I’ve had lower back pain off and on for the past several years, which generally keeps me from exercising. I can hardly get out of bed the day after exercise and it takes 2-3 days before the pain goes away. Can you recommend any exercises that would help with my back?

Sam V.

Dear Sam,

Millions of people are in the same boat as you. It’s a sad fact, but nearly everyone will experience back pain at some point in their lives. It’s the second most common neurological problem in the United States (headaches are the first).

It might surprise you to know that low back pain is often caused by getting too little exercise. In other words, it’s not movement that’s causing the pain… it’s a lack of movement.

You see, our bodies were never designed to sit for hours on end. But these days we spend hours in front of our TVs and computers. Instead of walking, we hop in our cars… even if we’re only going a few blocks. Over time, we begin losing flexibility. Certain muscles shorten and your ligaments get weaker, causing you to lose range of motion. This can cause a host of back problems.

However, it’s not too late to stop this decline. The following are some simple stretches and exercises that can help you regain your flexibility and build a stronger back. Start off doing three to five reps each, and build up to 20 over time.

Hip Flexors

1. Stand in a modified runner stance, with right foot forward and left foot back, feet flat on floor.

2. Put your hands on your hips and keep your back and hips in straight alignment.

3. Push forward with your hips, while maintaining your erect posture. Slowly push your hips forward only until you feel a comfortable level of tension. Hold for a count of 10.

4. Switch sides by reversing your leg stance and repeat.

Lying Knee-to-Chest Stretch

1. Lie on your back and keep one leg flat on the ground.

2. Use your hands to bring your other knee into your chest and hold for 20 seconds.

3. Repeat with the other leg.

Pelvic tilt

1. Lie on your back with knees bent and feet flat on the floor.

2. Tighten your abdominal muscles and lift your buttocks slightly off the floor. At the same time, keep the small of your back pressed against the floor.

3. Hold for 10 seconds.

4. Return to the starting position.

Cat Stretch

1. Get down on the floor on your hands and knees.

2. Tighten your abdominal muscles and slowly arch your back toward the ceiling (like a cat).

3. Hold for 15 seconds.

4. Return to the starting position.

Bridges

1. Lie on your back with your knees bent and your feet flat on the floor.

2. Tighten your abdominal muscles and raise your hips from the floor. When your hips are raised, a straight line should form from your knees to your shoulders.

3. Hold to the count of five.

4. Return to starting position.

To Your Good Health,

Al Sears, MD

I’ve been doing the PACE program on my own and I love it but still work with a trainer from time to time. He tells me that I need to change my diet and eat a whole bunch of whole grains every day – in fact, five times a day. He’s got me eating whole-grain rice, whole-grain bread or whole-grain pasta with every meal and snack. He says that the carbs will increase my workout stamina and endurance. But I’m confused. Don’t carbs make you gain weight? So what’s the real deal, Doc?

Robbie D.

Dear Robbie,

Ever since the government began advocating a low-fat diet, people have turned to carbs as their number-one source of nutrition. So it’s not surprising that there’s a lot of confusion and misinformation out there today. Even supposed “experts” are confused.

Here’s the thing. When trainers recommend loading up on carbs, it’s usually for conventional endurance training … working out for 45 minutes to an hour at a time. That’s not what PACE is about. Instead of long, boring workout sessions, PACE focuses on short bursts of intensity. And there’s a good reason for that.

You see, when you exercise your body uses something called ATP for the first two or three minutes. It’s the most readily available source of energy, but becomes depleted quickly. So after a few minutes, your body switches to carbs stored in muscle tissue. This lasts for 15 to 20 minutes before you switch to fat.

That may sound good in theory, but there’s a major flaw when it comes to using fat for energy. When you melt fat during exercise, it tells your body it needed the fat. This trains your body to make more fat for the next time you exercise.

But short-duration exercises like PACE tell your body that conditions are perfect to shed fat and build muscle – not to keep lots of fat stores around for long-duration exercise. When you eat a lot of carbs, it sabotages this natural process.

Plus, a diet high in carbohydrates including whole-grain foods increases your risk for a whole slew of medical problems like:

Obesity. Carbs are the most fattening foods per calorie – especially the empty, refined carbs you find in most of today’s white breads. These nutrient-poor foods signal your body that you are nutritionally deprived or starving. This shifts your metabolism toward fat building. The more of them you eat, the greater your risk of weight gain.

Heart Disease. Refined carbohydrates are the main cause of heart disease in the modern world. These foods are very high on the glycemic index. Over time they can reduce the elasticity of your arterial walls, which can lead to cardiovascular disease or heart attack.

Diabetes. High-glycemic carbohydrates spike your blood sugar, which triggers a release of the hormone insulin. The more carbs you eat, the more insulin is released. This can lead to diabetes and insulin resistance.

You’re much better off skipping the carbs and the “sugar high” you get from them. Instead, focus on healthy fats and proteins from natural sources. Here are five tips that will work with PACE to keep you thinner, healthier and more energetic:

1. Stay away from foods that rank high on the glycemic index. This includes rice, breads, grains, pasta, corn and potatoes.

2. Try making protein the focus of each meal. It kicks your metabolism into high gear and helps keep your blood sugar stable throughout the day.

3. Add meats, poultry and fish to your diet. A good old-fashioned steak won’t raise your blood sugar and the protein will help you handle insulin better, build muscle and repair tissue – all essential for staying lean and preventing diabetes. I prefer grass-fed beef, free-range poultry and wild-caught fish.

4. Snack on nuts and seeds. They are a good protein source and contain heart-healthy omega-3 fatty acids. They’ll also help keep you full so that you’re not tempted to grab a bag of chips or candy bar for an afternoon snack.

5. Avoid processed foods, sweeteners and high fructose corn syrup. These foods have been linked to obesity and insulin resistance.

To Your Good Health,

Al Sears, MD

1 “How High Carbohydrate Foods Can Raise Risk For Heart Problems,” ScienceDaily, Tel Aviv University, June 27, 2009

I just started PACE last month and I’m trying to make sure I do everything exactly right. So far I think I’m doing pretty well, but I’m really confused when it comes to the glycemic index and glycemic load.

I thought I understood the glycemic index. Just pick foods that have really low scores. But now you’re saying that low GI foods could have big glycemic loads… and higher GI foods could have low glycemic loads. So where do I begin?

C.M.

Dear C.M.,

This is a great question and you’ll be glad to hear the answer isn’t nearly as complicated as you might think. In fact, once you understand the difference between these two measures, putting them together is easy. And they are critical to your weight reduction program.

You see, high glycemic foods can cause your blood sugar to shoot up very quickly. In response, your body releases insulin. And that’s bad news because the more insulin you release, the more fat your body will store.

This is where the Glycemic Index (GI) comes in handy. It’s basically a scale that ranks carbohydrates on how rapidly they cause your blood sugar to spike. I’ve been using this index at my clinic for years. And, when my patients stick with it, they often see amazing results.

But there’s another side of the carbohydrate story that’s missing…

While the GI tells you how fast foods spike your blood sugar, it doesn’t tell you how much carbohydrate you’re getting in these foods. The calculation for the GI doesn’t figure in how many grams of carbohydrates you would consume of a particular food. It considers the quality of the carbs but not the quantity.

This is an important distinction, because the amount of carbohydrates in the foods you eat also can have an affect on your blood sugar and insulin response. That’s where the Glycemic Load (GL) comes into play.

The GL gives you a “corrected” number that takes both the GI and the serving size into account. When these two measures are combined, it turns out that, while some foods may have a high GI score, the actual amount of carbs per serving is so low that the overall effect is harmless.

Take carrots, for example. They rate very high on the GI (92). But that number is based on comparing how fast carbs from carrots and an equal amount of sugar spike your blood sugar. So let’s say we wanted to compare eating 50 grams of carrot carbs to 50 grams of sugar. To eat 50 grams of carrot carbs, you’d have to eat about one and a half pounds of carrots! That means that each individual carrot has very few carbs, giving them a GL of only 1. So eating a carrot or two isn’t going to have much effect on your blood sugar.

And what about fruits? Cantaloupe and watermelon both rank high on the GI. But their low GL scores make them a nice treat when you want something sweet to eat.

Prunes are just the opposite. Taking only the GI (29) into consideration, they look like a good choice. But the GL tells the real story. Just one serving of prunes ranks a 34.2 on the GL.

Same with pasta. Most spaghetti, linguine and noodles have a relatively moderate GI. But with GLs in the 20s and 30s, these can be very fattening foods.

To find out how your favorite foods rank, check out the glycemic table on my website.

When used together, the GI and the GL work hand-in hand to help you make the best food choices possible to drop weight more quickly and keep it off.

To Your Good Health,

Al Sears, MD

I have an excess 37 pounds I’ve been trying to get off for several years, so I was really anticipating my PACE experience.

I did great for the first three days, but then I just sort of stopped doing it. That seems to be a problem with me when it comes to exercise… plenty of motivation up-front, then a complete loss of it once I get started. Can you give me any hints on how I can stay motivated and stick with the program?

–Jimmy B.

Dear Jimmy,

I don’t know you personally, so I’m not sure why you stopped doing PACE, but I do have a lot of experience with people doing exercise programs.

And I find that one of the reasons so many people tend to quit is because they’ve been conditioned for failure.

There are lots of programs that promise results, but they force you into restrictive diets and impossible workouts that you can’t possibly follow.

People who want to drop weight will often try over and over to do them, but those programs set you up for failure. After a few tries, instead of training your body, you’ve trained your mind to expect to fail.

Here’s what I do about that:

Follow these 4 steps, and as you do them you will overcome that conditioning for failure because you’ll learn new habits.

1. Stay positive: Forget past failures. They’re history. You’re resistant to “exercise” because modern fitness advice had conditioned you to expect hours of aerobics and slogging away on the treadmill. You dread exercise because nature doesn’t want you to exert yourself that way. “Cardio” seems unpleasant because it is.

PACE is anti-exercise. It’s a total of 12 minutes of exertion, as little as three days a week. I guarantee it won’t take long until you start seeing changes in your body. In fact, many people begin noticing results in as little as two weeks. So don’t give up before you even get started. PACE is easy to do, and you’ll have fun the whole way. When you see the results, I promise you’ll stay motivated to keep working out with PACE.

2. Exercise at the same time each day. You can vary your workout to your liking, so PACE is always exactly what you want to do. Because you’ll like it, PACE will become something you look forward to each day.

Instead of being an added chore, it quickly becomes a regular daily habit. (Hint: Many of my patients prefer mornings over evenings, and I tend to agree them. Morning exercise helps pump up your energy levels throughout the day. It’s also easier to get motivated before work than it is after a long day at the job.)

3. Do the exercises you enjoy. The great thing about PACE is that you can apply it to just about any form of exertion, so it’s never boring. Pull out the bike, jump into the pool, walk briskly through the neighborhood, sprint around the block, or do body weight and weight-bearing workouts in front of your favorite television program. All you have to do is apply the concept of PACE to whatever movement you want.

Just incrementally increase the challenge in each set of exertion, and make sure to fully recover in between, and you’ll grow stronger, fitter and leaner in a relatively short time.

4. Track your progress. Once you start doing PACE you might notice that your clothes begin getting looser, or maybe your belt has to be cinched a little tighter. That’s what you’re looking for. The object here is fat reduction, so don’t obsess over the scale.

My patients usually start noticing these changes within two weeks. The real excitement kicks in when they come into my office and find how many inches they’ve lost. Or how many pounds of body fat they’ve shed. I’ve found that measuring and tracking these changes can be a great motivator.

To Your Good Health,

Al Sears, MD

I’m trying to knock off a lot of weight before my wedding next year. The PACE exercises are helping and I’m also trying to stick with low-glycemic foods. I usually have something like oatmeal and fruit for breakfast, a green salad for lunch and a little bit of meat with plenty of vegetables at dinner.

But I get so hungry during the day and end up end up hitting the vending machine for chips and other snacks by mid afternoon. So I’m not dropping weight nearly as fast as I need to. Any suggestions?

–Amy D.

Dear Amy,

Eating low-glycemic foods and doing your PACE exercises are solid steps in the right direction. However, you’re missing the most important nutrient of all when it comes to weight reduction – protein.

Research shows that diets high in protein make you feel fuller longer, increase your metabolism and help you melt fat faster.1 Getting plenty of protein can also help you build attractive lean muscle mass.2

And here’s the other thing to remember about eating protein… most high-protein foods also naturally have fat. And that’s important for weight reduction. Because it’s these natural fats that signal your body that you’re full.

Chips and other junk snacks have unnatural trans-fats that your body doesn’t recognize as food, and they leave you hungry. To stop the hunger cravings, go for foods like nuts, seeds or even raw milk that have natural, good fat and send your body the “I’m full” message.

Here are some things you can do during mealtime that will help you drop fat:

Switch from grains to protein for breakfast. I love a juicy steak with eggs at breakfast. It fills me up and keeps my energy levels high while I see my morning patients. I recommend switching from grains like oats, wheat or corn to eating grass-fed beef and cage-free eggs.

Another of my breakfast favorites is a cheese and vegetable omelet with wild salmon. I like omelets because I can add vegetables like spinach and mushrooms for extra antioxidant power.

You can also include a protein shake each morning. Just make sure to use quality whey or egg protein to make it.

Power up your metabolism at lunch. Salads are fine, but throw in some boiled eggs, cheese, meat, nuts, seeds and avocado to turn them into high protein meals. Other great lunch choices include chicken, tuna or seafood salad. The added protein will rev up your metabolism to help you melt fat all day long.

Make protein the centerpiece of your dinner table. Instead of eating a “little” meat at dinnertime, don’t feel guilty about enjoying a nice, juicy cut of meat. A steak or roast from grass-fed beef is delicious. Add some spinach, asparagus or a green salad and you’ve got yourself a meal that tells your body that times are good, and you don’t need to store fat.

Change things up by having grilled or broiled fish on some nights and oven-roasted chicken on others. Buy free-range poultry you can.

Don’t be afraid to snack. If you get hungry between meals or before bedtime, there are plenty of high protein and healthy snacks you can munch on.

• Nuts and seeds

• Grass-fed beef jerky

• Organic cheese

• Plain Greek yogurt

• Trail mix

To Your Good Health,

Al Sears, MD

1 Manuela, P.G.M., Lejeune, et al, “Ghrelin and glucagon-like peptide 1 concentrations, 24-h satiety, and energy and substrate metabolism during a high-protein diet and measured in a respiration chamber,” Am J Clin Nutr January 2006; 83(1):89-94

2 Aubertin-Leheudre, M., Adlercreutz, H., “Relationship between animal protein intake and muscle mass index in healthy women,” Br J Nutr. 2009 Dec;102(12):1803-10

The place where I work has just given us free gym memberships. I’d like to be able to do P.A.C.E. workouts on the workout machines they have there. Can you give me some ideas?

– Mindy T.

Dear Mindy:

Mostly I prefer using body-weight exertion for P.A.C.E. But if you want to go to the gym and use the machines, there are a couple that will give you a good P.A.C.E. workout.

It’s a good idea to have a trainer show you how to properly use the equipment and their speed and resistance settings, which are important for the progressive intensity and acceleration of your P.A.C.E. sessions.

Here are three you can use, and two I recommend against using:

Elliptical machine – These mimic a natural foot motion. They’re kind of like a sprint because you get natural, alternating flexion and extension of the hip and knee. They also have less impact on the joints.

The elliptical has an added benefit. When you use the handles, you can work both your upper and lower body at the same time. That means your legs, arms, shoulders, chest and back are all getting a workout. However, if you only want to target your legs, just lean on the center handrail with your hands and let your legs do all of the work.

Crank up the speed and resistance when it’s time to add intensity and progressivity.

Rowing machine – One of my favorite pieces of equipment to use if I’m ever at a gym is the rowing machine. These machines work all of the major muscle groups in your body, including core muscles. At the same time, it’s a very low impact workout when it comes to your joints.

But it’s very important to use the rowing machine correctly. Make sure to use the muscles in your legs and hips for most of the work and try not to over-arch your back as you finish your strokes. Instead of arching, sit straight and bend at the hips.

It also helps to keep your elbows close to your body while pulling on the oars/handles. Take the speed up a notch or two to increase your intensity and use the resistance setting to add progressivity.

Stair Stepper – These high resistance machines work the large muscles groups in your legs and buttocks. And the exertion required to use a stair stepper is guaranteed to get your lungs and heart pumping. It’s like running up several flights of stairs at a time.

Start off at a slow pace during your first exertion period. Then, increase the speed and intensity after each recovery. As you add resistance, you’ll notice it may take longer than normal to recovery. That’s okay. Take all the time you need.

Continue to work up speed and resistance as you progress. As it becomes more difficult, avoid leaning on the rails at the sides of the machine or it will decrease intensity.

One gym machine to avoid is the treadmill. It un-trains your natural neuro-integration because you’re not moving.

You see, when you walk or run in a natural setting, your brain knows that all it has to do is stimulate the muscles that cause angular momentum in one direction.

Your flexor and extender of the hip and the knee, and the muscles of your upper body, are just focused on the forward momentum, and your lateral (sideways) stabilizers relax.

And because you don’t need the lateral stability, all kinds of accessory muscles can relax, too.

But when you’re on a treadmill, you have no momentum, and no inertia. The treadmill is moving underneath you. It’s like trying to hold a bicycle up without moving. And it’s completely unnatural because you are tensing all of those muscles that are normally relaxed if you were actually moving.

Also, I don’t recommend weight training on machines. Weight machines force you to train your body with an unnatural, same-side movement. Let’s say you’re using the fly machine. You will tend to use the muscles, tendons and flexors on the same side of your body to pull the weight toward the center. It’s an unnatural way of moving. The natural way to move is contra-laterally, which means opposite arm and leg movement.

The solution is to use your body weight instead and everything works out naturally.

To Your Good Health,

Al Sears, MD

Dear Dr. Sears:

Me, my husband (Jim) and our two sons are all overweight. Jim and I have been doing PACE with great results. We’ve already shed 12 inches between the two of us. But we can’t seem to get the boys involved. When it comes to exercising they’ve been fighting us all the way. My little guys are 9 and 12 years old. Any ideas on how to get them to participate?

Jenna D.

Dear Jenna:

I’ve got a boy myself, and I learned long ago that the secret to getting him involved is to approach what we do as fun and challenging.

Telling my son that doing push-ups is “healthy” for him isn’t exactly exciting to a 12-year-old. But if I turn it into a game, or a sports challenge, he’ll take me up on the offer every single time. And he will give it everything he’s got to beat me.

The key to getting involvement from your kids is to turn PACE into something the boys can relate to.

Here are three easy ways to get them involved …

To Your Good Health,

Al Sears, MD

Mark C.

Dear Mark:

Your trainer is correct in that for the first 15-20 minutes of exercise your body does burn carbohydrates, or sugar. But P.A.C.E.-style exertion also melts more fat than traditional exercise.

In one study participants went through either endurance training or high intensity training similar to P.A.C.E. The endurance group used more calories during their exercise sessions… but the higher intensity group melted nine time more fat per calorie compared to the endurance group.¹ And if they had tested P.A.C.E., they would have seen even more dramatic results.

Unfortunately, you can’t “turn fat into muscle.” It doesn’t work that way. Fat and muscle are two completely different types of tissue. They aren’t interchangeable.

P.A.C.E. uses the concept of acceleration – shortening your rest periods and getting up to your target intensity a little faster with each workout – to retrain your metabolism to store energy in your muscles instead of storing it as fat. This helps you build lean, strong muscles and have very low body fat.

The bottom line is, P.A.C.E. will help you recreate the naturally lean body you were meant to have, no trainer necessary. To help you, here is a full P.A.C.E. primer to help you when you work out with P.A.C.E.:

1. Exert yourself with incrementally increasing intensity for short periods of time followed by recovery. We’ve found in our experience that it’s best to do three sets of exertion, but remember to make your workout no more than 12 total minutes so you don’t use fat for energy, which will make you store more fat.Start off at a comfortable level. Then, increase intensity until you are slightly winded. When you reach this level and stop. If you’re a little de-conditioned, this might mean walking normally or slowly pedaling a bicycle for a short distance.Recover until your heart rate has come down to near normal, then start another set of exertion, increasing the intensity just a little bit. A few more pedals. Walk a bit faster. Then rest and recover. For your last set, try to reach very near, but not quite, your maximum exertion. Focus on where that maximum is, so you can reach a little further for it each time. This continual reaching but not quite getting there builds capacity in your heart and lungs, which is what gives your body power.

    

2. Track your exertion levels. The best way to evaluate your exertion level is to track your heart rate. You can estimate your maximum heart rate by subtracting your age from 220. This is only an estimate and your heart rate can get higher that more fit you becomeMeasure your heart rate before beginning. During your exertion, you’ll want to get your heart beat up to somewhere around 60-80% of maximum, depending on your current conditioning. (To calculate your heartbeat, just count the number of beats in 6 seconds and multiply it by 10. You can feel it by pressing your fingertip against the pulse in your wrist or neck.)
3. Accelerate Your Challenges. When you become more fit, you’ll discover two things. First is that you don’t need to rest as long between sets. Instead of resting for 3 minutes you rest for two and a half. And the next time just over two minutes. Shorten it a little with each workout. Second, you’ll also find that, for example, you can do sprints running at your target intensity from the start of a set, instead of needing time to get up to speed. Do that. Shorter rest and a quicker time to intensity mean your accelerating your workouts, which is what trains your metabolism to store energy in your muscles because you need it right away, instead of using fat which burns slowly.
4. Change It Up. As your body responds to your workouts, it will adapt to what you are asking it to do. If you keep doing the same thing, no matter how intense, your body will stop responding. So it’s important to continually push yourself by increasing the pace and intensity of your workouts. Your body needs a consistent set of new challenges to grow and achieve.

To Your Good Health,

Al Sears, MD

1 Tremblay A, Simoneau JA, Bouchard C. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994;43(7): 814-818.

Stats:

Lost 22 lbs., 7 inches off waist, 5 inches off hips

Went from size 13 to size 3

“My weight gain was so gradual, I didn’t even notice. It just snuck up on me and when I couldn’t button my pants, I realized it had gone too far. I didn’t feel good because of my weight. And because I didn’t feel good, I didn’t want do anything to make myself look good. I never did my hair, so I never did my makeup. And because I didn’t do my hair and my makeup, I didn’t have cute clothes. I thought if I didn’t feel cute, why should my clothes look cute? I was running around looking like someone who really let herself go.

“Before PACE Express, I was kind of shy and I didn’t really want to talk to people. I’d go to parties with my friends and I’d just kind of sit in the corner. I’d keep my head down and wouldn’t do anything to draw attention to myself. Now with PACE Express, I’ve lost 17 pounds of pure fat and 23 inches throughout my whole entire body: four in my waist, almost seven in my hips and over three in my thighs. My friend actually just had her birthday party a couple weeks ago and I went to it. I was talking to new people and socializing. I felt confident and I felt good about myself. My friend actually said to me after the party that she was surprised I stayed so long and that I was talking to people I didn’t know. Now I finally feel young and I feel fun.”