PROFESSOR OF MEDICINE, SECTION CHIEF OF HEALTH PROMOTION AND SPORT MEDICINE AND DIRECTOR OF THE HUMAN PERFORMANCE LABORATORY OREGON, HEALTH AND SCIENCES UNIVERSITY
Sasha Frate recently visited Portland for BGLife, to meet with Dr. Kerry Kuehl to share some of his incredible discoveries and expertise as a Professor of Medicine, Chief of Health Promotion and Sports Medicine & Director of the Human Performance Laboratory at Oregon Health and Sciences University.
Dr. Kuehl has published over 100 scientific articles and abstracts and is a sought after speaker on the topics of health promotion, sports nutrition, and the physiology of exercise.
As Director of the Human Performance Laboratory at Oregon Health & Science University, tell me about the types of performance testing and studies you conduct and oversee. How do the test results then integrate into real world scenarios- for example, what kind of difference can they make to athletes?
First of all, I was hired in 1983 to be the exercise physiologist for two exercise pioneers. They have published a lot of articles on exercise and nutrition, so when they hired me, we set up our laboratory to look at the effects of exercise and nutrition as medical therapy. I then went to medical school, got an additional Doctorate in nutrition and my role now, is to evaluate the effects of nutrition and exercise training on disease and illness. So we test a variety of individuals in our laboratory. We get referrals for people with chest pain, people that have exercise intolerance that can’t walk a block. We have doctors referring patients with muscle cramps and fatigue with exercise or shortness of breath. Then we do research studies with neurology with multiple sclerosis patients, individuals with neuromuscular disease, cardiovascular disease and musculoskeletal disorders like arthritis and obesity. So I’m one of the experts on exercise and nutrition as medical therapy. What we try to do is look at how exercise and nutrition will replace medicine to bring about and restore health and wellbeing. We also of course see elite athletes. We see all the professional athletes that are training for the Olympics. So we see the full spectrum; from individuals waiting for heart transplant that we’re trying to get to exercise and then the elite athletes training for the Olympics. Our lab is set up to see everyone and to apply the principles of exercise training for elite athletes to our unhealthy populations and get them moving.
What are the top one or two foods or substances that deplete energy and hinder mental and physical performance that you would recommend to minimize or avoid entirely?
The number one is sugary beverages. We should remove all soda pop and all fruit juices from schools As a doctor of nutrition and as a medical doctor, I have done a lot of nutrition studies. We’ve looked at supplements that are supposed to increase performance and we’ve looked at vitamins and minerals. There are a lot of fad diets out there that people use to lose weight, but probably the biggest issue in the world which is creating disease and illness, is processed carbohydrates. If you look at one food that is contributed to the four-fold increase in obesity and diabetes in the last two decades, it’s processed carbs and fructose, which are probably the biggest culprit in producing inflammation and creating disease. McDonald’s started in 1955. That’s when fast food came in and now we have food convenience. We don’t have to lift a finger to get food delivered to our house. We can watch TV, we don’t have to get up, we have channel surfing… we don’t have to leave our house and we have such an abundance of food, but the culprit food is actually processed carbohydrates. So anything that’s ready to eat off the shelf: cookies, granola, cereals, everything in the frozen section- that’s the biggest culprit for disease in the world, depleting our energy and creating inflammation.
One of the studies I’ve done is to look at an Anti-Inflammatory Diet. So we know that inflammation causes disease. In fact, inflammation probably is the cause of heart disease, cancer, diabetes… So we’ve looked at an Anti-Inflammatory Diet. What does that mean? It’s a diet that consists of whole food, mainly fruits, vegetables, whole grains, and lean meat, and the meat should not be red meat. Red meat is a good source of protein, but it’s very high in saturated fat. Whereas something like wild salmon and wild elk, are very high in protein, but very low in saturated fat. So when we look at an Anti-Inflammatory Diet it’s based on whole food and that leads into the study I did with tart cherries. We found that when we fed individuals tart cherries, it worked as well as 800 milligrams of ibuprofen, which is a very high therapeutic dose for ibuprofen. We had an equivalent does from the tart cherries on muscle pain and arthritis pain. The tart cherries have the highest incidence of anti-inflammatory and antioxidant of any food. So that’s why we studied the Montmorency cherry, because it has the highest flavonoid and phenolic content of any food.
Must the cherry be consumed as a raw fresh fruit, or can it be in the form of juice?
We had the equivalent of 45-50 cherries a day that individuals consumed and at Orgeon Health and Science University we have a big nutrition kitchen where our researchers prepared a purified juice because it was convenient in our study of elite runners, women with inflammatory osteoarthritis, and women with fibromyalgia. We found that the tart cherry juice, equivalent of 45-50 cherries a day, had a significant reduction in inflammation and pain. We also looked at biomarkers that show inflammation like C-reactive protein, tumor necrosis factor alpha, the interleukins called cytokines. These are the substances that cause inflammation and what we found is that the tart cherry juice significantly reduced C-reactive protein and inflammation. Not only did we have subjective reduction in pain and arthritis pain, but there was a significant reduction in pain by a doctor evaluation. We now have the biochemical, the molecular change, in the blood, of what happens when you eat something that’s as high as the tart cherry in antioxidant.
Now is this something that could be incorporated into one’s diet as a preventative, as well as part of the Anti-Inflammatory Diet?
Getting back to what we found in science: eat whole food. It’s really difficult to get the same benefits from supplements with cancer and heart disease prevention. You really can’t. So you have to eat whole food. You can’t take something out of the food and put it in a concentrated form and get the same benefits from it. You have to eat the whole food. In a carrot, or blueberries, there are hundreds of phytochemicals and nutrients that impact cancer and heart disease. So number one, we have to get back to eating food, shopping, growing our food and then cooking and preparing that food. If we do that, we’ll see a significant reduction in certain types of cancer. In fact, the latest study showed that if you eat 5 servings of fruits and vegetables a day, there is a 30-40% reduction in breast cancer, colon cancer, and prostate cancer, just by eating fruits and vegetables. Again, we’re about looking at a plant-based diet and food as reducing disease and illness. I think the biggest thing society could do is start shopping and eating whole food and preparing and cooking it and to stay away from fast foods and processed carbohydrates.
What are the best ways to boost metabolism? And, for those with a very high metabolic rate, how can they find a balance between training and not losing too much weight?
How to boost your metabolism: that’s the secret that keeps us thin and at a good body weight. When we increase our metabolism, we burn more calories and thus we get to eat more. On the other hand, when we’re overweight and obese, we actually have a reduction in metabolism. The only natural way to increase metabolism… and this is a secret, is to increase muscle mass. For every pound of muscle that you have, you burn 50 calories a day for that pound of muscle. If you started strength training, I would put you on a program and you would exercise 3 days a week for 30 minutes. After six months you’ve put on 10lbs of muscle. If you think about that, 10lbs of muscle that you now have times 50 calories a day: You’ve elevated your metabolism by 500 calories a day, and that’s just sitting there. Now, there are 3,500 calories in a pound of fat, so just by putting on 10lbs of muscle through sensible exercise, you will burn a pound of fat a week at rest. So people that are more muscular are metabolically active. They have a very high metabolic rates, whereas people who are overweight have high body fats, have lower metabolic rates because of the leptin and ghrelin ratio- these are the hormones that stimulate the metabolism. So the first thing you can do to boost your metabolism is to exercise and put on muscle. The second thing you can do is not buy what most people do for metabolism- a weight loss product or an energy drink. Right now 25% of U.S. adults consume an energy drink daily. Energy drinks are high in caffeine. They have other forms of stimulants called guarana, gotu kola and yerba mate, which boost your metabolism. It’s not the secret sauce. It’s not the vitamin A or vitamin B when you drink one of those weight loss products, it’s actually because they have caffeine in them and that’s the only way that they work. Caffeine has been shown to boost your metabolism. Is it healthy? It shows that a cup or two of coffee a day actually may reduce cancer and it’s a little bit of a stimulant. In the Olympics they now allow individuals to have a little caffeine before a race. So there are foods that stimulate your metabolism. Things like cocoa, green tea, turmeric and some other natural botanical herbs actually will improve your metabolism, but generally not enough to really change your weight. So you do have to exercise if you really want to boost your metabolism. If you’re overweight, you have to lose weight, you have to put on muscle and you have to eat a healthy, sensible diet.
You mentioned that these caffeinated beverages actually do boost metabolism, but you also said ‘don’t go there.’ Does the caffeine also have an energy- depleting factor?
The concern is: are energy drinks safe? Are the stimulants safe? I have been a medical expert on multiple cases on individuals exercising that used a stimulant prior to exercise and what that does is it doubles the effect on blood pressure. Some individuals have had a stroke or a heart attack, because it has increased the threshold for cardiac arrhythmias. So the caffeinated type of stimulants like gotu kola, guarana, and yerba mate do perk you up and give you vigilance, but they also increase the risk of cardiac arrhythmias and blood pressure related stroke and heart attack. You have to be careful and practice moderation. Individuals who have excessive amounts prior to an exercise event increase their risk of a dangerous side effect from a combination of exercise, especially strength training, with an energy drink.
Are there any other foods or supplements that you would recommend to aid post-exercise recovery such as the amino-acid L-glutamine for example?
There are thousands of studies on dietary supplements and the secrets to exercise performance and recovery. The first thing you have to realize is no study has shown a single amino acid to benefit either performance, or recovery. L-glutamine is a non-essential amino acid, meaning your body produces its own amount. Glutamine is very important for getting rid of the ammonia in our body and exercise increases ammonia. When you exercise, you break down muscle, and you produce ammonia. Now ammonia is very toxic to the body and there are individuals who don’t get rid of ammonia and they get serious effects like fatigue, post-recovery malaise, cognitive dysfunction and even liver disease and failure from the high ammonia. Some individuals don’t produce an enzyme to get rid of the ammonia. So glutamine is very important physiologically to get rid of ammonia. The problem is it hasn’t been shown to improve exercise performance or recovery in healthy people. However, there’s been some recent literature… I’m working with Dr. Hans Dreyer at the University of Oregon and we are looking at a supplement of amino acids given before and after total knee replacement to reduce the effects of deconditioning and disuse atrophy. After knee surgery people don’t exercise and they get a lot of muscle atrophy, so that’s part of their problem with recovery from the knee surgery is their loss of muscle. Dr. Dreyer has shown in a pilot study, that feeding these complex supplements of amino acids in a drink actually reduces muscle loss and improves the outcome from the surgery. So new research on the horizon looks like maybe post-recovery, a complex solution of non-essential and essential amino acids may help to restore the muscle that you tore down during exercise and help build the protein to build muscle. Until then, the best recovery drink… is chocolate milk. 12-16 ounces of chocolate milk is the best recovery- well, I should say milk, but I like chocolate milk- because milk has the right amount of protein, carbohydrates, and the right kind of protein and carbohydrate. So if you want to quickly restore within 15 minutes of your workout, we have all of our athletes drink chocolate milk. Then within 2 hours of their workout, they should eat the highest protein meal of their day. That’s when they usually should have their two chicken breasts, their brown rice, vegetables, because the body is really looking to absorb. So you’re highest protein meal of the day should be 2 hours after your workout, but immediately after your workout: chocolate milk.
What about someone who is lactose intolerant?
If you are lactose intolerant you can have an alternative like almond milk, soy milk or rice milk, which also have a good protein and the right amount of carbohydrate. So it’s pretty simple, just drink 12-16 ounces of flavored milk. It’s cheap, it’s available and it provides the right amount of calories.
Now, I should say, you can exercise all you want, you can eat as well as you want, but if you’re not getting 7-8 hours sleep… it doesn’t matter how hard you train and how well you eat, because it’s during sleep when you repair the damage of the day and when you build the muscle and your hormones. Everything I say here has to be balanced with a really good holistic preventive program of stress management, with sleep and recovery from the day. I used to think you could eat whatever you wanted as long as you exercised and the data over the last 30 years says “No.” You have to eat well, and you have to exercise to get the benefit. Now, the big three is that you have to sleep. People that burn the candle at both ends and only get 4-5 hours of sleep actually have increased cancer rates and increased immune deficiency. So sleep, recovery, and stress management are a big part of the diet and exercise theme. What’s the 3rd ingredient to healthy living? You need to get at least 7 hours of sleep in a 24 hour period to restore your body from the stress of the day. During the day we get oxidative damage- it’s oxidation that damages and causes inflammation, heart disease and cancer. One study showed that if you get less than 6 hours of sleep in a 24 hour period, you might as well smoke a pack of cigarettes a day on your heart, because there is no difference on premature heart disease from smoking a pack of cigarettes and getting less than 6 hours of sleep a day. Another study just came out, that if you sit 8 hours a day, it’s equivalent to smoking a pack of cigarettes a day. So sleep is very important to restore the damage of the day.
What are the most important, yet often overlooked or misunderstood guidelines for optimum health maintenance which people need to become more aware of, such as your mention of sleep?
Everyone thinks there is a secret pill. Every pharmaceutical company says that they have the pill to cure and every supplement company says they have the right vitamin or mineral. So people think they’re missing out on something that is going to restore their health, but I think we have to understand as a society that there are no secrets to health. If you want to live long and healthy, here are the things to do: Eat a healthy diet with fruits, vegetables, and whole grain. We have get back to eating healthy wholesome food, and there are no secret supplements that are going to help you. Cooking your food, preparing your food, shopping for you food, is key. Secondly, is exercise. It doesn’t have to be joining a gym or fitness center. The bottom line is that we have to bring physical activity back to our daily jobs and our life. At the turn of the century in 1900 we were an agrarian laboring society and 80% of our population in the world were manual workers who did labor and burned 400 calories a day. Today 80% of our society is automated. We sit at a desk, are sedentary, and we don’t burn those 400 calories that we did in our daily jobs.. Physical inactivity has caused obesity and diabetes to skyrocket. In fact, in the world today, 30 years ago twice as many people were underweight as overweight. Today more people are overweight than underweight for the first time in the history of the world, because of our overconsumption and lack of physical activity. So the other secret to life is getting physical activity and incorporating that in your day. Lifestyle- parking farther away from the store, walking to the store, walking your dog- and walking is a great form of exercise of burning a few calories. The fourth ingredient is stress management. How do we manage the stress, how do we manage the damage of the day? There is a lot of news right now about mindful meditation and how, in a few short minutes, you can calm down and sort of remove the stress of the day. In our cancer therapy program we are looking at mindful meditation as way to reduce the effects of stress and cancer. Again, these are really small things you can do throughout the day.
So stress management and how we deal with stress is a key component to health. Recent literature from our own cancer research that mindful meditation is a way to both reduce the effects of stress and cancer related stress. In a recent study by a Stanford researcher, Dr. Christianson looked at who lives longer and how to improve your longevity- those individuals that had a positive attitude, that dealt with stress in a positive manner, lived 10 years longer than those that were pessimists. Those that see the glass half empty are going to die early. Those that see the glass half full- the ones who see a solution to the problems, the ones who have stress and say “ok, how are we going to get through that?” So stress management is very important in both disease but also longevity. When people ask me what the secret is to aging, what’s the secret to life? Unfortunately we haven’t found the fountain of youth yet. Ponce de Leon tried to find the fountain of youth in Florida in 1500 and didn’t succeed. But, we know that healthy eating, cooking food, eating whole food, being physically active everyday, sleeping at least 7 hours in a 24 hour period, stress management, dealing with stress and having a positive attitude will do more for your health than any pill or anything that I know of. That is what our research has demonstrated over the past 30 years.
Find more on Dr. Kuehl’s research and publications by going to ohsu.edu/hpsm.
Next month we continue the second part of Dr.Kuehl’s interview, covering the Global Epidemic of Obesity.