Monday, May 18, 2015

Paleo, Step Back for an Unbiased View; It's Over-hyped


Perhaps a smaller East coast bike manufacturer? Not much recoil I suspect.
____________________________________________________________________

FRANK & JOE
Two 70-year-old men had been friends all of their lives.When it was clear that Frank was dying, Joe visited him every day.
 One day Joe said, "Frank, we both loved playing golf all our lives, and we started playing soon after high school.
 Please do me one favor: when you get to heaven, somehow you must let me know if there's golf there."
 Frank looked up at Joe from his deathbed and said, "Joe, you've been my best friend for many years.
If it's at all possible, I'll do this favor for you."
 Shortly after that, Frank died.
 A few weeks later, Joe was awakened from a sound sleep by a blinding flash of white light and avoice calling out to him, "Joe, Joe ."
 "Who is it," asked Joe, sitting up suddenly. "Who is it?"
 "Joe -- it's me, Frank"
 "You're not Frank . Frank just died."
 "I'm telling you, it's me, Frank," insisted the voice.
 "Frank, Where are you?"
 "In heaven," replied Frank. "I have some really good news and a little bad news."
 "Tell me the good news first," said Joe.
 "The good news," Frank said with joy and enthusiasm, "is that there is golf in heaven. Better yet, all of our old buddies who died before me are here too. Even better than that, we're all young again.
Better still, it's always Summertime and it never rains.
 And best of all, we can play golf all we want, and we never get tired. " And we get to play with all the Greats of the past.
 "That's fantastic," said Joe "It's beyond my wildest dreams! So what's the bad news?"
 "You're in my foursome this Saturday."
_____________________________________________________________________________________ 
First, my bias...or lack thereof. 
I'm a physician who's been a triathlete for over thirty years or so, and have used exercise primarily as my vehicle for weight control.  Although I've never met triathlon and exercise writer Matt Fitzgerald, I believe his "center of the bell curve" proposals espoused in the the Racing Weight series of books.  Very little in the dietary milieu is off limits as we are encouraged to be what Fitzgerald calls "agnostic health eaters."  It makes reasonable sense to me.

Plus, after reading Inside the Box a history of fitness writer/long time triathlete T.J. Murphy's positive experience with CrossFit, I signed up for it and class is at 6:45 pm tonight. CrossFit and Paleo seem to be joined at the hip in many arenas.  That said, this piece from Dan Diamond of Forbes takes a somewhat less supportive view.

The Paleo Diet Is Overrated

One reason why CrossFit has been so successful: It promises more than just a workout.
It gives you a lifestyle.

In workouts, CrossFitters compete with and motivate each other. Out of their box — CrossFit’s term for a local gym — CrossFitters bond with and date each other.

“Perhaps more than disciples of any other type of exercise, people who participate in CrossFit can’t help being drawn to people who do the same,” Courtney Rubin wrote in the New York Times last year.

A key part of the CrossFit culture is built around how to eat right, too. “To keep their energy up, [CrossFitters are] encouraged to follow something called a Paleo diet: heavy on meat and vegetables – food fit for a caveman,” noted Sharyn Alfonsi on 60 MInutes.

Update: Some CrossFit athletes suggested that the Paleo diet is only loosely associated with CrossFit. However, here’s what CrossFit.com’s official page on nutrition info (and the training guide given to gym owners) recommends to athletes getting started with CrossFit:

“Search ‘Google’ for Paleolithic nutrition, or diet. The return is extensive, compelling, and fascinating. The Caveman model is perfectly consistent with the CrossFit prescription.”

Yes, the Paleo diet can help you quickly lose weight. Scientists like that it gets people to abandon processed foods like white bread and potato chips.  But blindly believing that the Paleo diet is the answer to our nutritional needs is, well, prehistoric.

“The Paleo diet not only misunderstands how our own species, the organisms inside our bodies and the animals and plants we eat have evolved over the last 10,000 years,” Ferris Jabr writes at Scientific American, “it also ignores much of the evidence about our ancestors’ health during their — often brief — individual life spans.”

For instance, some supporters of the Paleo diet claim that sticking to ancient-style foods will avoid modern-day health problems, like heart disease. But evidence suggests that many Paleolithic-era humans actually had heart disease too.  The Paleo diet also can be exceptionally restrictive; many adherents try to avoid dairy, beans, and other common foods, because ancient humans didn’t have access to them.

But scientists note that there was no one-size fits all diet in the Paleolithic era; our ancestors, living all over the world, subsisted on a wide range of flora and fauna. And given our evolving nutritional needs, human diets should evolve too, some say.  “We were designed, from an evolutionary perspective, to nourish ourselves and live long enough to reproduce and raise our young to the point where they could be self-sustaining, which, back in the day, would have been the teenage years,” Michael Zemel, chief scientific officer for the biotechnology company NuSirt Sciences, told Metro Pulse in 2013. “This notion of eating for what we were designed to do — our design is a moving target. The goal of science and medicine is to optimize what we do, including what we eat, to maximize our health span.”

In a U.S. News & World Report meta-review of 35 diets, the Paleo diet was ranked #34 — tied with the Dukan diet as the worst on the list. The magazine noted that it lacked sufficient nutrition, among other problems.

“There are no responsible studies to support the healthfulness of a modern Paleo diet,” Tufts University researcher Susan Roberts wrote to the New York Times last week.
____________________________________________

The point here is not to criticize but to question the foundation and teaching of anything you're told or encouraged to do.  Much of what sounds easy or of benefit is just the opposite.  Sort of like the rumors on the Internet recently of Crest 3D White brands of toothpaste that can embed plastic balls in users' gums or the rumor going around recently that tv personality Rosie O'Donnell got an ISIS tattoo in support of the Islamic State's "struggle against Western Imperialism."

If it sounds too good to be true...........


Always thank the volunteers!


Monday, May 11, 2015

Yes, Triathletes Can Do a Relay Across the Channel.


Triathletes ordinarily wouldn't consider something like this, or a RAAM, or hike the Grand Canyon but we do things like this all the time.  It's a relay across the Channel. 

Read this and see if you wouldn't like to put this on your resume.  It's pretty cool actually!
______________________________________________


England to France in 10 Hours 24 Minutes by John Shrum, M.D.


White Cliffs of Dover still visible in the first leg of the swim

Get Five of your friends and an escort boat, the rest is just details.  

I've done a number of triathlons, and the English Channel relay might still top Kona.  You only have to swim an hour at a time, speed is not mandatory, and just think how your log book entry would read!
____________________________________________

 On July 31, Shirley Loftus, Bob Lazarro, of the Terrapin Masters, my two older children, Mo, 19, and Joseph, 17, John Post and myself swam a relay across the Mecca of Open Water Swimming. The Straits of Dover, better known as the English Channel, confront one with staggering obstacles. In a given season, from late July to late September, the tides prevent at least 20 days from being possible for attempts at crossing. Storms and bad weather may knock out another 15 to 30 days, even when the neap tide is acceptable. The logistics, the cost, the time away from work once conquered, the swimmer(s) then get to face what we did – 21 miles through 57 degrees Fahrenheit water and 8 foot swells, along with a head dizzying stomach churning boat ride when not in the water.

The idea began during a half-baked conversation between myself and John Post at Sloan’s Restaurant during the late Fall of last year. I said I’d be interested, but actually thought it would be several years yet before I gradually got around to organizing such and expedition myself. But John Post is relentless, if nothing else. Shortly after the New Year he called one Sunday afternoon and queried, "What are you doing on July 29th, 1998? “I have a feeling you are going to tell me,” I replied.

 “You are going to swim a relay across the English Channel. We have Reg Brickell lined up as Dr. John Post our pilot from July 29 through August 2nd.” This sounded pretty serious, but I was still skeptical of luring four other swimmers into this possible misadventure. Well, my long time training partner, Shirley Loftus, was immediately aboard, and John had not trouble signing on Bob Lazarro, from Maryland, so now we were four. The four months passed and our numbers did not increase. One day I asked my 19 year old daughter, Mo, if she’d “like to go Europe.” Much to my pleasant surprise she was enthusiastic; one week later, to my utter astonishment, 17 year old Joseph said he’d like to join us!

 I still felt one dip in 60 degree Fahrenheit water would scrap the plan for my children and in early May the moment of truth arrived. Shirley had discovered an excellent training spot near her home in Afton, Lake Sherando, where we could swim without restriction until Memorial Day. The first day out was raw, misty and windy. The air was about 55 degrees and when I read the water temperature at 56 degrees, I turned to return to the car. “We’ve got get in,” Shirley informed me. I looked to Mo for some support, but she gestured, to my chagrin, sympathetically to Shirl. I would still be standing there on the beach had not the girls plunged in. We went 25 minutes and survived. We returned the next day with Joseph and I was sure he’d balk. Forty-five minutes later the four of us emerged from the bone chilling water and I realized I was in with some pretty tough customers. We were going to England.

 I felt like I was in pretty good company. Bo Lazzaro had completed the Boston Light Race in the past, a swim I feel is the toughest open water race in the United States. John Post and two Iron Man Triathlons and one Manhattan Swim Marathon to his credit. Shirl, of course, besides winning 12 national Open Water Championships and being named to this year’s All American All Star Team, is no less than a past World Open Water Champion. Mo had swim for the University of Virginia Women’s Team this past year, surviving my former teammate Mark Bernardino’s body crushing workouts for seven months. Joseph, who swam for CYAC and CHS, was the least experienced of our group, but he had one huge advantage. He is a seventeen year old male, and definitely the fastest pool swimmer of our group. We were a strong team, I felt, in spite of our wide range of ages.

 We arrived in London on the morning of July 27th after a six hour flight that seemed to race by for me. We drove to Dover and got settled at our quarters. Within several hours we were training in Dover Harbor, that alone an experience that was like a dream come true. I was actually in Dover, 4 training to swim the English Channel with my family and friends. The was around 59 degrees which we all seemed to cope with. Shirley’s discovery of Lake Sherando and her insistence that we get in, even at 56 degrees, was paying huge dividends.

 The next day we trained again and explored Dover and Folkestone, just five miles away. The big event of the day was the rendezvous with our boat pilot, the incomparable Reg Brickell, Jr. Reggie’s dad, who passed away seven years ago, had escorted Channel swimmers across the Strait’s for forty years. His swimmers included such notable as Abou Heif, the great Egyptian legend, Penny Lee Dean and Doc Councilman. Reg, Jr, who has now performed the same service for 28 years, and younger brother, Ray, have their own fishing business, so basically, the Channel is Reg’s backyard, front yard and living room. He is a Robin Williams look alike with a pirate’s ring through his right ear lobe. He has a quick laugh and an impish grin, but even in briefing us about our routine, demonstrated a very serious, experienced manner. We could not help but notice that on a day that we Virginians were bundled up in thick sweaters, overcoats and heavy sweatpants, he and Ray got off their boat, The Viking Princess, wearing blue jeans and tank tops.

 Reg was very clear. Call him at 6:15 p.m. each night and he’s tell us whether we were a “go” or not. “Yes, it was possible,” he explained, “five days could and go during our neap tide and bad weather in the Channel would prohibit an attempt.” That day was so lousy he speculated that the next day, Wednesday, would be no good. Several hours later, he confirmed his prediction, so we were one down and four days to go. The weather remained grey, cold and windy, but we entertained ourselves with a training swim and more exploration of the town. The English were fun, great conversationalists, and I believe we all felt more and more comfortable with everything except driving on the left side of the road in vehicles that had the steering wheel on the right side. It was always a hellish experience to drive anywhere. It was great to get to know Bob Lazarro and his wife Roberta. Bob was a wonderful traveling companion. He’s funny, amiable and a killer in workouts. I didn’t even try to keep up with him and Shirley as they plowed the frigid Dover Beach water at a blazing pace every morning we trained. Bob was a tremendously confidence-inspiring teammate. Wednesday night, Reg gave John Post the word, another poor day coming up; two down, three to go. The previous evening we met a Japanese team, two women and four men from Tokyo that had succeeded in their swim in 12 ½ hours. They said it was very cold and very rough.

 Shirley and John in 1988 

We were now resigned to the possibility that our opportunity to swim may come down to our last day. On Thursday, the 30th, we thought we’d take the Hovercraft across the Channel and visit Calais for several hours. The weather was so horrendous, white caps blanketing the water as far as we would see, that all boat traffic across the Straits was canceled. So there was little doubt in our thoughts that Friday, too, would prove to be unacceptable for a chance to cross, but our mood at dinner underwent an abrupt transformation when Dr. Post returned from the phone booth and informed us, “Reg says he’ll meet us at Folkstone harbor at 4:30 a.m.” Suddenly, things became very quiet.

 Everyone’s appetite suddenly diminished. My own mouth went dry, my heart rate skyrocketed. Having got all my gear back at our B&B, I slept like a rock…for about 90 minutes. The rest of the night, I lay in my bed in a cold sweat.

 We boarded The Viking Princess at 4:30 a.m. in Folkestone Harbor and began a 45 minute trip back to Dover, where we would actually start at Shakespeare Beach. The sun rises earlier in England and as we made our way down the coast a beautiful, orange sun illuminated the sky. It was 45 minutes that will forever remain in my memory, as I was apprehensive, exhilarated, joyous and terrified all at once.

 When The Viking Princess got as far as she could near Shakespeare Beach, our lead off swimmer, Shirley, was instructed to get on her cap and goggles and swim to the beach, walk “clear of water,” and await the takeoff signal from Brian, our official observer from the Channel Swim Association.

 5 As we all stood on the deck awaiting Shirley to get off her sweats, she suddenly realized that besides Mo, seven men were standing in a circle staring at her while she stripped down. She started to laugh and giggled that she had never had so much attention getting undressed. Her remark made us all more relaxed and then she even went so far as to twirl her shorts in the air. There were several encouraging yells of “Shake it, Shirl,” and with that, she donned her cap and goggles. She quickly entered the water and her powerful, flawless stroke, quickly reached Shakespeare Beach. She kicked off an old shoe John had given her for good luck and waved at us that she was ready for Brian’s signal. At that moment, 5:28 a.m., July 31st (1998), my heart was in my throat. The sunrise by now was gorgeous, I was on a boat with two of my children watching Shirl getting ready to begin our odyssey to France. It was a great moment.

 On Brian’s signal, she gave us another wave, and better yet, a smile. She jogged into the water and quickly began the swim. The waves were already very choppy and within minutes Bob was seasick. Reg assured us that as the ocean literally bounces off the Cliffs of Dover at that location, it would become smoother further out.

 Shirl continued to plow through the water but she bounced off very high swells. Brian, our observer, informed me the water temperature was 14 degrees Celsius, or about 57 degrees Fahrenheit, and I knew it would get colder in mid-channel. At 30 minutes we help up a chart signifying the time for Shirl and as she swam on, the sky grew lighter yet. It was going to be sunny; Reg was right, as always.

Joseph was our number two swimmer and as he stripped down, with virtually no attention compared to Shirley’s disrobing ceremony, my heart rate approached levels unparalleled. He has virtually no body far, and spite of his youth and testosterone levels, I was frightened for him. The swells which had subsided somewhat during Shirley’s second 30 minutes now seemed to be gaining again in height. On Brian’s signal, Joseph climbed down the ladder as the rules demand. Within moments Shirl was out, our first hour behind us. She joked about not getting very far, but already, England was several miles behind us. She had done remarkably well.

Joseph looked smooth and strong the whole hour while the rest of us were tossed about like rag dolls on the deck. By now, Bob was flat on his back, the misery of seasickness overcoming him. After Joseph got out, shivering uncontrollably, he tried to choke down some heated water. He immediately leaned over the edge of our craft and “blew chunks,” as he put it in a postcard he sent to a friend.

 So as I looked around and saw Shirl bundled up, trying to keep from being thrown overboard, Bob lying flat out, turning green, my son, Joseph spewing over the bow, my daughter, Mo, fighting swells in 57 degree water and John Post waiting nervously for his turn still 3 hours away, I couldn’t help by needle Joseph, “Are we having fun, yet?” He laughed and acknowledged the fix we had gotten ourselves into.

 Joseph was still shivering so violently after he was dressed, under blankets and a sleeping bag, that I finally just lay on top of him and tried to rub his arms and legs. I wondered if he’d ever warm up. I worried that Bob wouldn’t even be able to get into the water. Mo churned through her hour and as her final minutes zoomed by, Bob Lazarro arose from the dead. He simply willed himself from his queasiness and into the water where he took off with a fury. It was as courageous as anything I’ve ever seen in sports. Mo looked positively beatific when she climbed aboard with Brian and Reg’s help. “Good swim. Ow wuz it, luv?” Reg asked. “Better than being on the boat!” she laughed, drawing guffaws from the three Englishmen.

 As Bob blasted onward, my wooziness began to dissipate and my nerves began to roar. Shirl and I had been exchanging Dramamine (hers) for AntiVert (mine) for four hours, so I was having much less trouble with seasickness.

 Finally, my moment arrived. The water sucked the breath out of me, but my adrenalin was so high I could have swum through an iceberg. (Well, at least I would have tried.) Reg wanted us to stay on the left side of The Viking Princess, so the boat would break the power of the wind sweeping over us. I am so poor at breathing on my right side, however, I took Tarzan - head out of the water strokes – when I tried to swivel my head towards the boat. Thirty minutes seemed slow in arriving, but after that, my 55 minutes signal came quickly. It was at times like any other swim, just colder and rougher, but I did think to myself several times, “Come on France, please get closer.”

 6 At one hour I was out, grateful for my hand warmers and my heavy “dork sweater,” the kids called it. Shirl and Reg informed us we were at the halfway point while I was in the water. I suddenly realized that the coast of France was as visible as England, which was slowly shrinking out of sight.

 After 40 minutes, I had begun to warm up as Joseph and Bob had said I would, but I then noticed John Post was having a tough time of it. I don’t know what the water temperature was at that point, but I’m sure it was the coldest section we’d encounter. John struggled for about five minutes and suddenly got cranking again as we all shouted encouragement from the side. While he ground toward our destination during his last 10 minutes, I began to realize, “we are going to do it!”

 We cheered when he came aboard and Shirley, indomitable as usual, really poured it on toward France. As the coast became larger, the swells grew to 8-10 feet, tipping The Viking Princess over as far as it seemed she could without capsizing.

 We were all thrown about on deck more violently, at times sliding from one side to the other. Attempts to move about were clumsy and lurching. One didn’t descend the steps to the room below, but rather, one was simply thrown downstairs. Attempts to empty one’s bladder were ludicrous. There was so much rocking, I could not even start stand up when trying to relieve myself. I would have apologized to the girls for peeing on the rim of the toilet, but my aim was so errant I don’t think I hit anything, except the walls, floor and my own shoes. The loads of food we unwisely brought went uneaten, washed overboard, spilled out of cups and crushed by sliding swimmers. Appetites vanished for the day. John ate some gingersnaps and Shirl got down one Power Bar, I think. The Shrums and Bob ate a total of two chocolate chip cookies.

 Shirl, Joseph and Mo churned through rotations once again and with 3 miles to go, Bob Lazarro again overcame his discomfort to pull us to within 1 mile of France.

 The swells remained formidable but the water was warming up, possibly to a muggy 60 degrees Fahrenheit! When I hit the water, the adrenalin again swept me along. I don’t know if anyone noticed, but was hard to not swim and smile at the same time. As I closer, The Viking Princess stopped and Reg Brickell got into a skiff, The Amy, and rowed along side me until I could stand up. I was still 100 yards offshore and learned later my teammates were snickering at my awkward, clumsy attempts to walk rapidly in thigh deep water. I got from Ray an empty tennis can that I could fill with rocks and sand from the beach at Cape Gris Nez. Finally, on getting “clear of water” as Shirley had been required to do 10 hours, 24 minutes earlier at Shakespeare Beach, I kissed the sand, and then asked some French picnic-ers on the beach, “Ou est la France?” They laughed and said, “You must be an American.” We had done it. I couldn’t wait to get back to the boat.

 The trip back was wet and rough, but nothing could dampen our spirits over those three hours. I just floated three feet about the deck. We all just kept reliving the day, smiling and joking in spite of our fatigue. I was so proud of all of us.

 We chatted some more with Reg, Ray and Brian at their favorite pub in Folkestone when we got back, but soon we departed for a hot shower and dinner. The last words I heard from Reg were his congratulations to Mo, “Good swim, Luv.”

 We spent one more day in Dover, reviewing our swim over and over and sending postcards. We made a trip out into the English countryside to the Channel Swim Association Secretary-Treasurer’s house to pick up some booty and do some paperwork. We then had one full day in London to sightsee and finally headed home. I had mixed feelings, not wanting the trip to end, but looking forward to our returning to Virginia.

Of course, we’ve talked about little else since getting home. It’s interesting how the English Channel lures swimmers like the Odyssey’s sirens. Since returning, both Mo and Joseph have said to me, “you know, we need to do that again, we can break 10 hours.” Definitely.

 Shirley and Bob have mentioned the thought of trying solo to me. I learned the other day that the water in the Channel was up to 64 degrees. It would sure be an adventure.


Looks warmer than it is

Tuesday, May 5, 2015

Testosterone. Don't Believe What You Hear!


Image result for testosterone

Testosterone, Should You Have Yours Measured?  Seriously?

 
I've had some thoughts lately on whether or not we should be concerned about "low T" as the ads report. Or, more importantly can we improve our performance by "improving" our testosterone levels?

This is a summary based on current 2015 evidence based guidelines. 

  1. Testosterone should be measured in early morning hours. If it is less than 300, a repeat value should be obtained and might need to contain a measurement of bioavailable testosterone. Total testosterone is not the whole story – the biologically relevant unbound or “free “ testosterone is difficult to measure in modern assays and is affected by common conditions like obesity. Interpretation of levels is sometimes more complex than comparing them to the usual normal range. As important, is the number obtained significant?
  2. Testosterone normally declines in men over 60. It is controversial whether it is helpful to administer medication to raise levels in this age group.
  3. Low libido is an important symptom of low testosterone but has many other causes. Erectile dysfunction is often not solved by administering testosterone because it is often due to a separate problem with nerve or circulatory function independent of the testosterone level. No one should be put on testosterone to remedy fatigue alone. It works poorly and has too many side effects. Testosterone is useful for maintaining bone health and muscle strength in those with low levels, these problems typically occur after many months of substantially low testosterone levels.
  4. If low testosterone is confirmed, an evaluation for cause should be considered. A common cause of low testosterone is obesity. Where possible, the cause should be treated instead of administering testosterone so that the body’s own hormone level rises back to what is normal for that individual.
  5. Testosterone therapy has risks. If testosterone is to be prescribed, patients must be screened for high blood counts, prostate disease, sleep apnea and tendency to blood clots. Family history of prostate cancer is also important.
  6. Patients on testosterone therapy should have regular testing for prostate disease and high hematocrit levels (blood levels).
  7. At present, there are no recommended oral testosterone formulations.

If testosterone is given chronically and then withdrawn, it requires a long period of time to withdraw and have the body’s own native production of the hormone “bounce back”. Time is determined by the type of preparation, the duration and dose. I've heard this is not a fun thing to do.


If you watch enough TV, the marketing guys are starting to get in your head.  You’re always looking for an edge, a way to perform better, perhaps both in the local 70.3 and maybe the bedroom.  Along comes the supplement industry. "Feeling Low? It might be low t."  Low what?  Where did this come from?  I searched for the term "low t" in two of my standard medical school texts, those 4" thick books you pay so much for, Pathologic Basis of Disease, 8th Ed., as well as my Textbook of Medical Physiology, 12th Ed., and didn't seem to be able to find the term.  Hmm.  And while there's a tremendous amount of information, as well as misinformation, out there that while I don't have time cover it all, let's see if we can't discuss indications for appropriate clinical use of this drug as I understand it in 2015.

  Triathletes are smart people.  But they're still people.  And if there's some kind of competitive advantage to be had by a pill or treatment, for athletic or personal gain, they're going to try it.  Heck, triathletes would put colored tape on their body or wear clothes to squeeze them if they thought it would help.  Oh, wait, they already do that.

Enter the supplement industry. Or would it be more accurate to label it the selling of dreams industry. You might note first off that trying to boost ones testosterone orally may not work as well as injections, gels or patches that provide more stable hormone levels. But according to the Mayo Clinic, it's unclear whether testosterone supplements can help otherwise healthy men. In fact, a study published in Nature Reviews Endocrinology found no scientific reason to prescribe testosterone to men over 65 with normal or low-to-normal testosterone levels.  Couple that with a study in the New England Journal of Medicine of men younger than 65 at risk for heart problems and heart-healthy older men which showed that both groups had a greater risk of heart attack when taking testosterone supplements.*

From Stephen Colbert -  Image result for colbert report low testosterone 
"A man on TV is selling me a miracle cure that will keep me young forever.  It’s called AndroGel and it’s for treating something called Low T, a pharmaceutical company-recognized condition affecting millions of men with low testosterone, previously known as getting older."

Finally, I've copied a couple Letters to the Editor that caps this discussion off nicely if one is considering evaluation and treatment.

"Much of the medical community finds fault with the seeming epidemic of men with low testosterone levels and the pharm company manufactured 'need for treatment of this condition'."

This ad campaign has been labeled as "a sophisticated effort to define low testosterone as a disease for which the treatment is [testosterone-replacement therapy.]
  • M.D.
  • Boulder, CO

I am positively exhausted from having to explain to my middle-age male patients that there is not a sudden epidemic of hypogonadism that they have been made aware of (and are suffering the symptoms of) by a benevolent pharmaceutical company ad. I have this conversation at a minimum of three times daily whereas, prior to last year, I had the conversation, maybe, three times a year. At least my anecdotal experience tells me that direct-to-consumer marketing is efficient use of Pharma dollars.
  • martyr
  • Upstate NY

Let's see - Viagra and Low-T supplements are covered by insurance - but the Congress is objecting to birth control being covered by insurance. The Low-T supplements only require a small co-pay (according to the article) but osteoporosis drugs, such as the one I take with proven medical benefit, has a high co-pay. To top it all off, women's health insurance costs more than men's - something is wrong with this picture....
  • ACW
  • New Jersey

As a woman, I have found, as most smart men and women have, that the most important sex organ is the one between the ears. A man who actually does have low testosterone due, say, to advancing age not only can continue to have a satisfying sex life, assuming the availability of partners and mutual affection, he may actually be a preferable lover, for reasons that need not be spelled out here but which will be clear to anyone who thinks about it.

Those ubiquitous ads for testosterone cream also list so many side effects (including, women should not come in contact with it)!
 I'm not sure I'd want to be intimate with a guy who was using it. I'd be scared of getting it on me.

Don't fix what ain't broke. Especially don't risk breaking it in the course of trying to soup it up.
  • JM
  • San Diego, CA


Really? Does anyone really believe this world needs more testosterone ? Humans need to get way better at managing the amount that's already floating around out there.


  *In the current issue of the Journal of the American Medical Association there's a research article about "Testosterone Therapy and Mortality, MI and Stroke".  In a study performed in veterans, testosterone was "associated with increased risk of mortality, MI, or ischemic stroke."  They also suggest further randomized trials to characterize the potential risks of testosterone therapy and I agree.  Whether these findings are applicable to every man who uses testosterone isn't known but it's a great big red flag that testosterone may be anything but risk free.

Image1, 2  Google Images
Partially reproduced from a piece I published on Slowtwitch
Summary from 2015 evidence based guidelines from Elizabeth Mason, MD

Friday, May 1, 2015

Road Rash - Best Care for Yours



Road Rash

"Ain't no doubt about it we were doubly blessed, 'cause we were barely 17 and barely dressed." Meat Loaf, Bat out of Hell

 Possibly without intending, Meat Loaf was describing the amount of protection one gets from cycling clothing when you hit the asphalt. Barely dressed. But, you look good doing it. Right?



 





This image was sent to me by a follower.  Glad it's not my elbow.  Bet you're glad it's not yours!  This is several days old, dry, quiet looking, but that hole on the right side could still be, as they say on TV, "A heap of trouble!" 

This injury is the result of a bike crash on to asphalt and I'll bet it hurt.   This was not done at the local Urgent Care but the local hospital operating room.  If, for no other reason, than to get the debris vigorously washed out of the wound.  The potential for infection is relatively high.  

Following your bike crash, you visit your friendly local emergency room where cultures are taken from the wound (put in a cotton tip, send it to the lab to see what unexpected bacteria can be found in what should be a sterile environment). Then you're introduced to the orthopedic surgeon on call, told that your next stop is the operating room...NO, you cannot go home to let the cat out or turn off the sprinkler because you're being prepped for immediate I&D, irrigation and debridement. You meet the holding area team, the anesthesiologist, the circulating nurse for the OR as she seats you in the center of the operating table, etc. You're surprised how cold the operating table is against your naked butt! Just the first of many unfamiliar sensations.

This is all a true story. This triathlete suffered a fairly involved injury, without broken bones, to her arm above the elbow and the above sequence occurred. This picture is her arm about a week out.  She's also under the care of an Infectious Disease specialist to help manage the antibiotics as appropriate to the organisms cultured at surgery. So what are the lessons that we take away from this? Well, it's hard for many of us to get through a full season without dumping our bikes at least once - or more.  If we're lucky it's just a skinned knee or lateral ankle that, with a minimum of local care, that heals uneventfully assuming an intact immune system. What about that dog bite? Or that more significant skin embarrassment with depth and significant bleeding?

On the road, as soon as possible following the crash (or animal bite), I'd suggest beginning by lavage (thorough wash out) of the area as best you can with the contents of your water bottle(s). I know a number of athletes who drink very little from their water bottles, particularly in cooler weather, and carry them for just such an emergency. You're prepared for a flat, loose spoke, broken chain, etc., why not be prepared for this is their motto. While you probably wouldn't use water from the creek, tap water from the nearest source, gas station, etc. to irrigate out any debris while still fresh helps a great deal. If there's any doubt, seek medical care. If the wound is over a joint or sizable, if it's at all deep, if you see a tendon, bone or joint, these are all reasons to proceed to the local medical facility right away. The longer you wait, the more time any foreign matter has to set up shop. You can also update your tetanus at that time. In fact, I know one athlete who called his docs office within minutes of an unprovoked dog bite, was told to "come now", which he did...still on his bike of course, and had the wound cleaned, tetanus administered, etc. in about an hour allowing him to finish his ride. Can't leave that calendar space white, even for a trip to the doctor, now can we? (See "Once a Runner,"  John L. Parker, Jr.)

For home care of road rash, shower, and although it may not be pleasant, use mild soap and a wash cloth to get all dirt and debris out of the skin or it will be a permanent tattoo.  Try to avoid any type of strong antiseptic as they frequently do more harm than good.  After you get the wound as dry as possible, apply a very light coating of antibiotic ointment and a sterile dry gauze type dressing.  If you use the non-stick type you will be rewarded for it later.  Keep the area clean and dry until it starts to show good signs of healing and change the dressing every couple of days.  If you have doubts anywhere in the process, get medical attention. Otherwise, happy riding.

Submitted by a Friend - Slow Food

Remember Slow Food?  (for our more seasoned racers)
Someone asked the other day, 'What was your favorite fast food when you were growing up?
We didn't have fast food when I was growing up, I informed him. All the food was slow.
C'mon, seriously. Where did you eat?
It was a place called 'at home,' I explained.
Mom cooked every day and when Dad got home from work, we sat down together at the dining room table, and if I didn't like what she put on my plate I was allowed to sit there until I did like it.
By this time, the kid was laughing so hard I was afraid he was going to suffer serious internal damage, so I didn't tell him the part about how I had to have permission to leave the table.
But here are some other things I would have told him about my childhood if I figured his system could have handled it:
Some parents NEVER owned their own house, never wore Levis, never set foot on a golf course, never traveled out of the country or had a credit card.
In their later years they had something called a revolving charge card. The card was good only at Sears Roebuck. Or maybe it was Sears & Roebuck.
Either way, there is no Roebuck anymore. Maybe he died.
My parents never drove me to soccer practice. This was mostly because we never had heard of soccer.
I had a bicycle that weighed probably 50 pounds, and only had one speed, (slow).
Our first television was, of course, black and white, and the station went off the air at midnight, after playing the national anthem and a poem about God; it came back on the air at about 6 a.m. and there was usually a locally produced news and farm show on, featuring local people.


Tuesday, April 28, 2015

Too Many Supplements/Vitamins May Increase Your Cancer Risk



"One pill makes you larger and one pill makes you small. And the ones that mother gives you don't do anything at all."
                                                
                                                                                                         Jefferson Airplane

Image result for pills

Dr. Oz is Way Off Base*
"More than half of Dr. Oz's recommendations are contradicted or not supported by medical research, a new study says.
Dr. Mehmet Oz is an extremely popular talk show host who dispenses health advice to millions of viewers, but he's been widely criticized for recommending unproven treatments."
                                                                                      WebMD News from HealthDay
Triathlete Cancer Risk?

They say that one third, or more, of triathletes, feel that they need one type of supplement or another to (attempt to) improve their athletic performance.  But, while according to Paul Offit, MD, head of infectious diseases at Philadelphia Children's Hospital in Do You Believe in Magic? who makes the point that there's precious little scientific evidence that most of them do anything, some researchers are beginning to discover that some might do the exact opposite.  In fact, Tim Byers of the cancer center at the University of Colorado, notes that more and more research is pointing toward the fact that people who consumed, "more dietary supplements than needed tend to have a higher risk of developing cancer."

Previous small studies that may have shown a benefit from vitamins or OTC supplements have been reversed when the study group expanded to "thousands of patients for 10 years." Just as pointed out in Offit's text, Byers research team learned that the "supplements didn't benefit patients health when compared to placebo, and that some people actually got more cancer while on the vitamins." 

"In one example, a trial on beta-keratin supplements found that people taking more than the recommended dosage ended up with a 20 percent higher risk of developing lung cancer, as well as heart disease. Another trial on folic acid found that people who took it ultimately wound up with more polyps growing in their colons — these small clumps of cells lining the colon can sometimes become cancerous."

In other words, if you can't back up the claims on the bottle with science, not just some anecdotal stories..."After taking this pill, I could run faster than Roger Bannister.  For real!" don't put them in your body.
____________________________________

*Half of Dr. Oz's Advice Unproven or Wrong: Study


WebMD News from HealthDay
Dec. 19, 2014 -- More than half of Dr. Oz's recommendations are contradicted or not supported by medical research, a new study says.
Dr. Mehmet Oz is an extremely popular talk show host who dispenses health advice to millions of viewers, but he's been widely criticized for recommending unproven treatments.
For example, during an appearance before Congress in June, Sen. Claire McCaskill (D-Mo.) told Oz he gave people false hope and said his shows were a "recipe for disaster." And a study that Oz said showed the effectiveness of coffee bean weight-loss pills was retracted last month, the Washington Post reported.
"Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits," said the new study in the British Medical Journal.
The authors added that the "public should be skeptical about recommendations made on medical talk shows," the Post reported.