Thursday, August 31, 2006

Fat belly, female? Check for PCOS

One of 20 North American women suffers from polycystic ovary syndrome that often causes obesity, large bones and muscles, hair to grow on faces and bodies, male-pattern baldness, acne, irregular periods. It is a common cause of infertility (24) and it increases their chances of developing diabetes (12), heart attacks, strokes (1) and uterine cancer. A study from Italy shows that polycystic ovary syndrome can be cured with the diabetic medication, metformin (Glucophage), and a low-refined-carbohydrate diet (26). We have known about this condition for more than 200 years, but only in the last few years have we have found a cause and cure.

Exciting research shows that drugs and diets to treat diabetes (23) and drugs to block male hormones can protect these women from developing diabetes, heart attacks, obesity and masculinizing traits such as hair on their bodies, acne, and large muscles and bones and that progesterone can protect them from uterine cancer (13,14,15,16).

A woman is born with about 4 million eggs. In a normal woman, each month one egg ripens and pops off the ovary to travel into the uterus. Women whose eggs ripen, but do not pop off the ovaries, have polycystic ovary syndrome. Their high insulin and male hormone levels cause the ovaries to make male hormones (9) that cause acne and dark body hair (2). Glucophage, Actos and Avandia are drugs that reduce insulin levels and therefore, lower blood levels of the male hormone, testosterone (7,21). So does a diet that favors whole grains and restricts foods made with flour or sugar, such as bakery products and pasta. Drugs that block male hormones also reduce masculinizing traits, lower cholesterol (10) and help the eggs to pop from the ovaries (3,4), but drugs to treat diabetes may be more effective (5,6). These women also are at increased risk for developing uterine cancer, so they are often prescribed birth control pills that contain progesterone and should try to lose weight when overweight.

If you think that you may have this condition, get a sonogram of your ovaries. Even if you don't have cysts, you could still have PCOS. Then you should avoid all bakery products, pastas, sugar-added foods and drinks, and fruit juices; and eat root vegetables and fruits only with meals. Base your diet on a wide variety of WHOLE grains, vegetables, beans and other seeds. Also check with your doctor to see if you are a candidate for Glucophage before each meal.

Journal references for this report

Wednesday, August 30, 2006

Herpes is more common than you think

One of eight North Americans (30 million) has genital herpes, but only 20 percent of those infected know it (1). Herpes is classified into type I that affects primarily the mouth, and type II that affects primarily the genitals, although both types can go both places. According to a study in the American Journal of Epidemiology almost one percent of North Americans acquire new cases of recurrent genital herpes each year. (14) That's 1,640,000 new cases of recurrent genital herpes. (730,000 men and 910,000 women).

To get herpes, you need the virus and broken skin. Since rubbing breaks skin, sexual contact with infected partners causes herpes. Typically, a person develops grouped painful or itchy blisters that look like poison ivy and disappear after one to six weeks. For some, genital herpes never recur, but almost all people who have a painful first episode will have recurrent blisters in exactly the same place (2).

A person who has herpes can be contagious, even when there are no visible blisters. The only way to diagnose herpes is to have a culture done on a wet blister. There are no dependable blood tests to tell if you have herpes because more than 92 percent of all Americans have had herpes and therefore have positive blood tests.

Herpes is the most common cause of swelling and pain around the rectum or vagina; anyone with these symptoms should get a culture for herpes, even if they are not sexually active.

Almost all North Americans have had herpes, but only 7 percent get blisters recurrently. If you have had one bout of herpes, you do not need treatment. If you have fewer than four recurrent genital herpes attacks per year, your doctor will probably prescribe 21 500mg tablets of Famvir or Valicyclovir that you keep on hand all the time and take them at the first tingling or itching that precede an outbreak. If you have more than 4 attacks a year, your doctor will probably prescribe valicyclovir 500 mg once a day for several years (7) or Famivir 125 mg TID (8). By the third year on that regimen, as many as 82 percent have no outbreaks at all. Exciting new research shows that taking acyclovir every day can help to prevent a person from being contagious (4). Valicyclovir and Famvir are both approved by the FDA for long-term use.

People with recurrent herpes can be contagious any time, but they are less likely to be contagious when they do not have blisters. Virtually everyone in North America has had herpes, but only 7 percent get it recurrently. If a person with recurrent herpes is on Valtrex every day, he or she will not shed as much and not be as contagious. Personally, I would not ruin a relationship because of herpes because you are not likely to find anyone who has not had herpes.

Journal references for this article

Monday, August 28, 2006

Side Stitches

It took years for the medical community to finally learn what causes a side stitch. Suddenly a runner develops pain in the right upper part of the belly, just underneath the ribs in the front. With each step the pain worsens. Doctors proposed all sorts of explanations for side stitch and most were nonsense. A stitch is not caused by gas in the colon because it is not relived by passing gas. It is not caused by a liver swollen with blood during running, because the liver has a very distensible capsule and the liver does not enlarge that much during exercise. It is not caused by cramps in the belly muscles because the belly muscles are not held rigidly when you have a side stitch, and it does not hurt when you push on the belly muscles. Lack of oxygen to the diaphragm doesn't cause them because blood flow to the diaphragm is not shut off by running. They are not caused by trapped gas in the lungs because gas does not get trapped in the lungs during exercise.

Then along came Dr. Tim Noakes, a medical school professor from South Africa, who offered the first reasonable explanation and a successful treatment. Thick fibrous bands called ligaments extend downward from your diaphragm to hold your liver in place. When you run, your liver drops at the exact time that your diaphragm goes up, stretching the ligaments and causing pain. Humans have a fixed pattern of breathing when they run. They have a two to one breathing ratio, breathing once for each two strides. Most people breathe out when the right foot strikes the ground. When you breathe out, your diaphragm goes up, and at the same time, the force of your foot strike causes your liver to go down. This stretches the ligaments that attach the liver to your diaphragm, causing pain. So the cause of a side stitch during hard running is a stretching of the ligaments that hold the liver to the diaphragm and the cure is to relieve the stretching of the ligaments.

When you get a stitch, stop running and press your hand deep into your liver to raise it up against your diaphragm. At the same time, purse your lips and blow out against the tightly held lips as hard as you can. Pushing the liver up stops stretching the ligaments. Breathing out hard empties your lungs. The pain is relieved immediately and you can resume running as soon as the pain disappears. The pain usually will not go away unless you stop running long enough to raise your liver.

Sunday, August 27, 2006

How to Start a Running Program

If you think you would enjoy jogging or running, here's how to get started. First, check with your doctor and get a good pair of running shoes. Start out by jogging slowly until your legs feel heavy or hurt or you feel tired. Then stop for the day, even if you have taken only a few steps. Do this every day or every other day. You should be able to work up to the point where you can jog slowly for at least 20 minutes. If you're happy with this program, you don't have to go any further. However, if you want to improve, follow the training methods that competitive runners use.

On one day, start out slowly and gradually pick up the pace. When you start to feel uncomfortable, slow down. When you recover, pick the pace up again. On the next day, if your legs feel stiff, don't try to run. If your legs feel fresh, run very slowly. Try to do these gradual pickup workouts every other day. Never do them when your legs are stiff or tired.

After a few months of alternating days of pickups and slow runs, you are ready to take the next step: intervals and longer runs. On Tuesdays and Thursdays, run faster. On Tuesday, try to run 220 yards fast (half a track length), rest and then repeat the 220-yard runs until your legs start to feel stiff. On Thursday, try to run two to five miles fairly fast, and on Sunday, try to increase your distance so you can run for at least one hour. On the other days, either run slowly, or if your legs feel stiff, take the day off.

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Sunday, August 20, 2006

Does massage treat low back pain?

Manipulation is as effective as everything else that a medical doctor has to offer to treat low-back pain, yet many doctors criticize osteopaths and chiropractors for using manipulation.

I remember a lead article in the New England Journal of Medicine (11/99) which showed that spinal manipulation is at least as effective in controlling low-back pain as the standard medical treatments of ultrasound, antiinflammatory drugs, anti-pain drugs, diathermy heat treatments, hot or cold packs, use of a corset or transcutaneous nerve stimulation. I have always recommended deep massage and manipulation for low back pain, for pain relief, not as a cure. When I had a persistant back problem, I chose deep massage of my back and was able to return to riding my bike in just six weeks.

Many medical doctors recommend cortisone injections when the evidence is that the most they can offer is temporary pain relief. It is not a cure. Surgery is specific for a limited number of cases of low-back pain and has a high failure rate. The NEJM article reinforced my experience that deep massage and manipulation can help to relieve some cases of severe low-back pain.

Saturday, August 19, 2006

What causes hiccups?

Most of the time, doctors never find the cause of persistant hiccups. When a cause is found it is almost always something that irritates or presses on the nerves leading to the heart, lungs or diaphragm, such as a tumor, stomach ulcer, or irregular heart beats.

Your windpipe, which carries air to your lungs, is located just in front of your esophagus, which carries food to your stomach. You certainly don't want food to pass down your windpipe, so it is covered with a trap door called the glottis. The glottis closes when you swallow and prevents food and drink from going into your lungs. The diaphragm is the huge muscle that is situated underneath your lungs. It moves down to pull the lungs down to fill your lungs with air. You get hiccups when the diaphragm suddenly contracts downward to pull the lungs downward and bring air into the lungs, but, before the air can get into your lungs, the glottis, the trap door over the windpipe, suddenly closes, and prevents air from entering the windpipe. Hiccups have no useful function after you are born, but when you were in your mother's womb, your face was under water and you closed your glottis when your diaphragm moved down to prevent water from getting into your lungs.

Everyone has a favorite hiccup remedy: touching a spoon against the uvula repeatedly while you try to breathe in, breathing into a bag, drinking water from the back side of a glass, massaging your neck, pulling on your tongue, sudden fright, pressing on your eyeball, or holding your breath. If none of those work and hiccups persist, doctors may prescribe Baclofen, a drug to reduce nerve messages; Metoclopramide, a drug to make the stomach contract; Chlorpromazine, a drug to tranquilize nerves; or Haldol, a drug used to treat schizophrenia.

Friday, August 18, 2006

How can I stay more alert late in the day?

Automobile accidents are more common at night because most people start to lose their ability to concentrate maximally after they have been awake for more than eight hours. A study from France shows that much of your early morning alertness can be restored just by napping or drinking coffee prior to driving (Annals of Internal Medicine, June 2006). Researchers tested young drivers during the day and again in the evening after drinking coffee containing 200 mg of caffeine, taking a 30-minute nap in the afternoon, or a placebo of decaffeinated coffee. They drove 125 miles between 6:00 and 7:30 PM, and again between 2:00 and 3:30 AM.

The doctors compared self-rated fatigue and sleepiness, inappropriate line crossings from video recordings, and polysomnographic recordings during the nap and subsequent sleep. Night-time driving performance was similar to daytime performance for 75 percent of the participants after coffee, for 66 percent after napping, and for only 13 percent after the placebo. This study agrees with many other studies that show napping or stimulants improve performance in activities that require concentration or memory in the afternoon or evening.

Wednesday, August 16, 2006

Do muscles recover faster AM or PM?

A study from France shows that it takes longer to recover from hard exercise in the evening than in the morning (International Journal of Sports Medicine, Volume 27, 2006). Cyclists performed ten six-second bouts of all out effort, with 30-second rest periods while the researchers measured peak power output, total mechanical work, peak pedaling rate, and peak efficient torque. The same group of cyclists performed these workouts in the morning on one day, and in the evening on another day. They found that the short-term recovery patterns were slower in the evening than in the morning.

While the researchers offered no explanation, decreased muscle performance late in the day may have a lot to do with brain function. Each muscle is made up of millions of individual muscle fibers. Each muscle fiber is instructed to contract by a single nerve fiber that receives messages from the brain. Your brain is far more alert after sleeping and napping than after being active for many hours. For example, students score higher in exams taken shortly after waking up than later in the day, and telephone operators answer more calls in the morning than in the afternoon. Late-day mental performance improves after napping, and the same may be true of muscle function.

Friday, August 11, 2006

Swollen ankles and feet

Your leg muscles function as a second heart to pump fluid from your legs to your heart. When your leg muscles relax, the veins near them fill up with blood. When your leg muscles contract, they compress the veins and squeeze blood up toward your heart.

When you stand still, your heart has to work very hard to pump blood against gravity from your feet to your heart. When your feet are above your heart, gravity works with you to help blood and fluid return to the heart. Eight hours of standing or sitting causes your feet to swell up to more than 110% of their size. This can make your shoes feel tight and your feet hurt.

The best way to prevent swelling is to elevate your feet. The next best way is to move your feet and toes frequently while you are sitting or standing. This can reduce swelling by more than 50 percent and will usually prevent the pain that it causes. If your feet still swell, check with your doctor. You may have a more serious cause, or you may need diuretics or compression stockings.

Thursday, August 10, 2006

Can awkward running form be improved?

Many people look terribly uncoordinated when they run. Telling them to change their form will just make them more uncoordinated. If a coach criticizes a team member for poor running form and doesn't correct the underlying causes, the person is likely to become self-conscious about how he or she looks, and run even more slowly. Coordination usually improves just with repeated practice in the chosen sport.

Running form can improve markedly if you can correct muscle imbalances and structural abnormalities with appropriate exercises and perhaps mechanical devices. A coach can videotape the athletes while they run, then review the tape in slow motion to analyze the mechanical defects. For example, leaning forward during running is often caused by weak back muscles, which can be treated with exercises to strengthen the back. Pointing the toes out is often caused by weak lower leg muscles and can be corrected by doing exercises to strengthen the shin muscles. Leaning back on the heels after foot plant can be caused by excessive rolling-in motion of the feet or weak calf muscles.

Treatment often includes special inserts in the shoes and calf strengthening exercises, such as toe raises while holding a heavy weight in the hands. Holding the shoulders up towards the ears during running is usually caused by weak shoulder muscles, which can be corrected by shrugging the shoulders while holding weights. A low knee-lift is often caused by weak quadriceps muscles in the front of the upper leg. The quadriceps can be strengthened by pedaling a bicycle, skating, or running up hills.

Tuesday, August 08, 2006

Do high arches cause running injuries?

Runners with high arches are at increased risk for suffering stress fractures, small cracks in the bones of their feet and lower legs; and those with low arches are at increased risk for knee cap pain. When you run at six miles per hour, your foot hits the ground with a force greater than three times body weight. The faster you run, the harder your heel strikes the ground. This force can break bones, damage joints and tear muscles. The human body is designed so you never land flatfooted when you run. You land on the outside bottom of your heal and roll inward toward the big toe. This helps to distribute the force of your foot strike throughout your foot and leg and protect you from injury. The further you roll inward, the greater the protection against this force. However, when you roll in too much, your lower leg twists inward excessively, causing your kneecap to rub against the long femur bone behind it and cause pain. This is called Runner’s Knee.

If you have pain behind the knee cap during running or walking, ask your podiatrist to look at your feet. If your arches appear to be flat, you usually will have a normal arch, but you roll inward so far that your arch touches the ground. Your treatment is to place special inserts, called orthotics, in your running shoes and to do special exercise that strengthen your vastus medialis muscle that pulls your knee cap inward.

If you develop pain in the medial side of your lower leg or your feet, your podiatrist will probably order a bone scan to check for stress fractures, small cracks in the bones of your feet. If you have stress fractures and high arched feet, you will need specially padded running shoes and have to learn to try to hit the ground with less force when you run.

Saturday, August 05, 2006

Does stretching prevent injuries?

There is little scientific evidence that stretching helps to prevent athletic injuries. However, a survey of high school coaches in Michigan shows that almost all stretch their athletes for an average of 13 minutes prior to practice or competition. Almost 95 percent of the coaches believe that stretching helps to prevent injuries, and nearly 73 percent feel that there are no drawbacks to stretching (Clinical Journal of Sport Medicine, May 2006). They felt that their personal experience and scientific evidence support their stretching practices.

Before you decide that scientific research is more correct than coaches’ opinions, realize that many athletic principles were used by coaches long before the scientific community showed evidence to support them. Runners have used interval training for more than 90 years and the first scientific evidence to explain its benefits was published just this year.

Muscles tear because the force on them is greater than their inherent strength, so injuries should be prevented by strengthening muscles, not by stretching them. There is data to show that stretching elongates muscles and tendons to allow a greater torque about a joint, which allows athletes to throw further, lift heavier, run faster, and jump higher. There is no good scientific data to show that stretching prevents injuries, but it may. Coaches and scientists do agree that you should not stretch cold muscles, so if you choose to stretch before your workout, warm up your muscles first.

Friday, August 04, 2006

Does exercise strengthen bones?

When you strengthen your muscles, you also strengthen your bones. If you’re not exercising, regardless of your age, you are setting your bones up for osteoporosis. A study from Deakin University in Melbourne, Australia shows that lifetime sports and leisure activity participation is associated with greater bone size, quality and strength in older men. The older men who exercised regularly when they were younger have stronger, bigger and tougher bones that are harder to break. (Osteoporosis International, June 2006).

Weight-bearing exercise in early life helps strengthen bones for later life, and exercising to strengthen muscles also strengthens the bones on which these same muscles attach. Another study showed that professional tennis players’ bones in the arm that holds the racquet are much larger and stronger than the bones in the other arm. The arm bones are bigger, denser and stronger in athletes who whose activities involve upper body strength, such as rugby, rock climbing, kayaking, and weight lifting, while leg bone mineral density was highest in athletes whose activities included both running and strength training.

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Wednesday, August 02, 2006

Does lactic acid help or harm muscles?

You exercise so intensely that your muscles burn and you gasp for breath. Then you slow down for a minute or two, catch your breath, and then go very fast again. This training technique has been used in all endurance sports since the 1920's. Now George Brooks of the University of California at Berkeley has shown why interval training makes you a better athlete (American Journal of Physiology-Endocrinology and Metabolism, June 2006).

Inside each muscle cell are mitochondria, the little furnaces that burn fuel for energy. A major fuel for your muscles during exercise is the sugar, glucose. In a series of chemical reactions, glucose is broken down step by step, with each step releasing energy. When enough oxygen is available, the glucose releases all of its energy until only carbon dioxide and water remain; these are blown off through your lungs. However, if not enough oxygen is available, the chemical reactions stop at lactic acid which accumulates in the muscles and spills over into the bloodstream. Lactic acid makes muscles acidic and causes a burning feeling. This recent research shows that lactic acid is the most efficient source of energy for muscles. Anything that helps muscles to break down lactic acid faster will make you a better athlete because it will increase your endurance and allow you to move faster when you are tired.

Since lactic acid is burned for energy in the mitochondria, anything that enlarges the mitochondria builds a bigger furnace and helps to increase endurance. Lactic acid is carried from the cells into the mitochondria by special proteins called lactate transporter molecules, so anything that increases these molecules will build endurance. An enzyme called lactic acid dehydrogenase is needed to start the reaction, so anything that increases this enzyme will also help. Interval training does all three: it enlarges the furnace (mitochondria), increases lactic acid transporter molecules, and increases the amount of lactic acid dehydrogenase.

Tuesday, August 01, 2006

Does your heart get tired during exercise?

A healthy heart is so strong that it is almost never a cause of tiredness during exercise. Tiredness during exercise comes from your muscles. They run out of fuel or out of oxygen. Skeletal muscles use both fat and sugar for energy. When your muscles run out of their stored sugar supply, called glycogen, they cannot contract and function adequately. You feel tired, your muscles hurt and you have difficulty coordinating them. On the other hand, your heart muscle gets energy directly from fat and sugar in your blood and even from a breakdown product of metabolism called lactic acid. It is virtually impossible for the heart muscle to run out of fuel unless you are starving to death.

A healthy heart doesn't run out of oxygen either. Oxygen comes to the heart directly through arteries on its outside surface. If these arteries are not plugged up with plaques, they are large enough to supply all the oxygen that the heart can possibly need. However, fatty plaques in arteries can block the flow of blood. When the heart does not get enough blood, it will hurt and can start to beat irregularly. Exercise won't make a healthy heart hurt. If you develop chest pain during exercise, something is wrong and you need to check with a doctor immediately.