Richard G. Petty, MD

Resting Racehorses

Your humble reporter lives on a horse farm, and many of our equine friends compete on a regular basis, so we are always interested in anything to keep them fit, healthy and happy.

I was interested to see a report of some research done in Finland. The main carbohydrate store in muscle is called glycogen, and Seppo Hyyppä, from MTT Agrifood Research Finland, looked at the way in which muscle glycogen stores are rebuilt after exercise. This is an important question, and not only for horses: glycogen is the most important nutrient during exercise and if glycogen stores are depleted the horse breaks down the protein in its own muscles to provide energy. So if the horse is chronically over-exercised it can hurt him.

The two most important factors in rebuilding muscle glycogen were:

• Sufficient recovery time between intense training periods, and
• Hydration

Giving horses an isotonic glucose-electrolyte rehydration solution soon after exercise helps to overcome dehydration significantly better than providing them with plain water.

The research also showed that weighing the horse before and after exercise gave a reasonably accurate estimate of the rate at which glycogen was being replenished. If you don’t have a set of weighing scales handy, you can measure the horse’s chest circumference.

The research also confirmed what every horse owner knows: you can tell a lot by looking at a horse: his general alertness and, for example, suppleness and appetite, indicate that he is in good condition.

“A canter is the cure for every evil.”
--Benjamin Disraeli, 1st Earl of Beaconsfield (English Statesman, Novelist and, in 1868 and from 1874-1880, British Prime Minister, 1804-1881)

“A man on a horse is spiritually as well as physically bigger than a man on foot.”
--John Steinbeck (American Writer and, in 1962, Winner of the Nobel Prize in Literature, 1902-1968)

Stretching and Exercise

I think that most of us have been told that it is really important to stretch before we hit the gym, and do it again after we have finished. It is said to improve performance as well as reducing the risk of injury and post-exercise stiffness. It is one of those things that has just entered mass consciousness.

However a new study using the Cochrane database shows that stretching before or after exercise has little or no effect on muscle soreness between half a day and three days later.

Two researchers identified 10 relevant trials, each of which involved between 10 and 30 people. Nine of the studies had been carried out in laboratory situations and people stretched for everything from 40 seconds to 10 minutes.

The investigators used a 100-point scale to assess stiffness after exercise. The results showed that the effects of stretching were extremely small. Stretching reduced soreness by less than 1 point on the 100-point scale. The size of the effect was similar if stretching was performed before or after activity. 

The authors point out that there is still a need to see whether stretching can have an effect on people in the community who have reduced levels of flexibility.

“A great man can bend and stretch.”
--Chinese proverb

“The simple exercise of stretching helps to counter the congestions, compressions, and adhesions which obstruct the flow of the vital force through the spinal column with its sixty-two branching nerves and thus to regain energy. This truth of the need of spine-loosening movement is instinctively known by every dog and cat, every lion and tiger, for they apply it immediately after awakening from sleep. The back, the legs, and even paws are bent and stretched and even rolled by them in this natural exercise.”
--Paul Brunton (a.k.a. Raphael Hurst, English Philosopher, Traveler, Spiritual Teacher and Author, 1898-1981)

“Dachshunds are ideal dogs for small children, as they are already stretched and pulled to such a length that the child cannot do much harm one way or the other.”
--Robert Benchley (American Writer, Actor and Critic, 1899-1945)

Exercise May Be the Best Anti-inflammatory

It is almost twenty years since I was awarded my research doctorate and some of what I said at the time was controversial: I made a lot about the link between inflammation, diabetes mellitus and cardiovascular disease. Now we know more, and the link is a lot less controversial.

A number of studies have suggested that regular exercise reduces inflammation but it is still not clear whether there is a definite link. And if there is a link, how does it work? One candidate that we have discussed before has been a link between the autonomic nervous system – sympathetic and parasympathetic - and inflammation. When we exercise, the sympathetic nervous system increases our heart rate and improves lung function, while the parasympathetic system helps to slow things down as we stop exercising.

A recent study by kinesiology and community health researchers at the University of Illinois provides evidence that may help explain some of the underlying biological mechanisms that take place as the result of regular exercise. 

The objective of the research was to examine the independent effect of the “tone” in the parasympathetic nervous system by assessing heart rate recovery after exercise, and whether there was a link between heart rate recovery and circulating levels of C-reactive protein (CRP). CRP, which is mainly produced by the liver, circulates in the bloodstream and is a standard marker for inflammation in the body. We also know that CRP levels tend to rise as we get older, and it may one of the factors involved in the increasing rates of cardiovascular diseases, diabetes and Alzheimer’s disease as we age.

This was a cross-sectional study that focused on baseline test results from 132 sedentary, independently living individuals aged 60 to 83 (47 males; 85 females) who had been recruited to participate in the Immune Function Intervention Trial (ImFIT), a randomized longitudinal trial designed by Woods and funded by the National Institute on Aging to examine the relationship between exercise and immune function.

Participants included only individuals who did not take medications that included corticosteroids, which could interfere with immune measurements. Smokers and/or those with severe arthritis, a history of cancer or inflammatory disease, chronic obstructive pulmonary disorder, uncontrolled diabetes mellitus, congestive heart failure, recent illness or vaccination, or a positive stress test were excluded.

The physical fitness of subjects was assessed through a battery of tests that measured such variables as fatigue, blood pressure, oxygen intake and carbon dioxide elimination and heart-rate recovery in conjunction with exercise on a walking treadmill. Tests also were administered to determine the subjects' levels of physical activity, physical fitness, emotional stress and body composition, including bone density and body fat. Blood samples also were drawn to measure CRP levels.

The results were published in a recent issue of the Journal of the American Geriatrics Society.

It is important that they measured body fat. We know that increasing the amounts of intra-abdominal fat lead to an increase in inflammation: a fat tummy becomes a factory for inflammatory mediators.

The most interesting findings related to heart rate recovery following exercise.

The speed at which people were able to get back to their resting heart rate after a strenuous exercise test was inversely related to the levels of CRP. That means that individuals who had better parasympathetic tone had lower levels of inflammation.

And as any gym rat will tell you, one of the best-known ways improve parasympathetic tone is with aerobic exercise. When an unfit person exercises it can take a long time for his or her heart rate to come back to normal. As you get back into doing regular exercise, your resting pulse rate falls and so does the time that it takes for your heart rate to recover after exercise.

Since the study was cross-sectional, i.e. the researchers took a snapshot of the participants' reactions and measurements at a single, fixed point we cannot say anything about cause and effect relationships.

The research confirms the conclusions of previous research that has indicated that high body fat is related to high inflammation and high fitness to low inflammation, though the researchers did not parcel out total body and abdominal fat. But this new research also suggests that physical fitness may be associated with a decrease in inflammation that is independent of body fat, and that it may be mediated by the parasympathetic nervous system: high parasympathetic tone is related to low inflammation.

So the nervous system may be the key player linking fitness, fatness and inflammation.

If this is correct, exercise alone will likely not be the whole answer. We also need to address other factors that modulate the activity of the parasympathetic nervous system including:

• Physical, psychological and social stress
• Adequate good quality sleep
• Diet and nutrition: there may be foods that can increase stress on the autonomic nervous system
• Adequate hydration: dehydration can be a major stressor on the body
• Breathing: shallow breathing and hyperventilation are all known to stimulate the sympathetic nervous system and damp down the calming activities of the parasympathetic nervous system

Men, Exercise and Broken Bones

One of the problems that we all face as we get older is that unless we are careful, our bones can gradually become weaker. This is a particular problem in women, but a growing body of research indicates that men can run into trouble as well. At one end of the spectrum is “osteopenia:” a reduction in bone mineral density, and at the other end of the spectrum is full-blown osteoporosis.

The reason for taking the problem so seriously is that any degree of thinning of the bones can predispose us to so-called “osteoporotic fractures.” Sad to say, serious fractures are common among older people and can have devastating consequences, particularly if a hip is broken. Man people find it difficult to walk again. For years now we have recommended that women should take exercise to reduce the risk of thinning of their bones, particularly after menopause. But now research published in PLoS Medicine indicates that men who participate in sport or other vigorous activity may also reduce their risk of fractures.

Karl Michaelsson and colleagues at University Hospital, Uppsala, Sweden, report research in which over 2000 men who were initially studied in 1970-1973. The amount of physical activity that they took outside working hours was recorded, and then they were questioned again as they aged. Each of the surviving men was questioned again when they were aged 60, 70, 77, and 82. About half of the men were still alive at the end of the study, and the researchers recorded the number of fractures that the men had suffered during the 35 years of the study.

Based on the answers to the questions on physical activity at the start of the study, the researchers divided the men into three groups: those whose lifestyle was considered to be ''sedentary,'' those whose leisure activities included some walking and cycling and those who participated in sports for at least 3 hours a week. These were referred to as the low, medium, and high-activity groups. Over the 35 years, 428 men had at least one fracture and 134 broke a hip. However, there were significant differences between the groups. 20% of the low-activity men had fractures, compared with 13% of those with medium activity and only 8% of those in the high-activity group. Of greatest importance was that the chance of having a hip fracture – the worst type of broken bone in an older person - was dramatically reduced by increased activity.

The researchers conclude that taking exercise reduces the risk of osteoporotic fracture in men. Participating in sports seems to be particularly effective: they calculated that one-third of fractures could be prevented if men could be persuaded to take part in sports regularly.

There is also an excellent summary by Harri Sievänen and Pekka Kannus from Tampere in Finland. As always each entire article is available online.

And I am to get my running shoes this very instant…

Burning Fat And Carbs

I was just flipping through a few magazine articles about diet and exercise and it amazed me how each writer was telling the reader that THIS was THE TRUTH about how to exercise and burn calories, and yet many contradicted each other.

This confusion and attempt to insert some order and certainty should not be too much of a surprise: there is still an enormous amount about metabolism that is simply not known. All of the articles were well written and well intentioned. Yet I am sure that many of the writers probably do not realize how much of what they are saying is guesswork!

The whole field of exercise and metabolism remains in a state of flux, though good progress is being made.

In a some new research from the Copenhagen Muscle Research Center at the University of Copenhagen in Denmark has been published in the Journal of Physiology, that helps us to understand a little more about the way in which muscles metabolize during exercise.

During exercise and physical activity, the primary fuels used by muscles are carbohydrate and fat. When you do mild exercise you tend to burn relatively more fat and less glucose. But as the exercise becomes more intense, a higher percentage of the energy demands of the muscles are supplied by glucose, until at the highest intensities almost only carbohydrates are used. One key question for any aspiring exerciser is how and why this happens? Is the shift in fuel source a property of the muscle itself, or does it represent the interplay between what is happening in the muscle and the exercise-related responses in the rest of the body.

The research looked at muscle fuel utilization in the quadriceps muscle during graded exercise done with only one leg. Nine healthy males did the one-leg exercise at 25, 45, and 85% of maximal workload. Their results showed that when only a small mass of muscle is contracting, the shift in fuel source from fat to glucose with increasing intensity does not happen. The explanation is that blood flow and oxygen supply are easily able to keep up with the demand.

The key to understanding the shifts in fuel source do not lie in the muscles at all, but in adaptations in the whole body during exercise. The oxidation of fat during exercise requires a fine interplay between the cardiovascular, neurological, endocrine and muscle metabolic systems.

The research also helps explain why athletes "hit the wall" during events like a marathon: the body can no longer switch fuels efficiently.

There are also some implications for the adaptations made in middle-aged adults who are using exercise to prevent or treat conditions like diabetes or obesity.

What we need to do is use slower training methods with good quality loose breathing to maximize oxygenation of the blood. This in turn allows fat oxidation to be maintained even during intense exercise with a large muscle mass.

And it looks as if we are heading back to the idea that cardiovascular work should be done before we start lifting.

Yoga and the Brain

Depression and anxiety are increasingly common throughout the world, and although each may be a consequence of psychological and environmental stresses, there is also a genetic predisposition and an increasing number of reproducible disturbances in the brain.

In recent years, there has been increasing interest in the role of brain gamma-aminobutyric acid (GABA) levels, which is the brain's primary inhibitory neurotransmitter, in both depression and anxiety, following the finding that each may be associated with low levels of GABA in different regions of the brain.

There have also been reports that yoga may help stress and anxiety as well as depression.

Now colleagues from Boston University School of Medicine (BUSM) and McLean Hospital have found that practicing hatha yoga may elevate brain GABA levels.

This new research is published in last month’s issue of Journal of Alternative and Complementary Medicine.

The researchers used magnetic resonance spectroscopic imaging to compare the GABA levels of eight subjects before and after one hour of yoga. The control group consisted of 11 people who read a book or magazine instead of doing yoga. They found a twenty-seven percent increase in GABA levels in the yoga practitioner group after their session, but no change in the comparison subject group after an hour spent reading.

It is too early to start recommending yoga for the treatment of depression or anxiety, but it is fascinating that it will produce changes in brain chemistry that are very similar to those that we hope to achieve with other forms of therapy.

Motivational Interviewing and Exercise

Researchers from Germany have re-visited the interesting topic of the association between aerobic exercise and psychiatric disorders, and presented their work in a poster (NR20) at the 2007 Annual Meeting of the American Psychiatric Association in San Diego, California, this morning.
There is good evidence that exercise can help people with depressive and some other psychiatric disorders. Unfortunately, like everyone else, people with psychiatric problems have trouble in developing regular exercise habits or staying with the program. The mood problem itself may stop them, or the physical pain that so often accompanies depression.

223 people were screened at the time of admission to hospital and 82 decided to participate. That is a disappointing but unsurprising rate of participation. The patients were offered a three-month running/walking program that they could continue after discharge. They all had weekly meetings that included exercise-related psychoeducation, stretching and 40-50 minutes of aerobic exercise.

In addition the experimental group received brief interventions using motivational interviewing, a specific technique to foster changes in behavior. Motivational interviewing is a client-centered non-judgmental and non-confrontational appraoch to change that attempts to increase peoples' awareness of the potential problems caused, consequences experienced and risks faced as a result of the behavior in question. Alternatively, therapists help clients to try and envision a better future and to become increasingly motivated to achieve it. These strategies seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change.

In people who had the motivational interviewing, the completer rate was 78%, compared with 33% in the control group who just had the psychoeducation, stretching and exercise.

The patients’ initial self-assessments concerning the importance and efficacy of regular exercise for their individual recovery did not predict compliance.

This confirms that motivational interviewing is highly effect in helping people with mental illness initiate and continue with a regular exercise program.

This new research adds to a body of evidence that has shown that motivational interviewing can be helpful in the treatment of obesity, weight management in women with type 2 diabetes, exercise in women with fibromyalgia, quality of life in people with chronic heart failure and physical exercise in long-term cancer survivors.

It may also be very helpful in people who need to exercise yet have no psychiatric problems: any of us!

Researchers from Germany have re-visited the interesting topic of the association between aerobic exercise and psychiatric disorders, and presented their work in a poster (NR20) at the 2007 Annual Meeting of the American Psychiatric Association in San Diego, California, this morning.
There is good evidence that exercise can help people with depressive and some other psychiatric disorders. Unfortunately, like everyone else, people with psychiatric problems have trouble in developing regular exercise habits or staying with the program. The mood problem itself may stop them, or the physical pain that so often accompanies depression.

223 people were screened at the time of admission to hospital and 82 decided to participate. That is a disappointing but unsurprising rate of participation. The patients were offered a three-month running/walking program that they could continue after discharge. They all had weekly meetings that included exercise-related psychoeducation, stretching and 40-50 minutes of aerobic exercise.

In addition the experimental group received brief interventions using motivational interviewing, a specific technique to foster changes in behavior. Motivational interviewing is a client-centered non-judgmental and non-confrontational appraoch to change that attempts to increase peoples' awareness of the potential problems caused, consequences experienced and risks faced as a result of the behavior in question. Alternatively, therapists help clients to try and envision a better future and to become increasingly motivated to achieve it. These strategies seeks to help clients think differently about their behavior and ultimately to consider what might be gained through change.

In people who had the motivational interviewing, the completer rate was 78%, compared with 33% in the control group who just had the psychoeducation, stretching and exercise.

The patients’ initial self-assessments concerning the importance and efficacy of regular exercise for their individual recovery did not predict compliance.

This confirms that motivational interviewing is highly effect in helping people with mental illness initiate and continue with a regular exercise program.

This new research adds to a body of evidence that has shown that motivational interviewing can be helpful in the treatment of obesity, weight management in women with type 2 diabetes, exercise in women with fibromyalgia, quality of life in people with chronic heart failure and physical exercise in long-term cancer survivors.

It may also be very helpful in people who need to exercise yet have no psychiatric problems: any of us!

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 5. Exercise, Environment and Sleep

One of the most valuable things to do to help children or adults with ADHD is to help them to structure their time.

All the approaches that we have already discussed, from medications to diets, herbs and homeopathy are all tools designed to help people get to the point where they can create, accept and maintain more structure in their lives. Exercise, the environment and regular sleep are all essential contributors.

Exercise
Aerobic exercise may be particularly helpful for people who also have a mood disorder or anxiety probably by reducing inflammatory mediators in the blood.

There is a movement therapy called eurythmy that was developed by Rudolf Steiner. It is quite popular in central Europe, and there has been a report that it could help children with ADHD. 


Environment
There is evidence that children with ADHD do better if they are outside, and even being a green room seems to help them. 


There are plenty of anecdotes about children and some adults with ADHD improving if they have classical or New Age music in the background. Paradoxically some like and claim benefit from “heavy metal.” There is recent evidence from New Zealand indicating that music therapy may contribute to the reduction of a range of ADHD symptoms in adolescents, as it does in younger children. With the advent of the iPod, it is easy to make a playlist of music that helps attention and concentration.

The data on the effect of watching television, computer time or playing video games is a mixed bag. There are people who say that children under the age of three should not watch television at all, and the American Academy of Pediatrics recommends that children under the age of 2 years should watch no television, and that television time should be limited to less than 2 hours daily in older children. The research data has not produced a clear answer one way or the other. Some of the most recent research does suggest a link between the amount of time that children spend watching television and attention-deficit/hyperactivity disorder, but it remains unclear as to whether elevated levels of television viewing are the cause or result of ADHD symptoms. Other researchers have failed to find a connection. The best thing is to play safe and to keep television viewing to a minimum: there are so many other things for a child to be doing.
   
There have been questions about whether other environmental factors, particularly lead, mold and Candida could cause ADHD.

Lead toxicity is well-known to cause neurological problems, but studies of a link between lead levels and ADHD have usually failed to find a link, and in a study in which children with minimally elevated lead levels were given a drug – penicillamine - to remove lead, there was no change in ADHD rating scores. So it is unlikely that lead is a factor in most children.

Because of the high rates of allergies in people with ADHD, there have been attempts to see if mold or other environmental pollutants could be causing ADHD. So far the data has drawn a blank.

Another environmental factor that has been look at is the yeast Candida albicans. It can produce nasty infections in people with compromised immune systems. But in addition, some people have claimed that Candida infections can cause an array of medical problems, including ADHD-like symptoms. People who are thought to have Candida have been treated with diets as well as the antifungal agent nystatin, with mixed results. It would be good to do a formal study of Candida in ADHD and see if there is a link and if treatment helps. So far we just do not have one.

Sleep
Sleep disturbances are extremely common in ADHD. They often get better once an individual is treated, but it is still a good idea to practice good sleep hygiene.

1. Stress management
2. Exercise a couple of hours before retiring
3. Keeping mentally stimulated until it is time for bed
4. Though we want to have a regular bedtime and bedtime ritual, to begin with don't go to bed until you are tired
5. No caffeine, alcohol or nicotine after 6pm. (Preferably, of course, no nicotine ever!!) {Remember that many over the counter painkillers contain caffeine, as does chocolate}
6. Try to keep the bedroom atmosphere relaxing, and establish a sleep ritual
7. Keep the room quiet and dark
8. If you like aromatherapy, lavender and chamomile are usually best
9. If you cannot sleep, get up and do something relaxing: struggling to go to sleep is virtually impossible.
10. Do not have a television in the bedroom. Bedrooms should be reserved only for sleep in children and for one other activity in adults
11. Always get up at the same time in the morning, to try and re-set your brain, and as soon as you get up, be exposed to as much bright light as possible

Twelve Tips to Reduce Your Risk of Colorectal Cancer

Colon cancer, or, more accurately colorectal cancer, includes cancerous growths in the colon, rectum and appendix. It is the third most common form of cancer and the second leading cause of death among cancers in the Western world. Colorectal cancer surpasses breast and prostate cancers as a leading cause of cancer deaths in both men and women.

And the key point is that with early screening and a few simple dietary modifications, you can dramatically reduce your risk of getting it.

These are the 12 Tips to Slash Your Risk of Colorectal Cancer

1. Receive regular colorectal cancer screenings beginning at age 50 if you are at normal risk
2. If you are at higher risk due to a personal or family history of colorectal cancer, other cancers or inflammatory bowel disease have a discussion with your health care provider about screenings before age 50
3. Eat between 25 and 30 grams of fiber each day from fruits, vegetables, whole grain breads and cereals, nuts, and beans
4. Eat a low-fat diet: colorectal cancer has been associated with diets high in saturated fat, particularly fat from red meat
5. Eat foods with folate, such as leafy green vegetables
6. Try to drink at least 80 fluid ounces of pure water a day unless you have a medical reason for not doing so
   
7. Drink alcohol in moderation: 2 units of alcohol or less each day
8. If you smoke, here is another good reason for quitting. Alcohol and tobacco in combination are linked to colorectal cancer and other gastrointestinal cancers
9. Exercise for at least 20 minutes three to four days a week. Moderate exercise such as walking, gardening or climbing stairs may help reduce your risk
10. If you get any persistent symptoms such as blood in the stool, a change in bowel habits, weight loss, narrower-than-usual stools, abdominal pains or other gastrointestinal complaints, it is essential to report them to your health care provider
11. Maintain a healthy weight. Obesity may increase the risk of colorectal cancer
12. Maintain a good intake of calcium and vitamin D:  this combination has been shown to reduce the risk of colorectal cancer

For more information, I recommend visiting the Web site of the American Cancer Society.

I keep their details in the "Resources" section on the left hand side of this blog.

Deep Vein Thrombosis

I am sorry to hear that the United States Vice-President Dick Cheney has just developed a blood clot in his leg and is being treated with anticoagulants (blood-thinning medications) that he will need to be on for several months.

He experienced some discomfort in his lower left leg this morning, and the diagnosis of deep vein thrombosis was made.

Mr Cheney is now 66 years old and has a history of cardiac problems. He has suffered at least four  myocardial infarctions (heart attacks) and has a pacemaker.

He had quadruple bypass surgery in 1988 after his third heart attack.He also had an operation to remove blood clots around his knees in 2005.

Mr Cheney recently returned to Washington after long flights to Japan, Australia, Pakistan and Afghanistan.

As I discussed a few months ago deep vein thrombosis - often shortened to "DVT" - can be associated with long-distance flying because it leads to inactivity and dehydration. Not, as was formerly thought, low oxygen pressure.

Blood clots in the legs are not in themselves life-threatening but they can be dangerous if they become wedged in the lungs (pulmonary embolism) or other organs, which can in severe cases be fatal.

Although the venous and arterial sides of the circulation are often thought of as quite different, it is not that unusual for someone to have problems in both, either because of immobility, metabolic disturbances or low grade inflammation.

With Spring Break and early summer vacations coming up, please don't forget to keep moving when you are on planes, limit the alcohol and coffee cnsumption, and have plenty of water to drink.

Bon voyage!

Aging and Exercise

It is a common observation that it becomes more difficult to do a lot of exercise as we get older, and the biceps no longer bulge quite as much after an hour in the gym. We have to exercise harder to get the same results.

Metabolism slows down as well, and for years it has been assumed that those events are linked: we slow our metabolism and find exercise harder because we gradually lose muscle mass.

But new research shows that it isn’t quite so simple, and the results should encourage any of us over forty to stay in the gym.

A new study published in the journal Cell Metabolism will likely help our understanding of that difficulty, as well as unlocking another of the secrets of type 2 diabetes.

As we become older, we hide more fat in our muscles and livers, and this fat has been linked to the age-related rise in insulin resistance that may go on to cause type 2 diabetes and hypertension.

A research team from the Howard Hughes Medical Institute based at Yale University School of Medicine compared the skeletal muscle of rats aged three-month-old and two-year-olds.

They found that an enzyme called AMP-activated protein kinase (AMPK) slowed down its activity in the older animals. AMPK's role in skeletal muscle is to stimulate the body to burn off fat and to provide fuel for the cells. It does this by producing mitochondria – the power packs of the cell. So AMPK activity in our skeletal muscle does at least three things: it stimulates glucose uptake, increases fat oxidation and promotes the production of new mitochondria.

It has been known for some time that the skeletal muscles of marathon runners have a much greater mitochondrial content and a greater capacity to burn fat. This is probably linked to high levels of AMPK activity.

The animals were exposed to a chemicals that produce that produce acute or chronic stimulation of AMPK. They were also exercised and some were fed more food, each of which should stimulate the production of new mitochondria.

The researchers found that the older rats had lower AMPK activity than the younger animals. In addition, the muscle of young rats who did more exercise had double the normal AMPK activity while in older rats this effect was severely blunted.

The message is this: as we age it is not muscle mass but enzyme activity that falls first. We have to work harder when trying to maintain the same benefits from exercise as we did when we were young.

We know that loss of skeletal muscle mass and function as we age is a major problem that has a significant effect on quality of life of older people. If this study is confirmed in humans it would have enormous implications. In the older rats, the AMPK activity was almost gone, implying that no amount of exercise would bring those muscles back. But it would be good to know if we can work out some other methods for bringing those enzymes back to life.

Although the paper doesn’t mention it, there is also some evidence that AMPK activity may be important in controlling feeding behavior in the hypothalamus at the base of the brain and the “stress hormone” norepinephrine plays a critical role in the way in which exercise stimulates AMPK. As we get older we usually find that our tempers are less fiery and part of the reason for that is that we produce less norepinephrine.

Start exercising early in life, and never get out of the habit. For if you do, you might lose that AMPK activity forever.

“Wholesome physical exercise reconstitutes energy, stemming the aging process, making the body light and firm, while safeguarding against fatigue and inducing cheerfulness.”
--Sushruta Samhita (Indian Surgeon who wrote the book the Sushruta Samhita, c. 6th Century B.C.E.)

“Exercise is the chief source of improvement in our faculties.”
--Hugh Blair (Scottish Presbyterian Minister and Writer, 1718-1800)

“It is exercise alone that supports the spirits, and keeps the mind in vigor.”
Marcus Tullius Cicero (Roman Political Figure and Orator, c.106-43 B.C.E.)

Dexterity and Strategy

I am a great believer in trying to do new things to stimulate latent abilities in the brain: there is more and more evidence about how valuable that can be.

Here is a very simple little game that can provide you with an excellent neurological work out.

Do not try it for more than a minute or two, or you might get repetitive strain injury or a psychological meltdown!

Healthy Aging

I have talked about the small number of simple steps that can dramatically reduce your risk of getting congnitive decline as your get older and some new evidence to show the benefits of non-drug treatments for dementia. I am pleased to say that my conclusions have just been supported by an editorial in the Journal of the American Medical Association.

I would like to let you know about another great resource: the International Council on Active Aging (ICAA) which has produced a great package of action items that are all rooted in good quality scientific research. The list is very similar to the ones that I have created for you here, and are very precise.

1. Invest in good shoes and socks
2. Play games
3. Walk
4. Increases your physical activity
5. Do exercises to improve your balance
6. Get regular eye checks, not only for corrective lenses, but to be checked for early evidence of diabetes or high blood pressure
7. Seek out friends family and neighbors
8. Modify your diet toward a "Mediterranean" one
9. Laugh
10. Get enought sleep

Whatever your age, I urge you to spend a few minutes working on a simple plan that will fit your schedule: your mind and body, family and friends will thank you forever.

Reducing Your Cancer Risk

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
-- Thomas Alva Edison (American Inventor, 1847-1931)

I am sure that you will agree that prevention is better than cure. And this is a good time of the year to review where you are in your life and what you want or need to do for yourself and your loved ones.

According to a study reported in the Lancet in November 2005 more than one third of cancer deaths are attributable to nine modifiable risk factors.

To evaluate exposure to risk factors and relative risk by age, sex, and region, the investigators analyzed data from the Comparative Risk Assessment project and from new sources, and they applied population-attributable fractions for individual and multiple risk factors to site-specific cancer mortality provided by the World Health Organization.

Of the seven million deaths from cancer worldwide in 2001, approximately 2.43 million (35%) were attributable to nine potentially modifiable risk factors. Of these deaths, 0.76 million were in high-income and 1.67 million in low- and middle-income nations; 1.6 million were in men and 0.83 million deaths were in women.

Smoking, alcohol use, and low consumption of fruits and vegetables were the leading risk factors for death from cancer worldwide and in low- and middle-income countries. In low- and middle-income regions, Europe and Central Asia had the highest proportion (39%) of deaths from cancer attributable to the nine risk factors studied.

For women in low- and middle-income countries, sexual transmission of human papilloma virus (HPV) was also the leading risk factor for cervical cancer. Smoking, alcohol use, and overweight and obesity were the most important causes of cancer in high-income countries.

Between 1990 and 2001 mortality from cancer decreased by 17% in those aged 30 to 69 years and rose by 0.4% in those older than 70 years, according to the authors, but this decline was lower than the decline in mortality rates from cardiovascular disease for men and women. The decline in mortality in men was largely due to reduction in mortality from lung, prostate, and colorectal cancers, while in women, lung cancer increased in the 1990s, and death rates for breast and colorectal cancer decreased. An article published almost ten years ago in the journal Cancer Epidemiology, Biomarkers, and Prevention, it was estimated the worldwide attributable risk for cancer to infectious agents as 16%.

The nine factors were:

1. High body mass index
2. Low fruit and vegetable intake
3. Physical inactivity
4. Smoking
5. Alcohol abuse
6. Unsafe sex
7. Urban air pollution
8. Indoor use of solid fuels
9. Injections from healthcare settings contaminated with hepatitis B or C virus

This all makes good sense, but it is good to see high quality research in reputable journals confirming what we suspected. The research also gives us further compelling reasons for taking a good look at our lifestyles and hopefully the motivation to do something to improve them. And in the case of air pollution and injection of contaminated products, to be active in getting things cleaned up.

“Keep your own house and its surroundings pure and clean. This hygiene will keep you healthy and benefit your worldly life.”
-- Sathya Sai Baba (Indian Spiritual Teacher, c.1926-)

“Length of life does not depend so much on a good physical constitution as it does on the best use of the six non natural things, which if we rule aright, we shall live long and healthy lives: to divide the day properly between sleep and waking; to adjust our air to the needs of the body; to take more or less food and drink according to our age, our temperament and whether we live an active or inactive life; to take exercise or rest according to the quantity of food and whether we are lean or fat; to know ourselves and be able to rule our emotions and subject them to our reason.  Whoever handles these wisely will live long and seldom need a doctor.”
--Giorgio Bagliivi (Italian Physician, Pathologist, Researcher and Author of De Fibra Motrice, 1669-1707)

“The best doctor prevents illness, a mediocre one treats illnesses that are about to occur, and an unskilled one treats current illnesses.”
--Chinese Proverb

Exercise Beats "Dieting" in Managing Obesity

An important report was presented at the Scientific Meeting of the United Kingdom Society for Behavioural Medicine in Cambridge earlier this month.

A team of researchers from Leeds Metropolitan University and the University of Hull studied 62 women aged 24 to 55. They all had a Body Mass Index (BMI) over 30, which is classed as clinically obese. (Regular readers will know that most experts have moved away from using BMI to evaluate metabolic and cardiovascular risks).

The program encouraged women not to diet but to take part in exercise classes. They were required to do four hours a week of exercise, such as t'ai chi, aqua aerobics or circuit classes.  So it was not necessary to become a hard core exercise freak!

The researchers found significant improvements in health and mental well-being.

The women in the study were also taught about good eating habits, including how to read food labels and cook food, and they received social support and behavioral therapy to help them respond to body cues such as hunger and feeling full.

After a year, the women had only lost a little weight but were significantly fitter and happier with themselves. Their blood pressure, heart rate and cholesterol fell and respiratory fitness increased. And the women also felt better in terms of general well-being, body image, self-perception and stress.

This small, simple study re-emphasizes what we have said to tens of thousands of people: fad diets will only help in the short term. For all practical purposes you can eat what you want, but in moderation. But try gradually to change the composition of your diet. I have written some advice on doing that. In Healing, Meaning and Purpose we also provide a number of tactics to help you tackle some of the psychological and social hurdles that may stand in the way of weight management. Which include something not often discussed: the twelve ego-fears that can be the hidden drivers to a lot of our behavior.

Understand them and you can gain a remarkable degree of control of your thinking and your emotions.

And it is exercise that should be the centerpiece of a weight management strategy.

This was re-inforced by a study published last week in the Archives of Internal Medicine: people who lost weight by restricting calories lost bone mineral density. Those with exercise-induced weight loss did not.

And as you doubtless know, loss of bone mineral density is one of the key risk factors for osteoporosis.

So please don't buy in to some new "miracle" diets: they simply don't exist.

Instead:

• Gradually increase your level of exercise
• Slowly change the composition of your diet
• Keep your internal organs - especially your intestine - in balance
• Develop your food awareness (I am going to do a whole post/article about that!)
• Learn how to deal with the psychological, social subtle and spiritual aspects of suboptimal eating (Check out the reources that I have already provided + a new eBook in the New Year)
  

And before you know it, you will be exactly where you want to be.

Promise!

 

Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.”
--Plato (Athenian Philosopher, 428-348 B.C.E.)

“The way to cheerfulness is to keep our bodies in exercise and our minds at ease.”
--Sir Richard Steele (English Dramatist and Essayist, 1672-1729)

Multiple Sclerosis and Integrated Medicine

Although there are some fairly effective conventional therapies for multiple sclerosis (MS), many people with MS explore complementary and alternative medicine (CAM) therapies for their symptoms. The most effective strategies are to combine conventional and unorthodox treatments that address the physical, psychological, social, subtle and spiritual aspects of the illness. This combined approach also avoids the problem of people taking herbs or supplements that may either interact with each other or with conventional treatments.

It is also essential for us to get over the idea that MS is just something to be conquered. That may seem like an odd comment, but the language and the mindset of fighting, battles and warfare can be problematic. Let me explain something that I discuss at length in Healing, Meaning and Purpose.

There have been two distinct approaches to health in the Western medical tradition. The first is that the role of a physician is to treat diseases. That is the way that all my colleagues and I were trained. The second approach is to consider that health is the natural order of things. So in the first case we constantly hear the use of military metaphors: People speak of  “a war on cancer,” “killer cells,” “magic bullets,” and the need to adopt a “fighting spirit.” Sadly this aggressive attitude by the medical profession may be at odds with the wishes and needs of an individual, the family and the other people in a person’s life. We have to try to strike a balance between the whole instinct to fight and expressions of healing and acceptance.

In the second case, the philosophy is grounded in the idea that we need to work in harmony with nature. The maintenance of health and well being comes from reestablishing balance and harmony not just in ourselves but also in our relationships with each other, with society and with the entire environment around us.

Some of the most commonly CAM therapies include dietary modification, nutritional and herbal supplementation, and mind-body therapies. There has been a revival of interest among MS researchers about the therapeutic potential of low-fat diet and essential fatty acid supplementation in MS. The research on CAM therapies in MS is still exploratory, but considering peoples' interest and common use of these therapies, further research in this area is clearly warranted. Many sufferers show “spontaneous” recoveries, so reports of cures with unorthodox remedies are often treated with skepticism.

Diet, Vitamins and Supplements: There have been scattered reports of symptoms improving after the removal of dental amalgam, but there is scant evidence that this is really worthwhile. There is some evidence 1. 2. 3. 4. that polyunsaturated fatty acid (PUFA) supplementation may help MS. There used to be a lot of support for something called the “Swank diet,” but over the years the evidence has not been very good. In a small number of people with MS certain foods can make them worse. This is to expected if there is an autoimmune component to the illness. It is always a good idea to see if there is something that makes a person feel worse. The other important qestion is whether food additives may be causing symptoms. Although this must be uncommon, I have written elsewhere about occasional cases of MS symptoms with all the classical neurological, biochemical, radiological and electrical signs that have improved or become completely better after removing aspartame from the diet.

Physical exercise: Exercise is highly recommended for people with MS, though it is best to avoid it during an attack. There is evidence that over-exertion can actually bring on an attack. There is some literature about the use of Feldenkrais bodywork in MS, but a study from the University of North Carolina failed to find any benefit. T’ai Chi Ch’uan, qigong, yoga and graduated exercise have all been helpful to some people with MS, but it is essential to discuss it with a healthcare provider to see how any one of these fits in to an package of care. There is no published data on the use of Pilates in MS. At least not in any of the languages that I can read. But since it has been shown to improve posture and flexibility, it is logical to think that Pilates might be helpful, and it would be very valuable to see some research on it.

Acupuncture: Although widely used, the research on acupuncture in MS is not yet convincing. Like most acupuncturists I’ve had some good results in treating pain, muscle stiffness and fatigue. I’ve also seen people achieve some remarkable recoveries, but there are two issues: MS is a relapsing and remitting illness. And second, many of the people who did well only did so because they shifted their thinking: acupuncture became the vehicle for their personal transformation rather than a device for removing nasty symptoms.

Homeopathic remedies: Even the most enthusiastic homeopaths have fairly limited expectations of what homeopathy can achieve in MS.

From the point of view of homeopathy there is little point in making the diagnosis on multiple sclerosis because the disease has such a variable course with highly variable symptoms. To a homeopath the diagnosis is not useful: it is the symptoms that are all important. The homeopathic treatment of MS is highly individualized: one of the key items is the timing of symptoms and associated features. Some of the most common remedies for people with MS are:

• Agaricus
• Alumina
• Argentum Nitricum
• Arsenicum
• Aurum Metallicum
• Causticum
• Cocculus
• Conium Maculatum
• Ignatia
• Lachesis
• Nux Vomica
• Natrum Muriaticum
• Phosphorus
• Plumbum

This is not the whole list of homeopathic remedies that we have sometimes found helpful, but it highlights some of the more commonly used ones in people with the symptoms of MS.

Herbal remedies: Many herbal remedies have been tried in MS, and many experts have told me that they have had some good results. There is an important issue in MS called “apitherapy,” a.k.a. bee venom therapy (BVT). Several reports suggest that bee venom may be an effective treatment for patients with MS. But formal trials suggest that although the treatment appears relatively safe apart from itching and swelling of the skin, it does not seem to be helpful. 

The best approach is to embrace the best of what conventional medicine has to offer, combine unorthodox approaches and to realize that management of a chronic illness is not about dominating it but learning from it and learning strategies for peacefully co-existing with it.

Aerobic Exercise, Diet and Abdominal Fat

Most of us are probably aware of the difference between fat inside the abdomen – “intra-abdominal,” also called visceral fat – and fat on the hips or the outside of the abdomen. The fat inside the abdomen is associated with insulin resistance, diabetes and at least a dozen other medical problems. This fat is also covered in cortisol receptors and breaks down and reforms extremely rapidly. By contrast the fat on the outside of the body has relatively few metabolic consequences until the amount of it becomes extreme.

Excess fat in general is not a good idea, but it is the intra-abdominal fat that is the best target for treatment.

New research has shown that the addition of aerobic exercise to a standard dietary weight loss program can preferentially reduce abdominal fat in overweight people.

The investigators did a twenty week prospective study in which looked at 45 obese women with an average age of 58 years. During the study the participants bought their own breakfast in consultation with a dietitian, but had their lunch and dinner prepared by the kitchen staff of the hospital. They were either told to continue with their normal routine of daily activities, or to do low-intensity or high-intensity aerobic exercise. The investigators not only did all the standard measurement on their volunteers, they also did fat biopsies and measured the size of the fat cells.

They all lost weight, but in the people who did the high-intensity aerobic exercise, they also had a reduction in the size of the fat cells in subcutaneous tissue taken from the abdomen.

This is interesting, but it’s necessary to sound a note of caution about the experiment: the investigators were measuring subcutaneous fat cells rather than the all important intra-abdominal fat cells. The trouble with measuring those is simply getting at them. It is not easy trying to get fat out of the abdomen without some invasive procedures.

Exercise and Mood

Most people who exercise on a regular basis soon begin to notice that if they miss a day or two, it will quickly have an effect on their mood and motivation. There’s recently even been some research to confirm it. Many years ago it was shown that one of the mechanisms for the “Runner’s high,” was the production of endorphins and we now have a great deal of research that is revealing the fundamental mechanisms linking exercise and mood.

Though the link between exercise and mood has been recognized for decades, in the last few years we have seen an increasing body of evidence that exercise can have a useful effect on people with mood disorders. The evidence is extensive (For example: 1. 2. 3.) and is now so strong that many clinicians – and certainly all practitioners of Integrated Medicine – routinely recommend physical exercise as part of a package of health care. There is particularly good evidence that exercise will help with some of the less common types of depression. An exercise program may particularly benefit  women with progesterone-related premenstrual mood disturbances.

We now have some good evidence  about the mechanisms by which exercise can improve mood. Researchers in China did some experimental work in rats with what they called “Chronic unpredictable stress.” It is just what it sounds like. If the little critters keep getting stressed, they develop many of the signs of depression: they show loss of appetite, social withdrawal and a reduction in exploratory behavior. We could say that the repeated stress reduces their resilience. Chronic stress causes dysfunction in the hormonal system that links the hypothalamus and pituitary glands at the base of the brain, with the adrenal glands that are perched atop the kidneys.

The researchers then gave some of the rats the opportunity to exercise on a wheel. The exercising rats had an increase in the amount of a growth factor called brain-derived neurotrophic factor (BDNF) in a key region of the brain called the hippocampus. In the non-exercisers, the levels of the growth factor went down as they experienced more and more stress. Exercise also smoothed out stress-induced rises in the hormone cortisol.

This is particularly interesting because previous research had shown us that exercise can increase BDNF levels in the brains of stressed and unstressed animals. We also know that if an antidepressant is going to work, it has to be able to stimulate the production of BDNF in the hippocampus of the brain.

One thing that has not been much studied is the impact of exercise on sleep architecture. Most exercisers know that a good workout, run or hike can make you sleep like a log. And there is increasing evidence that correcting sleep disturbances can be a most effective way of improving mood. So much so that many of us now believe the sleep disturbances underlie many mood disorders, rather than sleep disturbances being symptoms of sleep disorder.

My conclusion from reading the literature and working with countless individuals is that unless there is a medical contraindication, a combination or weight training and aerobic exercise should be part of the treatment program for anyone with depression. The biggest problem is motivating someone with depression t do something like exercise. Sometimes it is necessary to wait until the primary treatment has taken hold. Though we have often had a great deal of success by using some of the motivational systems that I’ve described in Healing, Meaning and Purpose.

Breathing

“Without mastering breathing, nothing can be mastered.”
--George Gurdjieff (Armenian-born Adept, Teacher and Writer, c.1873-1949)

I strongly recommend breathing. It’s actually one of my favorite pastimes….

Of course breathing is all-important, but it is just as important to ensure that you are breathing in good quality air. Scattered throughout the world are weather fronts accompanied by hot dry winds of ill repute:

• The Santa Ana Winds of Southern California,
• The Mistral of France
• The Khamsin of North Africa
• The Foehn of Switzerland
• The Sharav in Israel
• The Chinook of Canada
• The Sirocco in parts of the Mediterranean
• The Xlokk of Malta
• The Zonda in Argentina
• The Halny of the Carpathian Mountains

These are just some of these winds, that have been known for centuries to precipitate a variety of symptoms in the exposed population, including depression, irritability, insomnia and headaches. The explanation of these effects is an increase in the number of positive ions in the atmosphere, which alter the amount of serotonin in some parts of the brain. I was consulted about an epidemic of headaches amongst people working in an electrically insulated room. It soon became clear that the setup had allowed an enormous concentration of positive ions, and once they installed a negative ionizer virtually all the headaches stopped. We believe that many of the beneficial effects of high altitudes or of being near waterfalls of fountains spring from the way in which they generate large numbers of negative ions.

Poor oxygenation of the lungs has been known for many years to be associated with disease. Pulmonary tuberculosis classically affects the upper lobes of the lung, where there is the poorest oxygenation, and it has been known for a century that people suffering from a blockage of the mitral valve of the heart, which leads to high blood pressure in the lungs, do not get tuberculosis in that part of the lungs.

Conscious control of the breath enables us to modulate the activity of the autonomic nervous system. Specific types of breathing can induce specific psychological and physical effects.

We usually breathe through one nostril at a time. Either the right or left nostril is dominant for anywhere from 45 minutes to two hours. You then switch sides. This is known as the nasal cycle, and is one of the faster circadian rhythms. The popular yogic practice of single nostril breathing is thought to feedback directly into the hypothalamus of the brain. You can learn to use this to your advantage. If you are right handed, if you direct your focus onto opening the right nostril, you may well find an increase in salivation, which is an aid to good digestion. A useful trick that we have used for many years is at bedtime to start by lying on your left side, which has the effect of opening the right nostril, and after ten minutes roll onto your right side for sleep. Again you reverse this if you are left hand dominant. It seems that this simple trick lowers your core temperature, which is one of the main determinants of sleep. There is some research that opening the right nostril increases body temperature, while opening the left has a calming effect. These techniques are often very helpful. Apart from these physical effects, using the breath is one of the quickest ways to learn to sense the subtle forces of the body.

You may already have some breathing practice that you like, and by all means continue using it. If you need a new one, the simplest that I have ever been taught, and that I have used with countless students and patients is this:
Count your breaths. Breathe deeply using your abdominal muscles, so that you are drawing more air into your lungs. Stop immediately if you feel faint or dizzy. As thoughts come up, keep concentrating on the incoming and outgoing breath. Gradually slow the breath, by extending the pause between the inhalation and exhalation.

I always make myself unpopular when I insist that people check with a healthcare provider before stating any exercise plan, including breathing. But I'm going to say it anyway. It just makes good sense!

“Controlled deep breathing helps the body to transform the air we breathe into energy. The stream of energized air produced by properly executed and controlled deep breathing produces a current of inner energy which radiates throughout the entire body and can be channeled to the body areas that need it the most, on demand. It can be used to fuel a specific physical effort, such as tennis or jogging. Or you can use this current of inner energy to relieve muscular tension throughout the body, revitalize a tired mind, or soothe localized aches and pains.”
--Nancy Zi (American-born Chinese Opera Singer, Voice Teacher and Qigong Expert)

DHEA: Hype, Hope and Disappointment

Dehydroepiandrosterone (DHEA) is a hormone that has attracted a lot of attention. It’s launched hundreds of websites, product lines and a few books and magazine articles. So what’s all the fuss about, and should we all be chomping down on DHEA tablets?

DHEA is manufactured at several sites in the body, but by far the most important is in one of the outer layers of the adrenal gland. Like all the steroid hormones it is made from cholesterol. It has various protective effects in the body, regulates some enzyme systems, can be converted to estrogen and under certain circumstances to testosterone. It has very weak androgen (male hormone) activity.

In cell culture it has a lot of other actions too, but it is always difficult to jump from effects seen using large doses in isolated cells, to giving advice on what supplements people should be taking.

There has been a lot of talk about the possibility that some people may, as a result of stress or toxins, suffer from exhaustion of the adrenal glands. There is a great long list of symptoms that may be caused by this so-called adrenal fatigue, deficiency or insufficiency: the terms are often – and incorrectly – used interchangeably. And therein lies the problem. It is such a long list that it is non-specific. It’s always a bit of a worry when someone tells me that dozens of different symptoms are all caused by one single biochemical problem. That just isn’t the way that the human body works.

I have seen and treated countless people with a condition known as Addison’s disease: true chronic adrenal insufficiency. It can be a very serious illness and it is quite different from the “adrenal fatigue” that people talk about in some popular books. People with chronic fatigue syndrome do have lower levels of activity in what is known as the hypothalamic-pituitary-adrenal axis, but it is not because the adrenal glands are not working properly, but because the hypothalamus in the brain is not doing it’s job properly. There’s also no proven link between “burnout” and adrenal function.

During my years as an endocrinologist and holistic physician, I’ve spent a great deal of time looking for adrenal fatigue in sick people and I’ve never found it. I’ve done all the tests recommended by proponents of adrenal fatigue and adrenal insufficiency and when we’ve done the tests properly, we’ve drawn a blank. There are a great many parallels between the adrenal insufficiency story, and the old - and discredited - myth about people becoming unwell because of a thyroid deficiency that cannot be picked up on standard thyroid function tests.

So can DHEA do you any good? Or can it be harmful? What exactly is the evidence?

1. There is a comprehensive study, called The Dehydroepiandrosterone And WellNess (DAWN) study that should give us some solid answers as to the risks and benefits of DHEA. I shall post details of the findings as they become available. But some things we know already:
2. DHEA has been touted as an anti-aging supplement. But in a two-year prospective study done in older people attending the Mayo Clinic in Rochester, Minnesota, neither DHEA nor low-dose testosterone replacement had physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life. Perhaps the people in the study didn’t get enough DHEA, but it doesn’t look that way. Instead it seems that just giving the supplement doesn’t seem to do very much. But there is increasing evidence that 50-100mg of DHEA each day will improve muscle strength and muscle mass in older people who are doing strength training. Once again, it does nothing in people who are not exercising. Sorry!
3. According to the results of a small placebo-controlled, randomized trial published in the Archives of General Psychiatry, DHEA can be effective for midlife-onset minor and major depression. The study was conducted the National Institute of Mental Health Midlife Outpatient Clinic. In the trial, 23 men and 23 women aged 45 to 65 years with midlife-onset major or minor depression were randomized to six weeks of DHEA therapy, 90 mg/day, for three weeks and 450 mg/day for three weeks or to six weeks of placebo followed by six weeks of the other treatment. The subjects did not receive any other antidepressant medications during the study. Both of the doses of DHEA helped improve depression: there was no advantage in going to a higher dose, and there was no difference in the treatment response of men and women. The trouble with this study was not just the small size and the short duration, but the DHEA was not compared against a standard antidepressant. So we are still in the dark as to how effective it really is. It’s nice that it’s better than placebo, but this is just the first step in a larger research program.
4. A study from Taiwan indicated that people with higher levels of DHEA sulfate had a lower overall mortality over a three-year period. That is interesting, but absolutely does NOT mean that artificially increasing our levels of DHEA with supplements will make us live forever: we don’t yet have that kind of magic bullet.
5. In mice, quite large amounts of DHEA have the effect of slightly reducing the normal increase in stiffness of the left ventricle that can happen as animals get older. We have no idea whether something similar might help in humans, and the amounts of DHEA involved may rule it out as a viable treatment in people.
6. 50mg/day improves subjective wellness in people who have no active pituitary gland. A rare condition, and we cannot use this evidence to advise healthy people about what to take.
7. Because DHEA is converted into estrogen and/or testosterone, it may have the potential to exacerbate or initiate hormone-responsive tumors. The evidence is not strong one way or the other, but it remains a worry. I don’t think that anyone recommends DHEA to people who have a personal or family history of breast or prostate cancer.

There is a BIG literature on DHEA. But my current conclusions from all this?

1. 50-100mg of DHEA is probably worth trying if you are over 50 years of age and doing regular exercise.
2. It may help a bit with mild depression.
3. It should not be used in people with a personal or family history of breast, prostate or any other type of hormone-sensitive cancer.

Tips for Trips

I’ve not written any new items for a couple of days while I was in England and out of range of anything resembling a decent Internet connection.

But a grand total of seventeen hours on planes made me think that it’s high time to tell you about some of my tips and techniques for dealing with the rigors of flying.

I’ve got so many of them that my tips will stretch over more than one article.

By now most people will have heard about the importance of:

1. Maintaining hydration: the low pressure and dry atmosphere on planes can quickly dehydrate us. I try to drink at least 20 fluid ounces every two hours that I’m in the air.
2. Avoid drinking alcohol and coffee.
3. Keep mobile. When it is safe to do so: walk up and down the aisle. Stretch your legs and arms and gently rotate your neck while sitting in you seat.

The most worrying things about flying is the risk of developing a Deep Vein Thrombosis (DVT).  This is an important topic: one in 2,000 long-distance passengers will suffer a blood clot, which can be fatal if the clot detaches and reaches the lungs: this is known as pulmonary embolism. DVTs are more likely to occur if there is a change in the rate of blood flow, the character of the blood of the normal functioning of the walls of the large veins. There are a number of well-recognized risk factors for the development of DVTs:

1. Obesity
2. Immobility
3. Oral contraceptives
4. Some cancers
5. Cigarette smoking

There is a great long list of potential causes, but our focus today is on factors that can increase your risk of developing a DVT if you fly.

DVTs have been recognized to occur not just in passengers on planes, but also in people at extremely high altitude.

For many years it has been assumed that the low pressure and the immobility together increase the risk of DVT. But new research from the Universities of Leicester and Aberdeen was published in the Journal of the American Medical Association in May.

In a study of 73 people, the researchers found that sitting for long periods was the main cause, and warned people about all forms of travel.

During the study, the volunteers spent eight hours sitting in chambers with reduced air pressure and oxygen. They were allowed to move around for a couple of minutes each hour. They were then also tested in a chamber without changes in the atmosphere. The idea was to simulate the conditions on a plane. Blood samples were taken before and after each "flight" to check for factors involved in blood clotting.

For all these factors, no significant differences were seen between blood samples taken from volunteers on a simulated flight or exposed to normal air pressure. So it is not the low air pressure and oxygen saturation that is to blame: it is the lack of movement.

It is also unlikely that the advice to take an aspirin before a flight is going to be much help.

During my travels I have seen people selling extracts of horse chestnut (Aesculus hippocastanum) to prevent DVTs. There is actually some research that horse chestnut can help with chronic venous insufficiency. But there is no credible evidence that taking a couple of horse chestnut capsules will prevent a DVT, or the less severe problem of ankle swelling. And horse chestnut is well known to have a number of side effects, so there doesn’t seem to be much point in taking it to prevent ankle swelling and DVTs when flying.

The smart move (ha!) is to do regular exercise during flight, and to avoid dehydration.

I’ll tell you some of my tips for turning flights into highly productive work time and how to avoid jet lag in other posts.

Yoga for Attention Deficit Disorder?

Apart from a sizeable number of pharmacological treatments coupled with psychological and family therapies, an enormous number of unorthodox treatments have been tried for attention deficit disorders and attention deficit hyperactivity disorders (ADD/ADHD). One of the best reviews was published in the Annals of the New York Academy of Sciences. I have the privilege of being a member of the Academy.

There have been some recent attempts to see if ADD/ADHD might be helped with yoga or meditation.

The first study came from Australia and was published in 2004. It was small: only eleven boys with ADHD were enrolled in a 20-session yoga class, but nonetheless, the results were encouraging. The yoga was done as an adjunct to conventional treatment with medications. The authors concluded that yoga increased concentration, promoted mental and physical discipline and induced confidence. The parents of the boys thought that the kids doing yoga were rather less hyperactive.

Another study has just been published from Heidelberg in Germany. The main paper is in German, but there is a short summary in English. This again was a pilot study, this time involving 19 children. These researchers felt that yoga practice, and in particular forward bends that improve breathing were the key to helping the children develop better concentration.

There is a nice summary of mainly peer-reviewed papers on research into yoga. This website doesn’t critically evaluate the research, but it’s a good starting point if you are interested in some of the research going on into the potential health benefits of yoga and some related practices.

Exercise Burn Out

When we think about burnout, most of us concentrate on the psychological, relational and subtle aspects of the problem. But it is really important to be aware that just about any activity that isn’t balanced and moderated can burn us out.

I have just read a very nice article about avoiding workout burnout. We have all known youngsters who have so over-indulged in something like chocolate cake that they have become sick. Despite Mae West assuring us that “Too much of a good thing can be wonderful,” even the most positive of activities can turn around and bite us if not done in moderation. How many of us have returned to the gym and behaved like a bull in a china shop. And paid for it for the next three days….

One thing to add to this nice article. If you do over do it in the gym, and your muscles feel as if you’ve just gone ten rounds with Mike Tyson, you can usually reduce the period of pain and stiffness with the supplement Methylsulfonylmethane (MSM). So long as you are not sensitive to it, three 500mg capsules can be very helpful.

“Temperate temperance is best; intemperate temperance injures the cause of temperance.”
--Mark Twain (a.k.a. Samuel Langhorne Clemens, American Humorist, Writer and Lecturer, 1835-1910)

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