Tuesday, September 6, 2011

As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments

Alex di Suvero for The New York Times

Tina Basle is back running again, but she has lost speed and endurance after a hamstring tear that doctors were unable to heal.

Published: September 4, 2011

REPRINTS

Until she tore her hamstring a year and a half ago, Tina Basle ran marathons. Since then, she has been on a desperate search for a cure.

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The Athlete’s Pain

A Rush for Cures

Articles in this series will look at popular sports medicine procedures that remain unproven.

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Josh Cochran

It took her from doctor to doctor, cost her thousands of dollars and led her to try nearly everything sports medicine has to offer — an M.R.I. to show the extent of the injury, physical therapythat included ultrasound and laser therapy, strength training, an injection of platelet-rich plasma (or P.R.P.), a cortisone shot, another cortisone shot.

Finally, in February, she gave up.

“I decided this is never going to heal, so let’s get on with it,” she said.

And so Ms. Basle, a 44-year-old digital media consultant who lives in Manhattan, started running anyway. She has lost a lot of speed and endurance. And, she added, “the stupid hamstring is really no better.”

Medical experts say her tale of multiple futile treatments is all too familiar and points to growing problems in sports medicine, a medical subspecialty that has been experiencing explosive growth. Part of the field’s popularity, among patients and doctors alike, stems from the fact that celebrity athletes, desperate to get back to playing after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal.

But now researchers are questioning many of the procedures, including new ones that often have no rigorous studies to back them up. “Everyone wants to get into sports medicine,” said Dr. James Andrews, a sports medicine orthopedist in Gulf Breeze, Fla., and president-elect of the American Orthopaedic Society for Sports Medicine.

Doctors love the specialty and can join it with as little as a year of training after their residency, as compared with the more typical two to four years for other specialty training. They see a large group of patients eager for treatment, ranging from competitive athletes to casual exercisers to retirees spending their time on the golf course or tennis court.

The problem is that most sports injuries, including tears of the hamstring ligament like Ms. Basle’s, have no established treatments.

Of course, some remedies for certain injuries do work: putting a cast on a broken bone or operating to repair a torn Achilles tendon. But patients whose injuries have no effective treatment often do not know that medicine has nothing to offer. And many expect cures.

“They watch ‘Grey’s Anatomy’ and think we can do anything,” said Dr. Raymond Monto, a sports medicine orthopedist in West Tisbury, Mass. “And to a certain extent, we allow that.”

Added to that is the effect of sports stars and their doctors. Patients “see a high-profile athlete and say, ‘I want you to do it exactly the same way their doctor did it,’ ” said Dr. Edward McDevitt, an orthopedist in Arnold, Md., who specializes in sports medicine.

The result is therapies that are unproven, possibly worthless or even harmful. There is surgery, like a popular operation that shaves the hip bone to prevent arthritis, that may not work. There are treatments, like steroid injections for injured tendons or taping a sprained ankle, that can slow the healing process. And there are fads, like one of Ms. Basle’s treatments, P.R.P., that soar in popularity while experts debate whether they help.

All this leads Dr. Andrew Green, a shoulder orthopedist at Brown University, to ask, “Is sports medicine a science, something that really pays attention to evidence? Or is it a boutique industry where you have a product and sell it?”

“For a lot of people it is a boutique business,” he said. “But are you still a doctor if you do that?”

A Theory Becomes a Fad

If ever anyone wanted to know how untested sports medicine treatments come into use, they would need only look at platelet-rich plasma, medical experts say. They joke that it is the perfect example of what is a tried-and-true path to popularizing a new treatment. It is what Dr. John Bergfeld, an orthopedic sports medicine specialist at the Cleveland Clinic, calls the Orthopedic Triad: famous athlete, famous doctor, untested treatment.

While there are no official statistics on P.R.P. treatment, all agree that it has exploded on the scene, propelled by testimonials from celebrity athletes.

Part of its appeal was that it made sense. Blood contains platelets that secrete growth factors that, in turn, can help tissue heal. So if a patient’s own platelets are injected into the injury site, they might speed recovery. And since it is the patient’s own platelets, the treatment is unlikely to be harmful.

It is easy to extract platelets. A doctor spins a tube of a patient’s blood in a centrifuge and then removes the middle layer of cells. Those are the platelets.

Evolution in our bodies

A CONVERSATION WITH DANIEL LIEBERMAN

Born, and Evolved, to Run

By CLAUDIA DREIFUS

Published: August 22, 2011

REPRINTS

Among his academic peers, Daniel Lieberman, 47, is known as a “hoof and mouth” man.

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Bryce Vickmark for The New York Times

HOOF AND MOUTH MAN Daniel Lieberman studies how the human head and foot have evolved over the millenniums.

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That’s because Dr. Lieberman, an evolutionary biology professor atHarvard, spends his time studying how the human head and foot have evolved over the millenniums. In January, Harvard University Press published his treatise, “The Evolution of the Human Head.”

We spoke in a Cambridge hotel room for three hours last winter and then again on the telephone in June. An edited and condensed version of the two conversations follows.

Q. Why heads?

A. Our heads are what make our species interesting. If you were to meet a Neanderthal or a Homo erectus, you’d see that they are the same as us — except from the neck up. We’re different in our noses, ears, teeth, how we swallow and chew. When you think about what makes us human, it’s our big brains, complex thought and language. We speak with our heads, breathe and smell with our heads. So understanding how we got these heads is vital for knowing who we are and what we are doing on this planet.

Q. Are there any practical benefits to your research?

A. There are. A majority of the undergraduates who register for my evolutionary anatomy and physiology class here at Harvard are pre-medical students. Learning this will help them become better doctors. Many of the conditions they’ll be treating are rooted in the mismatch between the world we live in today and the Paleolithic bodies we’ve inherited.

For example, impacted wisdom teeth and malocclusions are very recent problems. They arise because we now process our food so much that we chew with little force. These interactions affect how our faces grow, which causes previously unknown dental problems. Hunter-gatherers — who live in ways similar to our ancestors — don’t have impacted wisdom teeth or cavities. There are many other conditions rooted in the mismatch — fallen arches, osteoporosis, cancer, myopia, diabetes and back trouble. So understanding evolutionary biology will definitely help my students when they become orthopedists, orthodontists and craniofacial surgeons.

Q. Your other specialty is the evolution of the foot. Why this emphasis on the farthest points of our bodies?

A. Actually, I’m interested in the entire body. However, I got into feet because of my interest in heads. Some years ago, I was doing an experiment where I put pigs on treadmills. The goal was to learn how running stressed the bones in the head. One day, a colleague, Dennis Bramble, walked into the lab, watched what was going on, and declared, “You know, that pig can’t hold its head still!”

This was my “eureka!” moment. I’d observed pigs on treadmills for hundreds of hours and had never thought about this. So Dennis and I started talking about how, when these pigs ran, their heads bobbed every which way and how running humans are really adept at stabilizing their heads. We realized that there were special features in the human neck that enable us to keep our heads still. That gives us an evolutionary advantage because it helps us avoid falls and injuries. And this seemed like evidence of natural selection in our ability to run, an important factor in how we became hunters rather than just foragers and got access to richer foods, which fueled the evolution of our big brains.

So I got interested in how we developed these stable heads. I’m a runner myself. It’s always interesting to study one’s passion. By 2004, we’d found enough evidence to publish a paper in Nature where we declared, “Humans were born to run.” We cited the many dozens of adaptations in the human body that had made us into superlative endurance runners, even compared to dogs and horses.

Before bows and arrows and before horses were tamed, we did “persistence hunting” where we ran kudu, wildebeest and zebra into exhaustion. These animals can’t pant when they gallop. They overheat. People would find a big animal and chase it till it collapsed. You need no technology to do this, just the ability to run long distances, which all of us have.

You can see proof of this capability every November when 45,000 people run for many hours through the streets of New York.

Q. People with bad backs often blame evolution for their pain. They say, “My back aches because man was not meant to walk on two feet.” Are they right?

A. If that were true, natural selection would have its toll and we’d be extinct. What is more likely is that many people sit in chairs all day, get no exercise, and thus have weak backs. We did not evolve to sit in chairs all day.

Q. In your lab, you study the phenomenon of barefoot running. How did that become part of your portfolio?

Exercise for healthy brain

July 27, 2011, 12:01 AM

How Exercise Can Keep the Brain Fit

By GRETCHEN REYNOLDS

Digital Vision/Getty Images

For those of us hoping to keep our brains fit and healthy well into middle age and beyond, the latest science offers some reassurance. Activity appears to be critical, though scientists have yet to prove that exercise can ward off serious problems like Alzheimer’s disease. But what about the more mundane, creeping memory loss that begins about the time our 30s recede, when car keys and people’s names evaporate? It’s not Alzheimer’s, but it’s worrying. Can activity ameliorate its slow advance — and maintain vocabulary retrieval skills, so that the word “ameliorate” leaps to mind when needed?

Obligingly, a number of important new studies have just been published that address those very questions. In perhaps the most encouraging of these, Canadian researchers measured the energy expenditure and cognitive functioning of a large group of elderly adults over the course of two to five years. Most of the volunteers did not exercise, per se, and almost none worked out vigorously. Their activities generally consisted of “walking around the block, cooking, gardening, cleaning and that sort of thing,” said Laura Middleton, an associate professor at the University of Waterloo in Ontario and lead author of the study, which was published last week in Archives of Internal Medicine.

But even so, the effects of this modest activity on the brain were remarkable, Dr. Middleton said. While the wholly sedentary volunteers, and there were many of these, scored significantly worse over the years on tests of cognitive function, the most active group showed little decline. About 90 percent of those with the greatest daily energy expenditure could think and remember just about as well, year after year.

“Our results indicate that vigorous exercise isn’t necessary” to protect your mind, Dr. Middleton said. “I think that’s exciting. It might inspire people who would be intimidated about the idea of quote-unquote exercising to just get up and move.”

The same message emerged from another study published last week in the same journal. In it, women, most in their 70s, with vascular disease or multiple risk factors for developing that condition completed cognitive tests and surveys of their activities over a period of five years. Again, they were not spry. There were no marathon runners among them. The most active walked. But there was “a decreasing rate of cognitive decline” among the active group, the authors wrote. Their ability to remember and think did still diminish, but not as rapidly as among the sedentary.

“If an inactive 70-year-old is heading toward dementia at 50 miles per hour, by the time she’s 75 or 76, she’s speeding there at 75 miles per hour,” said Jae H. Kang, an assistant professor of medicine at Brigham and Women’s Hospital at Harvard Medical School and senior author of the study. “But the active 76-year-olds in our study moved toward dementia at more like 50 miles per hour.” Walking and other light activity had bought them, essentially, five years of better brainpower.

“If we can push out the onset of dementia by 5, 10 or more years, that changes the dynamics of aging,” said Dr. Eric Larson, the vice president of research at Group Health Research Institute in Seattle and author of an editorial accompanying the two studies.

“None of us wants to lose our minds,” he said. So the growing body of science linking activity and improved mental functioning “is a wake-up call. We have to find ways to get everybody moving.”

Which makes one additional new study about exercise and the brain,published this month in Neurobiology of Aging, particularly appealing. For those among us, and they are many, who can’t get excited about going for walks or brisk gardening, scientists from the Aging, Mobility and Cognitive Neuroscience Laboratory at the University of British Columbia and other institutions have shown, for the first time, that light-duty weight training changes how well older women think and how blood flows within their brains. After 12 months of lifting weights twice a week, the women performed significantly better on tests of mental processing ability than a control group of women who completed a balance and toning program, while functional M.R.I. scans showed that portions of the brain that control such thinking were considerably more active in the weight trainers.

“We’re not trying to show that lifting weights is better than aerobic-style activity” for staving off cognitive decline, said Teresa Liu-Ambrose, an assistant professor at the university and study leader. “But it does appear to be a viable option, and if people enjoy it, as our participants did, and stick with it,” then more of us might be able, potentially, to ameliorate mental decline well into late life.

Thursday, July 21, 2011

About snacking

Here is an interesting article about snacking.

Eating Tips » 10 Ways To Snack Smarter

10 Ways To Snack Smarter

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10 Ways to Snack Smarter

Eating a snack or two between meals can curb hunger so that you don’t inhale the dining room table when you finally sit down to supper. Snacking can also help you get in all the nutrients you need. On the flipside, grazing all day—particularly on foods of little nutritional value—may result in eating too much and packing on extra pounds. The key is taking a smart approach to snacking.
Here are ten simple strategies to get you started.

Keep chewing. One study found that people who chewed almonds thoroughly (up to 40 chews) felt full longer than those who chewed the same amount of nuts fewer times.

Snack on citrus. Grapefruit’s “diet food” rep might be justified: one study found that when people simply ate grapefruit with each meal, they lost up to 3 1/2 pounds over three months. Grapefruit may help manage appetite by lowering insulin levels, say researchers.
Keep chickpeas in the pantry. They have a meaty texture and a nutty flavor along with plenty of satiating fiber and a little protein—perfect when you’re watching your weight.
Toss grapes in the freezer for an easy snack. Because they’re sweet and you savor them individually and slowly, you’ll get a lot of satisfaction for just a handful of calories.
Include a treat every day. Believe it or not, giving yourself little treats may be the secret to losing weight—for good. Aiming to be “too good” sets you up to fail. If you like a glass of wine with dinner, make room for it. Prefer dessert? Skip the drink and go for a low-calorie chocolate treat instead.
Snack (and multitask) mindfully. Munching mindlessly in front of the TV is a surefire way to gain unnecessary pounds—but that doesn’t mean you can never enjoy your favorite program over a bowl of freshly popped popcorn or (fill in your favorite snack). Instead of popping a big bag of microwave popcorn, for example, choose a “mini” 100-calorie bag. And be sure to account for those calories elsewhere in your day.
Use snacks to fill nutritional gaps. Use snacks to fill nutritional gaps. Make your snacks count. Choose those that provide calcium and fiber—two nutrients that people often skimp on. Two snacks to try: a cup of yogurt with a half-cup of whole-grain cereal mixed in, or a skim latte plus an apple.
Brown-bag your snack. Skip the vending machine and satisfy the afternoon “munchies” with a healthy snack you packed at home. You’ll save money and get a bigger bang for your nutritional buck. Try an ounce of almonds and an orange or a handful of pretzels with some hummus. Planning snacks that provide both carbohydrates and protein will help tide you over until dinner.
Choose your “midnight” snack wisely. If a good night’s sleep is what you crave, there may be a food combination to help. Specialists recommend a pre-slumber snack that’s rich in carbohydrates and contains a bit of protein; this combination is said to increase the tryptophan levels in the brain, causing you to sleep more soundly. Try low-fat yogurt with a sprinkle of granola, a small bowl of oatmeal or a sliced apple with a bit of peanut butter.
Don’t get tripped up by travel. However often you fly, prepare in advance so you’ll have healthy snacks to eat en route. For shorter flights, pack a quarter-cup of dried fruit, such as apricots, a handful of almonds and a few whole-wheat crackers as healthier alternatives to the salty snacks served in-flight. Sip plenty of water; low humidity and recirculating cabin air can be dehydrating.

Monday, March 28, 2011

Heathy breakfast

This is what Art and I have been eating for many years.

2 Tbsp granola
2 Tbsp oats
1 Tbsp pumpkin seeds
1 Tbsp sunflower seeds
2 Tbsp raisins
3 prunes
1 Tbsp almonds

Cook with 1 1/2 cup of water, bring to boil and serve. You may add banana and any kind of fruits.

HEALTH NEWS from consumer reports

A bowl of cereal a day keeps hypertension at bay

Mar 24, 2011 10:29 AM

Men who start the day with cereal are 19 percent less likely to have high blood pressure than people don't have cereal for breakfast, according to a study presented this week at an American Heart Association meeting in Atlanta. Those who have two to six servings a week are 11 percent less likely to have elevated levels. In either case, people who opt for high-fiber varieties fare even better.

The study hasn't yet been published in a peer-reviewed journal, but it is part of the respected Physicians' Health Study and included approximately 17 years of follow up with some 13,400 participants.

Our tests of high-fiber cereals, show they don't have to taste like cardboard. Costco's Kirkland Signature and Kashi GoLean both did well in our taste tests. Look for products with at least 3 grams of fiber and no more than 4 grams of sugar per serving.

This study also underscores the importance of breakfast, which has been linked to other health benefits as well, including a healthy weight, controlled cholesterol and triglyceride levels, and improved sensitivity to insulin.

See our tips for other ways to control your blood pressure and the heart tests you need and those you don't.

Study links cereal consumption to lower blood pressure. [American Heart Association]

Physicians' Health Study [Harvard Medical School]

—Nicole Sarrubbo

Monday, March 21, 2011

vitamin D

Dear Yoga students,

In a recent yoga class we had a discussion about vitamin D. Here is a note about the benefits of vitamin D from ConsumerReportsHealth.org. You may subscribe to these reports at http://blogs.consumerreports.org/health/2011/02/vitamin-d-recommendations-can-vitamin-d-supplements-prevent-respiratory-infections-.html?EXTKEY=NH13S00H.

Can vitamin D supplements prevent respiratory infections?

Vitamin D clearly helps build and maintain strong bones. And in recent years a number of articles have suggested, though not proved, that insufficient levels of the vitamin are also linked to everything from breast cancer and tuberculosis todepression and multiple sclerosis. Now a new study adds some more evidence for the vitamin’s role in preventing respiratory infections such as sinusitis and pneumonia to the list.

In the study, published this month in the Journal of Infectious Diseases, Finnish researchers divided a group of 164 young male military recruits into two groups. Half received a placebo and half got 400 international units (IU) of vitamin D. After six months, there was no difference between the groups in the percentage of people who reported symptoms, such as a cough, runny nose, or sore throat. But those who received the vitamin D supplement were significantly less likely to have missed duty because of respiratory infections than those who got a placebo.

Although more convincing studies are needed, what I found particularly interesting was the improved outcome with a fairly low dose of 400 IU a day. Last year, the Institute of Medicine raised the recommended levels of vitamin D to 600 IU a day for most adults and 800 a day for those 70 and older. Some experts recommend even higher amounts, up to 3,000 IU a day for people living in areas such as the Northeast, where people might not be able to make enough of the vitamin from exposure to ultraviolet light.

I would hesitate to recommend those higher doses, since the risks are still unclear, especially in patients with heart disease. Instead, I would stick with the new IOM guidelines. Of course, the best way to get vitamin D is through dietary sources, such as fortified milk and fatty fish such as salmon or sardines. Limited exposure to sunlight can also provide vitamin D, but talk with your doctor first, to assess your risk of skin cancer. Testing can make sense if you have symptoms your doctors suspects might be related to low levels of vitamin.

—Joseph Mosquera, M.D., is a board-certified physician also trained in integrative medicine, and a ConsumerReportsHealth.org adviser

Maggie at Yoga Plus