Soy and Osteoporosis Prevention: What’s the Connection?

The Johns Hopkins Health Alerts had an interesting piece Soy and Osteoporosis - does Soy help aleviate Osteoporosis ?

The risk of developing osteoporosis increases as we grow older. Exercise, proper nutrition, and – when appropriate – medication can all help to prevent osteoporosis. But what about isoflavones?

To cut to the chase the answer is NO. The isoflavones in Soy do not help alleviate Osteoporosis. As you might have read in other blogs I'll take supplements which have a good chance of working but soy can be written off.

Original research at American Journal of Clinical Nutrition.

Runners Knees ? They hurt much of the time ?

Safety and efficacy of undenatured type II collagen in the treatment of osteoarthritis of the knee: a clinical trial



Right now I limit myself to running three times a week only so that I don't totally wreck my knees. It's a delicate balance as I hate painful knees but I want to run a 10K in less than an hour during 2010.

I'm experimenting with UC-II to see if it does any good!

The research reports say that it's more effective than glucosamine and chondroitin. I've tried both of these and they have no effect on my knees so I'm hoping that UC-II is better.

Currently, glucosamine and chondroitin are the two most commonly used nutraceuticals in humans as well as in animals to alleviate pain associated with arthritis (6). However, recent randomized controlled trials and meta-analysis of these supplements have shown only small-to-moderate symptomatic efficacy in human OA (7).

An emerging novel nutraceutical ingredient known as UC-II has received considerable attention in the treatment of OA. UC-II is a novel undenatured type II collagen derived from chicken sternum cartilage.

Let's get physical: Nine facts about fitness - New Scientist

Let's get physical: Nine facts about fitness - New Scientist

New Scientist is launched into the mailbox every week and every week it teaches me something new.

What counts as Exercise ? The standard is now 150 minutes a week of moderate intensity.

So what is moderate intensity ? For most people it means walking at 100 steps a minute. This gets you to 3 METS - the lowest level to qualify as moderate.

So what is a MET ? 1 MET is when you are lying flat doing nothing i.e. just about as low energy as it gets.

3 METS means burning 3 times as much energy as the 1 MET state.

Moderate intensity is between 3 and 6 METS.

So what is 6 METS ? A slow jog should get you to 6 METS.

Click on the link to New Scientist and learn much more and if you want to be amused read the comments at the bottom of the article because a long discussion broke out about how to cheat New Scientist and evade some of their rules.

Vigorous Exercise _ Good for the Brain

Reuters carried this story about vigorous exercise improving the aging brain. One question that the writer, Megan Brooks put to Dr Laura Baker, the leading researcher on the study was "Might it be possible to get the same brain benefit from lower intensity aerobic exercise?". My thought was "Why take a chance ?" If you know vigorous exercise will push back the impact of an aging brain, why take the chance of just doing the minimum intensity.

Exercise protects and improves the aging brain

Megan Brooks

Fri Jan 15, 2010 3:32pm EST

NEW YORK (Reuters Health) - Two new studies provide more evidence that regular aerobic exercise not only staves off the problems with thinking and memory that often come with age, but it can actually help turn back the clock on brain aging.

Health

In one study, researchers found evidence that engaging in moderate physical activity such as brisk walking, swimming, or yoga in midlife or later may cut the risk of developing mild thinking problems.

In the other study, a group of elderly individuals who already had mild problems had improvements in their mental agility after six months of high-intensity aerobic activity.

People with mild mental impairments of the kind studied - known as mild cognitive impairment -- typically have some memory difficulties, such as forgetting people's names or misplacing items. Each year, 10 to 15 percent of individuals with mild cognitive impairment will develop dementia, as compared with 1 percent to 2 percent of the general population. Previous studies in animals and humans have suggested that exercise may improve thinking and memory.

To investigate further, Seattle-based researchers studied 33 adults with mild cognitive impairment. Twenty-three spent 45 to 60 minutes on a treadmill or stationary bicycle four days a week for six months, while the other 10 "control" subjects did stretching exercises but kept their heart rate low.

Six months of intense aerobic exercise "improved cognitive abilities of attention and concentration, organization, planning, and multi-tasking," study chief Dr. Laura Baker noted in an email to Reuters Health. In contrast, cognitive function test scores continued to decline in the group that didn't have vigorous exercise.

Might it be possible to get the same brain benefit from lower intensity aerobic exercise?

"In theory, yes," Baker said, "but we are just now starting the studies that will help us know how little is enough. In the next five years, we'll have a much better idea about the minimum 'dose' of exercise needed (how often, duration of exercise sessions, how much exertion is needed) without compromising the cognitive benefits."

Baker, who is from the University of Washington School of Medicine and the Veterans Affairs Medical Center, Geriatric Research, Education, and Clinical Center, also noted that the average magnitude of mental improvement with aerobic exercise was "bigger for women than for men."

And while she's not exactly sure why, she noted that, for the women in the study, aerobic exercise improved the body's sensitivity to insulin, a hormone that plays an important role in providing energy to the muscles and organs of the body and to the brain. "Contrary to our expectations, aerobic exercise did not improve insulin sensitivity for the men," Baker said.

EXERCISE TO WARD OFF MENTAL DECLINE

The other study, by Dr. Yonas E. Geda and colleagues at Mayo Clinic in Rochester, Minnesota, involved 1,324 elderly adults free of dementia in 2006-2008. Experts determined that 198 had mild cognitive impairment and 1,126 had normal cognitive function.

Those who said they had engaged in moderate exercise such as brisk walking, aerobics, yoga, strength training or swimming in their 40s, 50s and beyond were less apt to have mild cognitive impairment, the researchers found.

Moderate exercise in midlife was associated with a 39 percent reduced likelihood of developing mild cognitive impairment, and moderate exercise in late life was associated with a 32 percent reduction in the odds of mental decline. The findings were consistent among men and women.

These two studies, both published in the Archives of Neurology, contribute to a growing body of literature supporting the benefits of a physically active lifestyle on the brain.

SOURCE: Archives of Neurology, January 2010.

HBO: Documentaries: The Alzheimer's Project: Watch the Films: The Supplementary Series: Identifying Mild Cognitive Impairment

Running 10K at 66

No. 1 Health Objective for 2010 - Run a 10K event - 6.2 miles in less than 60 minutes.

Can I still do it ? Only time will tell.

Why ? I just like the feeling that running gives me and running seems a healthy activity - maybe the healthiest. Runners who keep running into old age seem to do better every possible way compared to people who stop running (and many times better than those who have never pushed their bodies hard). Read the report on a study of runners (and the control group of non-runners) which has now been on-going for over 20 years. At the start everyone was at least 50 years old and by now they have progressed into their '70s and older.

So I want to run 10K (6.2 miles) in under an hour before the end of 2010. What can I achieve right now ? I can run 10K on a treadmill in 62 minutes. Not bad but a long way short of objective because running on a treadmill is easier than running on the road and that's what I need to do at a running event.

This is my plan for 2010:

1) Increase endurance so that 10K is easy not really hard - target to achieve a long run 0f 15K i.e. 50% above race distance

2) Run 10K on a treadmill in 59 minutes by gradually over time increasing running pace.

3) Add a 1% incline to the treadmill to start to replicate running outside compared to on a treadmill and try to get to 59 minutes.

4) Run 5K on the road with a target time of less than 28 minutes.

5) Run 10K to see where I stand time wise.

This leads to the big question. How to improve my running time. I need to be able to run 10K at least 5 minutes faster on the treadmill than I can currently manage.

An important running concept is VO₂max

There are two ways to go:

- hard, fast intervals

- long, slow distance.

After reading the long article by Seiler and Tønnessen I'm going to start train with long slow distance. This means running a lot at below race pace.

The body adapts to endurance training by:

a) increasing the flow of blood to leg muscles by growing additional tiny blood vessels all the way to the muscle fibers so that oxygen carried in red blood corpuscles has as short a distance as possible to get to the muscles that need oxygen. Lots of long, slow distance encourage the body to become more efficient at running distance. This is called peripheral adaptation.

b) encourage the heart to produce stronger contractions, to eject a bigger fraction of the blood in the heart at every contraction and to increase the diameter of major blood vessels close to the heart. This is central adaptation.

Central adaptation needs faster running pace taking heart rate up close to maximum. More on this over the months after I make good progress with long, slow distance.

Our species probably evolved to run and that might be why running seems to be the healthy activity and it might even encourage a larger brain.

Of course, one can dream about running distance in the Kenya mountains - enjoy this video.

I'm a Boniva man - once a month (last Sunday in the month - unless there are 5 Sunday's when it becomes the second to last Sunday). I've read the long, long document wrapped up with the tablets but I was surprised, no amazed when reading Jane Brody's piece in the New York Times this week "Options for Bone Loss, but I'm no Magic Pill."

The whole piece is very interesting but these 2 points grabbed my attention:

1. . . . the most disturbing side effect of these drugs has been a growing number of patients who experience an otherwise uncommon injury — a low-trauma fracture of the thigh bone or other major bone — and a delay in healing or complete failure of a fracture to heal, especially after many years on bisphosphonates. It is believed that in slowing bone turnover, the drugs may impede the repair of normally occurring microfractures and eventually result in a major fracture.

2. These side effects have prompted a warning that after five years on bisphosphonates, people should take a break from the drugs for at least a year.

So I went back and read that long, long screed termed Highlights of Prescribing Information and the take a break after 5 years is no where to be seen. I have no reason to disbelieve Jane Brody so I have to think that long, long screed inside the Boniva pack is "light" on information.

If you are wondering what osteoporosis exactly looks like, click on the image below to see Dr Susan Ott's collection of bone images from her web site on osteoporosis and bone physiology.

Knee Cartilage and Vitamin D

I'm back to running 12 to 15 miles a week and I've been just a tad surprised that my knees have not been hurting non-stop but I've given all the thanks to my knee lubrication in 2008. However increasing my Vitamin D intake might well have been helping as well.

The research, in Tasmania, Australia, looked at men and women aged 51 to 79 years with an average of 61 years. This is right in my age range and hence the interest.

The paper has the title Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: The Tasmanian older adult cohort study

Dr. Changhai Ding is a long time researcher on cartilage, osteoarthritis and knees (look at his long list of research papers) said "Cartilage loss is the hallmark of osteoarthritis."

I've increased my Vitamin D intake up to 3,000 IU's a day and hopefully this has increased the level of serum 25-hydroxyvitamin D [25 OHD] . The research was carried out in Tasmania, Australia and maybe that was why the mean 25-hydroxyvitamin D [25 OHD] baseline was 52.6 nmol/L - the sunny climate gave high Vitamin D levels. In northern climates a Vitamin D level of 30 nmol/L and up is seen as normal.

The next thing to do is to get my Vitamin D level measured to find out if my less painful knees are related to much higher Vitamin D levels (bearing in mind my levels were around 30 nmol/L in April 2009).

Soy - good for mens bones ?

Soy - good for mens bones ? NO - unfortunately.

A 10 year study in Singapore which followed 63,000 men and women came to the conclusion that consumption of soy, tofu and isoflavones had no protective benefits for men.

Gender-specific Associations Between Soy and Risk of Hip Fracture in the Singapore Chinese Health Study

For both genders, hip fracture risk was positively associated with cigarette smoking and was inversely associated with body mass index. There was a statistically significant association of tofu equivalents, soy protein, and isoflavones with hip fracture risk among women but not among men.

Should men eat a lot of soy ?

Probably not - read more.

XEROSTOMIA - Dry Mouth

Who would have thought that you could say Dry Mouth in a really complicated, obscure way by using the word xerostomia - try using that in scrable and see everyone object.

The January 2010 edition of Mayo Clinic Health Letter had advice for people like me who take omeprazole to stop acid reflux which was not that welcome. When one stops taking omeprazole (or the alternatives like Nexium; Prevacid; Prilosec; Protonix; Aciphex) the stomach plays a good trick - it now produces even more acid than before.
I've been trying to gradually taper off Omeprazole and what Mayo tells me is "I'm wasting my time." Tapering doesn't reduce the impact of coming off Omeprazole - sad! I'm now down to taking Omeprazole on Sunday and Wednesday. I have been feeling acid reflux more but how long will it last ?

My interest in xerostomia is because I often wake up in the middle of the night, and the morning, with a very dry mouth. It turns out that this can be bad for teeth enamel because saliva neutralizes acid (coming up from the stomach) that could dissolves tooth enamel and the saliva also stops bacteria that can grow on the teeth surface and also dissolve tooth enamel.

Making sure that tooth enamel does not get wrecked due to easing back on Omeprazole involves getting enough fluoride. Luckily I don't drink much bottled water - I can drink tap water without any trouble. If you do drink a lot of bottled water you might be low on fluoride. Then again if you drink all of your water filtered then that can be a problem; filtration takes fluoride out of the water.

It's never easy.

Current vitamin D doses insufficient for mothers-to-be

By Stephen Daniells, 16-Sep-2009

Many mothers to be are not getting enough vitamin D, even those taking supplements at the recommended doses, says a new study from Northern Ireland.

Almost all of the women in the study had blood levels of the vitamin below 80 nmol/l, a level which is widely considered to be the cut-off for vitamin D sufficiency, showing that current recommendations may be insufficient.

Currently in the UK, pregnant women are recommended by the Food Standards Agency (FSA) to take supplements with a daily dose of 10 micrograms vitamin D. In the US and Canada, where no specific recommendations exist for pregnant women, adequate intakes are inline with the general population and set at 5 micrograms per day.

Dr Maria Barnes from the University of Ulster, Coleraine, told NutraIngredients.com that, as their study was observational, it was impossible to determine the dose of vitamin D required to improve maternal vitamin D status.

“Clearly such recommendations can only be established following a number of well designed double-blinded, randomised placebo controlled vitamin D intervention studies during pregnancy,” said Dr Barnes.

“However, from our study it is evident that general dietary supplementation given to pregnant women may be inadequate to maintain or improve vitamin D status, particularly during wintertime,” she added.

The researchers, from Queen's University, Belfast, the University of Ulster, and Belfast City Hospital report their findings in the British Journal of Nutrition.

Bigger doses needed

A wider debate is ongoing in nutrition circles regarding vitamin D intakes. Late last year the American Academy of Pediatrics (AAP) said children should be consuming 400 International Units (IUs), or 10 micrograms per day. This would mean doubling the current US recommendations. Others have recommended increasing levels to 2,000 IUs.

The US National Academy of Sciences' Institute of Medicine (IOM) said it will be reviewing its recommendations “in the not too distant future”.

According to Dr Barnes and her co-workers, children born to vitamin D-deficient mothers are at an increased risk of rickets, while maternal insufficiency may detrimentally affect bone build-up, and increase the risk of type-1 diabetes and asthma.

Study details

The researchers recruited 99 pregnant women at 12, 20 and 35 weeks of gestation, and 38 non-pregnant controls living at a latitude of 54 to 55 °N. S

Vitamin D levels, calculated using serum concentrations of 25- hydroxyvitamin D (25(OH)D), the non-active 'storage' form of the vitamin in the body, showed that 35, 44 and 16 per cent were vitamin D deficient at 12, 20 and 35 weeks of gestation. Furthermore, 96, 96 and 75 per cent were vitamin D insufficient at the same gestation stage.

While women taking supplements did have higher vitamin D levels, “vitamin D insufficiency was still evident even in the face of supplement use”, wrote Dr Barnes and her co-workers.

“To our knowledge, the present study is the first to measure vitamin D status in free-living Caucasian women with uncomplicated pregnancies, which collected samples longitudinally throughout pregnancy whilst concurrently sampling non-pregnant age-matched controls,” stated the researchers.

“Given the potential consequences of hypovitaminosis D on health outcomes, vitamin D supplementation, perhaps at higher doses than currently available, is needed to improve maternal vitamin D nutriture,” they concluded.

Data on D

Vitamin D refers to two biologically inactive precursors - D3, also known as cholecalciferol, and D2, also known as ergocalciferol. The former, produced in the skin on exposure to UVB radiation (290 to 320 nm), is said to be more bioactive.

While our bodies do manufacture vitamin D on exposure to sunshine, the levels in some northern countries are so weak during the winter months that our body makes no vitamin D at all, meaning that dietary supplements and fortified foods are seen by many as the best way to boost intakes of vitamin D.

Source: British Journal of Nutrition
September 2009, Volume 102, Issue 06, Pages 876-881, doi:10.1017/S0007114509297236
“Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study”
Authors: V.A. Holmes, M.S. Barnes, H.D. Alexander, P. McFaul, J.M.W. Wallace

Cancer Safety Fears Of Most Common Heartburn Treatment Rejected By Major Clinical Study

Cancer Safety Fears Of Most Common Heartburn Treatment Rejected By Major Clinical Study

I'm taking Omeprazole - a proton pump inhibitor to try and avoid the threat of esophagus cancer due to repeated flooding with stomach acid. This study confirms that the medicine does not itself cause cancer. One kind of thought this must be true but good to have a serious 2 year study make sure.

Of course my alternative healthcare provider say that it's all non-sense. The stomach needs to have a lot of acid and if the acid producing cells in the stomach lining are prevented from working then bacteria accumulate in the stomach and produce even stronger acid.

I kind of doubt this but there is always someone with a different point of view.

Full without food: Can surgery cure obesity? - health - 02 September 2009 - New Scientist

Full without food: Can surgery cure obesity? - health - 02 September 2009 - New Scientist


Over the past decade, genetic and endocrinological research has pointed to a complex set of hormones and neural signals that control food intake (New Scientist, 9 August 2003, p 38). There seem to be two systems at work: one that aims to keep body-fat stores constant over long periods of time, and another that controls food intake over the course of a day.

It is this short-term control mechanism that has been thrust into the limelight thanks to gastric bypass surgery. "Suddenly, the signalling from the gut has turned out to be much more potent than people believed - and possibly a better drug target," says Nick Finer, an endocrinologist at University College London.

Our digestive system produces both hormones that make you hungry and those that make you feel full, or sated. Ghrelin, produced by the lower part of the stomach, is a powerful promoter of hunger, while the small intestine releases a number of hormones when it senses the presence of food. These aid digestion as well as producing feelings of satiety, and include cholecystokinin, glucagon-like peptide-1 (GLP-1), oxyntomodulin and PYY.

Current thinking is that changes to the levels of any or all of these hormones could be responsible for the effects of the bypass. Shrinking the stomach seems to reduce ghrelin production, which would curtail hunger signals. A bypass also delivers nutrients to the more distant parts of the small intestine faster and in greater quantities than normal, which would stimulate the release of more satiety hormones.

The other surprising outcome from bypass surgery is its effects on type 2 diabetes, a condition in which people can no longer regulate their blood sugar. After eating, the pancreas normally releases insulin, a hormone that reduces excess glucose in the blood. In type 2 diabetes, though, the body cannot respond to insulin properly or the pancreas fails to make enough of the hormone, or sometimes both.

Type 2 diabetes is much more common in people who are overweight, and it was expected that the weight loss following a bypass would improve symptoms. But doctors have been amazed by just how quickly this happens - sometimes in a matter of hours and certainly long before any significant weight loss occurs. Many bypass patients have been able to throw away their diabetes drugs. "If you change the anatomy of the bowel, you improve diabetes like nothing else has ever done," says Francesco Rubino at Cornell University-New York Presbyterian Hospital in New York. The upshot is that bypass surgery is now being considered for diabetics of lower and lower weight - perhaps even approaching normal weight if their diabetes is severe enough.

(see "A surgical cure for diabetes?").

new glucagon and GLP-1 co-agonist eliminates obesity

Qnexa Obesity

Qnexa Obesity

VIVUS announces that obese patients on Qnexa had a weight lost averaging 14.7%.

Read full details.

What Vivus says about the trial:

• The EQUATE trial demonstrated superior weight loss with both the full-dose and mid-dose of Qnexa, as compared to the individual components and placebo.
  
• Subjects treated with full-dose and mid-dose Qnexa had an average weight loss of 9.2% and 8.5% respectively, as compared to weight loss of 1.7% reported in the placebo group (ITT LOCF p<0.0001).
  
• Average weight loss was 19.8 pounds and 18.2 pounds in the treatment arms as compared to 3.3 pounds in the placebo group.
  
• Qnexa was well tolerated with no drug-related serious adverse events in the study.

Read more.

Time to get excited about real help for serious weight loss ?

• Remember this is not really new technology because Qnexa is a combination of phentermine and topamax.
• There are side affects - lots of them.
• Qnexa is not yet available. In fact it has yet been submitted for approval by FDA.

Benefits of exercise differ by sex and race | Health | Reuters

How much health benefit you get from physical exercise might depend on your gender, and your race, new research suggests.

The work is based on data from more than 15,000 middle-aged African
American and Caucasian men and women who have been participating since
the late 1980s in the large Atherosclerosis Risk in Communities Study.

Benefits of exercise differ by sex and race | Health | Reuters


The key points:

• exercise helps promote health across the races and genders
• there are differences which are significant
• mild to moderate exercise decreased triglycerides only in white people
• increased activity reduced LDL in women but not men

Why so much variation ? No one knows. These are new results which might be contradicted by later research. This particular study used questionnaires which obviously depend upon the honest of participants.

What I've learned this month: Kidney Stones; Osteoporosis; Prostate Cancer; Calcium intake

Kidney Stones and how to prevent them forming.

I have a kidney stone but the doctor is certain that it's old and will probably never descend. I think he really meant that it will never come down but he was being careful just in case the unexpected happens.

The Mayo Clinic Health Letter, September 2009, has the happy line that "you wont soon forget the pain of first passing your first kidney stone." Then it goes on to mention there's a 50% chance that you'll pass another one within 10 years !



What to do ? Prevention strategies concentrate on reducing calcium, uric acid and maybe oxalate in the urine.

• Drink a lot of fluid - 12 cups a day (preferably water)
• Reduce meat eating to less than 8 ounces a day
• Reduce sodium in your food

Now we come to the tricky parts:

• Vitamin D, which I take to help deal with osteoporosis, can increase the risk for kidney stones, if your body is predisposed to making calcium kidney stones.
• If your stones are of the calcium oxalate type then limiting oxalate containing foods is worth thinking about. We are talking about spinach, beets, peanuts, potatoes and chocolate. Of course, all of these are also a good way of increasing calcium intake to address any osteoporosis issues.
• Getting calcium up in your diet helps reduce oxalate absorbed in the intestine because calcium bind to oxalate in the intestine and blocks oxalate absorption.
  
• I get my calcium up via Greek yogurt and calcium citrate tablets. I also think that calcium citrate is easier to absorb if one is also taking a Proton Pump Inhibitor, such as Omeprazole like me, rather than calcium carbonate.

What about Prostate Cancer and Calcium ?
Always a cheery topic !

September, 2009 edition of Nutrition Action was, as usual, stuffed full of interesting bits but the piece starting "What can men do to lower their risk of prostate cancer ? 'Avoid high milk intake' says Harvard's Walter Willett" caught the eye.

The NIH and AARP study tracked milk drinkers for 6 years. The study found no link between prostate cancer and consumption of whole milk or non-fat milk or yogurt or cheese. However the study found that men who drank at least 2 cups of skim-milk a day had a 23% higher risk of advanced prostate cancer than those who drank no skim milk. Strange in the extreme.

So how might milk increase or encourage prostate tumors ?

One theory is that it's connected to IGF-1 (Insulin-like Growth Factor). Milk increases it and it's possible that higher levels of IGF-1 is related to more aggressive prostate cancer tumors. So why milk and not yogurt or cheese ? The theory is that the fermentation leading to both cheese and yogurt denatures IGF-1. Of course it might be the calcium. Excess calcium might account for the higher prostate cancer risk.

The Health Professional Follow-up Study tracked 47,000 men for 16 years and found that those who took in more than 2,000 mg a day of calcium had a risk of fatal prostate cancer 2 1/2 higher than those who took in less than 750 mg a day of calcium.

So what have I learned so far this month ?

Dealing with Acid Reflux (GERD) with a Proton Pump Inhibitor like Omeprazole might have lead to osteoporosis. Dealing with osteoporosis with higher calcium intake might, over time, lead to prostate cancer.

Somehow the chain has to be broken. At the moment I'm getting my supplemental calcium up to around 1,200 mg a day and getting all (nearly) all my dairy intake from yogurt and cheese. Normally I don't drink milk of any kind.

What I've Learned this month: Kidney Stones;Prostate Cancer; Omega-3 fish; Lactate Threshold Training.

Kidney Stones and how to prevent them forming.

I have a kidney stone but the doctor is certain that it's old and will probably never descend. I think he really meant that it will never come down but he was being careful just in case the unexpected happens.

The Mayo Clinic Health Letter, September 2009,  has the happy line that "you wont soon forget the pain of first passing your first kidney stone." Then it goes on to mention there's a 50% chance that you'll pass another one within 10 years !

What to do ? Prevention strategies concentrate on reducing calcium, uric acid and maybe oxalate in the urine.

• Drink a lot of fluid - 12 cups a day (preferably water)
• Reduce meat eating to less than 8 ounces a day
• Reduce sodium in your food

Now we come to the tricky parts:

• Vitamin D, which I take to help deal with osteoporosis, can increase the risk for kidney stones, if your body is predisposed to making calcium kidney stones.
• If your stones are of the calcium oxalate type then limiting oxalate containing foods is worth thinking about. We are talking about spinach, beets, peanuts, potatoes and chocolate. Of course, all of these are also  a good way of increasing calcium intake to address any osteoporosis issues.
• Getting calcium up in your diet helps reduce oxalate absorbed in the intestine because calcium bind to oxalate in the intestine and blocks oxalate absorption.
  
• I get my calcium up via Greek yogurt and calcium citrate tablets. I also think that calcium citrate is easier to absorb if one is also taking a Proton Pump Inhibitor, such as Omeprazole like me, rather than calcium carbonate.
  

What about Prostate Cancer and Calcium ?
Always a cheery topic !

September, 2009 edition of Nutrition Action was, as usual, stuffed full of interesting bits but the piece starting "What can men do to lower their risk of prostate cancer ? 'Avoid high milk intake' says Harvard's Walter Willett" caught the eye.

The NIH and AARP study tracked milk drinkers for 6 years. The study found no link between prostate cancer and consumption of whole milk or non-fat milk or yogurt or cheese. However the study found that men who drank at least 2 cups of skim-milk a day had a 23% higher risk of advanced prostate cancer than those who drank no skim milk. Strange in the extreme.

So how might milk increase or encourage prostate tumors ?

One theory is that it's connected to IGF-1 (Insulin-like Growth Factor). Milk increases it and it's possible that higher levels of IGF-1 is related to more aggressive prostate cancer tumors.

So why milk and not yogurt or cheese ?

The theory is that the fermenation leading to both cheese and yogurt denatures IGF-1.

Of course it might be the calcium. Excess calcium might account for the higher prostate cancer risk. The Health Proffessional Follow-up Study tracked 47,000 men for 16 years and found that those who took in more than 2,000 mg  a day of calcium had a risk of fatal prostate cancer 2 1/2 higher than those who took in less than 750 mg a day of calcium.

So what have I learned so fat this month ? Dealing with Acid Reflux (GERD) with a Proton Pump Inhibitor like Omeprazole might have lead to osteoporosis. Dealing with osteoporosis with higher calcium intake might, over time, lead to prostate cancer.

Somehow the chain has to be broken. At the moment I'm getting my supplemental calcium up to around 1,200 mg a day and getting all (nearly) all my dairy intake from yogurt and cheese. Normaly I don't drink milk of any kind.

Exercise - Waste of Time ?

Time Magazine must be delighted with the storm of protest generated by their cover story - Why Exercise Won't Make You Thin.

The writer is John Cloud who asks "I still have gut fat that hangs over my belt when I sit. Why isn't all the exercise wiping it out?"

John Cloud is no stranger to storms of protest threatening his existence but he has an excellent turn of phrase.

As a Personal Trainer I really liked John Cloud's line:
"On Wednesday a personal trainer will work me like a farm animal for an hour, sometimes to the point that I am dizzy — an abuse for which I pay as much as I spend on groceries in a week."

As it turns the answers to John Cloud's questions about how avoid over-eating can be found on the Time web-site. Look at this video of nutrition advice (good advice) made in the Time & Life cafeteria.

The American Council on Exercise (one of my personal training qualifications is through ACE) took John Cloud's article very seriously and published almost a peer-reviewed journal article.
Lots to read - all of it good:

Editorial: Why Time Magazine’s Article on Exercise and Weight Loss Could Be Harmful to Your Health

By Cedric X. Bryant, Ph.D., F.A.C.S.M., Chief Science Officer, American Council on Exercise

The cover story of the August 9, 2009, issue of Time magazine featured an article entitled, “Why Exercise Won’t Make You Thin.” In this piece, author John Cloud made several inaccurate and unsubstantiated claims regarding the value of exercise, particularly as it relates to weight loss. What follows is a summary of some of the most misleading assertions made in this highly publicized article, as well as the American Council on Exercise’s response to these assertions:

• First and foremost, the article categorically implies that exercise has no meaningful role in weight loss. Such a conclusion is as false as it is reckless. The author’s “evidence” is the fact that he has “gut fat that hangs over his belt when he sits,” despite maintaining a regular exercise habit. In all likelihood, his unwanted abdominal girth is probably a by-product of genetics and/or consuming more calories than he expends


• Weight loss and maintenance are a matter of simple accounting that is dependent upon energy balance. In order for weight loss to occur, individuals must burn more calories than they consume. Regrettably, many individuals who regularly exercise are unable to meet their weight-loss goals because they eat too much. In reality, however, their “personal weight situation” and overall health profile would be far worse were it not for the extra calories they expend while exercising.


• An overwhelming body of scientific evidence exists that confirms the positive role that exercise plays in weight loss and maintenance (Hill and Wyatt, 2005; Jakicic and Gallagher, 2003; Jakicic et al., 2001). These findings refute the notion (advanced by the author) that exercise impairs weight-loss efforts by substantially and uncontrollably increasing appetite. Recent research suggests that appetite may be suppressed for 60-90 minutes following vigorous exercise by affecting the release of certain appetite hormones. It also appears that aerobic exercise is more effective at suppressing appetite than non-aerobic forms of exercise (Broom et al., 2009). In general, individuals who participate in moderate exercise tend to eat approximately the same number of calories (or only slightly more) than they would if they did not exercise. Elite-level athletes typically consume high volumes of food after their exercise workouts, but they almost always expend more calories than they consumed (Blundell and King, 1999). It is important to keep in mind, however, that appetite is influenced several factors and is a very complex process making it difficult to generalize the impact of exercise on appetite. The bottom-line is that exercise and diet go hand-in-hand with successful weight management.


• Surprisingly (and disappointingly) the author failed to mention the tremendously important role that exercise plays in the maintenance of weight loss. According to data from the renowned National Weight Control Registry, consistent exercise participation is the single best predictor of long-term weight maintenance. In others words, if individuals want to be successful in getting off the weight-loss rollercoaster (i.e., repeatedly losing weight and regaining it), they need to regularly engage in physical activity.

Read all of the ACE position.

The Pennington Biomedical Research Center had John Cloud visit for a day and I'm thinking they regret the invitation - Pennington put out this correction !


Much outrage about John Cloud but my vote for the best rebuttal is this one:

• On studies that have a diet only, exercise only, and exercise plus diet groups, the exercise plus diet groups (with scant exception) come out on top when it comes to weight/fat loss. Diet only, almost always beats out exercise only.
• One very well conducted 12 week study by Kramer et. al., which included both aerobic, strength training, and a dietary control, showed the following results. Fat mass losses - diet only: 6.7kg, diet/cardio: 7kg, diet/cardio/resistance: 10kg. Most noteworthy - the D+C+R group lost almost no lean tissue whatsoever, whereas the diet only group lost almost 3kg worth of lean tissue.
• Putting on and saving muscle tissue will have a lasting impact on your body's ability to lose fat. Plus you will look much better.
• Exercise becomes more important once you have lost the weight. Exercise should be a central strategy in preventing a re-gain.
• Pertaining to the above, the National Weight Loss Registry (which tracks those who have lost and kept off at least 30 lbs), shows that high levels of physical activity are a primary predictor of success.

Osteoporosis - It's a long road to hard, solid bones

If there is ever a good time to take Boniva then this was it. A beautiful Sunday morning in Hilton Head, South Carolina.

A few energetic people out on the beach early,  dogs being exercised and pelicans flying overhead in formation.  

Boniva is a once a month medication to try and improve bone density. It's not that difficult to take - a little difficult to swallow but then you have to stay on your feet for at least an hour. This is to guard against partically digested particles of Boniva coming back up into the esophagus and causing irritation and possibly ulcers.

Walking is a great way to take up the precautionary hour.

News had just come out that Amgen's Prolia ( refered to scientifically as denosumab) has had the next stage of FDA approval. The committee which advises the Food and Drug Administraion voted 15 to zero that denosumab should be approved to treat menopausal women with osteoporosis. The committee voted (12 to 3) against recommending denosumab for treatment of moderately weak bones (osteopenia). 

The big advantage of denosumab is that you get an injection every 6 months. So far I've been taking Bonivia on schedule exactly as recommended but the general experience is that within thefirst year most people stop taking the medication because it's both unpleasant and you have to keep track of when it's time to take the tablet again.

Listen to the video of Professor Stevens talking about the denosumab trial which lead to the FDA committee saying yes. The New England Journal of Medicine paper mentioned in the video is this one.

Are you drinking too much ? One question for you.

One hard or easy question on your drinking habit:
For women:
How many times in the last year have you had more than 4 drinks in a day ?


For men:
How many times in the last year have you had more than 5 drinks in a day ?

Men tend to be bigger than women so that is why they get an extra drink.

If you answer 2 (or more times) then you might have an unhealthy alcohol problem.

How accurate is this one question ? The researchers think it's about 80% right.

The idea is that Primary Care Doctors, who usually have a lot of conflicting information to deal with, can have one simple to understand question to see if heavy drinking might be something to factor in.

So it's a question for yourself before you feel so bad that you just have to drag yourself to the docs.

Of course there is then the question of what exactly is a drink ? Try this.

Don't forget, alcohol has a great deal of positive benefits, read this, if you avoid the negatives.

Eating too much and still staying healthy

Punching out Padma Lakshmi - would you really do that ?

If you don't watch Top Chef none of this is going to make any sense but the New York Times had an excellent article about how to stay healthy even if your job involves eating - even if it involves a lot of, lot of eating.


Top Chef is in the genre of reality show. This links explains.

In the article Padma reveals that she puts on maybe 15 pounds during the filming of the series but after filming ends she stays away from red meat, chesse and alcohol until her weight is back where it should be. See the results in her nude photo shoot for Allure Magazine.

Only click her if you want to see Padma naked.

By the way, Tom Colicchio is an equally important component of Top Chef and he has an outpost of his restaurant chain Craft here in Atlanta ( Buckhead to be exact - near Lennox on Peachtree St.). I've eaten there and can recommend it.

Stop Worrying about Swine Flu and take Vitamin D ?

Yesterday I had a small worry that vacination supplies for H1N1 Swine flu would fall short come the Autumn. Particularly if Seniors have to be left out of a vacination program becomes there just is not enough of the vaccine to go around.

So what to do ?

Maybe I had the right idea back in May this year - get your Vitamin D levels high enough and the threat of all flu's goe away (or at the very least, lessens significantly).



The idea comes from this pretty substantial paper "On the Epidemiology of Influenza" - serious stuff.





For me the key chart is this one showing numbers of people having the flu charted against their Vitamin D intake. The research ran over 3 years and involved women who the first year took no supplemental Vitamin D, then in the next year took 800IUs per day of Vitamin D then in the third year took 2000 IUs a day of Vitamin D.

By moving up to 800 IUs a day of Vitamin D the incidence of flu reduced considerably and then by moving to an even higher dose of Vitamin D (2000 IUs), flu almost completely disappeared.


So there you have a strategy for flu season even if getting vacinated is impossible. It's also the way to go if you have any residual doubts about innoculations.

Do not get old - if you want to be vaccinated against H1N1 Swine Flu

This afternoon (29th July 2009) the CDC recommendations for inoculation protection against Swine Flu (H1N1) be as follows:

1. Pregnant Women (that seem right)
2. People caring for or live with children too young to be vaccinated (babies less than 6 months)
3. Health care and emergency personnel
4. Children and young adults
5. Adults up to 64 years old

And then ?



If there is any vaccine left over (not very likely) - seniors.

US advisers say pregnant women first for H1N1 jab

Wed Jul 29, 2009 2:50pm EDT

ATLANTA (Reuters) - Expert U.S. advisers accepted recommendations on Wednesday to put pregnant women at the front of the line for vaccines against the new H1N1 pandemic influenza virus, with relatives and caregivers for infants second.

The Advisory Panel on Immunization Practices nearly unanimously accepted advice from the U.S. Centers for Disease Control and Prevention to first protect pregnant women, infants and healthcare workers against the virus.

Healthcare workers and children at risk of serious complications should follow -- and then healthy young adults aged 19 to 24, the panel said.

Members of the panel said young adults should be a priority because they are more likely to become infected, and because they may spread the virus through society.

(Reporting by Maggie Fox, editing by Gerald E. McCormick)

Swine Flu H1N1 - is it something to worry about if you are overweight or obese ?

If you happen to be in the obese group then you probably don't need to worry about anything else but maybe you should.

Swine flu seems to be picking disproportionately on the over weight. This chart was prepared by Sonia Olsen of the CDC.

Swine flu seems to be at least twice as dangerous to the overweight as to everyone else.

Swine flu seems to be on the rise up and down the coast of the USA and people are dieing. Here is the latest CDC status report. Holiday makers in China from the USA are starting to be rounded up if there is a suspicion of swine flu.

My previous post about swine flu and it looks as if swine flu will be a serious issue come the Fall.

This is what the virus looks like, very infectious but not very dangerous most of the time, but the danger is that it will mutate into something really dangerous while remaining highly infectious.

Overeating Explained - simply and believably

Would you believe that women in the age group 20 to 29 on average weigh 157 pounds ?

So what ? Anything strange about that ?

Well, 40 years ago, women 20 to 29 years of age weighed in at 128 pounds on average.

Weight going up almost 40 pounds in just over a generation !
If those are the numbers for women, just think about how much heavier men are now compared to 40 years back.

David Kessler was a commissioner of the US Food & Drug Administration - if you can't trust someone like him - who can you trust ? This is his book The End of Overeating.

The murder mystery that he solves is why the temptation to overeat is so strong - maybe irresistible. The reason is all to do with the combination of sugar, fat and salt layered together in a food dish. Put fat, sugar and salt together in the wrong (or right from the point of view of the food manufacturing industry) then you just can't stop eating - it becomes an addiction.

Look at the video - it takes an hour but it is serious stuff worth your time because it's not just not about knowing but how to escape from the addiction that the combination of sugar, fat and salt.

David Kessler was asked about eating and children. He said "If you look at children at the age of 2 or 3, they compensate. If you give them more calories in one meal, they'll eat less later in the day. But if they get exposed to sugar, fat and salt all day for a few years, they lose the ability to compensate. By age 4 or 5 they are eating all the time !"

So what to do ?

Food Rehab by David Kessler:

1. Determine what you are going to eat ahead of time and block out everything else
2. Put what you need (not want) on your plate and do not go back for more
3. Picks foods that satisfy - not those that stimulate you to eat even more
4. Anticipate stimulation - know how to deal with food addiction
5. Be alert to your emotional stressors that trigger you to automatic eating
6. Turn off that image of the trigger food before you start debating yourself on whether or not to eat it
7. Think negative - pair unhealthy food that you've been lead to crave with an unpleasant image - stop being programed by the food manufacturers.

Stop the addiction !

Lower Health Care Costs

Health Care is in the news and ACSM's Health & Fitness Journal, which I really like, devoted its regular Take Ten column to "10 Ways to Lower Your Health Care Costs'"

This column is usually right on but this time, I don't know if it's really on the money.

Stay Healthy is definitely a good way to keep down health care costs (No. 10 out of 10 tips) but may be difficult to control. However regular exercise (No. 1 out of 10 tips) is sensible.

Image via Wikipedia

I've blog'd about flossing and so I like that flossing is No. 2 on the list.

Buy generics - yes that's why it's Omeprazole for me and not Nexium which is much more expensive.

Some of the other Take Ten lists I like much more.

How much exercise - as a minimum do you really need ?

Tough question because emotionally you might want a really big number like every day - two hours a day - or you really hate exercise but want to stay around long enough to see that grand-daughter getting married.

Wayne Westcott has been seriously researching this question at the South Shore YMCA, Quincy, Massachusetts and he might have the answer.

The ACSM [American Council on Sports Medicine] has a simple to understand recommendation on strength training and it is:

• 8 to 10 exercises covering all the major muscle groups
• 1 set of each exercise
• 8 to 12 reps per set
• exercise like this 2 or 3 times every week (non-consecutive day)
• full-range of pain-free movement i.e. no cheating by just doing part of a rep but don't go into the pain zone either
• Take about 6 seconds over each rep i.e. no rush, moderate speed but not dead slow either.

Wayne Westcott started using this minimum strength and endurance protocol in 1996 and since then has trained and studied more than 1600 men and women with ages ranging from 21 to 80 years.

So what can we learn from Wayne's experience concerning:

• changes in body weight (particularly weight loss)
• body composition (less fat and more muscles)
• blood pressure (lower would be good).

Image via Wikipedia

Because the ACSM recommendation says 2 or 3 times a week, he did 2 times a week with about half the people and 3 times a week with the other half.
Overall these are his numbers for results of doing the minimum recommended for just 10 weeks. In those 10 weeks, without changing anything else you'll see:

1. Body Weight change Loss 0.6 pounds
2. % body fat Reduced 2%
3. Weight of fat in body Reduced 3.7 pounds
4. Muscle and bone in bodt Increased 3.1 pounds
5. Systolic Blood pressure change Reduced 3.8 mm

Over the first 10 weeks of exercise the typical experience is to not lose much weight but for clothes to fit much better and smaller sizes become possible.

So if you really want to do the minimum but still get the health benefits should you exercise 2 or 3 times a week ?

The answer is 3 times a week if you want to lose weight and it's also 3 times a week if your objective is improvement in health.

However if want you really want to do is put on some more muscle, then 2 times a week seems to give the same result as 3 workouts a week.

Here are the numbers with working out 2 or 3 times a week:

1. Body Weight change Reduce 0.1 pounds with 2 times a week but 1.3 pounds with 3 times a week
   
2. % body fat Reduced 1.9% (2 /week) but 2.2% (3/week)
   
3. Weight of fat in body Reduced 3.2 pounds (2/week) but 4.4 pounds (3/week)
   
4. Muscle and bone in body Increased 3.1 pounds with both 2 and 3 /week.
   
5. Systolic Blood pressure change Reduced 3.1 mm (2/week) but 4.6 (3/week)

Image by Getty Images via Daylife

Calories count - even if you don't

December 2007 I blog'd about how accurate, or not, restaurants reported on the calorie counts for their food. It was pretty inaccurate then and it's still way off. The Wall Street Journal had a piece on the same topic today.

You might be able to forgive Applebee's for their Italian Lime and portobello sandwich which is posted at 360 calories but tested at 395 calories but how far are you willing to go in forgiving Taco Bell for posting their fresco bean burrito at 330 calories when it came out tested at 449 calories. It is just too far off to believe that it's a one off mistake.

Take a look at this list to get an idea of just how far under are the posting for many of the restaurant chains.

Osteoporosis - fixing the problem

A very non-intuitive thought from Australia that on-going testing for bone mineral density can be very misleading ! These are their words - published 24th June 2009.

The test for bone mineral density is not that accurate so a lot of care is needed to assess results.

You might get a misleadingly low result and this might cause the doctor to wonder what's happening:

• are you (as patient) taking the bone medication regularly
• is the medication not working for you and needs to be changed.

The Australian recommendation is not do repeated tests of bone mineral density in the first three years of starting on medication to increase bone mineral density.

Their reason is that bone density medication (such as boniva that I'm taking) is so reliable in increasing bone mineral density that all that is needed is to take the medication exactly as prescribed at exactly the right intervals.

Earlier this year a survey was published on how women reacted an osteoporosis diagnosis.

Read the survey (the survey uses the abbreviation PMO to mean Post-Menopausal Osteoporosis).

About half the people questioned were not sure about their bone mineral density numbers and around a quarter admitted to not taking their osteoporosis medication regularly. Some people have argued that the regular bone mineral density tests should show up not taking medication regularly but the Australian paper shows that this is not true. Careful questioning by a doctor is better, faster and cheaper.

The survey was commissioned by Know my Bones Foundation.

Acid Reflux (GERD) - a surgical solution

I'm still thinking about Acid Reflux (also called GERD) and what to do.

I blog'd about trying the Alternative Medicine route and I'm continuing down that line.

However another even further out solution has come into view - what about a surgical solution ?

There is a pretty intensive surgical procedure known as Nissen Fundoplication. Nissen was a Swiss surgeon who came up with this particular solution for Acid Reflux in the 1950's. Once you read about it, you'll probably be like me and not be all that keen. It is radical surgery but on the other hand it's usually a success but with some nasty side-affects if anything goes wrong. Most doctors treat the Nissen Fundoplication as a last resort for acid reflux.

However another surgical solution has appeared on the horizon - the LINX Reflux Management System. The idea is to slide a magnetic band to the bottom of the esophagus and to surround the place where the esophagus enters the stomach i.e. exactly outside the lower esophageal sphincter.

Why risk surgery when a medication like omeprazole will keep the symptoms suppressed and prevent further damage to the esophagus ? To keep acid reflux suppressed and all the potential pain and damage that entails means taking medication life time. This is the take on the options by Torax - the inventors of LINX. Play the small video on the page to see how the solution works.

Taking Omeprazole (or any of the other Proton Pump Inhibitors) for years on end has the chance of creating osteoporosis which can lead to broken bones (hips and the like) and painful back issues. So avoiding decades of taking these medications has many attractions.

Does it work ? Here is the paper writing up a feasibility clinical study and that was preceded with animal studies to find out if the idea had any chance.

This approach might have a chance but I'll give the Alternative Medication a chance first.

Too Many Doctors: what about gastrex and betafood

I like my doctors. There are only two - the Primary Care Practitioner or GP [General Practitioner] as the British call them and the Gastroenterologist. Some people have many more than two doctors and I feel sorry for anyone in that situation.

You'd think that the two doctors they'd communicate and work together ? Not a bit of it !

When the gastroenterologist prescribed Omeprazole, at no time did he try to deal with any threat of osteoporosis. He could have told me to get my calcium and vitamin D intake up high but he did not. After I was diagnosed with osteoporosis my GP said to talk to the gastroenterologist to find out if the omeprazole prescription needed changing. No suggestion about calcium, vitamin D or anything else.

Of course I did wonder why the GP didn't discuss directly with the gastro but apparently they don't like to do that !

I tried an experiment while on vacation. I stopped taking omeprazole for 18 days just to find out what the result would be. The answer is that food started to catch in my throat again. So I need to keep on with omeprazole. The theory when I started on the medication that by stopping the acid reflux my esophagus would heal. The experiment showed that had not happened and possibly will never happen.

So what to do ?

The next step might be the craziest yet - I'm trying an alternative nutritionist.

So now, as well as the prescriptions from the main-stream doctors, I'm taking the prescription from alternative medicine : Gastrex; Betafood; Spanish Black Radish. None of these has any clear action. You can search the web until Google runs dry and still not know if a supplement has any particular action.

So I'm hoping that you do not have to believe in these supplements that alternative medicine prescribes.

Regular drinking: good idea or bad idea ?

A lot of research, and I mean hundreds of studies, seem to show that alcohol is good for you but is this really true. I joined in with this happy piece about increased bone density with moderate drinking - and a longer life as an additional bonus.

Scientific American summarized it "Three decades of research shows that drinking small to moderate amounts of alcohol has cardiovascular benefits. A thorny issue for physicians is whether to recommend drinking to some patients."


The New York Times Roni Rabin had a really good article putting the other side of the argument:

1. Alcohol is addictive and if you are prone to addiction that alcohol is highly dangerous
2. Alcohol might not be processed at all well by your body
3. The studies might be biased in favor of alcohol because of confounding factors
   
4. Researchers might be biased in favor of alcohol because the source of their research funding.

The Annals of Epidemiology published the results of a serious symposium.
Their words: "Debate on harms and benefits of moderate drinking continuesThe Annals recently published the proceedings of a symposium on the health effects of moderate alcohol. A summary of the symposium was written by the organizers and sent to the readership of several other journals. Others at the symposium had a differing view of the conclusions. In particular, there is disagreement over interpretation of the epidemiological data that support or refute the contention that moderate alcohol consumption has health benefit, and over whether that issue was resolved at the Symposium. Also available is a response from guest editors to the commentary. Readers of The Annals will find the arguments of considerable interest, since they invoke fundamental epidemiological issues of bias and misclassification that are at the center of so much epidemiological work, and we would welcome any further commentary from the readership on these issues. – The Editor "

The summary paper " The Harms and Benefits of Moderate Drinking" has some blockbuster quotes (in large and unmissable type):

• New research has clearly indicated that the frequency of drinking is as important as, or even more important than, the amount of alcohol consumed.
• It is important that the effects of alcohol consumption, moderate or otherwise, not be viewed in isolation, but as part of broader social, cultural, and lifestyle issues. There are differences among drinkers and the range of outcomes they are likely to experience.
• There is evidence that moderate alcohol consumption may modify the risk of developing type 2 diabetes. Meta-analytic reviews of the data have shown a U-shaped relationship between moderate drinking and the risk for type 2 diabetes for both men and women.
• There is a need for greater attention to the positive aspects of alcohol consumption, which are closely related to its psychosocial effects. Current research is largely devoted to assessments of harms, often neglecting the benefits, despite the fact that the vast majority of those who drink do so moderately.
• Communication between patients and their health-care providers is an important mechanism by which individual behaviors and perceptions about health may be changed. Provided with the proper tools, physicians and other practitioners can tailor their messages, depending on the patient’s age, sex, past alcohol use experience, cardiovascular risk, and other factors.
  

Luckily, for science, there are people who argue that research on alcohol and its impact is fraught with difficulties to classification and associated behaviors. For instance, wine drinkers seem to have healthier habits ( food, exercise, life-style) than beer drinkers who in turn have healthier habits compared to spirits drinkers.

Any classical medical double blind trial on alcohol is going to difficult, dangerous and probably unethical. How could you give someone 60 grams of alcohol and expect them not to notice - let alone drive home afterwards. However it is time for someone to find a way forward because at the moment alcohol in moderation seems to have many benefits (and of course like all medication some undesirable side-affects).

Back in 2003 Scientific American published a special edition titled "Eating to live". A digital download costs $7.95. Within the edition is an article "Drink to your health" - Three decades of research shows that drinking small to moderate amounts of alcohol has cardiovascular benefits. A thorny issue for physicians is whether to recommend drinking to some patients. The article has a graph showing health benefits going up in a straight line to 5 drinks a day (if your body can tolerate that amount of alcohol).

Save Now

Alcohol has 7 calories for every gram. So if you take 12 grams as a "drink" then you have at least 84 calories in there (more if it's mixed with something sweet). Five drinks a day is 420 calories. So you are probably going to have to forgo dinner unless you exercise hard every day. Jogging a mile burns about 110 calories. So 4 miles of easy jogging burns off 440 calories - so you are back in balance - easy.

Richard Lehman's Medical Blog

Richard Lehman's Medical Blog is a gem.

He's writing for other doctors (primarily other British doctors working in Britain's National Health Service).

For average idiot's, like me, he is always a challenge to follow with any real understanding but if you have a continuing interest in medicine but no formal education - read every one of Richard's Blogs - they appear about every two weeks (fortnightly in British) and for me they are must reads.

A quick feel for his writing:

"So I was strongly inclined to pass over this Danish study, but I’m glad that I didn’t. It is quite an intellectual tour de force as well as a logistic feat, combining three types of study within the population of Copenhagen, and it shows how the deft use of genomics can obviate the need for a randomised controlled trial.

The key element here is mendelian randomisation, the reshuffling of genetic material which happens each time we make a baby. I won’t go into further detail here, but if you are interested in such cutting edge stuff, I would strongly recommend a look at this paper and its accompanying editorial (p.2386)."

Of course he can sound a little condescending but I'm sure he is not:

Cardiac computerised tomography exposes patients to large amounts of radiation for large sums of money and often negligible clinical benefit. In the USA, you can apparently get it done in “small community hospitals”, which were lumped together with larger centres in this exceedingly unsophisticated before-and-after study.

Before these centres participated in the Advanced Cardiovascular Imaging Consortium in Michigan, they used twice the dose of X-rays that they did afterwards. But if you really need to know how furred-up your coronary arteries are, and want much smaller doses of radiation, it’s best to wait for the arrival of prospectively triggered sequential scanning in your area, or even better, single heartbeat acquisitions.

Week-end Sport: 100 meters in stilettos and naked bicyle riding

Just back from Brazil these two photos caught the eye.

The first shows really intense competition. The women are competing in a 100 meters race with a prize of 10,000 Euros (around $13,000) shopping trip. The women are running very hard in stilettos - you have to admire the desire to win.

Of course they should have had a men's event as well. The race was in Sweden, so no doubt next year there might well be a men's stiletto event.







The naked bicycle ride in London, England was not competitive - unfortunately. The riders were protesting the ever rising traffic congestion in London and that bicycling needs to be encouraged. Well done to all the participants.

Live longer, drink more and have stronger bones

Two news items this week to make me smile.

The first is research results showing that drinkers live longer - amazing but true.

Age and Aging: "Both men and women who drank alcohol had decreased mortality compared with nondrinkers. Those who drank 2 or more drinks per day had a 15-19% reduced risk of death. The reduced risk was not limited to one type of alcohol. Stable drinkers (those who reported drinking both at baseline and follow-up) had a significantly reduced risk of death compared with stable nondrinkers. Those who started drinking at follow-up also had a significantly lower risk. Those who quit drinking were at increased risk of death, which was significant in women."

The remark within the above quote, that women who gave up drinking had significant increased risk of death, is a strong message. We await publication of the full report with impatience.

The second item is in the June 2009 issue of Tufts Health and Nutrition Letter which arrived today and what is the front page story but "Moderate drinking linked to better bone density." Women who have 2 or more drinks a day had 5% to 8.3% better hip and spine bone mineral density i.e. stronger bones. For men the improvement in bone density was 2.4% to 4.5%.

The researchers go on to say that alcohol is a strange topic because it helps prevent heart disease but increases the risks for breast cancer. Nonetheless, the positive affect of alcohol on bone density is larger than that for any other nutrient - including calcium. Amazing.

Some balance is needed. Too much alcohol - bad. You only get the good effect from beer and wine - not from spirits.

Of course you need to be sensible. Watch this video:

Flossing to stop heart attacks

The reason you floss is to protect your heart.

You know that - right !

However many reasons you might have for not flossing - remember that your heart needs it.

I was convinced about this several years ago and now I floss twice a day - as close to 12 hours apart as possible. Usually 9.30am and 9.30pm.

Now there is the news that there is an underlying genetic link.

Vienna, Austria: The relationship between the dental disease periodontitis and coronary heart disease (CHD) has been known for several years. Although a genetic link seemed likely, until now its existence was uncertain. Now, for the first time, scientists have discovered a genetic relationship between the two conditions, a researcher told the annual conference of the European Society of Human Genetics today (Monday 25 May).

"These factors already indicated a possible mutual genetic basis underlying the two diseases", said Dr. Schaefer. Now we know for sure that there is a strong genetic link, patients with periodontitis should try to reduce their risk factors and take preventive measures at an early stage", he said. "We hope that our findings will make it easier to diagnose the disease at an early stage, and that in future a greater insight into the specific pathophsyiology might open the way to effective treatment before the disease can take hold."

What to do if the urge to snack is strong

Losing weight is a constant battle.


Every day the urge to snack can be strong. Just one small bite wont do any harm. Will it ?


There can be times when that siren call to snack is too loud to ignore. So what to do ?


On the way to the refrigerator to pick up a snack, stop and get down on your knees.


Then do exactly the same as this video.


Two minutes later you'll feel good and the urge to snack will have gone away.

The Amazon - anything to worry about ?

We are off on an expedition to the Brazilian Amazon.

So you have to buy a hat and it has to be a Tilley. This is an LTM3 Airflo hat. It turns out its made in Toronto, Ontario with an address on Don Mills Road which I've driven down many times.

We bought the hat, and a lot else besides at UV Gear. For anyone living in the Alpharetta - Johns Creek, Ga area, UV Gear is at the junction of Kimbal Bridge Road and Web Bridge Road [sandwiched between the bridal gowns shop and Bickram Yoga - by the way, the Yoga studio is the only place in Georgia that sells Lululemon exercise clothes].

UV Gear told us that they could equipment anyone for a two month trip with luggage weighing just 10 pounds. We did not test them on this, our credit card would have folded under the load.

Now we have had our injections: typhoid; yellow fever. The malaria tablets are ready for before we get to the malarial mosquito infected areas.

Bring on the Amazon.

Kathy Anne Art

I attended one of Kathy Anne's courses on Photoshop Elements at Art + Soul in Virgina.

Loved her.

http://www.kathyanneart.blogspot.com/

How to get a fast brain

Brain Health, brain processing speed seems to be an issue this month because both the Duke Medicine Health News and the Berkeley Wellness Letter featured articles on brain health. 

Duke even had a diagram to help us all understand how the brain works. This is it. I get clicking from my knees but perhaps the clicks are from inside my head.

Just in case you are wondering, the numbers in the diagram have some meaning:

1. Pre-frontal cortex which governs working memory
2. Primary auditory cortex for sound analysis and recognition
3. Wernicke's Area for speech recognition.

The people the research looked at were all healthy and aged 65 and up who did 8 weeks of brain exercises aimed at increasing brain speed. The results were amazing, possibly too good to be true, in that the people involved doubled their memory scores as compared to those who did not go through the 8 weeks of brain exercise.

So what exactly did they do ?

There were 6 different activities which started with separating low-pitched and high-pitched sounds. The machine used started to play the sounds slowly and distinctly but then gently increased the pace until the sounds started to fuse together. 

The details are in this paper but it is a challenge to read !

The Berkeley Wellness piece was nothing like as geeky as Duke's effort. Berkeley said that the brain does not change with age but it does process information more slowly with age. The slowdown starts at about 15. Berkeley quoted the same research as Duke but added the thought that the brain speed improvement seen by the researchers was probably only temporary.

So what to do:

• Exercise. This probably helps the brain by increasing blood flow and reducing blood pressure
• Keep using your brain to learn on a lifetime basis
• Blood Pressure - keep it down
• Diabetes - avoid if you can as the high levels of insulin which go along with Type 2 diabetes are associated with a declining memory
• Keep weight down
• Taking statins to keep cholesterol down on balance is good for the brain
• Raise good cholesterol [HDL] as there is a theory that HDL helps block formation of plaque in the brain. How do you raise HDL ? Intense exercise, if your body will take it, is the best approach.
• Aspirins (and similar) seem to reduce chronic inflammation that plays a role in Alzheimer's
• Healthy diet - a Mediterranean type diet
• Depression - get treatment as depression reduces mental activity.

Sharp Brains Guide to Brain Fitness might be worth looking at.

Vitamin D and Influenza

Vitamin D, if you have enough in your blood, stops influenza. Can it really be that simple ?

I blog'd about Swine Flu (H1N1) recently and came to the conclusion that the present outbreak is not a big worry. At least not a big worry compared to osteoporosis or something big of that nature. However come the Fall, after Swine Flu has had the chance to mutate while infecting the southern hemisphere during their Winter the situation might be very different. 6 months on Swine Flu might have turned into something to really worry about.



The solution to avoiding flu might be just to fool your body in believing that it's always Summer. Look at this chart showing Vitamin D concentrations in the blood through the year. This particular study followed a group of 45 year old Brit's to see what happened to their Vitamin D concentration. As you can see, even in Summer, Vitamin D was barely adequate (30 ng/ml is about as low as you'd want to go and 50 ng/ml is much better) and in Winter badly low. So this group of people were ripe candidates to get colds and flu.

I've blog'd about Vitamin D enough:

• Vitamin D
  
• Vitamin D - babies, children teenagers
• Vitamin D - from sunshine or food
• Vitamin D - get an accurate test

So when I came across On the epidemiology of influenza which links flu to Vitamin D, I thought I'd struck gold. This paper links low Vitamin D levels to the spread of flu of all kinds. This is part of the conclusions:
"Compelling epidemiological evidence indicates vitamin D deficiency is the "seasonal stimulus" [22]. Furthermore, recent evidence confirms that lower respiratory tract infections are more frequent, sometimes dramatically so, in those with low 25(OH)D levels [90-92]. Very recently, articles in mainstream medical journals have emphasized the compelling reasons to promptly diagnose and adequately treat vitamin D deficiency, deficiencies that may be the rule, rather than the exception, at least during flu season [40,41]. Regardless of vitamin D's effects on innate immunity, activated vitamin D is a pluripotent pleiotropic seco-steroid with as many mechanisms of action as the 1,000 human genes it regulates [93]. Evidence continues to accumulate of vitamin D's involvement in a breathtaking array of human disease and death. [40,41]"

The Vitamin D Council has more scientific papers than you could possibly read before this Fall's flu season. So the quick answer is take at least 1,000 IU's of Vitamin D every day and that should just be enough to have your bodies mechanisms to fight infections like colds and flu, fully primed and eager to fight off invaders.

Exercise does make a difference - even later inlife

Exercise makes a difference to health - more is better - less is worse - but it takes time to have an impact. We've all known this but at last a 35 year long (and still going strong) study from Uppsala, Sweden has proved it - finally.

I blog'd a few weeks ago about people, mainly men, who'd been laid off after decades in the same job, flocking to the gym and working out for hours, several times a week. You might be tempted to think "Too late to make a difference" but as it turns out "Not true." 

The study started to 1970 when all the men aged 50 years in Uppsala, Sweden were contacted to invite them to participate in this research. 2200 men said yes - over 80% of the men living in the area at the time. Why  were only men invited is not clear and is a weakness in the study. Do the results apply to women. Probably but likely with some gender twists.  The study has published every few years since then:

• list of all their publications
• the original at 50 years of age Uppsala Prevention Study
• the study when the participants were 82 years old

The investigations include anthropometric measurements, blood pressure, blood and urine sampling, bone density measurement by whole body DXA, ECG examination, tests of cognitive function, questionnaire, and a dietary investigation.

Long may it continue. It contrasts with what I said about this 4 week study on exercise and antioxidant supplements.

I also blog'd months ago about the long-term could health results of running.

• the active live longer and better than the inactive (no great surprise here but the Swedes quantify the extent)
• changes in exercise level ( up and down) take 5 to 10 years to show up in health and mortality. It's no surprise to learn that these things take effect slowly but this research shows pinpoints it to the range 5 to 10 years.
• if you've been inactive all your life and then start to exercise seriously then within 10 years (maybe even after 5 years) your health and mortality is as good as those who have been active all their life. Sad news for the always active but great news for those who's work has stopped them looking after their health and wellness.
• in the other direction, if you have been active but then join the couch potatoes, your health and mortality sinks after maybe 5 years (and at most 10 years) your risk is the same as those who have always laid back and taken life easy.

What the research did not show was exactly how hard and how much you had to workout to make a difference. This research sets the bar at 3 hours a week of exercise and is not too specific about how hard the exercise has to be to pay health dividends.

.

I blog'd months ago about the positive impact that running has on health.

Of course, you might have forgotten, brains get bigger with aerobic exercise - no kidding.

Could taking anti-oxidants really eliminate exercise health improvement ?

Taking anti-oxidants makes exercise a waste of time !

Can this really be true ?

German researcher Michael Ristow makes this bold claim in the paper published this week - "Antioxidants prevent health-promoting effects of physical exercise in humans". The paper is only 6 pages long, well written and fairly easy to read.

A few words of caution: in this research, health-promoting effects are simplified to decrease in insulin resistance. The paper, while excellent, is typical of most published research on exercise and health in that they are afflicted by the 3 S's.

1. SHORT time period over which the research is carried out. In this case 4 weeks. 
2. SMALL number of participants. In this case 40 (1 dropped out leaving 39).
3. SCANT information about the people participating in the research study. What was their general health; what else were they doing while the study was ongoing.

What is very different about Ristow's point of view is that he views the production of Reactive Oxygen Species [ROS] in the muscle mitochondria and the body's subsequent reaction to control them as being a promoter of good health (and probably a long healthy life). 

Until now everyone else has thought of Reactive Oxygen Species as dangerous and needed to be snuffed out as soon as possible using anti-oxidants. 

This statement from the Linus Pauling 

Institute summarizes the usual position on Reactive Oxygen Species: 

Antioxidants, both enzymatic and non-enzymatic, limit oxidative damage to biological molecules by various mechanisms. Dietary antioxidants, such as vitamins C and E, significantly contribute to antioxidant defense systems in humans and may help protect us from certain age-related degenerative diseases.

Of course we all get antioxidants from food. Lots of fresh vegetables and plants are the best source. Nature is rich in antioxidants, there are probably at least a million different molecules with antioxidant properties. 

What exactly did Ristow do in the research ? 

He took 40 healthy men (25 to 25 years) and divided them into 4 groups;

1. Exercise program on trained fit men plus antioxidants
2. Exercise program on trained fit men but NO antioxidants
3. Exercise program on previously untrained men plus antioxidants supplements
4. Exercise program on previously untrained man but NO antioxidants.

Before and afterwards he measured:

• insulin sensitivity
  
• formation of Reactive Oxygen Species in the muscles by measuring the concentration of thiobarbituric acid-reactive substance.

What he showed was that in both the fit, previously trained men and the unfit, not working out men, taking antioxidants (Vitamin C and Vitamin E) stopped improvement in insulin sensitivity. The clearness by which antioxidants stopped the improvement is both amazing and surprising.

Not surprisingly the nutritional industry has not taken this research too kindly at all. 

Alexander Schauss was quoted “The primary objective of this study was to study the effect of a 4-week intensive 5-days a week exercise program on insulin sensitivity. Yet the title of the paper leads one to believe otherwise,” he said.

“This is a small gender-biased study of 40 male subjects, 25 to 35 years of age. When I read through the study for the first time I had to wonder how could the authors have come up with such a title for their paper?” 

More of the same !

However for some time the nutraceutical industry has wondered whether antioxidants really did live up to the marketing claims.

So finally, should one give up on taking antioxidant supplements ?

A good question deserves another good question !

1. Are you exercising hard and eating a range of fruits and vegetables? If you believe this research then no to antioxidant supplements.
2. Are you exercising hard but eating poorly ? Safer to get antioxidants from supplements rather than none at all.
3. Not exercising hardly at all but eating poorly ? Probably safer to take a supplement.
4. Not exercising much but eating nutritiously ? No need for antioxidants.

Osteoporosis - best way to solve the problem

I thought I had the osteoporosis issue under-control: 

1. Take Alendronate (generic version of Fosamax)
2. Take calcium tablets to get calcium intake up to 1200 mg every day
3. Take Vitamin D to get up to 800 IU's every day

then in a year's time go back to my doctor and find out if bone mineral density in the spine is heading back to where it should be.

What's the  problem:

1. Should it be Alendronate or Boniva or Reclast ? The gastroeneterologist who's prescribing Omeprazole to deal with my acid reflux issues thinks the prescription should be Reclast or at least Boniva. If it stays at Alendrate then he says to double up on Omeprazole on the one day a week I take Alendrate. Issues still on-going.
2. Is 1200 mg a day of calcium enough ? Professor Heaney at Creighton University thinks that 2400 mg a day of calcium is the better amount for anyone who has been low on calcium (possibly my issue).
3. Is 800 IU's of Vitamin D enough or should I be aiming for 1000 IU's ?

Professor Heaney wrote a long paper on Calcium, Dairy Products and Osteoporosis that went through the evidence that low calcium is a big part of osteoporosis. For him, the answer is to get calcium intake up high - no thoughts about drug treatment. Medscape interviewed Prof Heaney about calcium and osteoporosis - this is a transcript. 

One view on drugs for osteoporosis.

A snippet from the interview: 

Medscape: Is there an amount of calcium that would be considered excessive? For example, if someone were already taking a supplement several times per day for osteoporosis prevention (ie, 1500 mg), could they also add 3 servings of dairy products without getting too much calcium?

Dr. Heaney: That quantity of calcium you have just described would not be too much. The published upper intact limit established for calcium is 2500 mg. And although it is not explicitly stated, I can tell you (because I have served on the committee that developed the recommendation) this amount applies only to supplements and not to food. There has never been a documented instance of calcium poisoning from food.

Prof Heaney also throws in that Calcium phosphate is a better supplement than the Calcium citrate I've been taking ? Something else to think about. 

Prof Healey explains the role of the Parthyroid in controlling the build up and breakdown of bones.

The total quantity of skeletal remodeling is regulated by circulating levels of parathyroid hormone (PTH), which operates mainly by controlling the activation threshold for new remodeling loci. PTH is secreted in response to both systemic, i.e., nonskeletal, calcium demand and to the demands to mineralize bone undergoing the formation phase of the remodeling cycle. PTH secretion is reduced to low levels on high calcium intakes and rises to high levels on low intakes. As a direct consequence, the quantity of bone being remodeled at any given time is an inverse function of effective calcium intake. Thus, whenever calcium intake is raised experimentally in a group of adults, bone remodeling falls, first resorption, then, later, formation, as well. That response is an inescapable consequence of the way the system is controlled and does not necessarily have nutritional significance, particularly since it will happen even at calcium intakes well above the nutritional requirement.

Swine flu: Early findings about pandemic potential reported in new study

Researchers from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, working in collaboration with the World Health Organisation and public health agencies in Mexico, have assessed the epidemic using data to the end of April. Their key findings are as follows:

• The data so far is very consistent with what researchers would expect to find in the early stages of a pandemic.
• The researchers' best estimate is that in Mexico, influenza A (H1N1) is fatal in around 4 in 1,000 cases, which would make this strain of influenza as lethal as the one found in the 1957 pandemic. The researchers stress that healthcare has greatly improved in most countries since 1957 and the world is now better prepared.
• The epidemic of influenza A (H1N1) is thought to have started in Mexico on 15 February 2009. The data suggests that by the end of April, around 23,000 people were infected with the virus in Mexico and 91 of these died as a result of infection. However, the figures are uncertain – for example, some mild cases may have gone unreported. The numbers infected could be as low as 6,000 people or as high as 32,000 people.
• The uncertainty around the numbers of people who have been infected with influenza A (H1N1) in Mexico means that the case fatality ratio (CFR) of 0.4% (4 deaths per 1000) cannot be definitely established. The CFR is in the range of 0.3% to 1.5%, but at this stage the researchers believe that 0.4% is the most likely.
• For every person infected, it is likely that there will be between 1.2 and 1.6 secondary cases. This is high compared to normal seasonal influenza, where around 10-15 percent of the population are likely to become infected. However, it is lower than would be expected for pandemic influenza, where 20-30 percent of the population are likely to become infected.
• In an outbreak in an isolated village called La Gloria, Mexico, children were twice as likely to become infected as adults, with 61% of those aged under 15 becoming infected, compared with 29% of those over 15. This may suggest that adults have some degree of immunity against infection, because of having been previously infected with a related strain of influenza, or it may mean that children are more susceptible to infection because they interact much more closely together, for example in school, than adults.

Professor Neil Ferguson, the corresponding author of today's research from the MRC Centre for Outbreak Analysis and Modelling at Imperial College London, said: "Our study shows that this virus is spreading just as we would expect for the early stages of a flu pandemic. So far, it has been following a very similar pattern to the flu pandemic in 1957, in terms of the proportion of people who are becoming infected and the percentage of potentially fatal cases that we are seeing.

"What we're seeing is not the same as seasonal flu and there is still cause for concern – we would expect this pandemic to at least double the burden on our healthcare systems. However, this initial modelling suggests that the H1N1 virus is not as easily transmitted or as lethal as that found in the flu pandemic in 1918," added Professor Ferguson.

The above early findings about the emerging pandemic of a new strain of influenza A (H1N1) in Mexico are published May 11, 2009 in Science.

Swine Flu - something to worry about ?

Swine Flu virus - probably not worth worrying about until the summer is over.

This is what the little beauty looks like. A tryst of pig flu proteins on the outside with bird and human flu interior. 

Could it be dangerous ? For sure, humans are not going to have immunity to this new H1N1 virus until we've all had exposure to the virus. 

This H1N1  flu virus is not as dangerous as the H5N1 bird flu virus which has killed about half of the people it's infected.

H1N1 pig flu is nothing like as dangerous. The people who have died probably other other health issues at the same time. 

However H1N1 pig flu does spread easily from one person to another (if no precautions are taken) unlike the killer H5N1 which does not spread from one person to another.

In the meantime the H1N1 virus is going to keep on evolving and there is the chance that it could become much more dangerous. Another 6 months on, getting towards winter, I'll definitely get a flu shot even though I'm guessing that flu shots for winter 2009-2010 will be only weakly effective.

Why do I think that ? It's going to take at least 4 months to create a flu vacine against H1N1 pig flu. During those 4 months it's going to be Winter in the southern hemisphere and H1N1 will be spreading fast and possibly evolving even faster. So the H1N1 flu we'll see in the Fall will be quite different to the virus currently causing concern.

Stay informed on the global spread of Swine Flu with this constantly updated map.

The New England Journal of Medicine is taking H1N1 seriously - read what they have to say.

Look at video on how the world can protect itself.

Latest Trends in Exercise and Fitness

Are there any clear fitness trends emerging for 2009 ?

1. Number 1 for me is couple training together. This can be a challenge for a Personal Trainer because there are now two people to keep safe, keep interested and keep challenged. I'm happy with couples working out together as long as they are nice to each other - don't bring any married couple arguments into the gym. Luckily for me, all the married couples working out together get on really well.

2. The second big trend is men wanting to improve their flexibility. This has surprised me as until this year persuading men to stretch was a hopeless task. We could spend a few minutes stretching or squeeze in one more set - "Let's get in one more set" has always been the male attitude but no more. Stretching and flexibility are now front and center for most men. 

3. At least we've reached Number 3 before mentioning the economy. I've seen the fragile economy affecting training in two ways. People are being cautiously frugal, cutting back on monthly spend, maybe working out as couples or less often because no one can be certain how long we have to survive the economic winter. 

4. People who have been laid off are flocking to the gym like never before. Men and women who might have worked two, three or more decades for one organization have been told this is the end of road for you with us. Good people who previously have barely fitted in one workout in two weeks are now in the gym for hours on end  4, 5 or 6 times a week. It has to be a good trend.

5. Older people are wanting to workout seriously much more than ever before. At 65 I smile a little when I say older people as I'm not quite sure who or what I mean. Let's just say good souls of 50 and upwards, usually with an injury or two, often a serious health condition which is being managed, want to make sure they can enjoy life in the best condition possible. 

That's my list of fitness trends in 2009. 

The ACSM did a carefully calibrated survey and came up with their view of fitness trends. The full article is at

 http://www.acsm-healthfitness.org/pt/re/acsm/fulltext.00135124-200811000-00006.htm;jsessionid=KDWPzdK9QldQMXypVlk7tZJwVpwVK7Y9thP4xFpPyLh6wHnJ6zXn!1160382954!181195629!8091!-1

but without ACSM membership you'll probably find it difficult to gain access. The survey is carried out on behalf of the ACSM by Walter Thompson, PhD, FACSM, FAACVPR, Regent's Professor at Georgia State University:

The ACSM top 10 fitness trends:

• 1. Educated and Experienced Fitness Professionals

• 2. Children and Obesity

• 3. Personal Training

• 4. Strength Training

• 5. Core Training

• 6. Special Fitness Programs for Older Adults

• 7. Pilates

• 8. Stability Ball

• 9. Sport-Specific Training

• 10. Balance Training

Then ACSM goes all the way to 20.

• 11. Functional Fitness

• 12. Comprehensive Health Promotion Programming at the Works...

• 13. Wellness Coaching

• 14. Worker Incentive Programs

• 15. Outcome Measurements

• 16. Spinning (Indoor Cycling)

• 17. Physician Referrals to Fitness Professionals

• 18. Exercise and Weight Loss

• 19. Group Personal Training

• 20. Reaching New Markets

My take on ACSM: 

- everyone wants to feel safe with their Personal Trainer so one can see why in general Educated & Experienced makes it to Number One for ACSM;

- children are not in my demographic but I recognize the impact that childhood obesity has on the rest of life - most obese children go on to become obese adults with all the diabetes and metabolic syndrome risks;

- it's not just about personal training - one wants everyone who can safely exercise to do so in whatever shape or form is safe and enjoyable;

- strength training is definitely starting to make progress compared to "cardio" but I'd say that 75% of gym members only do cardio in one form or another;

- Core Training often gets translated into "Can I get my tummy flat ?" and that's OK because core training makes for better posture, deals with lower back pain as well as getting the tummy flatter and tighter.

Of course ACE has it's own take on Fitness Trends.

ART and SOUL

Total disaster to total delight in just a few days.

My beloved Cougar, 150,000 miles and good for another 150,000 miles, or so I thought, stopped coughed up green and brown engine fluid and would not go at all. Verdict, engine totally wrecked. Problem can be solved with a new engine.

A few days of emotional melt down but spirits were revived by a long week-end at Art & Soul in Hampton, Virginia.  The wonderful chirpy delightful Claudine Hellmuth even managed to wipe out memories of spinal osteoporosis. 

A whole week with no workout, no running, no stretching - doesn't happen often.

Instead I learned a lot about blogging from Kecia Deveney about how to make blog'n fun. Kecia AKA Lemoncholy made a beautiful papier mache bird while I struggled with a mish-mash but she has real artistic talent and it showed. 

Jan Harris gently pointed me to improving technique without ever saying that and was even nice about my bird.

Then I spent a whole day with Kathyanne White aka Art in Common who took me many steps higher in Photoshop Elements expertise. 

This is her image which she allowed me to play with - thank you.

Then I worked on a photo of me from long ago taken at the Parthenon in Greece. The original was a holiday snap and this was an opportunity to see if Photoshop could improve it. One day I'll do something about the teeth.

Osteoporosis in Men

This year's annual physical was mostly good, apart from the big bad news. Something that I had worried about in a post September 2008.

Cholesterol good, blood sugar good, blood pressure fine, heart looks OK in the EKG but the bones, they definitely could be thicker and stronger.

I didn't actually say "what do you mean, I have osteoporosis ?" but I wanted to say it. After all I run, get good exposure to the sun for the vitamin D production, my diet has lots of calcium, so my bones should be strong. I was wrong, badly wrong. 

The diagnosis is osteoporosis of the spine and osteopeania in the hips. The femoral neck (both the thigh bones) is OK - good news at last.

I thought I had all the bases covered: I exercise with weights and I run; I'm aware of acid-alkali balance in food (too great a swing to acid causes calcium to be extracted from the skeleton to buffer blood Ph); I try and keep Vitamin D high (sufficient exposure to the sun); enough calcium in my food from green vegetables and from the calcium added to rice milk). 

Next step is to start taking 70mg of alendronate once a week [more on alendronate]. The instructions for taking are quite clear that one needs to take this in the morning and be standing up for at least 30 minutes afterwards. The concern is that if the tablet, or bits of a tablet, get lodged in the throat then esophageal ulcers can result. 

Alendronate is the generic version of fosamax and a lot cheaper. I hope just as effective. 

I really like my doctor but there was something a little cold about, "take the prescription, get lots of calcium [ at least 1200 mg a day], lots vitamin D [at least 800 IUa day], weight bearing exercise and come back in a year and we'll see if the bone mineral density is coming back up.

Worst of all, I might just have to take my own medicine - look at this post of mine from the begining of 2009.

GLUCOSAMINE - does it really stop knee pain ?

Andy commented on a post I did a few months back 

http://bodyrestored.blogspot.com/2008/11/running-arthritis-knee-pain-glucosamine.html

Andy is right in saying that glucosamine naturally occurs in our bodies and that taking a glucosamine supplement is just increasing the body availability of glucosamine. The US government is reasonably positive about glucosamine - see this reference.

Of course there is always another point of view: see this post from Dr John Crippen.

I've wondered why some people get great results with glucosamine but it never worked for me. 

One of my clients has arthritis, takes glucosamine, has done for years and finds it works somewhat. She knows, because if she goes through a spell of missing taking the supplement, then she starts to feel the difference. 

Another client told me recently that her husband had had knee pain for years and mentioned the pain frequently. He started taking glucosamine about 4 months ago. After the first couple of months he stopped mentioning knee pain and she can see from the way he walks that the knees have stopped being an issue.

Scientists call this anecdotal evidence - meaning that it doesn't get rated too highly. 

The research I mentioned in the November 2008 post 

http://www3.interscience.wiley.com/journal/121425887/abstract?CRETRY=1&SRETRY=0

was pretty dismissive on glucosamine. So what's happening ? Is it all just the placebo effect ?

My guess is that it comes down to genetics. Some people have the genes to make good use of glucosamine in their food and are able to take this nutrient input and repair damaged cartilage. If you don't have the right gene mix then the good affects just do not happen.

Going back to that research study, it was big, and because of that a whole bunch of people with lots of genetic variants were swept into the study. Just through talking to people who workout with me, my guess is that 20% of people with knee issues benefit from glucosamine but the majority do not. 

My personal bottom line: if you have knee issues then by all means try glucosamine for 3 months. If you are going to get any benefit from glucosamine then you start to feel a difference in about 6 to 8 weeks and then even more improvement for the next 6 to 8 weeks. However if by 3  months no improvement can be felt then it's not going to happen for you. Time to try something else.

Annual Physical - is it worth it ?

2009 the year to get serious about health.
After 65 years you might say "about time."

This is what 'furred up' arteries look like. To much cholesterol and fats in the blood for too long and the arteries start to get damaged. The brownie stuff with red bits in the picture is plaque in or on the artery wall. One day the plaque might break loose and float off to create a blockage. If the blockage is in a small artery in the heart or brain you'll feel and know about it big time.

Luckily for me my arteries seem, thus far, to be OK.

To keep everything looking good I set some health fitness objectives for 2009:

- get an Annual Physical
- run a 10K (6 1/4 miles) on the road in less than an hour
- a couple of strength objectives: 20 push ups with feet up on bench and 8 wide grip pull ups
- find out if I actually have a six-pack.

The results of the physical arrived in the mail this week.

VITAMIN D: After blogging about Vitamin D repeatedly I had mixed feelings with my Vitamin D measurement of 25-Hydroxy at 34.4 ng/mL. The normal range is 32.0 to 100.0. On the other hand it is the end of Winter and I've caught very little sun in the last 5 months (even here in Atlanta, GA).

So maybe it's OK but I'd better do two things. One is to work out exactly how much Vitamin D I get from food. That means reading all the nutrition labels, estimating how much I eat a day and then how much a day. It also means having to rethink not wanting to take a daily Vitamin D supplement. Am I being sensible since all the advice is to take a Vitamin D supplement, at least through the Winter.

Cholesterol and Triglycerides were OK after a little study of what the numbers mean.

Total cholesterol at 179 mg/dl was closer to the upper limit for a good health prognosis of 200 mg/dl than I wanted. However these days total cholesterol is not seen as that important. Far more important is the total for non-HDL cholesterol. I came in at 103 mg/dl on this measure - well inside an upper threshold of 139 mg/dl.

HDL was 69 mg/dl. 40 mg/dl and above is seen as good and above 60 mg/dl is viewed as protective against heart problems. HDL tends to be increased by intense exercise and most of my runs take my heart rate above 165 beats/minute (this is above 90% of heart rate maximum for me). So maybe the running is having a good impact on HDL.

The ratio of Total Cholesterol to HDL [Total Cholesterol/HDL] has started to become an important ratio. For me it calculates as 172/69 = 2.5. For heart health the present view is that you want this ratio to be less than 4.0. Amongst those who have suffered a heart attack, luckily not me, getting this Total Cholesterol/HDL ratio down is important. No one has ever had a second heart attack if they have brought the Total Cholesterol/HDL ratio below 3.0 after the first attack - quite a carrot.

I went through the notes from the presentations at the recent ACSM Health Summit in Atlanta to check everything that Ralph LaForge had to say on cholesterol and triglycerides.

My triglycerides [by the way triglycerides just means three fatty acid molecules linked together by one glycerol molecule] were measured at 93 mg/dl - well within the healthy upper limit of 149 mg/dl.

Our bodies handle triglycerides and cholesterol very differently.

Triglycerides are a form of fat and our bodies burn - oxidize - triglycerides for energy. Fit people burn up triglycerides quickly after a meal but not so in those Metabolic Syndrome or Diabetes for whom triglycerides can stay high for 4 to 7 hours after a meal. While triglycerides are high in the blood particles are being absorbed into the walls of blood vessels and adding to atherosclerotic plaque.

The small cholesterol particles and the intermediate size cholesterol particles are now viewed as the most dangerous. Fit people and unfit people deal with the intermediate size cholesterol particles quite differently. After a meal, the peak in these intermediate size cholesterol particles is about 90 minutes after a meal for fit people but unfit people take a lot longer to start reducing these particles - maybe as long as 4 hours. This longer time in the unfit means a longer time for the particles to cause damage to blood vessels.

At the ACSM meeting, Ralph LaForge also shared that the number of particles is important - not just the total quantity of cholesterol. However at the moment only a limited number of test labs provide cholesterol particle counts such as LipoScience. My tests were carried out by MB LabCorp.

For a long time no one understood why increased fitness, with no reduction in weight, seemed to be protective of health. Why would Diabetes, Heart Health, Metabolic Syndrome all be improved even if body weight is unchanged. It looks as if the answer is in the number of lipoprotein particles in the blood stream. The number of lipoprotein particles is just as important as the actual total quantity of lipoprotein.

Liposcience is using Nuclear Magnetic Resonance to measure the numbers of lipoprotein particles.

All of the cholesterol particles have a protein molecule attached to them. It is these proteins on the surface of the lipoprotein particles which attach to specific receptors in the lining of blood vessels. With increasing understanding of genetics and molecular structure it is now becoming possible to identify genetic differences (maybe defects) which cause different people to react differently. For example, in the case of some forms of hypertriglyceridemia [very high tri-glycerides in the blood], it is specifically the expression of apo CII and apo CIII which is responsible for the problem.

All of this has raised a question for myself - should I add to my Personal Trainer qualifications by taking the exams for Lipid Specialists i.e. helping people with cholesterol and tri-glyceride issue which will lead on to Diabetes, Heart Disease, Metabolic Syndrome. Quite a lot of study would be involved but a definite possibility for 2010.

Alternate Day Fasting

Sounds sad but it's true, just reducing calories (what might be called dieting) and starting to do some exercise is not enough. It has to be a low carb diet teamed with exercise to make a real difference.

The sad reality is that it's very hard to be disciplined all day every day. The old idea that you could 'cheat' on your diet once a week or even for the whole week-end just does not work. For anyone who is considerably overweight and as a result their body is probably very carb sensitive, 'cheating' is a disaster. If this is you then your experience is that even one 'bad' meal can eliminate all the weight loss of a whole week.

It's sad and one wishes the world was different but this is reality. So what to do ?

One option to consider is fasting on three days a week. Usually, fasting is a bad idea as it reduces your body's metabolic rate i.e. you end up burning fewer calories the longer the fast goes on. However if you fast for less than a day, that is from one breakfast time to the next, and on alternate days, your body should not start to protect itself by reducing calorie burn. Lots of varied exercise will keep the calorie burn high.

You can build into three days by partially fasting on one day when you have a small breakfast and then don't eat for the rest of the day. The next day is a 'normal' day which is somewhat calorie restricted i.e. eating carefully.

Then you add on extra fasting days and increase the discipline of fasting days.

To an extent you can make up for the one really 'bad' evening of the week by fasting and exercising the next day.

How much exercise to at least limit the damage ? At least 400 calories of exercise. Best to do this in an exercise sessions of at least 400 calories within 8 hours of the bad meal i.e. get up the next morning early and walk and walk.

Linking alternate day fasting and exercise to a low carb approach is the best way to go. Low carb will inevitably reduce the glycogen in your muscles so hard running or cycling will be difficult but walking or using an elliptical will be OK. On the 'eating' days workout with weights and resistance. The reason for this is to make sure you take in sufficient protein immediately after working out.

Is there any science behind this ? Yes, read this tough paper.

Cardiac Patients Doing Weight Training

Fifteen years ago the idea of anyone doing weight or resistance training a month after a heart attack was seen as very dangerous.

I'm still absorbing what I learned at last week's ACSM Health & Fitness Summit in Atlanta, GA. Heart health had a great deal of attention. The presentation by Paul Sorace, James Churilla and Peter Ronai was a great example of too the point education.

One exciting idea from them was to take the existing guidelines on exercise and then get through the typical 10 to 12 exercises for all the major muscle groups in about 15 to 20 minutes. In other words combine machine resistance and free weights exercise into one flowing circuit training workout.

Take each set reasonably steadily, don't rush it and allow about 30 to 60 seconds between each exercise.You should be able to get through 10 to 12 exercises with around 12 to 15 repetitions in each set in 20 minutes - maybe less.

Now that a weight and resistance is so compacted down timewise, you can think about adding strength training after a typical heart recovery, cardio workout. By reducing the recovery time between sets you will keep the heart rate up but not too high. So this workout should, if you are sensible, be safe.

When can you (or really should) start weights and resistance training ?

• You've had cardiac surgery (maybe a heart attack as well); then you've been doing your cardiac rehabilitation program exactly as specified for 4 weeks, then it's time to get into a resistance training activity as well
• You've had a transcatheter procedure; then you've been steadily doing cardiac rehab for at least 2 weeks; time to start some resistance training.

Of course you've got to be sensible! There are a whole bunch of conditions when you'd not want to start resistance training quite so soon:

• Congestive Heart Failure
• Valvular Disease
• Hypertension not under control with your top blood pressure number (Systolic) above 160; or your lower number (diastolic) above 100.
• Uncontrolled dysrhythmias
• Marfans.

But these items excluded it still leaves a lot of people able to get into building up their strength amazingly quickly after severe heart procedures.


That just leaves a couple of questions ?

1. Why build up your strength ? Is it worth the effort ?
2. Exactly how to go about it.

Why Build up your strength ?

• It decreases depression and that on it's own is probably a good enough reason.
• It increases your chances of staying independent
• You are able to do all the ordinary things of life so much more easily. All the way from just getting up out of a chair to picking up grandchildren
  
• If you've had a heart attack or a by-pass or a defibrilator implanted then the chances are that you have some other health issues as well - maybe diabetes, arthritis, osteoporosis - getting stronger muscles and bones will help all of these issues.

Then there is the question of how to go about increasing your strength safely.

• Chances are your medical insurance will stop paying for cardiac rehabilitation at some point. It's best to find a Personal Trainer who understands all of these issues.
• The American College of Sports Medicine will help you find someone knowledgeable.
  
• The American Council on Exercise helps you find a Personal Trainer.
• Put in Post Code 30022 ( north of Atlanta, GA) and I should come up, with several others, in the search results.
• Look at these videos which give you an idea of an easy start to exercise and progressing to very hard (after a suitable period of build up).
  

ACSM Health & Fitness Summit 2009

The American College of Sports Medicine brought their annual Health & Fitness Summit to Atlanta and I felt that I had to attend. About 1200 others thought the same way and an informative time was had.

I did feel sorry for the people coming from the northern states - this was an opportunity to enjoy some sun and warmth. Would you believe it but Atlanta was under a perpetual deluge for the entire conference.


The first session for me was 1pm Wednesday "Follow the evidence" with Chuck Thigpen talking about preventing & rehabing shoulder injuries and ended Saturday lunch time with Len Kravitz giving a wonderful presentation.


There were many highlights but the presenter that stuck in my mind was Ralph LaForge talking about Managing the Metabolic Syndrome and the related topic of Managing Dyslipidemia.


What did I learn from Ralph LaForge and how much of that is relevant to my clients ?

• The first objective of managing metabolic syndrome is to delay and maybe prevent diabetes. If a client moves on from pre-diabetic to diabetic then all the health issues and health costs escalate severely. Then after diabetes, heart issues will eventually arrive. If diabetes can be delayed then the heart issues will also be delayed - possibly prevented altogether.
• When looking at Lab Test results, total cholesterol is nowadays seen as not so important. Total Non-HDLC cholesterol is a very important number. However the ratio of Total Cholesterol to HDLC is important. One wants this ratio below 4. Ralph said that if a person has had a heart attack and then gets the ratio of Total Cholesterol to HDLC below 3 then there has not been a single incidence ever of a second heart attack.
• Tri-glycerides are also very important. Exercise makes the body oxidized i.e. use, tri-glycerides and thus their concentraion in the blood reduces. This is not true for cholesterol. High tri-glycerides are a concern because if they are really high, above 1,000, then pancreatitis can result.
• Exercise can reduce the bad affects of a heavy meal. If one gets about 400 calories of exercise [for instance by walking about 4 miles] within 8 to 12 hours of the meal then the tri-glyceride peak from the meal is reduced by about half.
• Exercise is the way to deal with the Metabolic Syndrome. Get at least 1,500 calories of exercise a week. This means walking 15 miles a week - 2 or 3 miles a week or do it all at the week-end with a couple of long walks. It's the total calorie burn that has a healthy impact.
• Use a pedometer - Ralph recommends a simple yet robust design such as Accusplit Eage 120 XLM. Walking 2,000 steps will burn 1,000 calories. Ralph recommends buying in bulk because in his experience clients are going to lose 2 or 3 pedometers a year.
• Exercise reduces the risk even if there is no weight loss. Exercise reduces the number of cholesterol particles in the blood, and even if the total cholesterol number does not come down, reducing the number of particles in the blood guards against the development od diabetes.
• Ralph said that a soda with sugar (around 100 grams) and caffeine, spikes blood triglycerides faster than anything - faster than anything containing fat. This is not at all intuitive. As a result Ralph asks his clients (patients) how many 'encounters' they have had with fast food. He said that a typical American has 25 to 35 'encounters' with fast food a week (including sodas).

There were many other great sessions which I'll have to pick up on in future posts:

• Ellen Coleman talking about Muscle Building Supplements (very sceptically) was lovely
• Annette Lang presenting on training the pregnant client was a total delight and very informative.
  
• Nanette Wenger, Chief of Cardiology at Grady Hospital, Atlanta (plus working at Emory) made an important presentation about womens' heart health
  
• Then there were the three Clinical Exercise Specialists (Paul Sorace, James Churilla, Peter Ronai) who presented on the benefits of resistance training for heart disease and diabetes.

Chances of getting Type 2 Diabetes

What's the chance of developing Type 2 Diabetes ?

You'd think this lady was low risk but it turns out she's high risk.

So I tried the Diabetes risk calculator at The American Diabetes Association and they said I was at risk. After looking closely at the way they calculate the risk it became obvious that everyone over 56 is scored as at risk.

Maybe the British need their own Diabetes risk calculator and they have it. Try the British version of the risk calculator. It turns out that ethnicity is a huge part of the risk. The British calculator also takes into account where you live. I lived at the northern edge of London for a long time so I entered N14 6BE into the box for postcode (similar to Zip code in the USA - but with smaller areas).

The British Medical Journal (BMJ) published this long article on how the risk calculator was calibrated.

Of course, if you are Australian you'd want to use the Australian test. This has a number of interesting questions that the other do calculators don't have - like waist size and eating fruit and vegetables.

Brains get bigger and better with Aerobic Exercise

Can you believe that walking, swimming, cycling, running can make your brain bigger and better ?

It seems so. Look at these images.


The images come from research on people in their 60s and 70s who went through 6 months of aerobic training. The blue areas in the image show areas of grey brain matter that became bigger after aerobic exercise. The yellow areas in the images show white brain matter areas that became larger.

As usual with a clinical trial there was a control group who did light exercise and stretching. They all had their brains MRI scanned before and after the 6 month trial. Result: white and gray matter within the brains of the aerobic exercisers but no change to the brains of the light exercisers.

The researchers also investigated people in the age range 18 to 30 to find out if aerobic exercise increased the size of their brains. The answer: no; aerobic exercise had no impact on brain size in this group.

The research report starts off with a scaring thought "Beginning in the third decade of life, the human brain shows structural decline, which is disproportionately large in the frontal, parietal, and temporal lobes of the brain. This decline is contemporaneously associated with deterioration in a broad array of cognitive processes."

An interview with one of the authors of the study - Art Kramer.

ACSM's Health & Fitness Journal has an article "Exercising the Brain" by Janet Fletcher Brady. She Has a few thoughts on types of exercises that improve brain health:

• Movements across the mid-line of the body. The swing action of arms across the body while running or walking fast might fall into this category.
• Reaction movements. These are rapid movements in reaction to a signal - say a light flashing.

AARP Magazine has a piece on "How breaking a sweat and doing yoga can make you smarter."

It includes this interesting idea of how to modify a Yoga exercise to make it more brain productive. While yoga has long been shown to affect mood, one yoga move in particular is getting attention for boosting brainpower. Superbrain Yoga, as the exercise is called, is being practiced across the country as an antidote to brain drain. Go ahead. Try it!

This simple move, shown at right, boosts brain function by stimulating acupressure points on the earlobes, according to Yale-trained neurobiologist Eugenius Ang, Ph.D.

Step 1 Place your left hand on your right earlobe, thumb on the front of the lobe with fingernail facing outward and second finger behind the earlobe. Then, with your right hand, grasp your left earlobe, again keeping your thumb on the front of the lobe, facing outward. Press both earlobes simultaneously, making sure your left arm is close to your chest and inside your right (which devotees say helps energy travel upward to the brain).

Step 2 As you press on the earlobes, squat down, keeping your back straight. Do 10 to 12 deep bends, inhaling through the nose on the way down and exhaling through the mouth coming up. You may place a chair underneath you as a safety precaution.

Step 3 Repeat daily. “It’s like putting more gas in your brain’s tank,” says Ang. To learn more, read Superbrain Yoga by Master Choa Kok Sui. —Janet Kinosian.

If you want to catch up with the research then start reading these interviews with leading neuroscience and cognitive scientists.

One last thought. What exactly is aerobic exercise? Is it 50% maximum heart rate or 60% maximum heart rate or something else ? Even if you happen to know your maximum heart rate, trying to guess if you are at 50% or 60% or some other % is too difficult. The safe and easy answer - after 10 minutes are you sweating just a little. If so, it's aerobic exercise.

Exercise for a better brain.

How to Look Muscular, Look Lean, Look Fit. It's called HYPERTROPHY

Summers coming, your healthy, you want to look lean, you want to look good and that means you need a workout plan for HYPERTROPHY.

This video shows you what to do.

This is your plan.

Why follow this plan?

• This is a 2 month plan and there are 2 months until school is out for the Summer and we are into swim suit season
• Workout 4 times every 6 days: Legs; Chest & Back; Arms and Shoulders; Whole Body. Hit the abs at every workout. Abs are key to looking great.
• Easy to remember workout. No need to take a book to the gym.
• Each workout has just 3 exercises. You do 10 sets of each exercise and try to get 10 reps on every set. Of course you usually will fall short and not make it to 10 reps on the later sets. That's OK. That's the way it is supposed to be.
• 3 different exercise and 10 sets of each means 30 sets in a workout - easy. No. You will sweat and probably curse a little because you are going to have to concentrate and tough out the last few sets.
• Do the 30 sets in 30 minutes. That's right 1 set every minute. So no time to socialize. Just concentrate on the end result.
• The weights used are not really heavy. Use a weight you can do 20 reps with but only do 10 reps each set. Remember there are 10 sets for every exercise!
• You are unlikely to get injured because weights used are not enormous.
• Nothing tricky with the weights. No increasing or decreasing weights at each set. Pick a weight for that exercise for that day and stick to it and let the sweat roll off you.
• The idea is to work alternate muscles, for example front of thighs (quads) and the back of thighs (hamstrings) or front of arms (biceps) and then back of arms (triceps). Each muscle has about 2 1/2 minutes to recover from one set before the muscle is working again. But you do 10 sets in total on each muscle so that each muscle gets sufficient stimulus to grow and grow big.
  

What do you need to know to get started ?

1. Can you do a pull-up ? If the answer is no then you need a different program. Concentrate on getting stronger before trying out this program.
2. Can you do reverse curls on an incline bench. Look at the video to see what I mean by a reverse curl. If the answer is no then once again this is not the workout program for you.
3. For the 12 exercises used in the program what weight or resistance allows you to just get to 20 reps.
4. Another way to go at this is to find out what is the maximum weight or resistance you can move then take 60% of that weight.
5. Record all the weights on last 2 pages of workout plan.

What then ?

• For each exercise, perfection is getting all sets done and achieving 10 reps on every set. Most days you do not get to perfection but you try to get close to perfection.
• You really want to get out to set 6 or 7 and are still able to hit 10 reps a set. If you do not then the weight is too heavy. Next time ease back a few pounds. Do not change the weight during a workout.
• What if you are perfect on the day and all 10 sets for an exercise result in 10 reps? Time to move the weight up just a few pounds - not too much.
• Each workout you have just a few things to remember going to the gym: the 3 exercises for the day; weight for each.
• After each workout what do you need to write into your training record? Write in which sets you got to 10 reps. Write in the reps for the sets you did not get to 10 on. Write what you think the weight should be next time (less or more).
• Remember your start and finish time. This is to give you an incentive to really hustle and get through 30 sets in 30 minutes.

What else ?

• Eating is key to getting ripped and muscular - NOT and I repeat NOT by starving yourself.
• Ideally eat a mixture of protein, carbs and some fat 60 minutes before working out. A small cheese and tomato sandwich is just about ideal and very easy to prepare.
• If you are working out just after waking up then a glass of skim milk with a teaspoon of whey protein powder plus a couple of dried figs will get some protein into your body fast.
• Take a post-workout drink to the gym with you. A glass of non-fat milk with a teaspoon of whey protein powder is fast to prepare and easy to transport. Drink it down the moment you finish working out. Before you shower!
• One to two hours later have a 'proper' meal - making sure it's high in protein.Tuna with green vegetables is a good combination. Easy to prepare and to take with you.
• Think about supplementing with creatine monohydrate every day (about 5 grams a day). Your decision on creatine.

Anything Else ?

• Stretch
• Future Options.

Exercise makes your brain grow

Senior moments are one of those standing jokes - but serious nevertheless. The good news from research by Kirk Erickson and Arthur Kramer (both medical doctors) is that exercise can help the brain grow (even in those of us who are getting "on" in years).


What happens to the inside of the brain as things start to wear ?

The take away points from this research:

• It's never too late to start exercising. Aerobic exercise will reverse mental decline. In many cases even if one is into the early stages of Alzheimer's, hard(ish) aerobic exercise will reverse decline (at least for a few years and maybe longer).
• Aerobic exercise (if it's hard enough) can increase the volume of white and grey matter in the brain.
• This good news extends to the 'Executive control functions' of the brain such as working memory, ease of change from one task to another, task co-ordination, planning, knowing and working towards goals.
• Muscle toning and stretching type of exercises, as useful as these might be, do not improve brain function.
• Higher fitness levels going into old age is correlated with less mental decline later. So workout hard while still middle age part of life.
• Hormone replacement for women is not well thought of currently but it is associated with better brain function. However exercise improvements to brain function are achieved even if a women is on hormone therapy.

So what is the exercise recipe to protect and improve brain function ?

• 6 days a week
• 30 minutes a day
• if you miss a day then make up the time with 60 minutes of exercise
• aerobic exercise has to be hard enough to make you breathless (if you are new to exercise then have your doctor check if your heart can take this)
• walking is a good aerobic exercise but stride it out - uphill is good
  
• 6 months on this exercise program should be enough to make your brain bigger and more productive.

What if you are trying to lose weight, so you are reducing the calories while increasing the exercise. The aerobic exercise can expand your brain but be careful about exactly which diet you go onto.

Holly Taylor, a professor at Tufts, has discovered that very low carb diets, like Atkins, reduce cognitive brain functions. She published her work in Appetite and said "The popular low-carb, no carb diets have the strongest potential for negative impact on thinking and cognition. The brain needs glucose for energy and diets low in carbohydrates can be detrimental to learning, memory and thinking." The longer one is on a low or no-carb diet the more brain function goes down but starts to reverse as soon as carbs are re-introduced to one's diet.




This clip from CBS morning show is worth listening to.

Old Dog Running

Last week had St David's Day - lots of Welsh emotion. Yesterday I put the Welsh National Anthem onto my blog. Listen to the singing.

France beat Wales at Rugby. I'll get over that in the end because it's still a good season because Wales beat England and there is still a chance of ending the season as champions.

Running went well. I ran 6 miles and that's the farthest I've run in a long time. The 6 miles took 60 minutes but I was very pleased with doing the distance. Then later in the week I ran intervals at 9.0mph. Only 220 yards each interval but I did 4 to get me to 880 yards. So I'm pleased. After getting my knees lubricated the over-riding priority was to not let me knees get that bad again.

In July 2008 I started running again with 1/4 mile run. To start with, each week I added on just a 1/4 mile a week to the longest run for the week. It took patience.

At the start of 2009 I set myself some running targets.
The big one is to run a 10K race on the road in under 60 minutes.

Supporting objectives to get to a sub-one hour 10K:

• 6 miles in under 57 minutes
• 3.1 miles (5K) in 26 minutes
• 1 mile under 7 minutes

10 K this year, maybe half-marathon next year and who knows a marathon the year after.

This year, and last, the running plan is mine. However for longer distances I like the approach of Furman University to try to achieve more with less training. They emphasize the dangers of over-training.

I like their plan to run a marathon with just 3 days a week of running training.

Look at Furman's complete running plans.

Welsh National Anthem

Today, March 1st is St David's Day -
the day that the Welsh celebrate as their very own.

Here in the Atlanta area we have our own Welsh Society
and today we had an excellent lunch at Seasons 52.

Enjoy the music - tomorrow I'll be blogging about running.

AGING and AGING WELL

Are you, optimistic about your aging, or pessimistic?

This is one of the questions in Dr Thomas Perls life expectancy calculator.

I wavered between clicking: "I feel I am aging well" or more modestly clicking "; "I am dreading my older years"; or maybe "Something in between the above two options". In the end I went for "Aging well". Who really knows if that is true, only time will tell.

Perhaps it was thinking about aging that I noticed this story about Jean Hirst, 72, who had her purse snatched by a 16 year old girl who ran off with the purse. Jean gave chase, caught up and got her bag back - amazing.

Then there was the story of Janet Lane, 68, who also had her purse snatched - this time by a 15 year old boy. Janet took a 100 yards to chase him down to get her bag back. The teenage boy was breathless unable to run any further.

Both of these stories are from England. Are women in their 60's and 70's retaining youthful fitness ?

In the last few days the British Medical Journal has published research on simple behavior changes which radically reduce the risk of stroke. The recipe is simple:

• Plenty of fruit and vegetables (at least 5 servings a day)
• Some physical activity - it does not need to be much
• Not too much alcohol - less than 14 drinks a week
• No smoking.

US News added in their thoughts on aging well. The ideas I liked:

• Don't retire. I was retired (from software development) for about 6 months and then started up again as a Personal Trainer. A decision that has turned out very well.
• Stay connected to people - loneliness is a killer
• Floss twice a day - of course this will improve the health of gum's and teeth but more importantly, flossing will improve your overall health.
  

Intriguingly, next month Psychological Science is publishing a study showing that attitudes to aging when young affect how one ages. "At the start of the study, 440 participants, aged 18 to 49, had their age stereotypes toward the elderly measured. Thirty years later, 25 percent of those with more negative age stereotypes had suffered a heart problem or stroke, while only 13 percent of those with more positive age stereotypes experienced a heart problem or stroke.

"We found that the age stereotypes, which tend to be acquired in childhood and young adulthood, and carried over into old age, seem to have far-reaching effects," said Becca R. Levy, associate professor of epidemiology and psychology and the study's lead author. The study appears in the March issue of the journal Psychological Science. "

I tried Thomas Perls' Life Expectancy Calculator and it gave me an estimate of 93 years.
I'm going to have to cogitate on whether this is good or bad.

What's my score?

• ACTIVE - yes, very (still running)
  
• Fruit and Veg - Yes, lots of
• SMOKING - No. never
• ALCOHOL - some but never above 14 drinks a week
• RETIRED - NO, never (probably)
• FLOSS - Yes, twice a day.
  

Checking Medication Information

How accurate is Wikipedia when it comes to information about prescription medication? Is it more reliable than the websites of the drug companies?

The Annals of Pharmacotherapy thinks that Wikipedia is just not good enough - not a full set of information for safe use by consumers. They compared Wikipedia against the traditional source of prescription drug information Mescape Drug Reference.

I did my own check using Omeprazole as my drug of interest:

• Medscape was good
• Wikipedia is pretty good - more international in its reporting
• rxwiki was very good
• Mayo Clinic was of course good
• Medco was informative and believable
• The Drug Information Portal run by the US National Library of Medicine seems the most comprehensive because it pulls in all the 'official' sources on drug information.

10 things I did not know about RxWiki
- this looks like a site to use in the future.







My personal 1 2 3:

1. RxWiki
2. Medco was good and easy to follow
3. Drug Information Portal has enough information to sear the retina.

Runners Stretches

Don't stretch before running.
Do not stretch when tired.
Don't even think about stretching when you are cold.

If you follow all the advice on stretching, you'll never stretch. I definitely recommend stretching every day, maybe even twice a day. Personally I rarely stretch before running, only when I feel really stiff and warming up is not helping to get loose. I never stretch after running simply because I usually feel done for - really tired.

Why do I stretch?

• It feels good. I enjoy stretching and as long as stretching does no harm I'm going to keep on stretching.
• Stretching keeps me running freely. I see other runners of my age and their stride length seems to get shorter each year and I'm hoping that stretching will avoid the "Old runners shuffle" for as many years as possible.
• Stretching helps avoid injuries. Some research says that stretching before running does not help avoid injuries but I question the research because they did less than 5 minutes of stretching each time.

If you search you'll find lots of stretching videos.
Here is a simple straight forward stretching video I like.

I'm qualified as a Personal Trainer with both ACE and ACSM so I'll share each organizations thoughts on stretching:

• Top 10 reasons to stretch from ACE
  
• Basic stretching from ACSM - the picture are small and need a close stare to understand but it has nothing dangerous.

I've previously posted about PNF Stretching which I offer to clients. Most clients love this form of stretching.

What I've learned so far this year

Time to file the accumulation of news letters and ask that question: Did I learn anything ? It's a question I've asked of myself previously.

1. Vitamin D, I keep blog'n about it, but it was excellent news that Monterey Mushrooms now expose mushrooms (white, brown and portabella) to Ultra-violet light to increase Vitamin D content. So you can get 100% of the present, and very low, daily government recommendation for Vitamin D from one 3 ounce serving of these super Monterey Mushrooms.
All this from Tufts University Health & Nutrition Newsletter.
The only small question is that the little monsters make the D2 form of Vitamin D - D3 is much better - but D2 is OK.

2. The Berkeley Wellness Letter has given up on supplementing with Vitamin E - "Bottom line, get your Vitamin E from food, not supplements because supplements have not proved beneficial and may be risky. Get Vitamin E from: nuts; seeds; vegetable oils; whole grains; leafy green vegetables; tomato sauce; red peppers - more details.

3. The National Cancer Institute stopped the SELECT Trial Selenium and Vitamin E Cancer Prevention Trial because those taking Vitamin E had slightly higher rates of Prostate cancer while selenium takers had a somewhat higher risk of diabetes. Nutrition Action Newsletter reported on this but did not recommend against continued use of vitamin E supplementation. Their exact words "If you take a multi-vitamin, stick with one that contains roughly the daily recommended targets for vitamin E (30 IU) and selenium (55 mcg)."

4. The same issue of Nutrition Action Newsletter had a new take, new to me at least, of the belly brain connection. They reported on Kaiser Permanente research had looked at a new way to measure the size of a big belly - measure the front to back distance - look at picture. They wryly call this new dimension the Sagittal Abdominal Diameter (which gets us to SAD).

Anyone with a SAD dimension above 10 inches has a doubled to tripled chance of dementia in later years.

5. Johns Hopkins Medical Letter had a piece about issues with long term use of Proton Pump Inhibitors to treat chronic ulcers or to alleviate GERD (gastro-esophageal reflux disease). I've blog'd about my personal concerns about taking Prilosec every morning because it interferes with calcium absorption which in turn leads to reduced bone density and long term to osteoporosis. The Johns Hopkins words "I'm concerned about the long-term use of Proton Pump Inhibitors, particularly for patients who have or at increased risk for osteoporosis and people with conditions such as liver disease that interfere with their ability to utilize Vitamin D and calcium."

6. Have you wondered how the Lo-salt products manage to have less salt, and hence less sodium, that normal salt ? The answer is by increasing the amount of potassium which then reduces the sodium content. If you have diabetes reducing your salt intake is a good idea.

Then the other shoe drops and sometime later a routine blood tests shows up high blood potassium - this is not good either. The Mayo Clinic Health Letter says "Even without symptoms, moderate to severely elevated potassium can be life-threatening."

So if exercise helps with overcoming cance what exercise exactly should you try ?

My previous blog pointed at piles of research showing that exercise helps both while receiving cancer treatments like surgery, chemo and/or radiation, and after cancer treatment, so what exactly should one try or not try ?

The previous post referenced Anna Schwartz's book Cancer Fitness. It so happens that she also wrote the cancer chapter in one of my favorite text books: ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities. The whole story in the title.

It is possible to get too addicted to exercise! As Anna points out, if one has uncontrolled vomiting or diarrhea then postpone exercise. I'd agree with that.

This afternoon my wife, a breast cancer survivor, and I did our aerobic workouts on treadmills next to each other. She did interval training with the upper limit on heart rate set to 133 beats per minute and the lower limit set to 115 beats per minute. These clever treadmills allow you to set exactly how hard you want your heart to work and then when you get up that upper limit the treadmill automatically slows down so that you heart rate can come down to the lower limit - in my wife's case this afternoon - 115. When you get back to this lower limit the treadmill immediately speeds up and inclines up to take the heart rate back up.

The basic exercise plan, which needs to be varied for each person and varied by day depending upon how you are feeling, includes:

• aerobic exercise (which helps heart and lungs plus helps keep down weight gain)
• strength training to hold onto as much muscle as possible
• stretching and flexibility to try and deal with reduced range of motion in some joints which can be very uncomfortable
• Balance to keep you away from falling and hurting yourself.

Aerobic exercise such as walking, water aerobics, cycling (probably best on a stationery cycle) or rowing (again probably best on land rather than actually on the water) 3 days a week (alternate days makes sense). 10 minutes is good as a start and building upon by adding maybe 2 minutes to the length each week up to around 30 to 40 minutes. It does not all need to be in one go on aerobic exercise day. In fact there is a lot in favor of splitting the exercise up into 2 or 3 chunks.

Strength exercise on 2 or 3 days a week. This could be just using your own body weight with, for instance, push ups against a wall or with elastic bands or with weights or if you go to a gym, with gym machines. You can do really excellent strength training at home.


Stretching to try to get rid of stiffness and to improve the range of motion around tight joints is a most days of the week activity.

Then there is balance. Balance exercises are important. It's amazing just how fast balance improves with regular practice but a lot of care is needed that you try balance exercises where it's safe, you can grab hold and the floor is soft and definitely no sharp edges close by.

Watch this short video of my wife balancing or, if you want to smile, look at me trying to balance.

When should you not exercise? OK, so we are past vomiting and diarrhea, what else to be careful about ? Blood counts give a lot of exercise related information.

• If hemoglobin level is less than 8.0 g/dl-1 then avoid high intensity exercises because your body's oxygen transport capability is going to be way down.
• Neutrophil count (absolute) is less than 0.5 x 10 to the 9/l then avoid activities that might increase the risk of bacterial infection e.g. swimming.
• Blood Platelet count less than 50 x 10 to the 9 /l then avoid activities which increase the risk of bleeding. This would include high impact activities like plyometrics, sprinting and football.
• Bone pain indicates that you should avoid activities which might cause fracture at the place of bone pain. For instance, bone pain in the wrist might indicate avoiding push ups.
• Severe lymphedema then avoid upper body exercises with the affected arm.

The early research on cancer and exercise all had the objective of "do no harm" and you can't argue with that. Thus far more than 40 controlled clinical trials have been performed looking at exercise in both cancer patients and cancer survivors. In general exercise helps but common sense is essential as is shown in this controlled study of physical activity in cancer survivors.

Look at this recommendation from the ACSM entitled "Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association."

Then there is the question of improving one's fitness prior to surgery. Read this!

If there is one last thing to say, it's that even a little exercise will make you feel better about yourself. Dorelle Laffal, diagnosed with breast cancer at 37, shows that a little exercise can take you a very long way.

Cancer Survivors - does exercise help ?

Reading Melinda Irwin's paper "Physical Activity Intervention for Cancer Survivors" is like staring at the dangerous end of a gun barrel. What comes out is not going to be pleasant - maybe downright nasty. Best listen to the message.



The message is simple "Obesity and a sedentary lifestyle are highly prevalent in cancer survivors, and a growing number of publications have shown statistically and clinically significant associations between low levels of physical activity, obesity and cancer recurrence and death. Adoption and maintenance of physical activity is a difficult challenge for healthy adults, and is likely to be even more difficult after a cancer diagnosis."


The Journal of the American Medical association (JAMA) carried the article Physical Activity and Survival after Breast Cancer Diagnosis. My wife has survived breast cancer and it is the kind of article that grabs my eye!

Their summary: "Physical activity also has been linked to a lower risk of breast cancer. An expert panel of the International Agency for Research on Cancer of the World Health Organization estimated a 20% to 40% decrease in the risk of developing breast cancer among the most physically active women, regardless of menopausal status, type, or intensity of activity. Physical activity has been linked to lower levels of circulating ovarian hormones, which may explain the relationship between physical activity and breast cancer. Lower estrogen levels among physically active women with breast cancer could potentially improve survival, although few data exist to support this hypothesis.<sup>"


The CA - a Cancer Journal for Clinicians - published Nutrition and Physical Activity During and After Cancer Treatment, 32 pages of what you have to do.

Their view is "Physical activity may have benefits throughout the spectrum of the cancer experience, but cancer survivors are often more likely to become sedentary for several reasons. Survivors tend to decrease their physical activity levels after their diagnosis of cancer, and most continue lower levels of activity through treatment and beyond, rarely returning to their pre-diagnosis levels of activity."</sup>


Anna Schwartz is in do doubt about exercise and cancer: "Exercise should be a regular part of a comprehensive care plan for all cancer patients, regardless of age and physical ability. Anyone can exercise, if the exercise is tailored to the ability of each person and progresses slowly, in a step-by-step fashion. Cancer patients can, and should be encouraged to exercise the day they are diagnosed. The advice to get more rest is a myth, and not the best advice for cancer patients."