When indicated, referral to other health professionals, physicians or laboratories.

Your assessment acts like an annual membership, and you will be reminded when you are due for follow ups and important preventive medical screening tests and visits.

For fitness enthusiasts, the process involves measurement of lactate thresholds for precise assessment of endurance over time and selection of future training intensities. For those who want to manage their disease risk over time, the assessment gives you a framingham score, estimating your 10 year risk for developing coronary artery disease. This is the perfect annual health screen for someone who is looking for an executive health assessment with a strong focus on fitness, lifestyle, and athletic performance. Together with the advice and medical testing of your family doctor, your assessment will leave you feeling as though no ’stone is left unturned’ with regard to your health.

Aside from your assessments with your medical doctor, all parts of your annual assessment are performed by Dr Oughtred himself which provides for a 5-star professional experience which you won’t forget. Take the time for your assessment now, and see what new avenues of health open up for you.

Lactate Testing is quickly becoming the preferred test for people that want to assess their aerobic capacity and determine how to make the most of their exercise program. I began to offer lactate testing to all of my patients in 2009 and I have found it effective not only for athletes but also for anyone that wants to take a more precise, deliberate approach to their exercise program.

Testing blood lactates is a relatively new practice in sport that has become popular in the last 10-20 years, especially in sports such as swimming, rowing, speed skating and endurance sports like marathons, triathalons, cycling, etc. At first, even the best trainers in the world were often confused with the use of lactate testing, but over the last 10 years, some consensus seems to have been reached on some topics and experts agree that lactate testing is a superior tool for 3 key purposes:

1 – Measurement of Endurance Performance:

Traditionally the preferred performance test for endurance activities has been the VO2 max test. A drawback to the VO2 max test is that it assesses aerobic power at a maximal intensity over a short period of time – this is not reflective of a true endurance activity which requires a longer duration of activity at a submaximal effort. Other downsides to VO2 max testing is that it can be very expensive (good equipment is very costly) and the devices used to breath in and out of can cause anxiety and discomfort in for the athlete. Aside from the minor discomfort of finger tip blood sampling, lactate testing suffers from none of these drawbacks, and is probably a better performance indicator at submaximal efforts.

2 – Assessment of changes in aerobic fitness over time:

The lactate test measures your lactate levels at many different levels of exertion. As you become more fit, your lactate levels will be lower at each of these individual exertion points; the test demonstrates that you are doing the same amount of work at lower intesities than before. This shift in lactate levels over time is a very sensitive indicator of training adaptation.

3 – A tool to opimize training intensities:

Because lactates can be used to estimate your intensity levels during exercise, it is probably the best method to determine and prescribe future training intensities or ‘training zones’. This is especially useful for fitness professionals so they can avoid overtraining or undertraining an athlete. Learning your ‘Lactate Thresholds’ can essentially make your training more specific to your goals. Whatever your goals, lactates can be used to help get reach them quicker; you can more precisely improve your endurance, your V02 max, your ability to heal and recover, or your ability to burn fat during a workout.

In his book, “The Science of Winning”, Jan Olbrecht talks about how he uses the lactate tests with elite athletes prior to big events in order to properly balance their aerobic and anaerobic systems. Although this use is less popular, it is very enticing; it is hard to argue with the 40 olympic medals that Olbrecht was part of in the Athens Olympics!

Understanding Blood Lactate

Lactate is a byproduct of glucose, or ‘sugar’ in your body. As lactate accumulates during exercise, we can assume that you are using glucose as an energy source. As the intensity of an activity increases, the percentage of energy that comes from glucose will increase, and you will produce more lactate, which can be measured in the blood. At low intensities of exercise, your body uses its aerobic energy systems (using oxygen for energy) which spares glucose and keeps lactate levels low. The more aerobically fit you are, the harder you can push yourself without accumulating lactate. Over time, as you become more aerobically fit, you will be able to achieve higher levels of intensity and keep your lactate levels the same. If we graphed this over time, your lactate curve would shift downwards, and to the right.

As you increase your intensity during exercise, you will eventually overwhelm your body’s ability to recycle or remove lactate from the blood. The highest intensity at which you can create lactate in the body and still remove it from your blood is called your lactate balance point. This is an important intensity to learn, and it has many other names; ‘anaerobic threshold’, ‘lactate threshold’, or just ‘threshold’ are the other most common names used. As you push yourself beyond this intensity, your body’s energy systems will actually become inhibited and your performance will suffer if you hope to perform much longer than 5-8 minutes. Getting to know this balance point is critical for everyone, not just athletes, exceeding your balance point in training could have negative effects to your health, your performance or even your ability to lose body fat.

How Lactate Testing is Done

So what does a blood lactate test look like? The most widely used method involves an endurance test that has incremental increases in intensity. Each stage can be anywhere from 2-5 minutes, and at the end of each stage a small blood sample is taken by a fingerprick and placed into an analyzer. The total test length can vary anywhere from 20-60 minutes, depending on the fitness of the athlete and the length or increments of the stages. Testing is usually performed on a bicycle ergometer or a treadmill.  As stated previously, the test is approximating intensity at all stages, and so it does not require the participant to go ‘all out’, but it does require the participant to go up to at least an 8 or a 9/10 on the exertion scale.

Becoming more popular is the FACT method, which involves an initial staged performance test as outlined above and then follows that up with a another staged approach that is thought to better isolate the balance point between lactate production and removal from the body. I utilize both methods, as I find the traditional method effectively demonstrates fitness adaptations over time and the FACT method is excellent for determining future training intensities or ‘training zones’.

Set Your Targets and Optimize Your Training Time

After your lactate test, you will have objective information from which you can set future targets for improvements. You will also have an outline of your individualized training zones that you can use to effectively target your weaknesses and make the most of your limited training time.

The 2 supplements that I recommend the most are Fish Oil and Vitamin D. Lately, its seems that the evidence for supplemental Vitamin D is mounting at a rapid rate, and I thought it would be appropriate to write about it.

Vitamins are called vitamins because our body’s cannot function without them – they are vital to life. Almost all of them have to be consumed in the food we eat, or we will get deficiency syndromes and die. Vitamin D is different; our primary source of vitamin D is from the sun.

Vitamin D functions as a hormone in the body, which makes it unique from other vitamins. The human body can make it, but unfortunately it needs a little help to be switched on. This is the where sunlight comes in; circulating vitamin D close to the surface of the skin is altered by the sun’s radiation, converting it from D2 to D3, the active form of the vitamin.

The active form of Vitamin D governs the absorption and metabolism of Calcium in the body, and calcium is used by all cells in the body. Thus it allows for proper functioning of the entire body, but in particular the immune system, the nervous system and the skeletal system allowing for strong bones and teeth.

Right now, research is demonstrating that lower levels of Vitamin D are associated with a variety of problems. For instance, experts agree that the increased incidence of Multiple Sclerosis and other autoimmune conditions at higher latitudes is at least partly due to a lower supply of Vitamin D from the sun. People with darker skin who live in higher latitudes are more susceptable to deficiency because dark skin acts as natural sunblock, and prevents the activation of Vit D. It is no coincidence that people with lighter skin live at higher latitudes.

It’s a catch 22: direct sunlight can lead to skin cancer, and the lack of direct sunlight can lead to more cancer, weak bones, insomnia, dementia, autoimmune disease and who knows what else. I don’t recommend tanning beds because it is too easy to burn your skin with them. Dietary sources of Vitamin D are usually not adequate on their own.

The solution is to either supplement your sunlight or supplement your diet. You would need at least 30 minutes of direct sunlight sunlight on at least 3 days of the week to get it from the sun, and even with that amount you are not guaranteed optimal intake. Because I live in Vancouver, where sun is hard to find in the winter, I recommend supplementation for most patients. Walter Willet from Harvard’s school of public health recommends 1000 IU for all people, regardless of where they live, and he says that the recommendation may increase pending further research. I recommend 1500 IU per day during the dark winter months and 1000 IU per day during the brighter/ sunnier months. When in doubt with your dosage, you can have your blood tested to fine tune your optimal dosage. I shoot for 60-100 pmol/L with my patients.

Review:

Supplement 1000 IU – 1500 IU Vit D per day, or ensure > 30 minutes of direct sunlight on 3 or more days of the week.

If in doubt, have your Vit D levels tested to see what your optimal intake is.

During my athletic career, I was impressed by the knowledge and understanding of the physical therapists that helped me.  Unfortunately, I almost always had to be injured before I would benefit from their expertise.  It made no sense to me to wait until I was hurt before addressing my physical weaknesses ; I wanted something more pro-active.  Prehabilitation (prehab) is the act of applying rehab principles to healthy individuals in order to prevent injury and enhance physical performance.

Rehabilitative principles are applied in a step-by-step fashion, to ensure that the body is not forced to do anything that it is not ready for.  I will outline some of these steps, and give you examples of why each could be important to you:

Reduce Pain and Inflammation

Pain or inflammation in a joint causes key muscles to be deactivated, as well leads to patterns of avoidance.  Running with a sore back for instance can train key stabilizing muscles not to work, leading to instability of the back long term, and can cause you to adopt habits that could make you a slower runner in the long term.

Ensure Proper Joint Motion and Stability

Tight ankles, especially one sided, can cause rotation through the entire body, cause unequal wear and tear of joints, overuse of other joints, and poor balance.  Weak hamstring muscles can increase your likelihood of tearing ligaments in your knee.

Efficient Movement and Posture

Your technique when you exercise determines which muscles get strong, which ones stay long and supple, which joints get stressed, and how tired you get.  Anti-inflammatory herbs or medications may help for your knee pain, but if the cause of the knee pain is the way you walk or run, then your pain will always recur.

Notice that none of the above steps have much to do with general fitness; someone can be very strong or fit, and still fail some of these steps.  Every day, people are exercising or performing simple daily tasks with limitations in the above categories, and those seemingly healthy activities can be making them unhealthy.  Don’t wait until you are unsatisfied with your physical health; learn about your physical limitations and what you can do about them right now.

Exercise and sleep can help to prevent cancer

A study in Maryland found that people who had less sleep had a greater chance of getting breast cancer.  The CDC recognizes sleep deprivation as a serious health problem with fewer and fewer people getting the sleep that they need to be healthy.  Lack of sleep is associated with many chronic ailments, including obesity, depression, cardiovascular disease, hypertension, and cardiovascular disease.  Where are the studies that demonstrate effective techniques to get people sleeping and exercising more?

Another reason to sleep longer – short sleepers and cardiovascular disease

In most people, blood pressure decreases while they sleep – a phenomenon that is thought to decrease the strain on the heart and blood vessels during the night.  Japanese researchers showed that individuals who had less sleep also had higher sleeping blood pressure, and consequently had more cardiovascular disease.

Vit B3 prevents the progression of alzheimers in mice

Nicotinamide (Vit B3) has long been used by Naturopathic Physicians as a treatment for neurological problems, and to enhance cognition.  This recent study suggests it may limit the progression of alzheimers disease in mice, but it is too soon to recommend it in humans because Vit B3 is toxic if taken in too high a dose.  Which begs the question…should I stop drinking water because it could kill me if taken in too high a dose?  B3 is very safe when taken in the right form and the right dose – consult your physician before using it.

You mean there is more to heart disease than blood pressure and cholesterol?

Cholesterol is a good measure of cardiovascular disease risk, but it is definitely not the only story behind heart disease.  With the widespread use of statin medications, cholesterol is becoming better controlled, but other risk factors like body weight and blood triglycerides are still increasing – evidence that we need to start treating the causes of heart disease instead of trying to mask its symptoms with costly medications that come with side effects.

Watch what you eat – for your children’s sake

A recent pediatric study proves that children will mirror the eating habits of their parents, underlining the importance of learning healthy eating habits not just for your own health, but for the health of your children as well.

British study associates coffee drinking with low birth weight babies

In light of a recent study, Britain has decreased its guidelines for caffeine intake to a maximum of 200mg/ day.  This is probably the equivalent of 2 small cups of coffee.  This same article from the BBC also mentions that the FSA may actually relax its guideline for alcohol consumption during pregnancy, as alcohol consumption is currently not recommended.

Another possible role for the hormone seratonin – controlling bone density?

A recent paper published in the journal Cell, discusses how Seratonin that is formed in the gut actually promotes the breakdown of bone in genetically modified mice.  Commonly referenced for its relationship to positive moods, seratonin is actually most plentiful in the human digestive tract, and the full scope of its effects have yet to be discovered.

Waist measurement – a simple and very effective risk analysis

Researchers in Europe are doing a good job at discrediting the old body mass index (BMI) model for cardiac risk analysis, in favor of a simpler and more effective waist to hip ratio.  It is the size of your waist (the area around your belly button) and your body shape that really matters when it comes to predicting your risk of dying from heart disease.

Probiotics – Good for your gut…and your curtains…?

Simply applying ‘good bacteria’ to curtains and other surfaces in hospitals has shown to cut down on infection rates, and the effects are comparable to that of antibiotic solutions.

Professor Gilbert Welch, MD, wrote a very interesting article in the New York Times recently about the current state of preventive medicine and how it pertains to the US presidential campagnes.

Today, Preventive Medicine should really be called early disease detection.  People are encouraged to come in to see the doctor at various ages in order to make sure they don’t have an illness that they are unaware of.  This approach is effective at detecting some diseases before they are out of control, but it does little to prevent disease and it ends up costing us more money.

In contrast, health promotion prevents disease.  The best preventive medicine involves educating patients (the word doctor means teacher) about how to care for their bodies, eat properly, exercise properly, and encouraging them to adopt healthy lifestyle habits and a positive outlook on life.

So next time you hear someone talking about preventive medicine, you may want to clarify: are they talking about disease detection or are they talking about promoting health so that disease is less likely to occur.

At his medical practice at the Sage Clinic in Vancouver, Dr Oughtred emphasizes health promotion, disease prevention and the enhancement of athletic performance.

In the December 2007 issue of Scientific American, Body, there was an article titled, “The Ultimate Blood Test”.  The article was a review of a new blood test called the Biophysical 250, the most comprehensive blood test available to date.  I was intrigued, and eventually I decided to call Biophysical Corp to learn more about the test.  After a few conversations, I was convinced that this was a test that I would be comfortable offering to my patients.

It’s called the Biophysical 250, because it measures 250 things in your blood, all at once.  For those afraid of having blood drawn, you can rest assured that the test requires only 2 tablespoons of blood.  The test covers blood markers for cancer, heart disease, autoimmune disease, infectious disease, nutritional status, hormonal status, inflammation, blood diseases, osteoarthitis, and organ dysfunction.  Biophysical Corp does not advocate testing anything that there is no treatment for, so they don’t test markers for alzheimers for instance.  Biophysical reports that in a trial of 120 clients who received the Biophysical, 27 clients had a moderate health risk, and another 15 had a major health risk.  The Biophysical 250 can help discover problems before they become problems, and there are many markers that wouldn’t normally be tested for until the disease was already apparent.   Some examples are:

• H-pylori (a bacteria associated with stomach ulcers)
• Autoimmune markers (For lupus, scleroderma, or rheumatoid arthritis)
• Insulin (high insulin levels are thought to precede type 2 diabetes)
• Cancer markers (Breast, Prostate, Colon, Pancreas, Liver, Testicular)
• Ferritin (high ferretin can be assymptomatic, and represents high iron stores, which can be harmful to the body over time)
• Thyroid Markers (thyroid disease is common, and can go a long time before being diagnosed)
• Hepatitis markers

The trouble with waiting until you get a disease, is that you stand the risk of not being able to reverse the disease process once it is diagnosed.  Cancer and autoimmune diseases are classic examples of diseases that have much better outcomes if treated earlier.

The Biophysical 250 does not replace a comprehensive annual health screen with your physician, but for those who can afford it, it can be a great, low risk adjuct to a comprehensive medical assessement for the patient that wants to know more about their existing state of health.

To learn more about the test, visit: http://www.biophysicalcorp.com/ .  The company has also come up with an abreviated version of the test that is priced more competitively, and still screens for several of the same markers.

Dr Oughtred has moved his clinical practice from it’s old location to it’s new home at Sage Clinic.

Located in Yaletown in the heart of Vancouver, BC, Sage Clinic is a natural healthcare clinic with naturopathic medicine and acupuncture.  The clinic is located at 487 Davie Street, across from Choices Market at the corner of Richards and Davie.

He is seeing patients there on Mondays and Wednesdays for any of his clinic services including the new Biophysical 250, health assessments, diet management, Chinese medicine, counseling, and joint stabilization therapy.

Because meats and vegetables are not normally consumed at breakfasts, it can be difficult to stick to your diet at breakfast.

• Foods to avoid at breakfast:

• Breads

• Hash browns and other Potatoes

• Cereals (especially ones with sugars added)

• Muffins & Croissants

• Jams & Butter

• Yoghurt (especially ones with sugar added)

• Milk & Fruit Juices

The following are examples of typical breakfast foods that are allowable

Omelettes

• Ask for greens or sliced tomatoes instead of potatoes or toast

• Add vegetables: Onions, zucchini, and other green veggies are best

• Hold the cheese, or use cheese sparingly

• Egg white omelettes are not necessary, but they are certainly lower calorie choices

• Frittata

• Eggs and Style

• Cottage Cheese

• Natural, unsweetened soy milk

• Tofu

• Sliced Tomato or mixed greens can be an easy side to your eggs

• Nuts and seeds (whole or spread versions)

• No sweetened peanut butter

If you have no other alternatives:

• Unsweetened oatmeal

• You can flavour with nuts, seeds or spices

• If you need milk, then try natural soy milk or non-fat natural yoghurt

• Apples, pears, or grapefruits are okay

• Protein smoothies are okay, but most restaurant made smoothies are too sweet

Green Table is a business that helps restaurants adopt more environmentally friendly practices. I encourage you to visit their website to see which restaurants are participating, and support businesses that are taking the initiative to look out for everyone’s health.

Members are expected to do things like:

• Send their organic waste to compost

• Recycle paper, plastic, glass, metal as much as possible; use energy-efficient equipment and lighting

• Use water-saving equipment and fixtures; use recycled, biodegradable and non-toxic supplies

• Buy local and organic foods, sustainable seafood, etc.

• Support like-minded local suppliers and service providers working to ‘green’ their operations

Go to their website and support the businesses in your area that are trying to make a difference.