August 22 2016

Dear Mark: Does Cupping Work?; Do I Need More Protein?

By Mark Sisson
43 Comments

Cupping In-LineFor 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!!

Jean

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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43 thoughts on “Dear Mark: Does Cupping Work?; Do I Need More Protein?”

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  1. Great post. I’ve been wondering about cupping since it’s been in the headlines lately

  2. Interesting. I think I’ll go with a regular massage, though. Probably more effective. But I guess you never know

    1. I have a carpel tunnel soreness on my wrist and inflamed neck from bad posture doing computer job. It was the cupping the helped relieved the pain and helped me healed faster. Massage by itself didn’t do much.

  3. In Greece, we use cupping against colds, flu and particularly pneumonia. My aunt knows how to do this using regular water glasses.

    1. I understand how cupping may possibly do some interesting things to tissue close to the surface – and perhaps even have some secondary impacts on circulation (just perhaps) – but I’m struggling to envision any mechanism by which cupping would impact body-wide virus and bacteria reproduction. (?)

      1. Maybe it has something to do with lymphatic circulation, and hence immune efficiency. Just a wild guess.

  4. Nice! I think I’m going to up my protein a bit as well. I’ve felt a little like some of my gains have been catabolized during some recent cutting

  5. I’ve been “cupped” by a doctor of TCM. Didn’t seem to help much of anything, but maybe she wasn’t very good at it. Cupping isn’t exotic; it’s just a medically induced hickey.

  6. Octopus cupping, eh? Well, I suppose it’s a two-for-one: localized muscle healing and calamari for later.

  7. I have had cupping used on my back several times years ago, and I found it to be very helpful for knots and muscle tightness.

  8. Two excellent questions! I’ve been curious about cupping but haven’t had the chance to research the practice. Thanks for the start!

  9. Another great informational article! I am fortunate to have a lean build and don’t have to consider this option. Also my skin is pretty fair and smooth, thanks to my genetics. And wonder do people who use cupping end up with broken capillaries appearance for life? Or do they fade.

    1. Cupping creates what is basically a bruise. I don’t think it’s any more likely to create permanently broken capillaries than any other type of bruise, but I suppose it could.

    2. I wouldn’t worry your little ol’ lean and smooth skin self about it …

  10. I couldn’t help wonder if cupping would smooth out the appearance of “cellulite” on body parts.

  11. I’ve gotten great relief from injury induced back pain by adding cupping into regular massage therapy. All my super rational friends think its bs, but whatever. It works for me.
    I’ve been doing a Primal Keto experiment for going on 90 days now, I have found I need to up my protein from the 50 grams/day the keto calculators recommend for me. My general day includes 40 minutes of yoga, Interval/Tabata workout (10-25 minutes depending on the day), and around 8 flights of stairs per day just in the normal course of getting things accomplished. I’ve been losing body fat, but haven’t felt GREAT. So I’ll be shooting for around 80 grams/day this week. I’m 5’3, 143# and 48 years old. My goal is to lose body fat, gain strength and definition, and prevent age-related body breakdowns. And to be super comfortable and sexy in my skinny jeans. ; D I’m hoping bumping the protein will result in faster body fat loss and more muscle definition.

  12. While effective and cheep to administer (all you need is a glass and a candle to burn the oxygen and thus create a vacuum), cupping is also used as a metaphor to describe something or someone that is not beneficial by saying that he or it is helpful as suction cups to a dead man (-;

    So there’s no problem upping the protein amount when on low-carb – low-calorie diet? I always thought that eating too much protein will create a results similar to to eating to many carbs, except during an illness. Like last week when I ate around 600 grams of rib eye in one seating. I was recovering from hand surgery and in a cast and that was the simplest thing to cook and eat (I had the butcher cut it into squares since I couldn’t use a knife) and I felt that my body needed it.

  13. Cool stuff about cupping! I’m a physical therapist but am (or was) a former collegiate athlete. So I get the difference between in field vs. in the lab. The theory makes sense with regards to decompression of the fascia restricting muscle movement. And it makes much more sense having the athlete move the limb/muscle through its full ROM too. Thanks for clearing this up!

    1. Kyle, great website! Very easy to navigate and informational.

      1. Thank you so much! Definitely have a long way to go to make it anywhere near as awesome as this site, haha. I really appreciate the compliment, it means a lot!!

  14. I’m thinking that the 2.4 pounds of lean mass lost by Jean couldn’t be all from muscle. Lean mass is everything that isn’t fat, including water, organs, bones, muscles, etc; and low carb dieters are known to carry less water weight than higher carb dieters. Moreover, it’s likely that Jean’s digestive organs could have shrunk a little since they’re probably digesting less food than they used to. Still, plugging a day of eating into a nutrient tracking app like mfp could be beneficial just to be on the safe side.

    1. certainly could not hurt to experiment, seeing as while 88g certainly is not low overall, it certainly could be too low for some individuals. especially if they are dieting aggressively. just add 15-20g more protein/day, as mark suggested, & see the results with the next body fat testing, & modify from there.

      1. I completely agree that adding protein could definitely help, just wanted to say that lean body mass isn’t necessarily the same thing as muscle.

    2. The only way to know is to do a DEXA scan. The skinfold test will not tell you anything about internal fat and all those test are notorious for being innacurate. They often underestimate the real fat mass and how the skin fold can say anything about lean mass I have no idea. Every fat measuring machine I’ve tried told me my body fat was 15% when Dexa revealed it was 20% ( an eye opener! ). It also revealed one of my legs had less muscle mass than the other ( so I’ve incorporated pistol squats focusing more on the leg that’s smaller. I couldn’t recommend it enough. DEXA scan is the way to go. doing a follow up in 12 weeks after now ditching alcohol which I think it’s what keeps my body fat at 20%.
      Funnily enough, my muscle mass/body ration was higher than 99% percent of general population and bonemass was 120% of what a person my age should have ( I’m 41 ).
      Another interesting fact was that my head weighs 4kg and all my bones in my body weigh about 4-5 kg in total!!!

    3. “I lost 2.4 pounds of lean mass. (Does this mean loss of actual muscle?)”

      Yep as mentioned ‘lean mas’ is weight that is not fat – including water.

      2.4 pound is just over 1kg – the weight of one litre of water (~31 US fluid ounces),

      And yes low carb often means less water held in the body.

      This lean weight lost is of no concern in my option – I can gain or lose a couple pound (a kg) overnight of water weight and I’m about 70KG (~155lb) -Lean Male.

      I don’t seem to lose any visible muscle from eating 50g of protein a day with gym 3 times a week (with active job/life) – though I try to get at least 70g – I lately I have been eating closer to 90 to 100g a day.

      Don’t get too tied up with ‘numbers’.

  15. While I am really excited to see the attention and media coverage that using cupping in sports is getting (and hearing the great results by elite athletes), I am disappointed in hearing how many people pass it off as “new” or a physical therapy technique when it’s been around for over 3000 years. I practice Rolfing and TCM and have used cupping for years. It was NOT invented by a PT in California and it is NOT new. Cupping, (not unlike myofacial release or Rolfing) frees adhered tissue and restores balance to the body’s relationship with gravity. It helps the body perform optimally by allowing muscles to be used as they were intended and making the body a more efficient “machine”.

    Just as dry needling is essentially acupuncture, cupping is yet another example of a TCM technique that western medicine has stolen, renamed and taken credit for. Shameful.

  16. Cupping is an awesome technique. I try to use it after a very grueling workout! Does anyone know of any other techniques to try and heal sore muscles?

    1. Cool/cold water showers. 30 seconds of cool water at the end of your workout might help. Helps me a lot, when I can bring myself to do it.

  17. Wow, great questions. I’m interested in reading Mark’s upcoming post about fascia. Oh, and totally agree with Chris about the sardines. They are one of my favorite quick easy and tasty sources of protein. I’m always trying to get my friends to jump on the sardine bandwagon with me but no one is ever interested 🙁

  18. The article at “Science based medicine” has this wonderful conclusion:

    “It is unfortunate that elite athletics, including the Olympics, is such a hot bed for pseudoscience. The Olympic Games are supposed to celebrate excellence, hard work, dedication, and friendly competition. Now it also represents gullibility and superstition, and spreads that gullibility to the viewing world.”

    That’s so good to know. It must be similar to the sports teams that switch over to low carb to get a performance increase. Simply pseudoscience.

    1. Well said Beatrice. Science is supposed to look at a question without bias or making assumptions, do the research, collect data and form possible conclusions. Looks like that publication needs a new name, how about Conventional Locked In Wisdom , or Afraid of What I Can’t Be Bothered to Understand? And I don’t even know that much about cupping other than it comes from TCM, but I’m willing to take a look and collect my own data.

  19. “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.”

    Why not a couple of bananas instead ? Since lean tissue breakdown is primarily for glucose needs, so I can’t see why one would not want to add some good carbs to avoid that.

    1. Then you lose the ketone body adaptation that you’re building. During early fasting (read low carbing) your body breaks down protein to amino acids to produce glucose (gluconeogenesis) primarily for your brain and red blood cells (your other tissues are quite happy to use fatty acids instead). This causes the initial protein loss. After 5-10 days of low carbing your brain will increase its use of ketone bodies in order to conserve muscle. The break down of amino acids slow.
      The increasing of glucose will slow this process down and potentially lead to more muscle loss on the other hand increasing protein will provide the correct signals in the body to continue the adaptation and provide ‘muscle building’ signals as well as increasing the pool of amino acids for synthesis.
      Eventually you only need glucose for your red blood cells and to replace lost glycogen after exercise, so very little is needed (but not essential due to gluconeogenesis from glycerol and amino acids).
      Hope that helps.

  20. Hi Mark,
    You rightly said that cupping is the new trend in fitness world thanks to Mr. Phelps. Some practitioners also claim that it can even help you release mental stress. Any idea if this treatment is expensive?

  21. Hi Mark,

    A friend wrote me:

    When I saw the “Cupping” marks on some of the Olympic athletes, it brought back memories from my childhood in Western Penna. My mother (immigrant from Sparta Greece) and father (immigrant from Crete) would use it on my two sisters and me when we had bad colds, especially chest colds. The called cupping with a Greek word – “Venduzzes”. I can remember wanting to cover all those circles. My mother would look to purchase thick rimmed drinking glasses to use for cupping.

    For ancient cupping see: http://holylandphotos.org/browse.asp?s=1,4,11,35,410,411&img=GSATNMMI04

  22. +1 for cupping when done by a real physio; applied with a simple hand pump. I do a lot of Olympic and power lifting, for track (cycling) sprinting – have had issues with tight lower back musculature and fascia, and the cupping has really helped at times when just stretching my hamstrings and glutes and extensors didn’t quite… No mumbo jumbo, just pulls on the fascia and helps stretch things out. All the power and olympic lifters at my gym tend to have it done once every week or two, legs, back and shoulders – all the hard to stretch areas. It’s basic maintenance.