Hypocaloric Ketogenic Diet and Protein Sparing

For the purpose of this post I am going to take it that you have already read the previous posts about Ketosis as I cannot describe ketosis every post or you and I would go a bit crazy.

Starting out a hypo caloric diet is a diet that is low in calories and typically used in the fitness community as a diet that will induce weightloss. Ketogenic diet is a diet that induces ketosis, and carbs must be limited to less than 100g in order for this metabolic change to occur. This approximate number comes from how many carbs the brain needs in order to function in a day. So in this hypo caloric ketogenic diet we will take it to an extreme and say we will be consuming zero dietary carbs, just know that you can consume carbs but try to keep it low and from mainly fibrous vegetables. Before we are able to set a caloric number for our diet we should go a bit off track and delve into what we will need to spare protein.

In the first 3 weeks of ketosis, before the protein sparing adaptations occur the brain will need ~100g of carbs roughly. So with a diet completely void of carbs the body needs to create the carbs. The body does this several ways. The first way is going to be from glycerol in the blood will be converted to glucose ~18g throughout the day. The second way is through the conversion of protein into glucose ~82g. So this is important to know so that we are able to understand what must be accomplished by our protein intake so that we can spare muscle protein. In an absence of dietary protein, the body will take protein from muscle and break it down into glucose. Something a performance minded or even vain individual might want to avoid. So protein is said to have a 58% anti-ketogenic factor meaning that 58% of protein consumed will be converted into glucose in the blood. So in order to cover the 82g of glucose we need for the brain we will need an intake of ~150g protein, in order to spare body proteins from being broken down into glucose. This number will change by week three as the body will have adapted and the brain will only need 40g while 18 still come from glycerol you will only need 25g glucose from protein, so you will need about 50g protein to spare muscle.

So thats it right? Not quite. Protein requirements are modified by two factors. The two factors are CHO(carb, glucose) intake and activity level. We roughly covered CHO intake, but now we must cover activity level. Activity level is very important as it increases our need for protein. If you are a sedentary person than the minimal protein you need is 0.8g protein per lb of LBM or your fat free mass. However if you are a strength or endurance athlete you will need a bit more, roughly 0.9g per lb of LBM or fat free mass. PROTEIN IS VERY IMPORTANT IN SPARING MUSCLE MASS. "Of all of the aspects of the PSMF or ketogenic diet, adequate dietary protein is absolutely critical to the success of the diet in maximizing fat loss and sparing body protein" (The Ketogenic Diet by Lyle McDonald).

Here is a chart to help (it is important to note that too much protein is just as bad as too little as it will take you out of ketosis so try to stick the this guideline somewhere around this number will be ideal)

Now that we know how much protein we need we can add in fats to whatever amount that will fill up to the desired hypo caloric level. you should have at least 150g Protein so 600cals from protein and the rest from fat ;)

Stress isn't only a negative.

So today on my way home I was contemplating things that I noticed throughout the day like I normally do. Only to realize a lot of the people I see seem run down, lethargic, and just plain ol' miserable. Now normally this really wouldn't compute, but today something was different. It got me thinking about how stress affects people and what effect it has on them. Then I began to think of a discussion we had in class, and how the professor asked if we thought stress was good? or if stress was bad? She quickly realized that I raised my hand twice. She walked over and said in the class that I was right. Then did a brief segment on both sides. However, I don't think a brief segment does eustress, good stress, justice.

Eustress, is the positive stress that helps to bring about positive change. Distress is the negative stress that typically brings about negative change.

In exercise physiology we would classify eustress as a workout that brings about positive adaptations or changes to make similar exercise bouts closer to our metabolic homeostasis. In a similar vein, in exercise physiology we would classify distress as chronically raised cortisol levels. Im going to make a complex issue into a very simple way to understand it so just remember its not so black and white and there is a lot of grey area. We will classify acute stress as beneficial and classify chronic stress as not being beneficial.

What initially brought this thought process on was me looking through my Facebook feed and realizing how many people are misusing your and you're. I can understand why you wouldn't care while on Facebook from time to time, but the truth of the matter is that most people are not just on Facebook occasionally but tend to use the social media quite often, as its the ones who are on there most often that commit this unforgivable crimes against grammar. If you are consistently just going through the motions of writing or typing with no care of the grammar YOU'RE using, you will begin to consistently make these errors when writing a professional paper. I'll tell you what, when trying to get a job getting minute details may make it or break it for you. Some may make the argument that consistently stressing over the minutiae may add to YOUR stress level, which may be true but practicing will help you to get better and the daunting tasking of using correct grammar will become more second nature.

However, this post isn't meant to be me being obsessive over grammar errors, because frankly I make a great deal myself. This is meant to be looked then extrapolate the underlying message to YOUR overall lifestyle. I'll make the correlation to exercise because as a personal trainer and exercise physiologist I typically see more of it in the gym. People come in stressed out from work and let it affect what THEY'RE (another commonly misspelled word!) doing in the gym. As a human being stress is always going to be there in one form of another, and typically if YOU'RE not stressed I would make the argument YOU'RE not pressuring yourself enough. Im not talking about pulling-hair-out stressed but you should always feel a pressure to do something better.

While in the gym you need to manage YOUR stress. However, that manifests itself for you, do it. Whether thats listening to music, repeating a mantra, or just solely thinking about what it is YOU'RE doing, not thinking about how many essays are due tonight, or that finals are in a couple weeks. In the gym, heck with everything you do focus on that task. There have been plenty of studies that show you truly cannot multitask on two things at once but rather one at a time and just switching between to two at lightning speed. The more you multitask the less productive you get and the less quality is achieved while doing that task. MANAGEMENT OF STRESS IS KEY! Make a list of to do's in priority. Focus on the first finish it then move onto the next. This will help mainly with your chronic stress.

Now focusing on eustress or the acute stressors of our lives. It is important that that we manage our chronic stressors first because adding stress even acute or beneficial stressors may turn to negative stressors (heres the grey area I was telling you about). Say that we managed to get our distress under control. We need to add some beneficial stressors to our lives. Exercise is probably the first one most people think of. I would concur, that is a very beneficial stressor. If you take a sedentary person and a person who SMOKES and exercises, you might imagine the non-smoker has a lower risk factor. Wrong, exercise is a potent eustressor that will even lower the risk factor more than smoking increases it. (STILL DONT SMOKE, BAD IDEA). Back on point, exercise is a good idea. However, if you don't have time to exercise (you really do but thats for another discussion) there are other ways to cause beneficial stressors. If you've read some of my other posts you can probably guess my next proposition. DIET, diet is another eustressor you can add, hypo caloric diet or a diet that will cause weightloss preferentially fat loss is what I would aim for. I mean eating less, if you say you can't afford that there might be something wrong with you mentally (hypo caloric diets can help with cognition as well). Im not suggesting take some time to learn about diets right now, because I can help you with that just email me brett@reinhards.us; but you don't even need to change what YOU'RE eating just eat less of it. Next is FASTING or if that word is too scary just skip a meal. Its basically the same thing.

As a physiologist specializing in exercise I am interested in anything that can give me or my clients an edge. Fasting or skipping a meal along with diet and exercise are simple ways of doing that. Even Bill Nye tells us, "we are what we eat or we are what we ate".

Heres a very basic understanding of why skipping a meal can help us. We all have cells in our body. All of our cells have built in mechanisms. Some of these mechanisms help to clean and purge the cells of nasty or bad portions of the cells. Especially due to our oh so wonderful western diet, some of our cells are just plain bad. Say we have several cells, some are healthy and others are unhealthy but we consistently feed all our cells a wonderful carb based meal (cells love carbs). Our meals consistently feed our sick and healthy cells to keep them alive. Me, I am mean to my sick cells and compassionate for my healthy cells. I simply don't want my sick cells taking food from my healthy cells. You would think you might want to feed YOUR sick cells more food to help them recover, but I propose a different option one far less likely to cause a negative gene expression causing some horrendous effect to occur. How can we protect against that? Well its simple really. Remember the built in mechanisms I was talking about, every cell in our body except for cancer cells have a mechanism which is often referred to as "survival mode", sounds pretty badass if you ask me. The actual process I'm talking about is called autophagy, its basically the house cleaning process and it cleans up your cells. There is a similar process called apoptosis, programmed cell death, where a neighboring cell actually destroys the cell. When you miss a meal or fast, these processes are induced, fasting will cause a greater effect. (www.leangains.com probably has one of the most substantial accumulation of fasting knowledge I can think of).

We can think of eating every 2-3 hours as pampering all of our cells (the healthy and the sick), giving them food, a blanket, and a pillow making sure they are nice and comfy. On the other hand we can think of skipping a meal as making our cells work for their keep. Health cells can undergo this stress and adapt and survive, while sick cells will typically die off or get killed. You may think that sounds bad but really thats a good thing, then YOUR body will create new healthy cells and you will become healthier as an effect. If YOU'RE an athlete and think YOUR muscles will fall off if you miss a meal, it won't. As you fast growth hormone (which is protein sparing in it of itself) increases and also helps to mobilize free fatty acids aka fat.

I tend to go off on tangents, mainly because I just feel obligated to share all this information with you, but I am also trying to write more so I can get a better hang of it and will eventually get better and saying what I want to say. Overall, I feel I made a good example of what the different stresses are and the importance of managing stress, along with additional good stressors we can add into our lives regardless of time.

if you are wondering why you don't hear to much about fasting in the media. I propose a question for you to ponder. If fasting consists of practically nothing but water for anywhere from 12-36 hours, where is the profit for suggesting this type of practice?

And with that I hope you learned something and I hope you try to keep a better eye on YOUR stress and YOUR spelling ;).

Brief and Partial Review of Ketosis Physiology

Ketosis Physiology not to be confused with Diabetic Ketoacidosis:

Interrelationship between Malonyl-CoA and Carnitine Palmityl Transferase 1 (CPT-1)



As Liver glycogen drops Malonyl-CoA levels drop, the enzyme CPT-1 becomes active which then transports Free Fatty Acids (FFA) into the mitochondria, which then causes rapid fat oxidation, the by product acetyl-CoA levels rise rapidly, which is typically used for energy production through the Kreb cycle when carbs are available. However, when carbs are unavailable acetyl-CoA accumulates in the liver. High levels of acetyl-CoA are then condensed in the liver, into acetoacetate, which can be further converted into beta-hydroxybutyrate and acetone, the final 2 of the ketone bodies.



As in Diabetic Ketoacidosis, there is a bit of difference in the onset of it. As in ketosis, one of the primary changes that occurs is a lack of insulin (ketosis there is a restriction in dietary carbohydrates that lowers the insulin) (DKA, specifically happens in type I diabetics, there is a lack of insulin possibly due to lack of injection of insulin. Thus causing glucagon levels to be higher, which then signals the liver to convert FFA into ketones, since this ketosis is induced by lack of insulin and not lack of carbs the body is still using carbs as the primary fuel source which in turn doesn't allow the body to adapt to using ketones as a viable fuel source causing the blood to be saturated by ketones and further increasing the acidity of the blood and depreciating the buffering ability of the blood. A non-diabetic persons body has built in feed-back loops that once ketone levels rise too high the body will secrete insulin which will decrease the produce of ketone bodies, then signaling the body to excrete excess ketone bodies through urine. In a type I diabetic this feed-back loop is not functional due to the pancreas' inability to produce insulin, further allowing the body to produce ketones and wreaking havoc on the person. It is typically treated with an insulin injection.

Body Weight, Body Fat, and Ketosis

Last Monday began the most recent of many low carb, particularly Ketogenic diet. Above I have attached a chart I have produced in excel to give a better picture of the weightloss that has occurred. I prefer charts to actual numbers, the picture helps to show a bit more of what may be going on inside what is a very intricate specimen, the human body. I would like to take a few moments to break this down and see if there is a specific reason the chart looks like it does.

Date Weight Body Fat %


4/16/2012 181.6 11.5%

4/17/2012 179.4 11.0%

4/18/2012 176.1 10.1%

4/19/2012 173.6 9.5%

4/20/2012 173.0 9.3%

4/21/2012 172.4 9.0%

4/22/2012 172.8 9.1%

4/23/2012 174.4 9.8%

4/24/2012 173.6 9.5%

4/25/2012 172.6 9.0%

 
Starting off from what I would call the "Easter Bulk". I have given it this name to give somewhat of an educated notion that I had a specific goal in mind. In all honesty, this bulk was driven by gluttony and an overabundance of Easter leftovers and candy. So knowing there was no way of this ending up well, I chose to have a workout everyday that my body would let me. I believe I only missed a workout one day within a 3 week period. Surprisingly, with the excessive calorie intake my body was able to handle this new workload quite well. Everyday was Reverse Pyramid Training, (RPT) after warming up I would start with the heaviest weight I could for 3-5 reps, then dropping the weight by 10% and adding two reps until I was performing around 13-17 reps for the last set. For those of you who havent ever done RPT, it is one of the most exhausting and draining exercise protocols I have ever done, typically you wake up the next morning completely drained independent of how much sleep you get. So with this caloric intake I was still exhausted but my mentality wouldnt let me miss a day. Even with my diet consisting of complete crap (ie. Peeps, snickers, sopes, weiner schnitzel, etc...) my lifts were consistently increasing. I recall during the 3 week period my bench press (I had jus previously fixed my bench for and changed my style to close grip index on inner ring) went from 225x3 to 255x5, extrapolate data for the same rep count would be something like 225x3 to 280x3. Although there was a whole week dedicated to bench press, this improvement is still quite impressive.

Now, back on track. The first day starting off we see fat percentage and weight are relatively close together on the graph. Roughly 2lbs of fat loss would equate to 1% body fat change. The diet being used is a ketogenic diet, as little carbohydrates as possible on most days <20g were consumed.

The start of day 2 we see over 2 lbs of a weight drop but only .5% body fat drop. Day 3 we see an additional 3.3 lbs drop and a .9% body fat drop. So now were down 5.5 lbs and 1.4% body fat. So whats the deal? I thought we agreed that 2lbs lost equals 1% body fat. If you guessed it wasnt fat, you get a golden star ( I would pass out candy, but that would be counter productive). So what is the weight that is being lost? Well, there is more than one answer. Free fatty acids, Protein, Carbs, and mostly water.

Free fatty acids, is basically fat, its the mobilized form of all the attractive jiggly stuff we carry around our waist and darn near everywhere.
Protein, for our purposes is basically muscle breaking down.
Carbs, or more correctly glycogen, is stored in our muscles and liver and is stored 1g with 3g of water.

After reading the above of carbs we are able to connect why on this low carb diet we are losing lots of water. As we get to Day 4, it is safe to say that we are in Ketosis, a metabolic state that shifts the body from primarily using carbs as fuel to using mainly FFA and ketone bodies. To learn more on ketosis scroll to the bottom of this post. Day 4 it is also safe to assume that whatever weight we lose from here on is majorly a function of fat loss. As we can see for the continuing days until 4/23/12 there is a relatively linear loss of weight and bf%. On 4/22/12 we can see a slight increase in both which isnt concerning because the night before was a heavy meal and the effects of low fiber intake has started to show. Beginning on 4/23/12 we see the weight spike bringing along bf% with it. This increase was induced by diet, a carb refeed if you will. If you saw the large amount of what was consumed you would be quite pleased to only see that small of a gain. As in past keto diets with carb refeeds the weight rebounds were upwards of 17lbs. Although this refeed was designed with continued dieting and carb depletion in mind, so the carb load was far fewer in quantity to facilitate continued fat loss but also restore some sanity lost during the low carb portion. Interestingly enough, the weightloss since has seemed rather linear as well, which makes me speculate what might be going on. The weight loss shouldve been a little greater the first couple days back on the diet. So today I will be implementing a bit more water and fiber content to see if that will help to speed up the evacuation of foreign contaminants.

While protein/muscle loss is typically a concern in hypocaloric diets, I feel that due to the high intake of dietary protein in combination with a Intermittent fasting proctocol along with a ketogenic diet I am confidently discounting the loss of protein loss on this diet, as it does not seem logical that to any significant degree it is a factor of the weight loss.








ALL BODY FAT % MEASUREMENTS WERE TAKEN WITH A FOOTSCALE USING BIOELECTRIC IMPEDANCE. The actual values themselves may be off but the the downward and upward trends can be seen as accurate changes.









Ketosis Continued:

 The main predictor of ketosis is carbs in the diet. Since roughly 100g of carbs are needed to support brain function on a day to day basis, any diet lower in carbs than that will induce ketosis. Commonly you will hear people quote that the brain can only run on carbs, which is mostly right. In a mixed diet environment, there are carbs available and is the perferred fuel. In ketosis, there are minimal carbs and available and the body spares carbs every way it can. There are a number of tissues that can only use carbs as fuel, brain, nervous system, neurons, bone marrow. All of them but the brain create a byproduct called pyruvate which can be sent to the liver to create carbohydrates thus creating a net carb decrease of zero. So the brain is the only tissue that needs external (external from itself) sources for carbs. The brain in ketosis can run on ketone bodies as they can cross the blood brain barrier, in the first few days the ketones cross the bbb and are sent to cells in the brain that convert the ketones to ffa and then are used as fuel. After the first couple days the brain circumvents this step and uses ketones as fuel directly. However, the brain can never fully run just on ketones, it can use ketones for up to 75% of its fuel source but will still always need the remainder from carbs. Lets say the diet is completely void of any dietary carb, how will the brain function? Well the body is very well adapted for circumstances just like this (which is why Im so confused when people are deathly afraid of not eating carbs or missing a meal, fasting can produce these same changes its called fasting ketosis). The body has ways of making carbs from internal and external means. Primarily protein will be broken down either from muscles, or dietary protein and will create carbs though a process called gluconeogenesis (gluco= carb, neo= new, genesis= creating) supplying enough carbs for the brain to run day in and day out. The rest of the body is fueled by FFA and ketone bodies for the next few weeks until the body adapts and stops using ketones are a larger percentage of fuel and typically uses FFA for the majority, a mechanism probably induced to make sure that the body does not use all the ketones so there is enough for the brain. This is probably far more than you would ever care to know about ketosis, but is a very basic and short summation of ketosis

African Mango or IRVINGIA GABONENSIS

Ok so I may be a bit late to the party, but why stop the party. The reason I bring this up is because Karla sent me an email and in it was an article on this African Mango and how it can help weight loss, clearly it was a joke on her part. However, looking throughout the vast depths of the internet not many other websites are taking it as a joke, they see it as the next big thing, think Hoodia, or acai berry. There are a couple of things I have against this,
1. it was showed on Dr Oz's show, and for all of you who dont know, I cannot stand that show and his charlatan ways.
2. There are a few sites ive seen spouting off information about how the seeds can help with leptin production, well actually help to stop producing it.
3. It has been proven by a few studies, and yes that all and well, however, it was funded in Cameroon. Can you guess where the majority of African Mango's are? Ill give you a hint, its underlined, bolded, italicised, and rhymes with gameroon. I dont know about you, but that seems a little too convienient to me. Not to mention in the study they let the participants track their own calories. Why would they use such a HIGHLY INACCURATE account of the MOST IMPORTANT factor of weight loss.

To further explain #2 a little better for those of you who dont know how leptin works, Ill give a very very brief description of what it is and its role.

Leptin, is a hormone that is sort of like a thermostat for fat. It is produced by the cells but in a much larger amount from fat cells. So the more fat you have, the more leptin you have (under non diet circumstances). The reason for this is to let the leptin receptors in the brain pick up those signals in order to tell how much energy (aka fat) the body has stored, this was an adaptive component for survival during the days we didnt have easy access to tons of calories. So as you lose fat the less leptin your body will produce, interestingly enough when you first stop dieting your body will drop its leptin levels by 50% or so, showing how much you body loves your fat. So your brain begins to think it is losing fat so it wants you to eat more so making you hungrier, as well as making many many other hormones in the body fluctuate.

Rough summary: Normal levels of Leptin good
Low levels bad.

thus getting back to topic, why would a site wanting to sell this product say the seeds do exactly the opposite of what they want it to do? I dont think they were meaning to deceive you but it certainly does speak on behalf of their credibility.

Moral of the story, dont go ahead and believe everything you hear and see. Just because it was proved in a study doesnt mean its true, you have to actually look at the details, sometimes details do matter.

Back to Exercise

Yesterday was the first day I checked out our new Student Recreation Center at CSUN. Damn that place is huge and awesome. The Gym i work at is a quarter of the size of one of their smaller weight sections. So luckily I can now just run to the gym between classes or if i get out early and yesterday I did just that. Had 3 separate gym sessions, all together yesterday I did a lot of exercise. Sets each consisting of 1 minutes of time under load (meaning my muscles had tension on them the whole time).

8 Sets of Chest Press
6 sets of latpull down
9 sets of rows
7 sets of leg press
4 sets of shoulders
2 sets of incline press.

Yesterday was also no where near what I should have eaten;

4 Scoops Whey Protein (480 calories 96 Protein)
3 oz of Mac's Chicharones (480 calories 54 Protein)
2oz Chicken (90 Calories 18 Protein)
3oz Steak (170 calories 27 Protein)
1 Cup Mushrooms
1/2 Green Pepper
5 Brussel Sprouts
2 Tbsp Peanut Butter (180 calories 7 Protein)

As you can see very low carbs and high protein and moderate fat. Still allowing for carb depletion especially with the type of exercise I had yesterday quite intensive. I sleep amazing, or as I told Austin this morning, I went in a coma for 8 hours.

Not quite as sore as I thought I might be this morning, but later tonight I will be feeling it.

Today I will be eating the same as yesterday, except for the possibility of cutting out the peanut butter, and some other type of fat and protein in place of the chicharones, something with a little more vitamin content.

As for today's exercise, I will be doing an idea marketed by Lyle McDonald and proven to be efficient by his forum and many experiments he has done with clients. It will consist of anywhere between 5-10 minutes of 1-1 minute intervals to cause some more fatigue and lactic acid build up. Then 5 minute rest, then 45 minutes of steady state cardio, preferably resting.

WARNING: this is only of some merit for those under 10% body fat and sometimes doesn't even help until lower than that roughly 7.5% and lower

The fatigue part isn't very important for dieting, and typically interval training would be a horrible idea, hence the short time. The lactic acid build up has some merit here, well not in it of its self, but the effects it has in the body once it is cleared. Once it is cleared the body releases a large amount of Free Fatty Acids or (FFA's) preferentially from 'stubborn fat' (just means there is not much blood flow and typically the body doesn't take much fat from here and only starts too once the other fat stores are low or depleted). Then to expedite the oxidation process I will be performing steady state cardio, but not too intense where I create lactic acid which will blunt the effects that we just tried to set.

Tangentially, just a tip for people trying to lose weight and stay motivated, who you surround yourself with will drastically change the difficulty of losing that weight. Hard to stick to diet, talk with your significant other or whoever you normally eat with and tell them your plans and how hard it is to stay on the bandwagon when you are confronted with tasty fatty food.
Hard to get up in the morning to gym, do the same. Also there is some merit, in having someone text you telling you every time they are at the gym, make it a texting battle, it will definitely help to fuel you

And with that I am done for today, hope something here helped to motivate you, helped you learn something, or even just helped you kill some time.

Observations of the World

The title may seem deep, but I don't know that it really is. Just a couple things I've noticed within the past day or two.

1. Time and what you spend your breaks on. (Especially important for diet veterans)
Being a diet veteran myself I find this especially important because at times I can lose focus on overall health while trying to lose weight or obtain the 'perfect' physique. I say 'perfect' because what you realized once you start achieving your goals you realize there will always be something you can change, just as a car enthusiast will tell you about their project car. Anyway, back to what I was saying about losing focus (that was a perfect example). So with the new semester I am taking a hodgepodge of health classes, with health science backgrounds and kinesiology backgrounds. So as the first few days of class, of course we go over the history of what we have described health as, back in the 50-60's it was just as long as nothing is wrong with you, you are healthy, then in the 80's it changed to the triangle of health, physical, environmental, and then mental. Then added a side to the triangle (so now a diamond?) which included spiritual and social, and If you were strong in all of those you had optimum health. And now today there aren't really levels of health but more a health continuum that you place somewhere on (hopefully high) 0 is dead and 10 is optimum. With that it got me thinking, especially because yesterday I got out of school early and I had enough time to make lunch for later. After that I was confronted with two choices 1. go to work early to actually get a workout today or 2. go to get coffee with my girl friend and throw away any chance at working out that day.
For me I chose number 2, naturally. But thinking about it maybe back two years ago if I had a girlfriend and thought of diet and exercise much differently (more of how the fitness community does) I would've chose number 1. This bothers me because of How i used to think and because of how the fitness industry expresses health and fitness. Health is a jumble of all of those sides I talked about not just about being active. So they expect you to throw out social and go with physical, anyone else ever feel amazingly health when you feel lonely? I don't.

2.Again in school we talked about two different kinds of professionals, typically is regular drs (can't think of the word) and the other is holistic (they think of the problem is a sum of multiple parts). My chiropractor Dr. Thomas Sawyer, is like the latter, one of the main reasons I keep going back, also he is very good. Many people tend to be confronted with a problem physically or mentally, so they go somewhere to fix that said problem and don't even take a second to look at what may have caused that problem.

For instance lets look at a circumstance, you have a constant nagging back injury. So you go to a regular chiropractor and he adjusts you and the pain goes away for maybe a day, a week, or maybe even a month. Only for it to return.
The second example you would go to a holistic chiropractor, he may adjust you as well and you start feeling better, however, he will also help you to assess which muscle are tight and which are causing your problems, then will help to loosen those muscles through stretches and exercises you may do to help expedite the process.

Now typically the first is usually quicker and which is why people tend to gravitate more towards that way (instant gratification, this typically tends to screw us). However it is a dangerous mindset that I see more and more people fall into, its something we as a whole need to get out of. However, the government isn't a large proponent for things like this, they make far more money taxing antibiotic companies that help to treat problems. Where as if they were to help with prevention of these diseases or problems, there wouldn't be much money to be made. The sad truth is money controls pretty much anything, which is why you must be careful taking advice from others and you need to look at what the facts are and why might such an outcome occur.
My favorite example of correlation is about shoe size and math skills.
There was a study done and the correlation of bigger shoe size was tied to better math skills. Now if you looked at that blindly you would think you've got to increase you shoe size some how. But if you took a deeper look at the study you would find that the study was done at an elementary school. Now lets think at elementary schools what are the populations of people. Children usually kindergarten-6th grade. Now lets look at the Kindergarteners, they have poor math skills due to them being young and un practiced, they are also small and have small feet because they are young. Now looking at the 6th graders, the big kids on campus, they've had far more experience with math and years of practice, increasing their math skills, also they are older and have grown more increasing their foot size. Well look at that Bigger feet, better at math, that must be the correlation. Now we all know that is complete bogus, but thats how a lot of studies are setup with certain protocols especially in the fitness industry and is why its ever so important to look at why something may happen and not be so nieve and believe everything you see or read somewhere.