Alex Guerrero: A doctor's take on Tom Brady's body coach

I have a confession to make: I own a TB12 hat. Not only do I own one, I really really love the thing. So, it's with mixed emotions that I write this.Alex Guerrero is half of TB12. He's more than just Tom Brady's business partner, though. He is the quarterback's body coach, fitness guru, nutritionist, masseuse, spiritual advisor and close friend. While much has been written about Guerrero, he remains a mysterious character - always present, yet one step outside of the spotlight. He's been publicly called both a miracle worker and a "glorified snake oil salesman." He has been lauded by professional sports stars like Willie McGinest and is being watched closely by the Federal Trade Commission. Alex Guerrero, it seems, is an enigma.Mike Chambers authored an article in Men's Journal this week in which he described a few visits with Guerrero at the TB12 facility in Foxborough. It was a very personal piece - Chambers had fractured his heel bone in a rock-climbing fall and came to the body coach for treatment during his recovery.What truly infuriated me about the article was that Chambers pitted Alex Guerrero against the surgeon who had reassembled the shattered pieces of his heel, going as far as to say that it was "as if [he'd] had an affair." Actually, maybe it was Guerrero who set that tone in their very first session:

"Is it safe?" I ask Guerrero, 51, whom I met through a mutual friend. "I'm not actually supposed to be bearing any weight."

He pauses, giving me his undivided attention. "It's completely understandable that your surgeon's number one goal is to protect his surgery site," he explains. "He doesn't care if you ever run again. He doesn't care if you want to climb Mount Everest. But here's the thing about rest: It makes you feel better, but it doesn't make you get better."

When a calcaneus shatters it is like a piece of shrapnel exploding. Bone fragments splinter in all directions, the fat and connective tissues swell so tremendously that it is often impossible to suture the skin around it. The risk of infection is high, the risk of the bone not healing correctly is very real. These are facts that have been studied and published in medical journals after being carefully scrutinized by doctors in the field. I'm not a surgeon, but I am a sports medicine doctor who cares for thousands of athletes every year. Yes - I said "cares for." I care for each and every one of my patients. Even the difficult ones who don't listen to what I recommend. Even the ones who seem to doubt what I'm telling them. In fact, I spend MORE time with those patients because I care so much. I care that my 67 year-old competitive sprinter still wants to sprint despite terrible hip arthritis. I care that my 10 year-old ballerina is dying to go en pointe but her feet aren't ready yet. I lose sleep over my HS senior who wants so badly to play in his Thanksgiving football game but might not be ready.Here's the thing - Alex Guerrero doesn't know if it's safe to have Chambers bear even 10% of his body weight on the treadmill, because Guerrero functions in a different world than doctors. He doesn't have to prove his therapies work, or even that they are safe. The thing about functioning in a space like that is that it's very easy to become cavalier. If you don't follow the patients with calcaneus fractures who stop coming to your out-of-pocket full-service gym, then you may not know if some of them go on to develop non-unions of their fracture or breakdown of their skin and soft tissues from walking on a treadmill too soon. So because all you see are the successful cases, weight-bearing at 3 weeks is safe and, even further, necessary. Maybe Guerrero has never had a case of a client (I call them patients) who took very high doses of calcium and vitamin D go on to develop painful kidney stones. Yes, flushing the kidneys with water can help prevent this but even in patients with active fractures there is no evidence that supratherapeutic doses of calcium are beneficial and we know they can cause harm.And then there's the whole alkaline diet situation. The assumption is that an acidic diet is inflammatory to the body. Tom Brady reportedly follows an 80-20 diet (roughly 80% alkaline, 20% acidic) to keep his body alkaline. Know who else is closely monitoring Tom Brady's blood pH? His kidneys. If you have at least one well-functioning kidney then you don't need a $200 manual to keep your blood pH stable. In fact, no matter how hard you try, you can't trick those little bean-shaped buggers. Your pH will not budge.While I'm at it, raise your hand if you paid $200 for a pair of recovery pajamas. My God, people. Seriously? I'm sorry - I can't judge. I have an elliptical machine I've used twice that now serves as a drying rack for wet clothes. At lease you have some comfy pajamas.The biggest problem I have with Alex Guerrero isn't just that he has been banned from falsely calling himself a doctor. It's not that he was fined by the FTC for marketing a miracle cancer-curing supplement he falsely claimed he studied in 200 terminally ill patients. It's not the concussion water he sold that Brady still claims to be effective in improving brain healing and protection. No, the biggest problem I have with Alex Guerrero is that, while he and Tom Brady seem to really believe in their methods and outcomes, they don't study and share them. They continue to profit from non-proven treatments, supplements, and other therapies and none of those profits seem to be invested in studying their efficacy.Despite everything that I have written to this point, I truly believe there is a lot of good going on at TB12. In fact, when I read that Chambers had seen Rob Gronkowski getting work done at the facility I let out a very loud "Thank God." Gronk is a tight, muscle-bound athlete with chronic back issues who could benefit from the kinds of treatments Guerrero offers. There is a lot to be said for the importance of muscle and soft tissue pliability, which is something that the body coach seems to know quite a bit about. Functional training - using body weight and resistance bands to ensure proper balance of strength - is widely used in athletic performance training. Neuromuscular training is also critical - putting the body through repetitive movements that the athlete has to perform on the field trains not only the muscles but the nerves and is shown to be protective. An excellent example of neuromuscular training is ACL prevention therapy, where athletes train their bodies to pivot and land in ways to minimize risk of ACL rupture.In fact, it's not just what happens in the gym at TB12 that sound promising. While Tom Brady's diet is a bit extreme, there are clearly nutritional benefits to eating less processed foods and less sugar. Drinking water is great for your body. Meditation, accupuncture, massage - these are all tools I use in my practice. (That was a lie, I don't really meditate. I don't ask my patients to meditate. I do have a really cool Buddha tank top that makes me both wish I meditated and look like I just meditated 5 minutes ago though.)Alex Guerrero has said that trainers and other medical professionals have called him a "quack." It's a shame to me that athletes feel like they have to chose between the body work that Guerrero offers and the medical care that doctors provide. It enrages me to know that Guerrero is telling clients that their doctors don't care about them and that their post-op protocols are bogus and even harmful. It's pretty clear that I don't agree with everything that Guerrero and Brady are peddling. That's okay, it's not a reason to close the lines of communication and function only behind closed doors.One thing is for sure - Alex Guerrero isn't going anywhere. It's early May and Jimmy Garropolo is still a Patriot. The death-watch for the greatest quarterback to ever play the game continues. Because Tom Brady is the face of Alex Guerrero's methods, the body guru has found himself smack dab in the middle of a smoldering sports drama that he himself continues to perpetuate. That's a lot of free press for a $50 per bag-of-nuts business. In my opinion, such high-profile therapy carries with it a significant amount of responsibility to potential consumers.Alex Guerrero needs to put his money where his mouth is. He owes it to his clients to prove that what he is doing works. Look, not everything in medicine is black and white. In fact, we function in an area of grey a lot of the time. That being said, the best way to treat athletes (and non-athletes) is to strive to make the grey parts either more black or more white, to figure out what does harm and what does good. You can only achieve that if you either practice what is proven or study what is not. In 2015 Tom Brady said on 93.7 WEEI that educating athletes about the care he received from Alex Guerrero would be his "calling" after football. I really hope that he and Alex Guerrero will share and, more importantly, study their outcomes as much as they advertise their business going forward.Follow me on Twitter for more info on professional sports injuries.