By Gabe Mirkin MD

July 25, 2011

A study From Harvard School of Public Health shows that telling overweight people to “eat less and exercise more” rarely helps them lose weight (New England Journal of Medicine, June 23, 2011). That encourages them to eat any foods they want and, as they age, they continue to gain weight which is associated with increased risk for heart disease, diabetes, strokes, breast cancer, colon cancer, and premature death.

120,877 healthy, non-obese women and men were followed for 20 years. The study shows which foods and lifestyle factors should be avoided to prevent an average weight gain of almost 17 pounds in 20 years. If you eat the wrong foods, you can gain weight even if you exercise. Small changes in eating and exercising can prevent this weight gain. Those who were overweight at the start of the study gained the most weight over the study time.

Study surprises: Weight gain is not associated with eating yogurt, nuts, or peanut butter. Yogurt appears to contain bacteria that cause the body to produce hormones that make you less hungry. Nuts contain primarily monounsaturated fats that are not associated with increased risk for weight gain.

Foods that caused the most weight gain:
• French fries (2 lbs per four-year period)
• potato chips (1.69 lbs)
• potatoes (1.28 lbs)
• other forms of potatoes (0.57 lb)
• sugar-sweetened beverages (1 lb)
• red meats (0.95 lb)
• processed meats (0.93 lb)
• refined grains (0.39 lb)
• sweets and desserts (0.41 lb)
• other fried foods (0.32 lb)
• fruit juice (0.31 lb)
• butter (0.3 lb)

Foods that caused weight loss:
• vegetables (-0.22 lb per four-year period)
• whole grains (-0.37 lb)
• fruits (-0.49 lb)
• nuts (-0.57 lb)
• yogurt (-0.82 lb).

Lifestyle factors: In addition to diet, the study shows that you should exercise daily, sleep 6 to 8 hours a day, restrict television watching, avoid smoking and do not take more than one drink a day.

 

 

Can you predict which children are likely to excel in certain sports just by looking at them?

Yes! Those with the longest Achilles tendons in the back of the lower leg will probably be better long distance runners, while those with the shortest Achilles tendons will probably be the best body builders (Medicine & Science in Sports & Exercise, August 2011) .

Look at the ratio of the Achilles tendon to the large bulge above it which is the calf muscle group. If the Achilles tendon is more than half way up your leg, you have a long tendon and have an advantage in running long distances. If the calf muscle bulge goes down almost to your ankle, you have the potential to be a body builder. Body building contests require athletes to have very large muscles which are characterized by long muscles with shorter tendons.

When you run, you land on your foot and spring forward in the air to drive your body forward. When you land, the Achilles tendon stretches and stores up to 70 percent of the energy of the force of your foot hitting the ground. Then the tendon shortens to release this extra stored energy, to drive you forward. Those with the longest tendons store the most energy to drive you forward with greater force. The authors proved this by showing that people with longer Achilles tendons required less oxygen to drive them forward after their foot hits the ground. Lack of oxygen is the limiting factor to how fast you can run over long distances.

 

 

Why have I suffered sports injuries primarily in the winter and spring?

You could lack vitamin D. To meet your needs for that vitamin, you have to expose your skin to sunlight or take vitamin D pills. You cannot get enough vitamin D from foods.

NFL players with low vitamin D levels are at increased risk for muscle and tendon injuries (American Orthopaedic Society for Sports Medicine’s Annual Meeting in San Diego, July 11, 2011). The lower the level of vitamin D, the more likely the players were to be injured.

Vitamin D acts directly on specific receptors in muscles to make them stronger and prevent injury (Scandinavian Journal of Medicine & Science in Sports, April 2010). A review of several studies shows that giving vitamin D pills to athletes with normal blood levels may not strengthen muscles, but lack of vitamin D weakens muscles. Giving athletes who have a deficiency defined by blood levels of D3 below 25 nmol/L, strengthens their muscles (Osteoporosis International, October, 2010).

We have known for more than 50 years that taking large doses of male hormones can help athletes recover faster and grow stronger with significantly larger muscles. Recent research shows that male hormones (the anabolic steroid nandrolone decanoate) strengthens muscles by stimulating the vitamin D receptor in muscles (Annual Meeting of the Endocrine Society, June, 2011). Athletes with vitamin D3 levels below 75 nmol/L may need more sunlight or vitamin D pills.

 

 

Lifting Weights Makes Bones Stronger

By Gabe Mirkin, M.D., July 25, 2011  —   An interesting study from the University of British Columbia showed that lifting weights strengthens the bones of women in their late sixties. The women were asked to use several weight machines three times a week for one year. At the end of that year, the women gained a tremendous amount of muscle strength, and they also had denser bones.

If a woman lives long enough, she will certainly develop osteoporosis which can shorten her life. This study shows that it is never too late to strengthen bones. If she already has osteoporosis, her doctor may advise bone-strengthening drugs such as Fosamax or calcitonin. Whether or not she takes drugs or supplements, she should start an weight-lifting exercise program. Join a gym that has weight-training machines and pick six to ten of the machines. Do a set of eight movements in a row on the first machine, rest a few seconds and then do two more sets of eight. Do this on each of the machines. Repeat this routine two or three times a week. It’s never too late to start.

EC Rhodes, AD Martin, JE Taunton, M Donnelly, J Warren, J Elliot. Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. British Journal of Sports Medicine, 2000, Vol 34, Iss 1, pp 18-22.

 

 

Flat Feet are Good For You

By Gabe Mirkin, M.D., July 25, 2011People with flat feet usually can run fast and are less likely to become injured. During World War II, having flat feet would have kept you out of the army, but a study published in the Archives of Family Medicine shows that army recruits who have the flattest feet suffer the fewest injuries.

Healthy army recruits had their arches measured before they started 12 weeks of basic training. Those with the flattest feet had the fewest injuries. When you run, you land on the outside bottom of your feet and roll inward to absorb the hard shock of your foot striking the ground. Most people who have flat feet have normal arches. Their feet appear flat because they have flexible ankles that allow their feet to roll so far inward that their arches touch the ground, so you can’t see them. The more you roll in, the greater the shock absorption and protection from injury. People with flat feet also are often fast runners because rolling in allows their feet to press harder on the ground to force them forward with greater force.

 

 

How to Raise Good HDL Cholesterol

 

 

 

By Gabe Mirkin MD, July 25, 2011  —  If your good HDL cholesterol is below 35, you are at increased risk for heart attacks. You can reduce chances of suffering a heart attack by two percent for every mg/dl rise in HDL.

To raise HDL cholesterol, burn at least 1200 calories with exercise per week. Lose weight if you are overweight. For every pound of fat lost, expect a one percent rise in HDL (1).

Exercise before you eat fat. A study at the University of Missouri showed that exercising regularly before eating high-fat meals raises HDL cholesterol considerably (2). Exercise stimulates the fat-clearing enzyme, lipoprotein lipase, which drops triglycerides to produce more HDL cholesterol.

Don’t smoke. A study at Vanderbilt University showed that within just one week of quitting smoking, HDL levels increased by seven points.

Avoid refined carbohydrates — sugar, flour, white rice and milled corn. Foods that cause a spike in blood sugar drop your HDL cholesterol.

1)                       Peter Kokkinos, a clinical exercise physiologist at Georgetown University observed the effect in 3,000 men. Tom Thomas, at the U of Missouri. Checked 4/14/11

 

 

 

 

Glucosamine and Chondroitin Sulfate for Arthritic Pain

 

 

By Gabe Mirkin, M.D., July 25, 2011  —  One in 10 Americans suffers from osteo or degenerative arthritis, a disease in which the currently used medications, acetaminophen, aspirin and nonsteroidal antiinflammatory drugs, do not slow or reverse the progressive destruction of joints and no cause is known. Over the last decade, reports have shown that pills containing chondroitin sulfate and glucosamine, two components of cartilage, may help alleviate the pain. Three major reviews in the scientific literature claim that the three studies showing that glucosamine relieves pain were poorly designed and therefore cannot be offered as proof of benefit. On the other hand, six studies from Europe and another from the United States show that chondroitin sulfate does help to slow joint destruction and pain caused by osteoarthritis (journal references for these studies).

One study in Rheumatology showed that glucosamine is not more effective than a placebo in controlling arthritic pain (8).

Several studies show that glucosamine helps control pain, but it is very difficult to test the effect of any drug on pain because a very significant number of people will benefit just as much from placebos. The authors performed a double blind study over six months in which they gave either 1500 mg glucosamine or placebo pills daily to patients with arthritis. Neither the doctors nor the patients knew who received glucosamine. One out of three patients receiving glucosamine had excellent control of their pain. but one out of three people receiving placebos also had the same excellent response.

Another study in the British medical journal, Lancet, showed that glucosamine helps to retard the breakdown of cartilage. Up to then, studies showed only that glucosamine helps to relieve pain. People with arthritis received either 1500 mg of glucosamine or placebo. X rays of their knees showed that the placebo group lost more distance between the bones of their knees than the glucosamine group.

The ends of bones at the knee joint are covered with cartilage, so the greater the distance between the bones on X ray, the greater the amount of cartilage. There is a serious problem with the study. People with arthritis often cannot fully straighten their knees, so it is impossible to use distance between bones to determine how much cartilage is lost. For example, if a person bends his knees a little, he will have the bones closer together than when he holds his knees straight. That means that anything that blocks pain will allow person to straighten his knees and have a greater distance between the bones at the knee. You should get the same benefit from any pain medicine. Furthermore, the study was sponsored by Rotta Research Group, who could gain billions of dollars from sales promoted by this study.

An earlier editorial in Lancet raises questions about the safety of glucosamine (2). Most research shows that glucosamine can help to relieve some of the pain associated with arthritis (3), but does not help to prevent cartilaginous damage and has not been shown to heal broken cartilage. Therefore, it is no more effective in treating arthritis than aspirin, but costs more than aspirin, but less than most brand name arthritis pain drugs that your doctor prescribes.

Glucosamine helps form aggrecan, the part of cartilage that allows cartilage to swell and shrink, acting like a shock absorber to help protect your knees from the trauma of running and walking. Adding glucosamine to cartilaginous cells in a test tube causes them to increases production of aggrecan (4).

However, in light of this good news, you should know that glucosamine can block the effects of insulin, causing blood sugar levels to rise (5,6,7), increasing likelihood of suffering the side effects of diabetes in susceptible people.

1) Lancet, January 27, 2001

2 )Mark Adams: editorial The Lancet, July 31, 1999, 354(9176):353-354.

3) Muller-Fabbender et al. Glucosamine compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2:61-69.

4)Bassler et al. Stimulation of Proteoglycan production by glucosamine sulfate in chondrocytes isolated from human osteoarthritis articular cartilage in vitro. Osteoarthritis Cartilage. 1998;6:427-434.

5) Am J Physiol Cell Physiol 1996;270:C803-11.

6) Diabetes 1995;45:1003-10089.

7) Proc Assoc Am Phys 1998;110:422-432.

8) A randomized, double-blind, placebo-controlled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee. Rheumatology, 2002, Vol 41, Iss 3, pp 279-284. R Hughes, A Carr. Hughes R, Ashford & St Peters Hosp Trust, Dept Rheumatol, Guildford Rd, Surrey KY16 0PZ, ENGLAND

Source of all articles:  www.drmirkin.com