Cissus Quadrangularis to heal Joint Pains from Exercise

Continuing from my previous blog post where I had discussed a ‘low weekly mileage 40 day workout routine’ to reduce 10k running time, as promised, here I’m writing about a herb which reduces joint pains called ‘Cissus Quadrangularis’ A.K.A. ‘Devils Backbone’ or ‘Hadjod’ (in India), which I’m currently using for my knee pain and other assorted creaks. Very ironically, my knee pain has originated from the aforesaid workout. I made the classical exercise mistake called ‘too much, too soon’ :D

In fact, some research papers state that Cissus Quadrangularis/Hadjod (CQ) does not just heal joint pains, but even repairs bone disorders[1], fractures[2] and damaged tendons and ligaments, helps to reduce bodyweight (emphasis on central obesity)[3], treats arthritis and other inflammatory disorders[4], helps controlling bone loss (during and after menopause)[5] and also reduces cortisol.

CQ is a plant from the grape family and is indigenous to India. Assamese[6] people and tribes from Meghalaya have long been using CQ for healing fractures. Hadjod, as the name suggests, means that it joins bones. In Sanskrit, its name is Asthisamharaka which translates to that which prevents the destruction of bones.

Bite Me

Considering how preoccupied researchers, runners, and the people who don’t run are with damage to bones, knee joints, tissues and ligaments due to running (especially long distances), based on the results of the research papers on CQ, it makes immense sense for everyone engaged in running short distances, marathons, ultramarathons, crossfit, bodybuilding and triathlons to incorporate CQ as a training supplement for longevity and vitality, and also because CQ has no notable side-effects[7].

In a pilot study, titled “Cissus quadrangularis reduces joint pain in exercise-trained men”, (Phys Sportsmed. 2013 Sep;41(3):29-35. doi: 10.3810/psm.2013.09.2021), it was found that 8-weeks of supplementation with CQ reduced joint pain by about 31% in a sample of 29 young, otherwise healthy, exercise-trained men (who had joint pain).[8] Do note that this was a pilot study so the results are not conclusive, however, considering the other research papers out there which suggest that CQ has significant benefits for the musculoskeletal system with no noted side-effects, CQ supplementation for athletes makes mighty sense.

CQ extract (250mg per tablet) named Hadjod is readily and cheaply available on Amazon from Himalaya Herbal Healthcare.

- Aman Yadav

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[1] www.ncbi.nlm.nih.gov/pubmed/24803925

[2] www.ncbi.nlm.nih.gov/pubmed/24163553 and www.ncbi.nlm.nih.gov/pubmed/25298715

[3] www.ncbi.nlm.nih.gov/pmc/articles/PMC1570348/

[4] www.ncbi.nlm.nih.gov/pubmed/26342521

[5] www.ncbi.nlm.nih.gov/pubmed/22779034 & www.ncbi.nlm.nih.gov/pmc/articles/PMC3388386/

[6] nif.org.in/innovation/traditional_bone_healer/265

[7] https://www.ncbi.nlm.nih.gov/pubmed/24113700

[8] https://www.ncbi.nlm.nih.gov/pubmed/24113700

REDUCE 10K RUNNING TIME IN 40 DAYS BY RUNNING LESSER

Shortcuts, who doesn’t like shortcuts! With celebrities like Tim Ferriss as role models, for a generation obsessed with life hacks, this paper presents a hack to reduce your 10k running time in 40 days, and that too by reducing running mileage.

However, as with all hacks/shortcuts it comes with its own set of snakes which bite you when you’re smugly taking a shortcut ladder. The patiently coiled snake here is the increase in running intensity during the 40 day period.

Recently, in an overeager state after having read the aforesaid paper, I inculcated the prescribed regime into my training but without reducing mileage and (in hindsight), as expected, I now have a nagging knee issue. Hence, the caveat here is to firstly do only a few of the intervals for a short while, and then start the 40 day training block (A.K.A. 40 day shortcut) after your legs are ready for the successive intense sessions. Again, this is a shortcut, so remember that you can safely do better if you adopt traditional methods of increasing running performance.

The aforesaid (year 2018) study/paper (https://www.ncbi.nlm.nih.gov/pubmed/29417745) is titled “Effect of Speed Endurance Training and Reduced Training Volume on Running Economy and Single Muscle Fiber Adaptations in Trained Runners”, and as the name suggests the test subjects (trained runners with 10k times of about 46 minutes) reduced their respective weekly mileage but introduced a couple of 30-40 seconds maximal effort running intervals every few days during the 40 day test period.

Ladders give, Snakes take, Rich man, poor man, Beggar man, thief, Ain’t got a hope in hell, That's my belief - AC/DC Sin City

Duration of the aforesaid study was 40 days and it consisted of 10 sessions of speed endurance training (very short max effort intervals followed by walking recovery period) and 10 sessions of aerobic moderate-intensity training (regular runs) for the trained runners. Total running distance during the intervention/test period was reduced by 36% compared to before the intervention/test. The trained runners who participated in the study were running about 23-27 kms per week.

The training protocol can be demonstrated for a 12 day period as follows:

Day	Exercise Type	Details
1	Aerobic Moderate Intensity	Regular run
2	Speed Endurance Training	10 bouts of 30-sec “all-out” running. Running bouts were separated by 3.5 min of recovery (walking app. 200 m to the start-line)
3	Rest
4	Rest
5	Aerobic Moderate Intensity	Regular run
6	Speed Endurance Training	10 bouts of 30-sec “all-out” running. Running bouts were separated by 3.5 min of recovery (walking app. 200 m to the start-line)
7	Rest
8	Rest
9	Aerobic Moderate Intensity	Regular run
10	Speed Endurance Training	10 bouts of 30-sec “all-out” running. Running bouts were separated by 3.5 min of recovery (walking app. 200 m to the start-line)
11	Rest
12	Rest

The same protocol, as tabled above, was continued for 40 days by the participants. The results showed that compared to before -- 10 km performance improved by 3.2% in the trained runners. Namely, a change from “45.2 +/- 1.2” minutes to “43.7 +/- 1.0 minute".

Since the researchers could not find the exact source of such improvement, even after conducting blood tests and muscle biopsies – they attributed the improvement to ‘better running economy’.

In the next blog, I’ll write about a herb which reduces joint pains called ‘Cissus Quadrangularis’ A.K.A. ‘Devils Backbone’, which I’m currently using for my knee pain and other assorted creaks. In fact, some claims converge to say that it even repairs tendons and ligaments J

- Aman Yadav

Active Fat Man: Adaptation to Physical Activity

The first half marathon (Airtel Delhi Half Marathon) which I ran was in the year 2008, and at that time my diet was bad and my weekly mileage was lower than what it has been over the next decade.

Now, after a decade of running more and more every year, I am at the same body weight but I am no longer as lean and cut, as I was during the initial years of running. Granted that age related metabolic decline is responsible to an extent, but that does not explain the pudginess I’ve been accumulating over the years even with increased exercise and less vices in my diet.

Very recently, I came across this paper titled, “Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans” (link to which is https://www.cell.com/current-biology/fulltext/S0960-9822(15)01577-8). 

This is a cross sectional study which only used accelerometers to measure physical activity, so the results can be questioned to an extent but overall it provides answers to what I’ve been usually bewildered with when I see the following high activity individuals with pudginess/high body fat/paunches: 

1. Indian (pedal) rickshaw operators. 

2. Some ultra-runners or runners with high weekly mileage. 

3. High mileage cyclists.
4. Triathletes 

5. Construction site workers. 

6. Rag pickers. 

7. Me. 

8. You (if you’re highly active). 

The aforesaid ‘study’ explains the long-term effect of physical activity on total daily energy requirements using two energy expenditure models: 

a. Additive Total Energy Expenditure Model – This model supports the traditional public health strategy to combat obesity, whereby increased physical activity is recommended to increase total energy expenditure to maintain body weight i.e. exercise more to burn more calories with no upper limit as to where this will model will stop working. So, as per this model, during a night out with friends, you can eat a 1000 calorie pizza accompanied by 3 pints of light beer (450 calories) and then burn these calories off next morning by running 20 kms. This is the model which I have used till now (unsuccessfully, which is I why I’m writing this) since it works on a very logical presumption of ‘plus’ and ‘minus’, as if the human body works on a debit credit banking system. However, as per the study – the human body adapts to physical activity and the total energy expenditure therefrom, as explained by the Constrained Total Energy Expenditure Model below. 

b. Constrained Total Energy Expenditure Model – This model states that “rather than increasing total energy expenditure linearly in response to physical activity, individuals tend to adapt metabolically to increased physical activity, muting the expected increase in daily energy throughput”. Simply put – you cannot outrun a bad diet by exercising more since your body will adapt to the physical activity. You can’t out-exercise a bad diet after a certain basic daily energy expenditure level.

As per the study, for CPM/d above approximately 230 (explained in next para), the total energy expenditure among individuals was negated by compensatory changes in energy expenditure on other activities. These other activities are explained as behavioural changes such as sitting instead of standing and resting more overall, and changes at the biological level. 

CPM/d means ‘counts per minute per day’ which was measured by accelerometers in the study and CPM/d of 230 equates to about 6000 steps per day which furthers equates to about 5 kms per day. The study makes immense sense if you recall the adage, “the last 5 pounds are the hardest to lose”, or when you can recall a friend saying I’m exercising so much but this stubborn belly fat is not coming off. 

The key takeaways from the study are the following: 

1. For sedentary individuals, this study will not apply since they’ve been in sloth mode for a long time and therefore the chances of metabolic adaptation at low levels of physical activity cannot happen. So for sedentary individuals who just discovered or were (vehemently) recommended exercise, there is no need for concern since your only concern should be to reach 6000 steps per day and then start researching more. 

2. More than exercising, a cleaner diet is more helpful in the long term to maintain health and body weight since overreaching in exercise has constrained potential to burn calories and also definitely leads to injuries and illnesses. 

3. The study was cross sectional (not longitudinal) and it only used accelerometers to arrive at its main hypothesis and therefore, if you’re stuck in a weight loss/fitness rut, it would be better to sprinkle more weight training or other exercises/sports every few months to perhaps not allow the metabolic adaptation which comes when CPM/d is above 230 (6000 steps per day). There are other research which show that increasing muscle mass can increase metabolism, even resting metabolism, so maybe lift more weights. 

- Aman Yadav

Weekly Running Dose For Life Extension

The heart is mainly a muscle, but unlike a nice and round Gluteus Maximus, you cannot display a well-trained Heart on social media for personal gains. Well, maybe Hanuman was the only guy who managed to display his heart in order to impress his Boss and Boss’ Wife (Ram and Sita). He had eyes on the ‘Best Employee of the Ever Award’.

As with any muscle, the heart also adapts to training stress from exercise and eventually becomes more efficient at supporting the enhanced cardiovascular requirements of exercise. But all is not good in the domain of cardio because most of the protective cardiovascular benefits from cardiovascular exercises such as running and cycling, wane away after a certain point as per The Copenhagen City Heart Study (referred to as “the CCH Study” below).

In the year 2015 when the CCH Study was published, suddenly excessive and hard running was labelled dangerous for cardiac health, based on the exercise related findings in the CCH Study. Not wanting to lose out commercially, immediately Runner’s World published a very poorly written rebuttal, and then after 1 year they came out with a more nuanced article which admitted the relevance of the findings in the CCH Study. Competitor Running, in contrast, wrote a balanced article without any attempt to debunk the study and protect its customer base.

The CCH Study was launched in the year 1975 by Dr. Peter Schnohr, to understand physical activity and athleticism as tools for cardiovascular disease prevention, and it involved a starting sample population of 20,000 men and women. The Study grew over the years to include the effects of alcohol, education, smoking, diabetes, sleep etc. on coronary heart diseases and strokes in humans. Do note that Dr. Schnohr was amongst the top 10 runners in Denmark at that time and he initiated the entire study based on the unpleasant symptoms he experienced during his strenuous training and to understand whether excessive running could be unhealthy.

For the past several decades, it is common knowledge and obvious through medical evidence that our bodies need the effects of regular and vigorous exercise, and that physically active people have a significantly lower risk of death compared with inactive people. However, no upper threshold for physical activity has ever been recommended.[1]    

The CCH Study reported that both duration and intensity of walking, running and cycling were important factors in relation to coronary heart disease related mortality, with intensity of exercise playing a stronger role in increasing the chances of cardiovascular issues.

There appears to be a U-shaped association between all-cause mortality and dose of jogging as calibrated by pace, quantity, and frequency of jogging. As per Dr. Schnohr, light and moderate joggers have lower mortality than sedentary non-joggers, whereas strenuous joggers have a mortality rate which is not statistically different from that of the sedentary group.[2]

Long-term strenuous endurance exercise might induce pathological structural remodelling of the heart and large arteries. Current data suggests that long-term training and competing in extreme endurance events such as marathons, ultra-marathons, ironman distance triathlons, and very long distance bicycle races can cause physical abnormalities and malfunctions in the heart and elevate cardiac biomarker levels. Additionally, long-term excessive exercise may be associated with coronary artery calcification, diastolic dysfunction, and large artery wall stiffening.[3]

A similar finding[4] on cardiac dysfunction and injury from marathon training was reported in this study labelled “Myocardial Injury and Ventricular Dysfunction Related to Trailing Levels Among Nonelite Participants in the Boston Marathon”. The findings of this study are more relevant to the sensationalised stories we keep hearing about in the media about runners suffering heart attacks during or after a marathon, but which instances as per this study are mostly attributable to the lack of proper training in such runners i.e. low mileage in training for a long distance race.

Best Employee of the Ever

As per the jogging/running part of the CCH Study, the findings for the relationship between running and mortality when adjusted for various factors is as follows:

Note:

Hazard Ratio (HR) below represents the chance of an event occurring. A HR of 1 means that there is no difference in survival between the two groups. A hazard ratio of greater than one or less than one means that survival was better in one of the groups. So in the CCH Study a HR of 1 represents that the chance of death is certain. Therefore, the HR for understanding the numbers below is to be compared with a ‘sedentary nonjogger’ whose HR is 1 i.e. a ‘sedentary nonjogger’ will die (HR = 1), and anything less than 1 represents that the chance of mortality has decreased in the exercise group as compared to a ‘sedentary nonjogger’ group.

Quantity of Jogging (adjusted for age and sex):

Hours of jogging per week	HR (Hazard Ratio)	Remarks
Sedentary nonjogger	1	Certainty of mortality at a given point time.
Less than 1 hour per week	0.32	68% lowered risk of mortality (as compared to a sedentary nonjogger)
1 – 2.4 hours per week	0.18	82% lowered risk of mortality (as compared to a sedentary nonjogger)
2.5 – 4 hours per week	0.38	62% lowered risk of mortality (as compared to a sedentary nonjogger)
More than 4 hours per week	0.35	65% lowered risk of mortality (as compared to a sedentary nonjogger)

Quantity of Jogging (adjusted for age, sex, smoking, alcohol intake, education, and diabetes):

Hours of jogging per week	HR (Hazard Ratio)	Remarks
Sedentary nonjogger	1	Certainty of mortality at a given point time.
Less than 1 hour per week	0.47	53% lowered risk of mortality (as compared to a sedentary nonjogger)
1 – 2.4 hours per week	0.29	71% lowered risk of mortality (as compared to a sedentary nonjogger)
2.5 – 4 hours per week	0.65	35% lowered risk of mortality (as compared to a sedentary nonjogger)
More than 4 hours per week	0.60	40% lowered risk of mortality (as compared to a sedentary nonjogger)

Frequency of Jogging (adjusted for age and sex):

Frequency of jogging per week	HR (Hazard Ratio)	Remarks
Sedentary nonjogger	1	Certainty of mortality at a given point time.
Less than or equal to once per week	0.19	81% lowered risk of mortality (as compared to a sedentary nonjogger)
2 to 3 times per week	0.20	80% lowered risk of mortality (as compared to a sedentary nonjogger)
More than 3 times per week	0.48	52% lowered risk of mortality (as compared to a sedentary nonjogger)

 Frequency of Jogging (adjusted for age, sex, smoking, alcohol intake, education and diabetes):

Frequency of jogging per week	HR (Hazard Ratio)	Remarks
Sedentary nonjogger	1	Certainty of mortality at a given point time.
Less than or equal to once per week	0.29	71% lowered risk of mortality (as compared to a sedentary nonjogger)
2 to 3 times per week	0.32	68% lowered risk of mortality (as compared to a sedentary nonjogger)
More than 3 times per week	0.71	29% lowered risk of mortality (as compared to a sedentary nonjogger)

Jogging pace (adjusted for age and sex):

Jogging Pace	HR (Hazard Ratio)	Remarks
Sedentary nonjogger	1	Certainty of mortality
Slow (9.66 km/h to 11.27 km/hour)	0.34	66% lowered risk of mortality (as compared to a sedentary nonjogger)
Average (above 11.27 km/hour)	0.25	75% lowered risk of mortality (as compared to a sedentary nonjogger)
Fast (threshold workouts)	0.54	46% lowered risk of mortality (as compared to a sedentary nonjogger)

Jogging pace (adjusted for age, sex, smoking, alcohol intake, education and diabetes):

Jogging pace	HR (Hazard Ratio)	Remarks
Sedentary nonjogger	1	Certainty of mortality
Slow (9.66 km/h to 11.27 km/hour)	0.51	49% lowered risk of mortality (as compared to a sedentary nonjogger)
Average (above 11.27 km/h)	0.38	62% lowered risk of mortality (as compared to a sedentary nonjogger)
Fast (threshold workouts)	0.94	6% lowered risk of mortality (as compared to a sedentary nonjogger)

When the findings of the CCH Study appeared for the first time on various news outlets and health magazines, there was a general uproar in the running community since most of the avid runners did not want to acknowledge or believe that something which felt so good could also be bad for them. The U shaped graph (namely, the diminishing returns from running distance and intensity) was unbelievable to most since till the CCH Study, none of the previous studies had categorically stated that hard running may be detrimental to the human body to the extent that all the benefits may wane away after a certain peak. Moreover many of the news articles based on the CCH Study provided a very general analysis of jogging related findings of the CCH Study, which needless to say sounded quite ridiculous to runners who were training for races, and who, as human nature goes, obviously did not want to hear that training for races would be counterintuitive.

The CCH Study was not anti-running. It was a comprehensive long term study on the pros and cons of hard training on the human body. Dr. Schnohr and others have stated that “….to our knowledge, there has been no study of the longevity of marathon, half-marathon or triathlon participants, but such studies would clearly be informative…”

The simplistic interpretation of the jogging related findings in the CCH Study by news media and individuals was incorrect since if you carefully see the above tables from the CCH Study, the following points emerge which demonstrate that the CCH Study was pro-running:

• There are benefits from any duration, frequency and intensity of running since the HR (hazard ratio) declines for each category of runner as compared to a sedentary non-jogger.
• Notwithstanding the above, the benefits from running are maximized by slow jogging (9.66 km/h to 11.27 km/hour) when done for 1 to 2.4 hours per week and in less than 2 to 3 sessions per week, and if the runner does not smoke, consume alcohol or have diabetes.
• As compared to a sedentary nonjogger, a person who runs can reduce his mortality risk to almost 50% even if he/she trains hard i.e. for more than 4 hours per week at a fast pace and in several sessions. Hence, even hard running is beneficial, but it’s less beneficial than slow running.
• The risk of mortality is only 6% lesser in a runner as compared to a sedentary nonjogger when a runner, (i) runs for more than 4 hours per week; (ii) runs more than 3 times per week; (iii) runs at a fast pace; (iv) smokes and drinks; and (v) has diabetes.

Therefore, unless you have picked up a few vices (alcohol and tobacco) and maybe have diabetes too, as per the CCH Study, even if you keep training hard, your mortality risk will always be lower than a sedentary nonjogger’s.

Also note that the CCH Study is only limited to determining cardiovascular health, and it has not considered the mental benefits of excessive/hard/intense/prolonged exercise (howsoever you may want to describe it).

As science has shown and as you may have felt yourself, the mental benefits from “excessive running” especially in treating the general malaise/depression in contemporary society may most certainly cancel the higher cardiovascular risks associated with hard running (marathons, ultramarathons, triathlons etc.) if seen in terms of personal choice in improving lives. Quality of Life, over Quantity of Life?

What you can do with the aforesaid data and analysis is decide what you want from running and your running schedule. If you want to run only for longevity then run less per week and run slow (less than 2.4 hours per week and slower than 11.27 km/h) and spend a few hours every week on strength training since strength training can reduce mortality risks significantly and also reduce cancer cell growth. However, if you run long distances out of sheer passion and mental health then keep training hard but reduce alcohol and smoking to decrease your mortality risk which otherwise comes in close proximity to a sedentary nonjogger due to these vices.

Finally, the findings of the CCH Study fit like a glove with Professor Alexander Y. Bigazzi’s (Department of Civil Engineering, the University of British Columbia) recent findings[5] of the minimum dose speeds (MDS) for Walking, Running and Cycling at which the amount of inhalation of pollutants is the lowest. Move faster than these recommended speeds and you will expend dramatically more energy which in turn will increase your heart rate and respiration and therefore you will inhale exponentially higher amounts of air + pollution. I had written a blog on this last year since in highly polluted placed like Delhi, during the months ranging from November-March, the air quality is extremely poor and a slower exercise speed is necessary to reduce air pollution. So a combination of the findings of the CCH Study and MDS (minimum dose speed i.e. workout speeds) is a win-win formula for areas with polluted air.

- Aman Yadav

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[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625209/

[2] https://www.ncbi.nlm.nih.gov/pubmed/25660917

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625209/

[4] http://circ.ahajournals.org/content/114/22/2325

[5] https://www.researchgate.net/publication/308535014_Determination_of_active_travel_speed_for_minimum_air_pollution_inhalation