Monday, December 31, 2007

OnFitness Magazine


OnFitness is a magazine that I sometimes see lying around in the gym - usually old, well thumbed copies. Earlier this year I decided to stop being a cargo cultist i.e. hoping that good things would just magically land right in front of me and instead buy my own copy of OnFitness.

It turns out that the magazine is trying to survive by gaining readers through word of mouth rather than advertising. I've never seen it on a magazine rack at a bookstore. This is the tough way to build magazine circulation.

The magazine approach is "The natural approach to health & fitness."

I can't agree with everything in the magazine but it's always interesting, sometimes provocative and once in a while just plain aggravating. For instance the January/February 2008 edition arrived today in my mailbox and included an article about bra's causing breast cancer. My wife who has survived breast cancer said that she was not going to stop wearing a bra and added in the thought "What about corsets? Did they cause intestinal cancers ?"

This Jan/Feb 2008 issue has multiple articles around the theme of exercise intensity. All worth reading and absorbing.

If you happen to stumble upon a copy of the Jan/Feb 2008 magazine, start off by turning to page 68 to find the article " Weight Training for Seniors." I know that this is one of my favorite topics - us old people need to hang on to muscle for as long as possible - weight training is the best way to do this.

I'm not in any way paid or encouraged by OnFitness to write about them but they are a magazine I presently read avidly.

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Sunday, December 30, 2007

Drinking alcohol may keep leg arteries healthy

I blog'd earlier today about telling the difference between lower back pain due to spinal stenosis as contrasted with the similar pain due to poor blood circulation in the legs.

By strange chance the January 2008 edition of American Journal of Epidemiology has an article about

Alcohol Consumption and Lower Extremity Arterial Disease among Older Adults


The article is not against moderate alcohol consumption as you might be tempted to expect. Rather 1 or 2 drinks a day seem to help.

In a study, researchers found that elderly men and women who reported drinking from one to 13 servings of beer, wine, or liquor a week had a 44 percent lower risk of being hospitalized for leg artery disease, compared with elderly men and women who reported no alcohol consumption.

"These results are consistent with the long-standing observation that moderate drinkers have a lower risk of heart attack, which is also caused by blockages in arteries," Dr. Kenneth J. Mukamal, of Beth Israel Deaconess Medical Center, in Brookline, Massachusetts, told Reuters Health.




Nexium and Osteoporosis

I take a Nexium capsule every morning so I'm interested in news about Nexium.

This month's issue of the Mayo Clinic Health Letter has a piece about the increased risk of osteoporosis from taking drugs like Nexium to stop acid reflux. The Mayo Clinic Health Letter come to be through the mail and I don't know whether there is an electronic version available - hence to way to let you click through to read the piece for yourself.

The issue is that to stop acid reflux you either take one of the proton pump inhibitors (like Nexium, Aciphex, Prevacid, Prilosec, Protonix, Zegerid) or take one of the H-2 receptor blockers (like Pepcid, Zantac) but they reduce proper absorbtion of calcium from food. As a result bones become weaker and down the line there is the possibility of a fractured hip.

Not taking Nexium or one of the others is not a good option because you get acid reflux back and left untreated you could eventually be dealing with a cancer in the throat.

The Mayo Clinic answer is to:
  • keep taking the pill for acid reflux
  • take your calcium supplement in the form of calcium citrate
  • take the calcium supplement multiple times spread through the day
  • increase calcium from food e.g. dairy if dairy is part of your diet, dark green veggies
  • make sure you are getting enough Vitamin D (for most people that means supplementing with Vitamin D in Winter and even in Summer if you always go out with sunblock already applied.)

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Nexium and Osteoporosis

I take a Nexium capsule every morning so I'm interested in news about Nexium.

This month's issue of the Mayo Clinic Health Letter has a piece about the increased risk of osteoporosis from taking drugs like Nexium to stop acid reflux. The Mayo Clinic Health Letter comes to me through the mail and I don't know whether there is an electronic version available - hence no way to let you click through to read the piece for yourself.

The issue is that to stop acid reflux you either take one of the proton pump inhibitors (like Nexium, Aciphex, Prevacid, Prilosec, Protonix, Zegerid) or take one of the H-2 receptor blockers (like Pepcid, Zantac) but they reduce proper absorption of calcium from food. As a result bones become weaker and down the line there is the possibility of a fractured hip.

Not taking Nexium, or one of the others, is not a good option because you get acid reflux back and untreated you could eventually be dealing with a cancer in the throat.

The Mayo Clinic answer is to:
  • keep taking the pill for acid reflux
  • take your calcium supplement in the form of calcium citrate
  • take the calcium supplement multiple times spread through the day
  • increase calcium from food e.g. dairy if dairy is part of your diet, dark green veggies
  • make sure you are getting enough Vitamin D (for most people that means supplementing with Vitamin D in Winter and even in Summer if you always go out with sunblock already applied.)
Nothing these days is simple - even taking something as low tech as calcium.
If you might have kidney stones, parathyroid disease even taking specific antibiotics, then you'll need detailed medical advice.

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Mayo Clinic Health Letter December 2007

New Letters flooded in after Christmas as if they had been stuck behind the deluge of Christmas cards and were now free to land in mailboxes everywhere. This month's Mayo Clinic Health Letter has its usual interesting selection of items.

One of its items covers lower back pain due to spinal stenosis and how to distinguish such a pain from pain due to poor blood flow in the legs. Some of the questions are worth remembering if you ever find yourself with lower back pain.

Does:
  • leaning forward at the waist relieve pain
  • pain start high and then radiate downwards
  • sleeping on your back cause pain
and you can ride a bicycle with no pain:

then the pain might be due to spinal stenosis.

Now to look at the alternative possibility of pain due to poor blood flow to the legs

Does:
  • stopping walking and standing still reduce the pain
  • does the pain while walking start in the calf and then radiate upwards
  • sleeping does not cause pain
  • riding a bicycle cause pain
then the pain might be due to poor blood flow to the legs.

If the answers take you in the direction of Spinal Stenosis then there are lots of options open to you to reduce the pain and to get your life back. Exercise is going to be important as is losing weight - big surprise with that ! Learn to swim the backstroke - it could help a lot. You'll need prescriptions for the kind of pain killers that quiet irritated nerves.

Poor blood flow to the legs might sound like the better option but it is not. In a similar way to blood vessels around the heart furring up and slowing (or even stopping) blood flow, the major blood vessels to the legs can also become partially blocked. The pain you feel in the legs as a result of poor blood flow is called claudication. It means that the leg muscles are not getting enough oxygen and as a result are letting you feel pain.

There is the temptation to walk, cycle, swim less just to reduce the pain. The trouble is that every time you reduce your exercise load the poor blood flow issue becomes worse. One day the blockage in your legs could come free and block a heart blood vessel or even something in your brain.

Do not let poor blood flow to the legs be one of the things your going to do something about one day. Get on it today.

One last thought: lower back pain could be due to a multitude of causes. At this time of year shovelling snow or raking leaves are obvious possibiulities. The advice above on telling spinal stenosis from poor blood flow to the legs are just a couple of the possibilities.

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Mayo Clinic Health Letter December 2007

New Letters flooded in after Christmas as if they had been stuck behind the deluge of Christmas cards and were now free to land in mailboxes everywhere. This month's Mayo Clinic Health Letter has its usual interesting selection of items.

One of its items covers lower back pain due to spinal stenosis and how to distinguish such a pain from pain due to poor blood flow in the legs. Some of the questions are worth remembering if you ever find yourself with lower back pain.

Does:
  • leaning forward at the waist relieve pain
  • pain start high and then radiate downwards
  • sleeping on your back cause pain
and you can ride a bicycle with no pain:

then the pain might be due to spinal stenosis.

Now to look at the alternative possibility of pain due to poor blood flow to the legs

Does:
  • stopping walking and standing still reduce the pain
  • does the pain while walking start in the calf and then radiate upwards
  • sleeping does not cause pain
  • riding a bicycle cause pain
then the pain might be due to poor blood flow to the legs.

If the answers take you in the direction of Spinal Stenosis then there are lots of options open to you to reduce the pain and to get your life back. Exercise is going to be important as is losing weight - big surprise with that ! Learn to swim the backstroke - it could help a lot. You'll need prescriptions for the kind of pain killers that quiet irritated nerves.

Poor blood flow to the legs might sound like the better option but it is not. In a similar way to blood vessels around the heart furring up and slowing (or even stopping) blood flow, the major blood vessels to the legs can also become partially blocked. The pain you feel in the legs as a result of poor blood flow is called claudication. It means that the leg muscles are not getting enough oxygen and as a result are letting you feel pain.

There is the temptation to walk, cycle, swim less just to reduce the pain. The trouble is that every time you reduce your exercise load the poor blood flow issue becomes worse. One day the blockage in your legs could come free and block a heart blood vessel or even something in your brain.

Do not let poor blood flow to the legs be one of the things your going to do something about one day.
Get on it today. If you need any specific exercise recommendations after seeing a qualified medical specialist post a question on this blog.

One last thought: lower back pain could be due to a multitude of causes. At this time of year shoveling snow or raking leaves are obvious possibilities. The advice above on telling spinal stenosis from poor blood flow to the legs are just a couple of the possibilities.

Tuesday, December 18, 2007

Asthma

Asthma is the biggest barrier to working out effectively for 3 of my personal training clients. My wife has had huge lung issues. Her lungs probably have the inflammation from an asthma reaction and probably 'something else' even though the 'something else' has never been diagnosed exactly. A chest biopsy was totally inconclusive. I am probably border-line sensitive to exercise-induced asthma. These factors motivated me to write Exercising Safely with Exercise-induced Asthma.

The Fall 2007 issue of Medline Plus Magazine focuses on Asthma with a front cover picture of Wynonna Judd - who never lets Asthma hold her back. Pages 14 to 19 give an easy to read update on the latest in Asthma treatment.

Anyone trying to exercise with Asthma needs to know:
  • take your medication exactly as prescribed. Trying to 'ween' yourself off the anti-inflammatory medications that form the preventative aspect of asthma treatment is making life difficult for yourself
  • warm-up slowly. If an exercise-induced asthma attack is going to happen it is most likely in the first 8 minutes of working-out. So warm up very slowly to try and get through this danger period safely.
  • if you do get an asthma attack, do not give up - you still might be able to work out but ease down to slow walking (better than stopping totally). There is every chance the attack will pass and then you have a period of an hour, possibly longer, in which the chance of a second attack is unlikely.
  • cool-down slowly. You might get an asthma attack if you finish working out too abruptly. Just stopping and sitting down feeling pooped - not a good idea. Slow down over about 10 minutes should give you protection from an asthma attack.
  • about 90% of people with Asthma are likely to get an exercise-induced asthma attack. So even if you have 'ordinary' asthma, following these simple rules is a sensible thing to do.
There are also some nutrition changes you should think about making - particularly with regard to omega-3 fatty acids, salt and caffeine. My book gives you all the details.

Saturday, December 15, 2007

Functional Training

The American Council on Exercise sponsored this research to find out if Functional Training could benefit those of us clocking up the years. For the study 24 people in the age range 58 to 78 (men and women) were recruited. The idea was to find out if simple looking exercises each using two or more joints at the same time could be just as beneficial, or even more beneficial, than the more traditional gym workouts centered around the use of machines.

Follow the Functional Training link to get the 5 page report which was originally published earlier this year in the ACE's Fitness Matters magazine (aimed at Personal trainers like myself).

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Friday, December 14, 2007

Men's Health on eating at restaurants

I used to love Men's Health Magazine. There was a time in the '90's when I was still living in London, England but often traveling to the USA and Canada that there were some years I bought every issue of Men's Health in the UK and at least half of the USA editions for the same year. At that time the UK edition of Men's Health was much raunchier than the USA version. I finally got over Men's Health when the recipes and sex advice had more space than workouts !

Once in a while Men's Health gets serious - especially when it has a book to sell. This expose on restaurant food is useful. Most of my clients eat out at least half of the time - sometimes a lot more than that. So it is important that restaurants provide accurate information on what exactly you are eating.

Most people struggle with the idea that restaurants they like and use frequently might lie to them but unfortunately that is the reality. If you look at this Men's Health survey, most restaurants you are likely to use lie to you about the calories in your meal, how much fat is in there and probably anything else they care to screw with - bon appetite.

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Wednesday, December 12, 2007

Avandia for Diabetes causing heart attacks in the elderly ?

After yesterday's welcome news that Nexium does not precipitate heart attacks, today the news is more somber, Avandia used in the treatment of Diabetes might be causing heart attacks.

Today, December 12, 2007, the Journal of the American Medical Association (JAMA) ran the result of research in Ontario, Canada. The researchers involved are based at the Institute for Clinical Evaluative Science in Toronto (ICES).

Avandia is used in the treatment of Type Diabetes. This study comes to a conclusion that the increased risks of Avandia are considerable. In the view of the researchers anyone taking Avandia has a 60% increased risk of heart failure, 40% higher chance of a heart attack and a 30% increased risk of death compared to other patients taking other diabetes medications.

This study looked at everyone in Ontario taking Avandia over a 4 year period and from this population drew the conclusion that out of every 100 people taking Avandia: there would be 5 additional deaths.

GlaxoSmithKline make Avandia and state that the risk is not as bad as the research would indicate because the patients being treated with Avandia tend to be sicker than the average and hence at higher risk. The FDA agrees with this and has no plans to further restrict Avandia use - Avandia already has a black box warning label.

The trial lawyers are happy with the position of the FDA and GlaxoSmithKline. This could be another money maker for the lawyers.

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Monday, December 10, 2007

Nexium does not cause heart attacks

A few seconds after the alarm goes off, always well before dawn, I swallow a Nexium capsule with the first glass of water of the day. Today the FDA put out a very welcome press release saying that Nexium and Prilosec do not increase the risk of cardiac events.

Nexium and Prilosec help heal erosions in the lining of the esophagus (known as erosive esophagitis). Last year, almost accidentally, I was identified as having this issue and since then Nexium has become part of my daily routine.

One good piece of news, unless of course you believe nothing put out by the government.

Tuesday, December 4, 2007

BBC American - Body Image Month

'Super Skinny Me' isn't heavy

I had to include this story from the LA Times because it talks about dieting and body image issues in Britain. As a big bonus it covers BBC America ( a cable channel I watch a lot, possibly second only to the Fox Soccer Channel).
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Here in the land of Big Macs and thin obsessions, 'Super Skinny Me' just seems so British.
By Mary McNamara
Los Angeles Times Staff Writer

November 30, 2007

Strangely enough, December is "body image month" on BBC America, which translates into five hour-long documentaries looking at issues as varied as small breasts, obesity and trans-genderism. In "Super Skinny Me," which kicks off the series, two female journalists go on five-week crash diets to see what it takes to whittle their normal-sized bodies down to a model- esque size 0.

No, wait. That's what the documentary would have been about if it had been made in the U.S., where dieting is an obsession, a national hobby and often a competitive sport. But "Super Skinny Me" is British, and so, rather than glamorizing the quest for thinness for the audience, the emphasis is what happens, physically and psychologically, to two women who have never been on diets before as they make their way through a regimen of cleansing drinks, rigorous workouts and colonics. (Hint: nothing good.)

You can tell this is not an American production right away, and not because of the accents. First off, can you imagine finding two female American journalists who had never ever been on a diet? Can you imagine a 28-year-old American woman saying, as Louise Burke does, that at size 4 she felt too skinny? Really, it's worth watching for the contrast in cultures alone.

"Super Skinny Me" is billed as a "Super Size Me" in reverse. But whereas Morgan Spurlock was willing to go to extreme lengths to make his point about the harmful effects of junk food -- growing bloated and pale and sweaty right before our eyes -- the creators of "Super Skinny" play it very safe. This is good for the mental and physical health of the participants, of course, but bad for the documentary.

When, after four weeks, Kate Spicer, 37, develops a fondness for colonics and has some binge issues -- her eating is described as "chaotic" -- she is taken out of the experiment. The decision is obviously the humane one, but it requires an appreciation for subtlety that is not what we expect from documentaries like this one. To an American eye, at least, Spicer's "chaotic" misery over drinking yet another glass of cleansing lemonade or sudden surrender to a dessert looks normal enough for a woman trying to squeeze down several dress sizes. This may be a sad reflection on the state of eating, or perhaps television, in America, but it seems something a little more dramatic is called for -- fainting, or meltdowns or something. Frankly, I've seen more physical and emotional deterioration on "Project Runway."

The very nature of the project makes it perhaps not the best choice for film. Although there was a wince-worthy fascination with watching Spurlock shove Big Macs in his face, it is not terribly exciting to watch women not eat. Five weeks may be a long time to exist on protein shakes, but listening to the women complain of fatigue and crankiness was a bit like listening to every woman I know, including myself, at some dieting point in their lives. Suck it up, I wanted to say, that's why it's called dieting.

Of course, the point is that these women didn't need to lose weight -- their weight, size and body-fat levels were all healthy. So right there you lose half of the obesity-prone American audience. What the filmmakers are saying -- that so many stars and, by extension, young women are obsessed with being very skinny -- is obviously valid. But neither of the women come close to the skeletal images of Nicole Richie or Keira Knightley. The visuals are not exactly startling, no hair loss or ashen skin, no cessation of menstrual periods. In fact, the women look pretty darn good after the five weeks, though, of course, that may be my media conditioning speaking.

All of which makes me wonder if this wouldn't have been a better newspaper story. The strongest moments came when the women were discussing how they felt on the diets -- exhausted or irritable or out of control. How it put a strain on their relationships, how it made them measure their self-worth in pounds (or stones). What was occurring internally was more interesting than what was happening externally. When Louise says straight out, "I don't think I've ever been so unhappy in my life," it's a little hard to believe. Yes, we've seen her slumping at work, but we haven't been made privy to her depressive thoughts.

And she's even pretty excited when those size-0 jeans slide on so nicely.

mary.mcnamara@latimes.com

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Mental Decline and Calcium Levels

Calcium levels are important to bone health. We all know that. Osteoporosis and low calcium level are linked (plus of course the need for sufficient Vitamin D - see yesterday's post on Vitamin D). However have you thought about the link between mental acuity and blood calcium levels.

The Journal of the American Geriatrics Society reported last month (November 2007) of this linkage in over 75's. Reuters have a good summary of the research. High levels of calcium can kill nerve and brain cells - hence possibly contribute to mental decline. So where might the high-levels of blood calcium in the elderly come from? The research hypothesis's about cancer, incipient kidney failure or possibly excessive parathyroid activity. I'd kick in one more thought about calcium being released from the skeleton as a result of reduced standing and walking (hence the 'body' signaling lower requirement for bone strength).

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Monday, December 3, 2007

Are you getting enough Vitamin D ?

Tufts Health & Nutrition Letter (December 2007 - Vol 25, #10) has an article about what is enough Vitamin D. There are two take aways in terms of immediate action from this article:
  • we are not getting enough Vitamin D. In late Winter the average American has 15 to 18 ng/mL in their blood of the principal and longest acting form of Vitamin D (25-hydroxyvitaminD). To get a cancer preventing impact a level of at least 55 ng/mL is needed.
  • Vitamin D supplements do not contain sufficient Vitamin D. Supplements typically contain 400 to 600IU whereas an intake of 2,000IU is justified from the research.
Read the labels on your supplements, Vitamin D comes in several forms. It is the D3 version that is most potent.

This article summarizes the situation:

Suboptimal vitamin D status is a highly prevalent but treatable condition in both hospitalized patients and the general population

Authors: Moore, Nicole L.1; Kiebzak, Gary M.

Source: Journal of the American Academy of Nurse Practitioners, Volume 19, Number 12, December 2007 , pp. 642-651(10)

The summary: Poor Vitamin D status (ranging from suboptimal to overt deficiency) is common in both hospitalized and ostensibly healthy individuals of all ages and geographic latitude. Suboptimal vitamin D status is associated with muscle weakness, functional deficits, and perhaps longer length of stay of hospitalized patients. Fortunately, treatment with 50,000IU of Vitamin D2 for several weeks is a very inexpensive and safe yet effective treatment to replete Vitamin D status.

This large dose of Vitamin D refers to the D2 variant. Vitamin D sufficiency can be sustained by sensible sun exposure or ingesting at least 800-1000IU of vitamin D3 daily. Patients being treated for osteoporosis should be adequately supplemented with calcium and vitamin D to maximise the benefit of treatment.

This recommendation from:

Optimal Vitamin D Status for the Prevention and Treatment of Osteoporosis

Author: Holick, Michael F.1

Source: Drugs & Aging, Volume 24, Number 12, 2007 , pp. 1017-1029(13)


Saturday, December 1, 2007

Fitness Trends from the ACSM worldwide survey

The November/December 2007 Health & Fitness Journal published by ACSM [American Council on Sports Medicine] recently arrived in the mailbox and as usual it had a few gems. One such is the results from the annual survey of fitness trends. The top 5 and the changes between last year and this year:
  1. Fully certified and accredited health/fitness professionals. (previously #3). In Georgia,USA there is draft legislation to license Personal Trainers. If a Personal Trainer is well qualified this is a good thing. However the major gym chains are all against it and probably are able to spend enough on lobbying to stop it becoming law.
  2. Fighting childhood and adolescent obesity. (previously #1). This slipping down a notch is a surprise as I can see more and more parents sending their children into the gym to workout with Personal Trainers.
  3. Personal Training (up from #7). In an area like mine, north of Atlanta, most people have long, tough commutes. Working out has to be squeezed into an already punishing schedule. Having a Personal Trainer makes sure that maximum value is obtained from time spent in the gym.
  4. Strength Training (previously #6). Weight loss or weight control is an issue for many and it is now well established that an integrated program of cardio (aerobic) training plus muscle strength training is the best combination of exercise.
  5. Core Training (unchanged at #5). Just about everyone wants a flat tummy and nice looking abs. This is not an easy look to get because you have to really work at it. The trick is to work the whole core area because just concentrating on the Rectus Abdominous (the 6 pack ab muscle in the front) does not get results. What you have to do is work the whole core area which includes everything front, back at sides from the hips up to the line across the nipples. To do all of this you need to know a lot of exercises and be able to use them in sequence and combination.

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