I thought it would be interesting to ask a back surgeon a few questions about fitness, weight control and back problems. I contacted famed NYC Dr. Nathaniel L. Tindel. He received his medical degree from the University of Pennsylvania School of Medicine and completed his residency at Lenox Hill Hospital. He is a Board Certified Orthopaedic Surgeon who practices in New York City and Long Island. Dr. Tindel is affiliated with Lenox Hill Hospital and is an assistant professor of orthopaedic surgery at The Albert Einstein College of Medicine and chief of spinal surgery, at the Jacobi Medical Center. From 2001-2006, Dr. Tindel was the Director of the Spine Service in the Department of Orthopaedics Surgery at the Montefiore Medical Center. He has been honored by New York Magazine as a top doctor in the New York metropolitan area.

He is the Director of the New York Center for Spinal Disorders that offers comprehensive evaluation and treatment for all back and neck problems including back and/or neck pain, scoliosis, back related trauma, fractures, deformity, infection, cancer, osteoporosis, sciatica. (http://www.nycenterforspinaldisorders.com/).

Dr. Tindel's first book I've Got Your Back: The Truth about Spine Surgery Straight for a Surgeon was published in January 2007 by New American Library and is entering its second printing. The book is designed to help patients make the match between a particular back problem and the treatment option most likely to work for them.

Name: Nathaniel Tindel, M.D.

Your Location: New York City

Website: http://www.nycenterforspinaldisorders.com/

Diet Detective: Hello and thanks for agreeing to do this interview! Back pain is a big problem for many of us. What was the biggest surprise you found in about back pain and a person' weight (aside from the obvious of carrying around more weight)?

Dr. Tindel: Despite many scientific studies looking at people who have back pain and a person's weight, the question of causality has not been conclusively established. Intuitively, many people assume that the evidence is clear, but it's not. That doesn't mean that there isn't a link between the two, just that researchers haven't found it, yet. A literature review of 65 of the best studies addressing the link between body mass index and back pain concluded that body weight can only be considered a possible weak risk factor for back pain, and the lack of good quality research precludes further commentary. What surprises me most about this important question (and I get asked by several patients every day) is how little high-quality scientific research has been conducted in this very important area and that we haven't figured out the answer.

Diet Detective: Is your weight one of the major contributors to someone having back pain, or is it just one of many contributory factors? And will weight loss "heal" or stop the back pain?

![http://www.nycenterforspinaldisorders.com/images/IGYBcover.jpg!Dr]. Tindel: Scientifically, as I mentioned above, body weight can only be considered to have a weak link to back pain. But you asked an important second question that has been given some attention recently. Namely, if you are overweight and you DO have back pain, does weight loss help the back pain? With the rise of bariatric surgery, several researchers have looked at this and found that if you do have back pain and you do lose weight then there is a good chance the back pain will get better (but not necessarily "cure" it) but more importantly, that your overall functionality will improve, as well. So my answer is that if you do have weight issues and you also have back pain, losing weight may be of benefit for the back problem.

Diet Detective: How and why is your posture so important? Is there anything someone reading this can do other than "stand up strait" to help his or her posture? Something failsafe?

Dr. Tindel: Posture is important but constantly nagging for someone to "stand-up straight" doesn't seem to work. If you have ever asked someone to "stand-up straight" (whose mother hasn't told their child this?) you've probably noticed that it works for about 15 seconds, and then they go back to their natural position. I frequently get asked by the mom's of my adolescent scoliosis patients to tell them to "stand up straight." To the mom's dismay, I always take the side of the adolescent. We are all packaged differently and we all have different postures that are uniquely balanced and in equilibrium with our bodies. This is not to say that sitting posture and posture while walking and doing sports and physical activities isn't important: it is! It's just that everyday standing posture is so unique that it's almost impossible to change.

Diet Detective: What's your number one back suggestion for active people?

Dr. Tindel: Exercise in moderation and keep it going! Aerobic condition is the best for the back and it's also good for the heart and lungs.

Diet Detective: I often hear Doctors recommending physical activity to help alleviate back pain, but it seems that those that are physically active constantly have aches and pains - especially the back. Can you comment and offer a few (non-obvious) advice?

Dr. Tindel: There is a big difference between having a chronic or intermittent back problem (whatever that might be) and having a little muscle ache after a work-out. Either way, if the problem persists, it should be evaluated. I've found that even professional athletes can have back pain because of improper technique and with the right coaching have cured their pain. You can start with your trainer and if that doesn't work, consider a physical therapist that specializes in sports medicine. I can't stress enough, though, that if your pain continues or gets worse, you should seek medical advice.

Diet Detective: If someone is physically active what are some things they can do to prevent back pain, assuming they already have it? Also, I've read research that shows that stretching doesn't not prevent injury, so is there anything we should be doing to prevent injury or re-injury?

Dr. Tindel: Being physically active is the best advice we give patients with back pain. But being "active" doesn't mean you are doing the right activities that have been shown to make the back stronger. Weight-lifting, per se, is very physically active, but hasn't been shown to help back pain. What works best is low-to-moderate aerobic activity. Walking, swimming, biking, hiking and yoga all are good examples.

The advice on stretching has gone full circle. What we know for sure is that it's good to stretch, at least a little and that overstretching is worse than not stretching at all. If someone is re-injuring themselves, it's worth taking a close look at their exercise strategy with a trainer or physical therapist. Often times, it's a simple solution.

Diet Detective: I used to enjoy getting massaged regularly-especially for my neck and back, however, it started to hurt more than help. I know the therapist was good and well trained-are there certain situations where massage is not recommended?

Dr. Tindel: Everyone loves a massage and I'm included. But, aside from a short-lived stress reduction and feel-good experience, there is no lasting effect of massage for back pain. Rarely, patients report worsening symptoms with a very aggressive massage, but that is not common. Overall, I recommend massage, but not as an alternative to exercise and re-conditioning.

Diet Detective: For those weekend or part-time athletes, are they at an increased risk for back injury / pain? Any suggestions (other than to your doctor.. J)

Dr. Tindel: Weekend or part-time athletes are at increased risk for back pain and a whole host of other joint and bone injuries including knee injuries, stress fractures, tendonitis, muscle strains and ligament injuries, to name a few. Instead of doing a few "hard" work-outs during the weekend, it's better to do a couple of easier ones, spread out over the week.

Diet Detective: I've heard that you should "work through" and continue being active if you have pain or injury. Does staying active help?

Dr. Tindel: Staying active is the most important message I tell my patients but "working through" the pain is a different story. Pain is very subjective so how one person experiences pain may be entirely different from another's experience. "Working through" the pain is a very individual experience and I don't generally advise it. More importantly, if you find yourself continually doing so, your pain should be evaluated by a medical professional.

Diet Detective: What about yoga in terms of back pain? It seems obvious that it's helpful, but can it hurt you? When shouldn't you be doing yoga or Pilates?

Dr. Tindel: Yoga and Pilates are two great ways to stay fit and they are at the top of my list for anyone, with or without back problems. The only downside that I come across is that many people unfamiliar with these type of activities do not realize how strenuous they are and how important a good instructor can be. I'm always happy when a patient of mine tells me they are doing this type of activity.

Diet Detective: Okay, enough of the medical stuff. I would like to ask you a few personal questions. If you could eat one forbidden or unhealthy food whenever you wanted without gaining weight, what would it be?

Dr. Tindel: Ice cream

Diet Detective: If there were one healthy food item (something you love) that you had to eat every day, what would it be?

Dr. Tindel: Bananas

Diet Detective: What's your favorite breakfast?

Dr. Tindel: Cupcakes

Diet Detective: Do you have a pet?

Dr. Tindel: Yes, a mixed-breed rescue dog names Sally.

Diet Detective: Last book read?

Dr. Tindel: The Master and Margarita

Diet Detective: What did you want to be at the age of 5? (as far as a career)?

Dr. Tindel: A brain surgeon

Diet Detective: What was your worst summer job?

Dr. Tindel: Fortunately, I loved all of my summer jobs, from fixing pools and being a life guard to summer camp counselor.

*Thank you!!!! *

(Source: Harvard School of Public Health ) A slightly greater number of males than females are born worldwide every year. In recent decades, although there are still more baby boys born than girls, there has been an apparent decline in the ratio of male to female newborns in several industrialized countries, including Canada, Denmark, England, Germany, Japan and the United States. That has led researchers to ask: Are there any factors that can influence the probability of giving birth to a baby boy or girl?

A new study from the Harvard School of Public Health (HSPH) and Karolinska Institutet in Stockholm, Sweden, found that mothers who experienced an increase in weight from the beginning of the first pregnancy to the beginning of the second pregnancy may be slightly more likely to give birth to a baby boy during their second pregnancy. The study appears in the journal Fertility & Sterility.  Keep in mind, this is one study, and does not mean that if you want a boy that you should gain weight. 

Brad Schoenfeld, CSCS, is an internationally renowned expert on fitness and sports nutrition. As the owner/operator of the exclusive Personal Training Center for Women in Scarsdale, NY, he is regarded as one of the leading authorities on women's fitness. He is a lifetime drug-free bodybuilder, and has won numerous natural bodybuilding titles including the ANPPC Tri-State Naturals and USA Mixed Pairs crowns.

Mr. Schoenfeld is the author of the best-selling book, Sculpting Her Body Perfect (Human Kinetics Publications, 2002), with two editions and over 100,000 copies in print. The book details cutting-edge training techniques for helping a woman maximize her genetic potential and has been endorsed by many of the leading fitness celebrities and models. His second book, Look Great Naked (Prentice Hall, 2001), was the #1 book on Amazon.com on multiple occasions and was an LA Times bestseller. His newest book, 28-Day Body Shapeover (Human Kinetics, 2005), details the fastest, most effective program for transforming your physique. With a 28-day calendar style workout that spells out every set, every rep, and every morsel of food, it takes all the guess work out of training and diet, helping you to achieve your best shape ever!

Mr. Schoenfeld also is the star of the Look Great Naked Videos; a three-video series that demonstrates targeted high-energy workouts for the abs, butt and thighs. The videos, based on his High-Energy Fitness^TM system of training, have received both critical and consumer acclaim. The are distributed internationally by Kochvision.

Mr. Schoenfeld serves on the review panel for the NSCA's Strength and Conditioning Journal, a peer-reviewed research journal for sports and nutrition. In this role, he helps to determine which papers get published in the journal.

Having trained many of the top fitness models, Mr. Schoenfeld developed a system of training called TM that is designed to help a woman achieve a toned, feminine physique. This system combines weight training into an aerobic-style workout that ultimately reduces body fat while accentuating lean muscle tone. In 1994, he founded the Personal Training Center for Women.

Mr. Schoenfeld is a Certified Strength and Conditioning Specialist (by the National Strength and Conditioning Association) and is dually certified as a personal trainer by both the American Council on Exercise (ACE) and the Aerobics and Fitness Association of America (AFAA). He also has received specialty certification in nutrition. He is a member of the American College of Sports Medicine as well as the International Association of Fitness Professionals (IDEA), which has bestowed upon him the title of Master Trainer-the highest ranking possible. He is available for expert advice, consulting, speaking, and free-lance writing on all fitness related matters.

Name: Brad Schoenfeld, CSCS, CPT

Birthday: August 14

Location: Scarsdale, NY

Website: http://www.lookgreatnaked.com/

Diet Detective: Hello and thanks for agreeing to do this interview! You've been helping people get in shape for years, and my first and probably most important question is what do you think is the most important thing that makes or breaks a diet/fitness program?

A person's determination. Contrary to popular belief, motivation comes from within. A trainer or nutritional counselor can provide a person with the framework to succeed and inspire by example, but they can't motivate someone in the true sense of the word. Without the person having that inner drive, the program ultimately won't endure over time. It requires a high level of determination to push your body to the point of discomfort week after week when you'd rather be hanging out or relaxing. That necessitates cultivating your motivation by constantly re-evaluating your reasons for exercising.

Diet Detective: You're specialty is training women-what are some of the key differences that women face in comparison to men when training?

Brad: Of course there are the obvious physical differences: Women tend to carry their weight in their lower bodies and have less strength in the upper body. There also are significant hormonal differences: Women have only a fraction of the testosterone of the average male (making muscle gain more difficult) and undergo hormonal shifts that can cause water retention and affect exercise performance. Perhaps the most significant difference, though, are the diverse physique goals that women generally have as opposed to men. While most men want to get big and strong, women are more often looking to be lean and toned. Since exercise follows the law of specificity-which states that you need to train specific to your goals-it's essential to take these factors into account when devising a comprehensive routine. One of the biggest mistakes I see personal trainers make is that they train women the same way they train men.

Diet Detective: Can you explain High-Energy Fitness?

Brad: High Energy Fitness is a three-phased system of training that I developed from working with hundreds of women at my private facility in Scarsdale (it is detailed in depth in my book, SCULPTING HER BODY PERFECT). In a nutshell, it's a periodized program that takes a woman from beginner to advanced levels in stepwise fashion. It starts with a conditioning phase, then moves to a toning and shaping phase, and then to an advanced bodysculpting phase, becoming progressively more challenging as one progresses from one phase to the next. It can help women of all ages and abilities achieve their ideal physique.

Diet Detective: How do you get a client motivated to stick to a fitness program?

Brad: The most important part of maintaining motivation is setting goals. The first thing I do with a new client is to assess their reasons for undertaking an exercise program and then commit them to paper. Goals should be broken down into short-term and long-term goals. This keeps a person focused on why exercise is important to them. As long as a person stays focused on their goals, adherence to exercise is almost always assured.

Diet Detective: Tell us the biggest secret that trainers typically don't tell their clients, but should?

Brad: To develop a mind-to-muscle connection. When you lift a weight, you should consciously visualize the target muscle and feel it working throughout the complete range of motion. Don't think about where you are feeling the muscular stress, think about where you are supposed to feel the stress. For example, when performing a bench press, you should focus on the muscles of your chest (i.e. pectorals) as you lift. Not only will this help to improve your form, but it will diminish the contribution of extraneous muscle assistance, ensuring that the target muscles perform the majority of the work. Employing this one simple technique can improve results by 25 percent!

Diet Detective: In all your years of training what do you consider the best non-weight related exercise (e.g. lunge)?

Brad: I tend to avoid using the term ‘best exercise'-variety is the spice of fitness! The human body is the most resourceful of all organisms and intuitively adapts to repetitive stress, including that from exercise. The longer you use the same exercises in a routine, the less effective they become. To counteract the adaptive nature of the body, a person should aspire to vary exercises from one session to the next, using as many modalities (i.e. dumbbells, barbells, cables, machines, etc) as possible-that includes body weight movements. Your muscles are thereby forced to constantly adjust to new stresses, ultimately fostering their ongoing development.

Diet Detective: If you could only do only one strength training exercise (using weights) what would it be?

Brad: It would have to be the squat. Not only does the squat work all the muscles in the lower body, but it requires stabilization from much of the upper body musculature, too. In short, it's perhaps the most complete movement there is. What's more, it's an extremely functional exercise. So many movements in everyday life revolve around lifting items from a squatting position. Assuming there are no medical contraindications, it should be a part of everyone's workout.

Diet Detective: What is the worst strength training exercise for women? Or one that is the most frequently done incorrectly?

Brad: The exercise that I see done most often incorrectly is the crunch and its many variations. Most often, people lift their torso far past the point where their abs are actively contracting. It's essential to understand that the thoracic spine has only about a 30 degree range of motion. Lifting the torso past this point only serves to activate the hip flexors, which far overpower the abs and thus take stress away from the target muscles. Worse, there is a lot of shear force exerted on the lumbar spine which can cause lower back problems. To perform the move correctly, the trainee should focus on pressing her lower back into the mat-only the upper back should come off the ground. It's a small movement that will have big effects when done properly. Also, place your hands across your chest, not behind the head! When the hands are behind the head, there is a reflexive tendency to pull on the cervical spine during exercise performance. This can cause serious injury to the muscles and soft tissue structures in the neck region.

Diet Detective: Can you tell us one strength training myth that we probably have not heard about? Or that we would be surprised to learn?

Brad: I actually do a seminar on this very topic at many of the national fitness conventions-it's one of my favorite subjects. The myth that seems to surprise the majority of fitness enthusiasts is that a person should train their abs everyday for best results. It's somehow been taken as gospel that the abs are this ‘special' muscle that can endure daily exercise. Truth is, the abs have the same muscle fiber composition as the biceps and quadriceps, yet I can't imagine anyone thinking they should train their arms and legs everyday! Training a muscle causes structural tears within the fibers that need rest to ensure optimal recuperation. The abs are no exception. The normal time course for protein synthesis (i.e. the time it takes for muscles to fully heal after a workout) is 48 hours. Thus, if your goal is to achieve six-pack abs, the midsection should be trained no more than three times a week, every other day. And along the same lines, training the abs won't make them any flatter. You can't spot reduce fat. It's a physiologic impossibility. There is no way to dictate what area of your body you lose fat from. So you can do abdominal crunches until the cows come home, but it won't help to whittle away that spare tire!

Diet Detective: If you could eat one forbidden or unhealthy food (candy, cakes, etc..) whenever you wanted without gaining weight, what would it be?

Brad: Sicilian pizza! It's my favorite cheat food. I could eat an entire pie and still want more. A good New York Cheesecake probably comes in a close second.

Diet Detective: What is the one food or meal you always eat before training? What do you advise clients to eat?

Brad: With respect to weight training, it's really the post-exercise meal that's most important. After training, your body is primed for anabolism (i.e. tissue building). I recommend consuming a drink of fruit juice and whey protein. This optimizes replenishment of glycogen stores as well as facilitating optimum protein synthesis. A good rule of thumb is to consume ½ gram of carbs and ¼ gram of protein per pound of goal body weight. Thus, if a woman aspires to weigh 120 pounds, then she should consume a drink containing 60 grams of carbs and 30 grams of protein.

Diet Detective: What's your favorite breakfast?

Brad: I basically eat the same breakfast every morning. I'll have an egg white omelet topped with black bean salsa, and a large bowl of steel-cut oatmeal with flax oil and diced fruit. It provides an ideal combo of complex carbs, lean protein, and essential fats that fuels my daily activities and keeps me mentally sharp.

Diet Detective: What do you consider the world's most perfect food?

Brad: Organic eggs. They contain a terrific mix of complete protein and essential fatty acids (including the all-important omega-3 fats).

Diet Detective: On those days when you're not motivated to work out, but you should, what's the one thought that gets you going?

Brad: I think back to how I looked and felt before I started working out and then think of the difference that exercise has made in my life. It's kept me from never having missed more than a week of training for the past 20 years.

Diet Detective: What person do you respect most, or who motivates you?

Brad: The two people I respect most are my parents-they instilled proper morals and ethics in me that have pervaded the way I think and act. Everything I've accomplished I owe to their upbringing.

Diet Detective: What do you do to reduce stress/relax/center your mind? Do you participate in an organized relaxation activity such as yoga, meditation or tai chi?

Brad: I'm a big believer in mind-body activities. I've studied meditation and self-hypnosis and have developed my own regimen based on these principles that helps me to relax. I also study martial arts which fosters a distinct mind-body connection.

Diet Detective: Do you have a Calorie Bargain?

Brad: Rather than a calorie bargain, I employ a "cheat day" in my diet. I eat in a very regimented fashion six days a week, then allow myself to basically eat what I want (within reason) on that seventh day. This allows me to satisfy any cravings that I might have so I don't feel deprived. It's something I preach in my books and to all my private clients-it really helps with dietary adherence.

Diet Detective: What's the most bodacious chance you've ever taken?

Brad: Without a doubt, opening my one-on-one training facility-the Personal Training Center for Women- in 1994. At the time, the concept of a personal training gym was totally obscure, and specializing in a one-on-one center for women was unheard of. Everyone was telling me I was crazy. But I had a conviction that it would succeed and spent a lot of time in cultivating a clientele. It was rocky at first, but the business slowly built itself up and today I have a waiting list for many time slots.

Diet Detective: What was your worst summer job?

Brad: I was a dishwasher at a Mexican restaurant when I was 16. I had to take two showers after getting off work just to get the stench of burritos off my skin!

Diet Detective: Define failure.

Brad: Failure is a necessary evil that takes you one step closer to success. This manifests itself in resistance training (i.e. lifting weights). The only way that you can develop your physique to its fullest is by pushing your body to momentary muscular failure-the point at which you can no longer lift the weight for another rep. It's a central tenet of exercise science and one that too many people neglect to employ in their workout routine.

Diet Detective: What's the best book about health that you've read? (Aside from your own)

Brad: "Advanced Nutrition and Human Metabolism" by Groff and Gropper. It's requires a good grasp of science, but for those who really want to understand nutrition, it's the most complete text I've come across.

Diet Detective: Do you have a pet?

Brad: I have a beautiful English bulldog named Winston. Dogs display unconditional love. He's been a true blessing in my life.

Diet Detective: What did you want to be at the age of 5 (as far as a career)?

Brad: A cardiologist-like my dad. By the age of six, though, I wanted to become a baseball player for the Mets. I was a fickle kid

Thank you!!!

(Source:[ University of Virginia Health System|http://www.healthsystem.virginia.edu/home.html] ) Certain preparations taken to enhance athletic performance or stave off disease contain an anti-oxidant that could cause harm. According to new research at the University of Virginia Health System, N-acetylcysteine (NAC), an anti-oxidant commonly used in nutritional and body-building supplements, can form a red blood cell-derived molecule that makes blood vessels think they are not getting enough oxygen. This leads to pulmonary arterial hypertension (PAH), a serious condition characterized by high blood pressure in the arteries that carry blood to the lungs. The results appear in the September issue of the Journal of Clinical Investigation.

"NAC fools the body into thinking that it has an oxygen shortage," said Dr. Ben Gaston, UVa Children's Hospital pediatrician and researcher who led the study. "We found that an NAC product formed by red blood cells, know as a nitrosothiol, bypasses the normal regulation of oxygen sensing. It tells the arteries in the lung to ‘remodel'; they become narrow, increasing the blood pressure in the lungs and causing the right side of the heart to swell."

Gaston notes that this is an entirely new understanding of the way oxygen is sensed by the body. The body responds to nitrosothiols, which are made when a decreased amount of oxygen is being carried by red blood cells; the response is not to the amount of oxygen dissolved in blood. He says that this pathway was designed much more elegantly than anyone had previously imagined. "We were really surprised", he said.

The research team administered both NAC and nitrosothiols to mice for three weeks. The NAC was converted by red blood cells into the nitrosothiol, S-nitroso-N-acetylcysteine (SNOAC). The normal mice that received NAC and SNOAC developed PAH. Mice missing an enzyme known as endothelial nitric oxide synthase did not convert NAC to SNOAC, and were protected from the adverse effects of NAC, but not SNOAC. This suggests that NAC must be converted to SNOAC to cause PAH.

Could regular use of NAC produce the same effects in humans" The next step is to determine a threshold past which antioxidant use becomes detrimental to heart or lung function, according to Dr. Lisa Palmer, co-researcher of the study.

"The more we understand about complexities in humans, the more we need to be aware of chemical reactions in the body," said Palmer.

According to Gaston and Palmer, NAC is being tested in clinical trials for patients with cystic fibrosis as well as other conditions; and clinical trials with nitrosothiols are being planned. These results, Palmer says, should motivate researchers to check their patients for PAH.

The results also open up a range of possibilities in treating PAH. Palmer added that the signaling process could be restorative and healing if they figured out how to keep NAC from fooling the body.

"From here we could devise new ways for sensing hypoxia or we could in theory modify signaling to treat PAH," Palmer said.