Reportage in a Chinese medicine practice in Lyon, France Acupuncture session. (Photo by: ... [+] BSIP/Universal Images Group via Getty Images)

Sometimes I'm not sure whether the best response to pseudoscience is to ignore it, or to patiently try to explain why it's wrong, or to get mad.

This week I'm mad.

My anger and frustration was triggered bya tweetfrom Memorial Sloan-Kettering's Integrative Medicine account, shown here:

Image captured by the author

For those who don't know,Memorial Sloan-Kettering Cancer Centeris one of the world's leading cancer centers, both for treatment and research. If you are diagnosed with cancer, MSK is one of the best places to go.

But not everything at MSK is world class. Unfortunately, they have an"integrative medicine"center that offers a mixture of therapies ranging from helpful to benign to useless. One of their biggest activities is acupuncture, which they claim offers a wide range of benefits to cancer patients.

The MSK tweet shown here was boasting abouta new, $3.7 million studyfunded by NIH to study the effect of acupuncture on pain that cancer patients experience from chemotherapy and bone-marrow transplants.

Here's why I'm mad: cancer patients are extremely vulnerable, often suffering the most frightening and difficult experience of their lives. They are completely dependent on medical experts to help them. When a place like MSK suggests a treatment, patients take it very seriouslyas they should. But they really have no choice: a cancer patient cannot easily look for a second opinion, or switch hospitals or doctors. Even if they have the money (and cancer treatment is extremely expensive), switching hospitals might involve a long interruption with no treatment, during which they could die, and it might also involve traveling far from their home.

Offering these patients ineffective treatments based on pseudoscienceand make no mistake, that's what acupuncture isis immoral. Now, I strongly suspect that the MSK's "integrative medicine" doctors sincerely believe that acupuncture works. Their director, Jun Mao, is clearly a true believer, as explained inthis profile of himon the MSK website. But that doesn't make it okay.

I've written about acupuncture many times before (here,here,here, andhere, for example), but let me explain afresh why it is nonsense.

Acupuncture is based on a pre-scientific notion, invented long before humans understood physiology, chemistry, neurology, or even basic physics, which posits that a mysterious life force, called "qi," flows through the body on energy lines called meridians. As explainedin this article by MSK's Jun Mao:

"According to traditional Chinese medicine ... interruption or obstruction of qi was believed to make one vulnerable to illness. The insertion of needles at specific meridian acupoints was thought to regulate the flow of qi, thus producing therapeutic benefit."

Today we know that none of this exists. There is no qi, and there are no meridians. In that same article, Jun Mao continued by admitting that

"the ideas of qi and meridians are inconsistent with the modern understanding of human anatomy and physiology."

And yet this is what they offer to patients at MSK.

Just to be certain, I readone of the latest studies from MSK, published early this year, which claims to show that acupuncture relieves nausea, drowsiness, and lack of appetite in multiple myeloma patients who were going through stem cell transplants.

It's a mess: totally unconvincing, and a textbook case of p-hacking (ordata dredging). The paper describes a very small study, with just 60 patients total, in which they measured literally dozens of possible outcomes: overall symptom score at 3 different time points, a different score at 3 time points, each of 13 symptoms individually, and more. I counted 24 different p-values, most of them not even close to significant, but they fixated on the 3 that reached statistical significance. The two groups of 30 patients weren't properly balanced: the sham acupuncture group started out with more severe symptoms according to their own scoring metric, andFigure 2in the paper makes it pretty clear that there was no genuine difference in the effects of real versus sham acupuncture.

But they got it published (in a mediocre journal), so now they point to it as "proof" that acupuncture works for cancer patients. This study, bad as it is, appears to be the basis of the $3.7 million NIH grant that they're now going to use, they say, in "a larger study in 300 patients to confirm these previous findings."

And there you go: the goal of the new study,according to the scientists themselves, is not to see if the treatment works, but to confirm their pre-existing belief that acupuncture works. Or, asone scientist remarked on Twitter, "they already have a result in mind, the whole wording of this suggests that they EXPECT a positive outcome. How did this get funded exactly?"

Good question.

So I'm mad. I'm mad that NIH is spending millions of dollars on yet another study of a quack treatment (acupuncture) that should have been abandoned decades ago, but that persists because people make money off it. (And, as others have explained in detail, acupuncture is actually a huge scam that former Chinese dictator Mao Zedong foisted on his own people, because he couldn't afford to offer them real medicine. For a good expos of Chairman Mao's scam,see this 2013 Slate piece.)

But I'm even more upset that doctors at one of the world's leading cancer centers are telling desperately ill patients, who trust them with their lives, that sticking needles into their bodies at bogus "acupuncture points" will relieve the pain and nausea of chemotherapy, or help them with other symptoms of cancer. I'm willing to bet that most MSK doctors don't believe any of this, but they don't want to invest the time or energy to try to stop it.

(I am somewhat reassured by the fact that MSK'sTwitter accounthas nearly 75,000 followers, while it's integrative medicine Twitter account has just 110.)

Or perhaps they are "shruggies": doctors who don't believe in nonsense, but figure it's probably harmless so they don't really object. To them I suggest this:read Dr. Val Jones's accountof how she too was a shruggie, until she realized that pseudoscience causes real harm.

And finally, let me point tothis study inJAMA Oncologyfrom last year,by doctors from Yale, which looked at the use of so-called complementary therapies among cancer patients. They found that

"Patients who received complementary medicine were more likely to refuse other conventional cancer treatment, and had a higher risk of death than no complementary medicine."

And also seethis 2017 studyfrom the Journal of the National Cancer Institute, which found that patients who used alternative medicine were 2.5 times more likely to die than patients who stuck to modern medical treatments.

That's right,Memorial Sloan-Kettering: patients who use non-traditional therapies are twice as likely to die. Thats why Im mad. This is not okay.

Read the original post:
Prestigious NY Cancer Center Will Spend $3.7M To Study Bogus Cancer Treatment - Forbes

If youre anything like me, the memory of your very first CrossFit WOD is burned into your lungs.

From the moment that the clock started running until the very last rep of the workout, you likely sucked wind harder than at any previous point in your life. As you fell to the ground afterwards in a heap of exhaustion, a love/hate relationship with the sport of fitness developed right on the chalk stained and sweat soaked spot.

What many of us were experiencing was an introduction to metabolic conditioning. This newly coined term describes a high intensity training model designed to, in the words of CrossFit founder Greg Glassman, increase the storage and delivery of energy for any activity.

In a 2003 Crossfit Journal article, Glassman shared his position on the importance of metabolic conditioning to avoid specificity of adaptation allowing for first wave cardiovascular and respiratory adaptations.

Its been 16 years since that original journal article was written.

16 years of thrusters, wall-balls and those ever elusive airdyne calories. 16 years of sweat, grit, commitment, and community. A lot of memories and training milestones can be packed into a 16 year time frame.

There are a lot of cardiovascular and respiratory adaptations that can be made as well. One of the greatest physiological adaptations that an athlete can make, however, remains largely untapped in the sports training community.This leaves the door to progress wide open, despite how seasoned and experienced a CrossFit athlete you may be. It is the adaptation that determines how the process of delivering energy for any activity that Glassman spoke about 16 years ago actually occurs.

Its our ability to utilise oxygen more efficiently and more effectively.

Understanding how oxygen is directly related to energy production may mark the next major paradigm shift in human health, fitness and sports performance.

When CrossFit first began, anaerobic output was a glaring weak link in the athletic chain for many athletes. The sport has evolved to the point where this statement might not be true anymore.

Past Games events have demonstrated the effectiveness of CrossFits ability to increase work capacity over short duration. High intensity workouts showcase a collective need to perform more aerobic capacity training.

But, what is aerobic capacity? Does it mean just putting in more LSD (long, slow distance) efforts or is it changing the way that our body utilises oxygen to fuel the release of ATP to power muscular activity.

It is possible to put in hours of focused endurance work each week while never making the critical adaptation which allows this process of more effective energy delivery to take place: that process is an increased tolerance to carbon dioxide and must be trained specifically in order to be improved.

Take the following test from the book The Oxygen Advantage by Patrick McKeown to determine whether your breathing is a buried weakness or a hidden strength.

Note: This is not a test of willpower or a test of how long you can hold your breath. Once you get the first urge to breathe stop the timer and you will have the information that you need to assess your C02 tolerance.

Was it 10 seconds? 20 seconds? 40 seconds or more?

If you were in a large room filled with athletes performing this test you would find that C02 scores would run the gamut from less than 10 seconds to more than 40 seconds.

What does your score mean, and how does it affect your athletic performance?

A score below 20 seconds indicates a comparatively high level of sensitivity to carbon dioxide which will require you to rely on a higher volume of oxygen during training while needing to offload more C02.

This is an athletic disadvantage when compared to an athlete who can work at higher intensities with an increased ability to utilise C02 for more efficient oxygen transport, instead of ridding the body of C02 prematurely and suffering the cost of gassing out as a result.

For every 5 second increase in your C02 tolerance score you can expect to feel more energy, increased stamina, and less fatigue in your aerobic training.

When you exhale and pinch your nose, carbon dioxide levels begin to rise. Your sensitivity to rising carbon dioxide will determine how you will need to breathe during a difficult workout which, in turn, determines your ability to use available oxygen to power those hard working muscles when you need it most.

I strongly believe that the ability to extract and utilisethese basic physiological principles will separate the pack in the seasons to come.

Although variance is a key tenet to the CrossFit training methodology, the WOD is written clearly on the board prior to each training session or competition along with the implicit energy system demands and estimated workout duration for all competitors to study.

A rudimentary understanding of energy consumption and energy demands allows each competitor to make basic decisions about pace prior to the workout beginning. Unlike a sport such as mixed martial arts where the energy demands may be directly dependant on the tactics and approach of your opponent, or a team sport such as basketball where a dynamic interplay between players dictates the pace of the game, CrossFit offers a strategic opportunity that is akin to understanding the basics of accounting.

Oxygen Is Currency. Movement is Expensive.

If you have a $1,000 budget for a 5 day vacation, you would be unlikely to spend $900 of it on the first day. Equally, if you saw a 21 minute workout on the whiteboard you would be unlikely to approach it as if it were a 400m sprint.

Understanding the aerobic and anaerobic demands of each workout beforehand allows you to approach each effort with a heightened level of athletic intelligence.

An understanding of how breathing impacts aerobic and anaerobic performance and that you can not only control your breathing but significantly improve it allows you to gain a competitive advantage in your next WOD despite the specific time demands of the workout.

Simple Breathing Techniques to Improve your Crossfit Performances

The process of cellular respiration is a complex one. Fortunately, even the most basic understanding of how oxygen fuels muscular activity can provide a distinct advantage in terms of pacing yourself during workouts as well as in the development of stronger breathing muscles and an increased tolerance to carbon dioxide: the secret ingredient when it comes to utilising oxygen effectively and efficiently.

The next time you find yourself bent over with hands-on-knees after a tough set of thrusters, struggling to get air into your lungs, keep the following in mind:

There is no shortage of available oxygen in the atmosphere.

It is your internal environment that has changed due to the intensity of the workout. More specifically, your ability to get oxygen from your bloodstream and into muscles has been diminished.

Thats because the key to unlocking oxygen from the bloodstream is C02 and big breaths taken while exhaling through your mouth are offloading C02 from the body at too high a rate to make efficient oxygen utilisation possible.

Heres an easy way to remember this next time that you train:

The amount of Co2 that you lose is the amount of oxygen that you cant use.

The knowledge of this basic physiological process becomes a competitive advantage for any athlete willing to train the following respiratory adaptations in order to master their breathing and improve their aerobic capacity:

You happen to have access to the most powerful and effective breathing machine ever created: the human nose.

The nose is designed for the purpose of up-taking oxygen, removing harmful particles from the atmosphere, warming air prior to entering the body and creating a highly pressurised flow of oxygen directly into the lungs and diaphragm. It also induces the release of nitric oxide, a potent vasodilator that widens the walls of your blood vessels creating a more effective pathway for oxygen rich blood to make it to muscles.

It may be smaller than the mouth, but thats the athletic advantage. If getting more oxygen into our bodies were the solution to avoid gassing out in workouts we would simply take bigger breaths. However, oxygen is in no short supply.

The ability to use available oxygen i.e, extract it from the hemoglobin in the bloodstream, which is the job of carbon dioxide, is the challenge that we face when training.

Nasal breathing allows us to increase our oxygen utilisation while decreasing the amount of C02 that we offload while training.

Keep in mind that C02 is not simply a waste gas, it is like oxygens teammate in a partner WOD. They work together and if one bales out, the others performance suffers.

Breathing through the nose can initially be difficult for many athletes. Therein lies the advantage for those willing to train the adaptation.

After a few weeks of consistent training, many athletes can perform at upwards of 90% max heart rate with nasal-only breathing. They uptake oxygen faster and more effectively and delay premature transitions into anaerobic respiration which come at the cost of increased metabolic waste to buffer.

They also remain fresh so that, if they do decide to shift to mouth breathing near the end of a workout in order to sprint to the finish, they are positioned for a powerful finish.

Use an assault bike, rower or ski erg and try the following 4 minute warm-up.

EMOM for 4 minutes:

Nasal breathing only. Put out as much wattage as the prescribed breathing cadence allows.

Before long you will be able to increase the wattage while sticking to the prescribed warm-up breathing pattern.

This is akin to doing pull-ups and push-ups for your breathing muscles while making the physiological adaptations to carbon dioxide that help separate you from the pack and break through those PR plateaus that weve all experienced.

Additional Training Tips

How you breathe post-workout will affect how quickly your heart rate returns to baseline levels as well as how effective your post-workout mobility session will be (you cant relax a body that is still in a high-stress state).

Your ability to recover more effectively sets you up for success in your next training session. This simple post-workout breathing exercise can help you optimise your recovery and get the most from your hard work:

As a CrossFit athlete, you train your body and you push it hard. Youve most likely already made nutritional changes to support your training and youve worked to prioritise sleep to support your recovery. Youve looked at the various pieces that make up the training puzzle and youve worked hard to put each one in place.

It just so happens that one of the most important puzzle pieces may have been right underneath our noses the whole time

Training comes down to getting oxygen to the body when it needs it most. No amount of willpower or dedication can outweigh the most basic and essential demands of our physiology. The more effective we become at using oxygen to fuel our athleticism, the higher we can raise the ceiling of our own performances potential.

David Bidler is a writer, speaker, and performance-breathing coach living in Portland, Maine. David owns The Distance Project: Strength and Conditioning. Follow him @the_distance_project on Instagram.

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Breathe to Perform: Improve Your Breathing To Unlock Hidden Athletic Potential - BOXROX