Running has taken a beating over the last couple years as new research calls into question the wisdom of long-duration, steady-state cardiovascular exercise. The criticism usually falls into one of three categories: 1) increased wear and tear on your joints, 2) it’s hard on your heart (“cardiotoxicity cycle”) and 3) increased oxidative stress. High intensity interval training (HIIT) is all the rage, and there is solid research to support this kind of exercise. But plenty of research supports good old-fashioned jogging too, and for my own peace of mind as an avid runner, lets review some of the good stuff shall we?


First a quick rebuttal to the anti-running points mentioned above.

  1. Joints respond well to use. Injuries can be largely avoided with good form and training habits. Multiple studies show decreased hip and knee joint replacements for runners.

  2. The drop in heart function after endurance training is short term. The heart recovers, and returns to an even higher level of performance in the long term.

  3. Short term increase in oxidative stress results in increased anti-oxidant production by the body and greater protection in the long term. Damage from oxidative stress is not based on how much you exercise, but rather on how your body is conditioned to handle it.


A key study discrediting the link between serious injury and running was written by Stanford University professor James Fries and his research team. Results of the study, published in 2008 by the Archives of Internal Medicine (renamed JAMA Internal Medicine), were remarkable and will continue to put smiles on the faces of runners for years to come. In a group of over 1000 people followed from 1984-2005, running (or another form of vigorous exercise) postponed disability by 16 years and death by 7-9 years. In addition, runners had fewer joint replacements than the non-running group. James Fries stated in a September 23, 2014 Wall Street Journal article that running is “the greatest intervention to postpone aging that’s ever been reported.” Fries will be publishing updated results next year, so runners have more good news to look forward to!


Ahhhhhh. A collective sigh of relief can be heard from runners everywhere. We should have never doubted what our bodies tell us every time we lace up those running shoes. We knew the answer all along: running is good.


Your’s in Health,


Joshua Penner, D.C.



Flu Shot?


Should you get a flu shot?

I’m not a conspiracy theorist, but I’m not naive either. So when the massive public health push for universal flu vaccination hits every fall I ask myself: Is influenza really as scary as drug companies and public health officials claim? Does the vaccine really work? Any bad side effects? These are good questions to research yourself, instead of just taking the word of the people making money from your decision.

Answering questions honestly always requires considering both sides of an issue. The message from pharmacies, drug companies, and government health authorities that influenza is a serious disease which can be avoided by a life-saving flu vaccine is unavoidable. We’ve all heard that side of the story so let’s take a look at a couple voices from the “other” camp that you may be unaware of, especially since this camp doesn’t have the same potential for bias due to financial gain. The two voices come from the Johns Hopkins scientist Peter Doshi, Ph.D., and neurosurgeon Dr. Russell Blaylock, M.D.

Dr. Doshi made the following points in his article published May 16, 2013 by the British Medical Journal:

  • growth from 30 million to 135 million annual doses of influenza vaccine in America over the last 20 years is not based on public demand or need, but rather on aggressive public health policies that overstate the threat of influenza as well as the benefit and safety of vaccination.

  • the CDC justifies it’s pro-influenza vaccine stance based on two key studies, however, researchers who performed these studies conclude that their results are “implausible” and likely the result of the “healthy-user effect.”

  • the only randomized controlled trial of influenza vaccine found no decrease in deaths.

  • serious negative reactions such as febrile convulsions in young children and an increase in narcolepsy in adolescents can occur.

  • the terms “flu” and “influenza” are not interchangeable. Only one in six “flus” might be influenza for which the “flu vaccine” could potentially provide some protection.

  • even in a year when the vaccine matches the type of influenza prevalent (which doesn’t happen every year), randomized controlled trials of healthy adults show that vaccinating 100 people results in only one less case of influenza (one instead of two).


Dr. Blaylock adds:

  • a study by the Cochrane group looked at hundreds of thousands of people and found that the influenza vaccine provided zero benefit to the general population in the areas of secondary pneumonia, hospitalization, and death.

  • the government recommends influenza vaccination for every child over the age of 6 months despite knowing that the shot contains a dose of mercury that is toxic to the brain, and that studies show zero effectiveness in children under 5 years of age.

  • for most, flu vaccines increase the odds of getting the flu by weakening your immune system for several weeks after the shot.

  • one study showed a 10 fold increase in Alzheimer's in people who get repeated flu vaccinations

  • it’s all about money: drug companies have a product that the government and the media help them sell and at the same time have no liability for since vaccines are protected from lawsuits.

  • bottom line: “the vast number of people who get the flu vaccine aren't going to get any benefit, but they get all of the risks and complications."


So what’s the best way to avoid the flu this winter? BOOST YOUR IMMUNE SYSTEM!!! Only half of people infected with a flu virus get sick. Those with healthy immune systems either don’t get sick at all, or experience milder symptoms and recover quickly while acquiring natural immunity to that particular virus for the rest of their lives. Not surprisingly, building a healthy immune system comes down to lifestyle. Eat healthy, exercise, cope with stress well, and OPTIMIZE YOUR VITAMIN D LEVELS! Vitamin D helps your immune system work well and significantly decreases your chances of catching all types of flues and influenzas. Sun exposure is the best way to get vitamin D, oral supplementation with D3 (not D2) can also be helpful.


Yours in Health,

Dr. Penner



Move It Or Lose It!!!


Ever heard of the saying “move it or lose it”? It’s as true for your joints as it is

 for a slug trying to cross the road. A quick look into the anatomy of a joint will

 demonstrate why this is true. It all has to do with circulation. For most tissues in

 your body, blood performs the vital function of delivering oxygen and nutrients,

 and removing toxic waste products of cellular metabolism. Joints, for the most

 part, do not have a blood supply. If you were to cut open a joint capsule or a

 piece of cartilage you won’t see any blood. So how do the living cells that make

 up joint tissues get their circulation? Wait for it... MOVEMENT!!!

 We all instinctively know this on some level. Walking is good for you, sitting

 on the couch all day is bad for you. This common knowledge is getting a little

 boring isn’t it? Do we really need a doctor to tell us that? When I was little, I

 didn’t want to become a doctor because I thought I would get tired of telling

 people that diet and exercise were the answer to everything. Then I became a

 doctor (thank goodness we are not held to our childhood decisions, otherwise my

 niece’s first grade classmate would be “a cat” when she grows up!) and I realized

 how good for you movement really is. Now I am excited to tell people about the

 incredible health benefits of exercise. The stats will blow you away.

 So I’m standing in front of a conference room full of people who work at

 Trident Seafoods corporate headquarters in Ballard a couple weeks ago. It’s

 standing room only as I give a presentation entitled “Be Fit While You Sit” which

 outlines techniques and stretches to relax tight shoulders, relieve muscle knots,

 stop having headaches that start in your neck, and gives tips on how to sit without

 back pain. It’s valuable information which counters the negative effects of sitting

 too much, and I find this discussion of posture and exercise to be absolutely


 Here’s why. I looked into the eyes of the good people at Trident and asked

 a question. I said: “If I were to tell you each one of you is capable of doing one

 simple thing which as been shown to lower your risk of mortality (that’s

 premature death by any means) by 44%, would you be interested in the

 answer?” After a brief pause for dramatic effect I said, “the answer is...walking.”

 That’s it? Walking can cut your chance of premature DEATH by almost half? Amazing

 isn’t it? A study published in the 4/11 issue of the Journal of American Medicine

 (JAMA) found that walking for 30 minutes a day at least 3 times a week

 decreases your risk of mortality (premature death by disease) by 44%. Movement isn’t

 just a little healthy, it’s a matter of life and death. We ought to be thankful that we live in a

 time in history where we can, for the most part, choose how healthy we will be. The

 major killers in America today are chronic, lifestyle-type diseases. We don’t have to

 worry about the bubonic plague coming along and wiping out 1/3 of the population the

 way it did in Europe in the 14th century. We’re lucky, we get to choose our health. So

 choose health today, and go for a walk!



Heel Toe


  Hanging around ultra-marathon runners has caused me to notice a couple of things. First, these people are crazy. The iconic 26.2 mile marathon distance is hardly considered a warm-up, with races going as long as 50 or even 100 miles. The second thing I noticed is that ultra-runners tend to have a different stride than most, landing each step on the front of their foot instead of their heel.

As a doctor who treats all kinds of runners, I have realized that forefoot strikers tend to have different types of injuries than heel strikers. Here’s how it breaks down: forefoot striking (FFS) tends to result in more pain in and around the ankle and calf but less injury overall, while heel strikers tend to have more knee, hip, and low back issues.

This year I signed up for the Whidbey Island Marathon and for the first time in my life, had to miss an event due to injury. Longer training runs were impossible because of significant right hip pain with each heel strike. This was about the same time that I discovered the correlation between running style and injury type, and about the time I had a conversation with a running friend of mine who told me that he got rid of his hip pain by “running faster” which caused him to land on his forefoot.

The connection between heel striking and impact injuries of the knee and hip was becoming clear, so I decided to change my gait and stop heel striking. If you are going to try this, a word of caution: start slow! Your calves are going to get really really sore. Try short distances to start with, followed by plenty of calf stretching and vitamin C for tissue repair. Running barefoot on turf is a good way to get the feel for it. Start with quick sprints the width of a soccer field (it’s impossible to heel strike when you’re sprinting), then slow down as much as you can while still forefoot striking. It’s going to take some time for your new gait to feel comfortable so don’t get discouraged; it doesn’t look as awkward as it feels! Shoes with a lower drop from the heel to toe will facilitate forefoot striking. Somewhere in the 4mm range is better than the typical 10-12mm common to most running shoes.  After I switched to forefoot striking, my hip pain went away and I am able to run longer distances again. My next event is going to be the Bellingham trail marathon with over 5000 feet of elevation climb during the race. Who’s with me?!!

It’s always nice when research backs up clinical observation. In October of 2007 the International Journal of Sports Physical Therapy published a study that looked at the amount of impact (or “power absorption”) at the ankle, knee, and hip joints during rearfoot striking (RFS), forefoot striking (FFS), and running barefoot. The study found that runners can slash the amount of impact on knees and hips by more than half by simply switching from rearfoot to forefoot striking. FFS with shoes on was very comparable with barefoot running in terms of diminishing impact through the knee and hip.

My clinical recommendation is that people with hip or knee pain, or people who want to run far or often should consider forefoot striking. People with calf strains, achilles tendon problems, or plantar fasciitis should approach transition to FFS with caution, but may experience long term benefit as calf muscles and tendons become stronger. Remember, calf muscles form tendons that wrap underneath your feet and support your arches. Strong calves make for healthy feet. Trail running is another way to decrease joint impact from running. Good thing Discovery Park is right around the corner! 



Dr. Penner completes 1st Half Ironman!


When I tell people that I just ran my first Half IronMan triathlon (a 70.3 mile swim-bike-run) the response is varied. Other triathletes are instantly excited and we share a connection which sparks a conversation that could last for hours if we’re not careful. Those who have never run a race of that magnitude often give me a puzzled look and ask "why would you ever want to do something like that?"

 Well... let me tell you; First of all, I feel a deep sense that something profoundly good is happening when I move my body. Mind, body, and soul are connected and I feel that when I use my body, especially when I use it a lot (like 5 hours and 11 minutes in a row for example).

Triathlons are particularly appealing to me because it’s such a good full body workout. Swimming developsupper body strength primarily while cycling and running are great lower body workouts with less impact than running ultra long distances. Spread the stress around as I always say. 

Secondly, I ran a half IronMan because it was hard. I want to be a person who intentionally faces hard things head on. I want to get used to doing hard things instead of shying away from them. Starting a business from scratch is hard, being a good dad is hard, denying my own selfishness is hard, life is hard! I want to work hard and play hard because this is where the good life is lived, this is where we find out all that we can be. You won’t find the same level of joy, success, or have the same sense of accomplishment in your life if you don’t tackle the hard things.

 So pick something you know you should do that’s hard, and do it. You’ll be better off for it and so will those around you. If you can’t think of anything, maybe try a triathlon. I have yet to meet an ironman triathlete who regrets owning that title.