Does Cupping Work?; Do I Need More Protein?

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For today’s edition of Dear Mark, I’m answering a couple questions from readers. The first one concerns cupping, the controversial therapy used by dozens of Olympians, including most notably Michael Phelps. What does it do, if anything? How does it work, if it even works? And then I discuss the need for increased protein intake in the context of losing lean mass. We want to lose fat, not lean, remember, and there’s evidence that increasing your protein intake can preserve lean muscle. Especially when you’re exercising a ton and eating low-carb.

Let’s go:

Dear Mark,

While watching the Olympics I have seen many athletes with these red circular spots on their bodies that they are calling “cupping.” What is “cupping” and does it work? Thanks Mark!

Grok on!

David R.

Cupping is the use of a vacuum seal to pull on a person’s skin, breaking capillaries and drawing blood to the surface. This creates the distinctively large round red or purple mark seen on many Olympic athletes this year. It’s an ancient treatment.

In the ancient Mediterranean, coastal healers would lower patients into octopus cages to be ravaged by the animal’s suction cups. It was inexact, more art than science, but it was effective. Around the turn of the 19th century, urban plumbers often doubled as medicine men, using their plungers to draw diseased blood up to the surface. During the 50s, door-to-door vacuum salesmen applied intense suction to cure housewives of their mania. The early 90s saw angsty suburban youths searching for kicks in between Nirvana record releases use swimming pool suction hoses to feel alive and boost skateboarding performance. And what is the hickey but an anti-inflammatory treatment between teen sweethearts?

Does it actually have any benefits?

One undeniable benefit of cupping is that it throws the supra-rationalist skeptics over at blogs like Science Based Medicine into an absolute tizzy of righteous indignation. How dare Michael Phelps use his influence to promote “pseudoscience” to millions of impressionable young fans? By flagrantly flaunting his cupping circles, Phelps has raised an armada of future Traditional Chinese Medicine practitioners. I’ll bet as many kids are now practicing acupuncture on each other with Grandma’s sewing kit as there are kids joining the swim team. For shame, Phelps.

According to a trainer with the US Swim Team, cupping has nothing to do with “chi” or “life force” or anything metaphysical. It’s simply another way to treat adhesions and knots in the fascial tissue surrounding and supporting an athlete’s musculature. I’ve discussed fascia before (and will do in the near future). It’s like foam rolling only in reverse. Instead of trying to finagle apart gummed up tissues through compression, cupping seeks to pull gummed up fascia off of muscle using decompression.

Furthermore, the athletes receiving the treatment aren’t just lying there. They’re moving the affected tissues through their full range of motion as the cupping is applied. This helps restore healthy movement patterns and tissue health. Another big advantage, according to the trainer, is that cupping works quickly. What might take weeks using conventional forms of physical therapy and myofascial release takes just five to ten minutes with cupping.

“This is just sports lore,” you might say. There aren’t any solid RCTs supporting his claims, just anecdotes and case studies. But it’s not like this is some weirdo in your yoga class making wild claims. The sporting world gets to a lot of this stuff before “science” does. They’re more willing to try stuff that sounds a little crazy if it could help their athletes get an edge. Sometimes they strike gold, sometimes they fail. The cream tends to rise to the top.

And it’s not like there isn’t any support in the literature. Dry cupping has been shown to improve pain, stiffness, mobility, and general symptoms in patients with knee osteoarthritis, and in patients with chronic neck pain, dry cupping improved both subjective and objective measurements of pain.

I think it may very well work.

Hi Mark,

My personal trainer measures my fat by doing the 7 site skinfold test. While I lost 1.7% fat last month, he also noticed that I lost 2.4 pounds of lean mass. (Does this mean loss of actual muscle?) I’m eating primally and very low-carb, and I’m doing sprinting, reasonable cardio (biking to and from work every day, about 80 minutes total) and lots of bodyweight exercises and lifting weights. Do you have any suggestions for how I can prevent further loss of muscle? I feel like I’m eating a decent amount of protein every day (3.5 scoops of Primal Fuel in the mornings, usually three eggs in my lunch with veggies, and maybe 4-5 oz of protein with dinner) but maybe I need to eat more?

Thanks for all that you do!!


3.5 scoops of Primal Fuel is 35 grams of protein.

3 eggs gives you 18 grams of protein.

4-5 ounces of meat gives you about 35 grams of protein, depending on the cut and amount of fat on the meat.

That’s around 88 grams of protein. It’s not low and I’d need to know your body weight, but given the amount of physical activity you’re doing and the fact that you seem to be dieting, you should probably eat more.

Very low-carb and low-calorie on top of high physical activity increases protein needs. Otherwise, you may breakdown muscle tissue for amino acids to convert into any glucose you require. We see this in the research into elite gymnasts on ketogenic diets who manage to maintain physical performance and lean mass while losing body fat. They aren’t eating the type of 90% fat keto diets you’d use for kids with epilepsy. They’re eating very low-carb, high-fat, and high-protein (around 200 grams a day) keto diets. And in the latest CrossFit keto study, ketogenic athletes performed well and only lost a little lean mass while eating a 1500 calorie a day ketogenic diet, but they had to increase their protein intake by 15% to do it. And they still lost some lean mass.

Anytime you lose lean mass, up the protein. It’s just a safe practice that usually helps, and never hurts.

Try another egg and 4 more ounces of meat. Tell me how that goes for you.

Thanks for reading, everyone. Take care!

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