News Letters - Health and Nutrition - How many is too many ?

The pile of health and nutrition newsletters at the end of the month, silently screaming "file me neatly", forces the thought "Am I buying too many newsletters ?" 

Then leading on to the unbidden thought "Am I getting anything out of all these newsletters ?"

The end of November is a good time to go through this month's pile to check for value and the pile is deeper than I thought. By the way, all of these are pay for news letters, so there is a limit to how much you can extract from the free web sites.

1. Tufts Health & Nutrition Letter  told me that if you want to increase intake of omega-3 (and I've no doubt that this is a good idea) then you need to supplement your food with  fish oil. Tufts reported on a test with 62 fire fighters over 12 weeks who took either flax oil or fish oil or the obligatory placebo. Only  fish oil made any real difference to the levels of EPA and DHA in  the blood stream. EPA and DHA are the long-chain omega-3 and are the only ones of any real value to our bodies. 
2. Wellness Letter from University of California, Berkley (The Newsletter of Nutrition, Fitness, and Self-care) told me that taking glucosamine or chondritin (or the two together) had only insignificant affect on knee cartilage. The hope had been that taking these supplements improved knee cartilage health and reduced knee pain. The GAIT study covered 1,600 people and for 60% of the participants the placebo worked as well as the supplements! A sad end to a lot of hope but my personal experience has been that glucosamine did not help.
3. Duke Medicine Health News has an interesting format whereby they report on research studies and then have Duke doctors and researchers comment on research findings. I think these are meant to be the voice of sanity and most of the time they are. I've often blog'd about Vitamin D so the article "Check Your Vitamin D intake to Avoid Multiple Health Consequences" immediately caught my eye with the message "Three 2008 studies link low vitamin D levels to depression, hip fracture, and increased risk of death." 
4. Mayo Clinic Health Letter strongly advocates colorectal cancer screening. I can feel smug about this having had a colonoscopy in 2006 and I am good to go through 2011. However I should have had the first colonoscopy at 50 not 62. About 2/3 rds of colorectal cancers are detected late. By contrast the 1/3 rd of colorectal cancers detected early have a 90% success rate.
5. Health After 50 (The Johns Hopkins Medical Letter) had just a paragraph on the health benefits of running. They reported briefly on a study at Stanford University Medical Center that after following runners and non-runners for 19 years (most participants are now in their late 70s) the runners were living longer and were healthier into old age. I blog'd on this item the moment I read it.
6. Nutrition Action Health Letter had a long piece on the key risk factors and warning signs for major cancers that are linked to diet, weight, or exercise. The chart below of Leading Cancer Killers illustrates the article. If one is lucky enough to avoid cancers of the lungs, breast, prostate, colon and rectum then chances of a long and happy life go up substantially.

Osteoporosis and Back pain

Osteoporosis is one of those things everyone should give some thought to. It hits men but women are sufferers a lot more often.

I worry that my wife might not be getting enough calcium or enough Vitamin D or perhaps not enough sunshine. All things which can slide one towards brittle bones which one day might fracture.

This week I've been reading the Johns Hopkins 2008 White Paper on Back Pain and Osteoporosis.I definitely recommend it to anyone who has any issues with their back or bones in general as $19.95 well spent. Johns Hopkins also provide a free report on osteoporosis.

The White Paper looks at the tough question of "What's the best exercise for chronic back pain ?" Johns Hopkins quotes the results from a study published in PAIN (you have to love a journal with an up front name like Pain!). The study recruited 240 people who had all had back pain for more than 3 months. 

They divided the back pain sufferers into 3 groups"

• those who received general exercise involving stretching strengthening and aerobic exercise
• those getting specific motor control exercise for specific trunk muscles with ultra sound feed back
• those who received spinal manipulative therapy.

In the first few months the people getting the specialized therapies progressed fastest but after 6 months it all started to equalize. The message seems to be to exercise - however you go at it and , most importantly, to keep exercising.

Anyone with osteoporosis probably wants to avoid exercises with the risk of causing broken or fractured bones. However Johns Hopkins is pretty adamant that "most people with osteoporosis should actually do more exercise not less." 

The National Osteoporosis Foundation sells an exercise video "Be BoneWise - Exercise" which provides exercises specifically for those with osteoporosis. 

Of course there is always the catch which says you really should have started looking after your bones a long time ago. There is one ongoing study - now 35 years long - which has been following 2,000 men (aged 49 to 51 years at the start). After this many decades they can see that only 8% of very active men have had hip fractures while 20% of non-active sedentary men have had hip fractures. 

The 2008 White Paper has some good tips for pain-free driving:

• Seat back almost straight up
  
• Knees slightly higher than the butt
  
• Both feet flat on the floor if you can (use cruise for long journeys)
  
• Hands at 9 o'clock and 3 o'clock position (rather than the higher position recommended by driving instructors)
  
• Elbows supported
• If back pain is very bad get out of the car and stretch every 30 minutes (if possible)
  

Johns Hopkins also has some some advice for getting some sleep. Back and neck pains go together with poor sleeping - not surprisingly. Firstly the right firmness of mattress is critical - not too hard and not too soft. The American Chiropractic Association is in favor of mattresses with inner spring coils. When buying a new mattress the Consumer Association says to lie for 5 minutes on each side while testing mattresses. Let you back start to conform to the shape it will be in overnight to get an idea for comfort. This makes for a slow decision but worth it.

Safe, pain-free exercise seems to be the key. Nearly every day and keep going - for ever. 

Some exercise ideas.

Running, Arthritis, Knee pain, Glucosamine, Chondroitin

I've never had any success with either Glucosamine or Chondroitin. They do not seem to reduce the discomfort in my knees after running. A lot of people have said, in all seriousness, that I should try glucosamine and I have but it has not helped.

Last month the extension to the Glucosamine/Chondroitin Arthritis Intervention Trail (GAIT) reported in the journal of Arthritis and Rheumatism that nothing worked better than a placebo !

This follow up trial had 357 participants and it lasted 18 months longer than the original 2 year GAIT trial. The participants were divided into 5 treatment groups:

• Glucosamine only
• Chondroitin only
• both supplements together
• Celebrex (as a pain killer)
• Placebo.

All the participants had repeated X-Ray examination to determine if cartilage loss was stopped or reversed. There were only tiny, insignificant differences between the 5 groups. The differences were too small to come to any conclusions.

These might be disappointing findings but it was an expensive, carefully designed study. The Berkley Wellness Letter said it was hard to imagine a better study being done any time soon. Their sign off advice was to keep on taking whatever you are taking now if it's working for you but apart from that caveat Berkeley Wellness said "Forget about glucosamine and chondroitin."

Runners live longer

5 miles in 52 minutes on November 18. 

Not that great but the farthest I've run in a long time and a good step to running 10K in under an hour. The knees are responding to patience and care.

Stanford University started a long term project in January 1984 to find out if running really was a good idea. All the participants were at least 50 years old at the outset in 1984. Stanford also recruited a similar group who did not run as a control. The non-running group did exercise and they ran if they wanted to but were not the 'committed' runners of the running group.

Conclusion  Vigorous exercise (running) at middle and older ages is associated with reduced disability in later life and a notable survival advantage. At 19 years [into the study from a start in 1984], 15% of runners had died compared with 34% of controls. Runners had a significantly lower risk of an HAQ-DI [Health Assessment Questionnaire]score of 0.5 (hazard ratio, 0.62; 95% confidence interval, 0.46-0.84).

It must be strange for medical researchers to follow a group of middle age people to start with into old age and watch them die. Then to find out reasons for the deaths and to plot and analyse the data. 

This project, now ongoing for 24 years was reported on after:

• 8 years
• 13 years
• and now the latest report after 21 years.

At the 13 year point the researchers titled they research paper: Postponed Development of Disability in Elderly Runners. However by the 21 year point with such a strong divergence in health the paper is titled: Reduced Disability and Mortality among Aging Runners.

Running is associated with a whole set of healthy choices in terms of nutrition, weight control, alcohol consumption and even seat belt use. So it is not just the miles on the road that make a difference.

I'm going to try to keep on running.

Stretching the PNF Way (with Video)

Stretching, for some people, is essential. 

For others it makes a pleasant end to a run or a workout. 

I encourage clients to stretch because:

• it reduces or gets rid of any post-workout or post-run soreness
• it stops muscles becoming too short and too tight
• it reduces chances of pulled muscles or strained tendons
• it generates a feeling of relaxation.

There  are several ways to stretch. 

In this video I show you PNF (Proprioceptive neuromuscular facilitation) stretching.

I first learned to do PNF stretching on an  ACE course on PNF stretching while working at Bally's. 

There is a lot of theory behind PNF stretching but the essential core of understanding is to activate the muscle to be stretched by having the client push against my resistance; to hold the working muscle against a balancing force from me for about six second; then to have the client activate the antagonist muscle to stretch the 'target' muscle. Then we do it again. The amount of force the client exerts, the exact position of the joint during the 'push' and the assistance I give to the clients force are all important. 

The best text book that I know on PNF is Facilitated Stretching by Robert E. McAtee and Jeff Charland. 

However The Wharton's BACK BOOK by Jim and Phil Wharton is also excellent and covers much more than just backs.

Other means of stretching include:

• stretching with no tools at all as typically used by runners after running (and sometimes before a hard run)
• stretching using "The Stick"
• stretching with a "Foam Roller"
• stretching with a "Stretching strap"

In future videos I'll show you all of these approaches to stretching and there is no need to use just one form of stretching, they all have their place at one time or the other.

Of course, if you regularly do Yoga or Pilate's then you'll recognise many of these stretches because there is nothing new in stretching - or at least nothing new in the last 4,000 years - apart possibly from The Stick.

Diet Advice

Giving diet advice is difficult. I'm usually reluctant to go into details even though I have relevant experience because there was a time when I weighed 50 pounds more than I do now.

Bookstalls and the web are full of diet advice with many, many tips - the 10 best tips, 15 best, 100 best.

From me the first tip, and only tip today is:

• if the center-piece of your meal is a protein, whether meat, fish or shellfish, then NO carbohydrate. By no carbohydrate I mean not letting french fries, mash (in fact potatoes of any kind), no pasta of any form, no grains of any variety, onto your plate.

So what does go with the protein ?

Vegetables of any and all kinds. The more colorful and flavorful the better.

That's my first, but probably not the last, diet tip.

A few of the more interesting diet tips from the Internet:

• 10 real life diet tips


• 13 tips from the Diet Detective


• 10 unconventional diet tips


• WebMDs 17 best foods for dieters


• Podcast with 24 diet tips

Cancer: when to exercise - when not to exercise

You have cancer ?

Should you exercise or not ?

Will exercise help or make things worse ?

Shelby Scott M.D., FACSM, FAAFP has an article in the November-December 2008 issue of ACSM's Health and Fitness Journal on 

Living with Cancer Part 2: Exercise and other treatment options.

In the category "be sensible" are these guidelines for patients with cancer:

• Check with your health care provider before beginning an exercise regimen to ensure there are no contraindications with chemotherapeutics
• Do no exercise if blood counts are low, especially the absolute neutrophil count
• Do not exercise if sodium and potassium are not normal
• Do not perform cardiovascular exercise if you feel extremely fatigued - stretch instead
• Do not use heavy weights if you have osteoporosis, cancer in the bone, or nerve damage
• Stop exercising if you have an increase in pain or difficulty breathing.

To be realistic about cancer, people often have: 

• weight loss, 
  
• anemia, 
  
• muscle wasting, 
  
• fatigue and 
  
• maybe pain.
  

Exercise cannot cure cancer but it can help:

• Exercise can prevent muscle wasting and joint stiffness
• Exercise can help sleeping more soundly
• Exercise can help reduce fatigue and increase energy levels for the rest of daily activities
• Exercise can help reduce pain by releasing endorphins in the brain.

Circuit Training

Circuit training: it's worth considering whether you are ready to put this intense form of exercise into your health and fitness program.

The best way to do circuit training is for 2, 3 or 4 people, of a similar fitness level, with similar objectives to circuit train together. Intensity is highest and results are the best if there is a good mix of competition and co-operation. As a Personal Trainer I try to inject intensity into a client workout so that it just as hard as when several people are training together.

Circuit training aims to work out the whole body and this includes heart, lungs and brain just as much as legs, core and upper body.

Circuit training hurts ! As a young man training for rugby, circuit training was a staple of my team's conditioning program, and I threw up many times. You do not need to go that far !

In this 3 1/2 minutes video, which is an extract from a 20 minute workout, you can empathize with the client who by the end has nothing left. I need to emphasize that he is a very strong fit man who can push himself beyond anything you'd expect. Do not copy this routine until you are very fit and then it will take you to the next level.

This workout uses the following exercises:

• kicking a heavy bag


• punching a heavy bag


• running
  Switch back and fore between kicking, punching and running 3 to 5 times
  


• Sit ups holding a dumbbell in each hand


• Swings - these are like push ups but each hand regularly swing up to shoulder level holding a dumbbell


• Jumping Jacks - knees up close to chest and then feet back as far as possible
Switch back and fore between Sit ups, Swings and Jumping Jacks twice


• Turkish Get Ups - lie on your back holding a heavy dumbbell in one hand and get to your feet without touching the dumbbell down to the ground
  Turkish Get Ups are so tough that you should only do one set on each side.
  
• ABS - lie on back, pick up exercise ball with feet (holding ball at the ankle)


• Push ups with hands on top of exercise ball - push ups on exercise ball is much tougher than with hands on the floor.
  If you have the strength left about 20 minutes in this circuit training workout, switch between Abs and Push ups twice.

This link is about Circuit Training for Body Builders.

This DVD will give you more ideas about designing a personal circuit training workout.

This site offers lots of ideas on circuit training.

Can supplements keep cancer away ?

Three-quarters of cancer survivors take vitamin supplements according to a study by Duke University Medical Center, Penn State University and University of Texas (MD Anderson Cancer Center). 

However Denise Snyder, one of the authors of the study had multiple comments about uncontrolled downing of nutrition supplements:

• " .  . supplementation may result in an imbalance of nutrients that may backfire and put cells at risk of cancer recurrence."
• there is little solid evidence that supplements can prevent cancer from recurring and further that they may pose risks to cancer survivors
• "Fortification has gone nuts. It disregards people's individual requirements, and if supplements are taken alongside fortified foods, there's a risk of overdosing."
• "Survivors hope supplements might strengthen their immune system, and taking them likely gives a sense of control over their cancer. And often people aren't aware that the benefits associated with certain nutrients can only be gained through dietary sources. Vitamins and minerals may be processed differently - possibly more safely - if they're consumed as part of a whole food."

What  about taking nutritional supplements while you are still under-going radiation or chemo for cancer ? 

According to the Duke Medicine Health News "Drugs and radiation therapy are thought to work, in part, by generating free radicals which kill cancer cells - but antioxidants neutralize free radicals." 

A report out in May 27 this year in the Journal of the National Cancer Institute Cancer says "Patients should avoid the routine use of antioxidant supplements during radiation and chemotherapy because the supplements may reduce the anticancer benefits of therapy."

How often does your doctor ask what supplements you are taking?

Do you volunteer this information to every doctor you see?

According to a report in the Journal of Clinical Oncology (Feb. 2008) for about two thirds of patients, their doctors do not know what supplements they are taking.

I know that my wife edits what she tells her 'ordinary' doctor about supplements she takes recommended by her alternative nutritionist and she also does not tell the nutritionist about injections prescribed by the 'ordinary' doctor because the nutritionist is firmly against injections. 

I wonder how many of us 'adjust' what we tell doctors if the subject of supplements happens to come up ?

Check on the rules, if any, that nutrition suppliers follow.

How much do you know about Nutritional Supplements ?

Do you take a supplement ? 

Simple question but do you mean a nutritional supplement or something else ?

Most people must take something because sales of supplements in the USA now exceed $200 million a year. I'll admit to taking Omega 3 capsules - usually 2 or 3 capsules spread through the  day for about 1 gram of Omega 3 in total. Read this for a detailed analysis of supplement usage in the USA.

How safe are these supplements ?

Charles Corbin (Professor Emeritus at Arizona State University) has come up with a quiz to test everyone's knowledge about the regulation of supplements.

Try these questions and then look at the answers.

1.  Dietary supplements are tested by the FDA for effectiveness and safety ?

2.  The FDA requires manufacturers to evaluate the identity, purity, quality, strength, and composition of dietary supplements ?

3.  Recommended doses for most dietary supplements have been scientifically established ?

4.  Dietary supplements, unlike medicines, do not have side effects or interactions with medicines or other supplements ?

5.  By law, dietary supplements must include labels similar to labels on foods in the grocery store ?

6.  Sellers of dietary supplements must have a license to sell them ?

7.  Sellers of dietary supplements must have completed an educational program in nutrition to sell them ?

8.  Dietary supplement labels legally may not make unsubstantiated claims about disease prevention, treatment, or diagnosis ?

9.  The FDA regulates and systematically enforces claims made for dietary supplements ?

10. Information is available to help consumers evaluate claims made for dietary supplements sold on the Web and in other locations ?

Now see how much you really know about how well we are protected:

 

1.   Dietary supplements are tested by the FDA for effectiveness and safety.

False. The truth is that the FDA does NOT test dietary supplements to assure that they are effective and safe. In 1994, the Dietary Supplement Health and Education Act (DSHEA) was passed by the congress and signed into law. Under this act, manufacturers, not the FDA, are responsible for the safety of the products manufactured or distributed. Furthermore, the manufacturer is responsible for determining that claims made about them are substantiated by scientific evidence. This means that dietary supplements do not need approval from the FDA before they are marketed, nor is a product prevented from reaching the market if no evidence exists concerning  its effectiveness.

 

2.      The FDA requires manufacturers to evaluate the identity, purity, quality, strength, and composition of dietary supplements.

True. On June 22, 2007, the FDA  announced a new rule that “...will help ensure that dietary

supplements are manufactured with controls that result in a consistent product free of contamination, with

accurate labeling.” The rule, effective in September 2007, requires supplement manufacturers to provide labels to ensure that a supplement is what it is purported to be, that it does not contain too much or too little of the ingredient, and that it is not contaminated. This is important because more than a few cases of contaminated supplements have been reported, and in some cases, severe illness and death have occurred (8). The manufacturer, not the FDA, will test products to ensure that they meet the requirements of the new rule. The consumer should understand that the FDA evaluates safety of supplements through “adverse events monitoring.” In other words, it relies on consumers to report adverse reactions to supplements. When such reports are received, the FDA investigates. The new rule is a step in the right direction. Nevertheless, it is still possible for supplements to contain ingredients other than those on the new labels. This is because products with incorrect contents may go unnoticed until complaints are brought against the manufacturer. It is important for consumers to report adverse effects so that unscrupulous manufacturers can be identified (report adverse effects at www.fda.gov/medwatch/how.htm). The new FDA rule does require manufacturers to report adverse reactions to their products. Currently, some dietary supplements carry the USP label. USP is an independent group that tests supplements to make sure that they are what they claim to be.

 

3.      Recommended doses for most dietary supplements have been scientifically established

 

False In fact, recommended doses have been established for some supplements, but for most, scientific  evidence is NOT yet available. The Institute of Medicine has developed dietary reference intake values for both macronutrients and micronutrients for foods. This includes recommendations for vitamins and minerals (in the diet). Other organizations have made recommendations concerning other supplements such as creatine and vitamins . Still, for many other supplements (such as herbs/botanicals and other substances listed in the definition previously presented), no standard doses have been scientifically established. In some cases, very large doses have been advocated for supplements including vitamins, although there is little or no scientific support for these megadoses. No rules currently exist concerning the serving size or recommended dose of dietary supplements.

 

4.       Dietary supplements, unlike medicines, do not have side effects or interactions with medicines or other supplements

 

False. The truth is that dietary supplements CAN have side effects and can interact with medicines and other supplements. Ephedra is a dietary supplement that enjoyed wide sales before April 2004, when its sale was banned because of adverse effects reported by users and medical personnel. It is important to consider all supplements (as well as medicines) when making decisions about supplements. Some can cause irregular heart beats (e.g., Ginkgo and kava), some interact with medicines (e.g., St. John92s wort interacts with birth control pills and HIV medications), and some can affect medical procedures (e.g., St. John92s wort increases risk of bleeding and should not be taken before surgery). Supplements often contain ingredients also found in medicines (many medicines are made from plants) and can have the same side effects as medicines.

 

5.       By law, dietary supplements must include labels similar to labels on foods in the grocery store

 

False. Current law requires supplements to have a label, but the law does NOT require the same detail on

food supplements that is currently required for packaged foods sold in grocery stores. As indicated in answer 2, the FDA will soon require new labels. These labels must describe the exact content of the supplement. The manufacturer must continue to supply (as required by current law) the "descriptive.., net contents of the product. Even with the new rule, supplements will not be required to include the more complete information contained on food labels".

 

6. Sellers of dietary supplements must have a license to sell them

 

False. Under current law, “Manufacturers do NOT need to register themselves nor their dietary  supplement products with FDA before producing or selling them.”

 

7. Sellers of dietary supplements must have completed an educational program in nutrition to sell them

 

False. There is NO current requirement that people who sell dietary supplements have any special training  or education.

 

8. Dietary supplement labels legally may not make unsubstantiated claims about disease prevention, treatment, or diagnosis

 

True  “A product sold as a dietary supplement and promoted on its label or in labeling as a treatment,

prevention, or cure for a specific disease or condition would be considered an unapproved  .  .  . and thus illegal drug”.

 

9. The FDA regulates and systematically enforces claims made for dietary supplements

False. The truth is that the FDA does NOT regularly regulate and enforce claims made for dietary supplements. “FDA has limited resources to analyze the composition of food products, including dietary supplements. It focuses these resources first on public health emergencies and products that may have caused injury or illness. Enforcement priorities then go to products thought to be unsafe or fraudulent or in violation of  the law”. The FDA “monitors the marketplace” with occasional lab content analyses or selected products and checks of Internet and consumer information. The Federal Trade Commission(FTC) regulates advertising of dietary supplements in national or regional newspapers and magazines; in radio and TV commercials, including infomercials; through direct mail to consumers; or on the Internet. The FTC requires that all information about supplements be truthful and not misleading. However, it is impossible for the FTC to monitor all claims. For this reason, a person cannot assume that claims made in the media and on the Internet concerning supplements are true.

10.               Information is available to help consumers evaluate claims made for dietary supplements sold on the Web and in other locations

 

True. Information is available to help consumers evaluate claims made for dietary supplements sold on the Web and in other locations.

Charles Corbin has written extensively over his career:

- some of his books

- some of his professional papers

- and his contribution to Learn out Loud.

Does this set of 10 questions and answers trigger other questions ?

Try this for even more answers.