Download to - American Running Association

RUNNING & FITNEWS®
September/ October 2008 • Volume 26, Number 5
Obesity and Diet: Facts About Fructose
Over the past few years there has been growing concern in the media and among the health conscious
that fructose and high fructose corn syrup (HFCS) are contributing to America’s obesity problem in
ways above and beyond other sugars and nutrients.
A typical and recent study, which was reported by the health website Fountia as having been published
in the Journal of Nutrition, comes from the UT Southwestern Medical Center (UTSMC). The study
turned out to be unusually small, with just six subjects, and a search of the Journal of Nutrition did not
turn up the article, but rather a link to several International Food Information Council (IFIC) articles
with conclusions somewhat different from the study.
The IFIC, whose purpose is to collect reliable information on food safety and nutrition by working with
experts, and then to disseminate that information to health professionals, educators, and consumers, has
established partnerships with—among others—the American College of Sports Medicine, the American
Dietetic Association, the Consumer Federation of America, and the U.S. Department of Agriculture. It
turns out the organization has much to say about fructose and HFCS.
The Fountia piece on the UTSMC study, for its part, reported that body fat synthesis was measured
immediately after sweet drinks high in fructose were consumed, and that “the carbohydrates came into
the body as sugars, the liver took the molecules apart like tinker toys, and put them back together to
build fats. All this happened within four hours after the fructose drink. As a result, when the next meal
was eaten, the lunch fat was more likely to be stored than burned.”
For the particularly fat-conscious right on down to those simply striving for the best overall health, this
sounds scary indeed. So let’s look at what current science really knows about this confusing topic.
Types of Sugars
The food supply contains a variety of sugars called monosaccharides (single sugar units like fructose
and glucose) and disaccharides (two monosaccharides linked together). Glucose is the main source of
energy for the body because most complex sugars and carbohydrates break down into glucose during
digestion. Sucrose is a disaccharide that contains equal parts glucose and fructose. Known as table sugar,
sucrose is found naturally in sugar cane and sugar beets.
Fructose is a monosaccharide, or single sugar, that has the same chemical formula as glucose but a
different molecular structure. Sometimes called fruit sugar, fructose is found in fruit, some vegetables,
honey, and other plants. Fructose and other sugars are carbohydrates, an important source of energy for
the body.
Which foods and beverages contain fructose? Natural sources of fructose include fruits, some
vegetables, honey, sugar cane, and sugar beets. Because it is a component of sweeteners such as sucrose
and HFCS, fructose is present in variable amounts in a wide range of sweetened foods and beverages.
High Fructose Corn Syrup
In terms of sweetness, corn syrup (which is produced from corn starch) resides at one end of the
continuum, as it is almost completely made up of glucose. Sucrose is a 50%-glucose-50%-fructose
1
mixture, as is HFCS, roughly. As we shall see, this fact about HFCS is often overlooked or
misinterpreted.
On the complete other end of the sweetness continuum resides 100% fructose.
<Not Sweet——————————Sweet————————————Very Sweet>
Glucose (starch)
Corn Syrup
Sucrose (table sugar)
HFCS
Fructose
—
Another way of viewing this is:
HFCS
Sucrose
_______ = ________
Corn Syrup
Glucose
That is, high fructose corn syrup is to corn syrup, as sucrose is to glucose.
HFCS is a liquid sweetener used in the manufacture of foods and beverages. The most common form is
HFCS-55, which contains 55% fructose and 45% glucose. By comparison, sucrose contains 50%
fructose and 50% glucose. HFCS-55 and sucrose have similar sweetness intensity.
To put the issue into context, HFCS is high in fructose only compared to regular corn syrups, which do
not contain fructose (only glucose). The most commonly used types of HFCS contain both glucose and
fructose and thus are similar to sucrose and honey in their fructose and glucose content.
Does HFCS Metabolize Differently than Sucrose?
Sugar is digested to free both its fructose and glucose molecules. So in the intestine, sugar becomes 50%
fructose and 50% glucose. This is almost exactly the same as HFCS. The only real difference is the
HFCS does not need to be digested. It is basically pre-digested table sugar. Does this mean that HFCS
converts to fat quicker than sucrose, and is stored by the body as fat sooner? Not really.
When studies compare the fat-conversion of sugars, they compare fructose (or fructose-glucose mixtures
like HFCP and sucrose) to the way pure glucose is converted. Most scientists agree that the metabolic
effect of consuming fructose in natural foods—or HFCS in processed foods—isn’t much different from
consuming sucrose, since natural foods with the highest concentration of fructose, like apples, still don’t
contain much more than the fructose found in sucrose. Remember, sucrose is sugar, which is about half
fructose and half glucose (starch). HFCS is also about half fructose and half glucose, and so the
functional equivalent—in metabolic, caloric, and general health terms—as sucrose.
Even though commonly consumed sugars provide basically the same number of calories, they are
metabolized and used by the body in different ways. Glucose from dietary sources is digested, absorbed,
transported to the liver, and released into the general blood stream. Many tissues take up glucose from
the blood to use for energy; this process requires insulin. Fructose is predominantly metabolized in the
liver, but unlike glucose it does not require insulin to be used by the body.
It is worth limiting the amounts of sugar one consumes, insofar as one’s daily caloric intake should be
nutrient-based, with calories from non-nutrient-rich food products only acceptable to the extent one’s
physical activity levels allows for the burning of them (see the discussion of discretionary calories in
“For Weight Control, Energy Balance Still Works Best“).
2
Fat Metabolism in Perspective
Triglycerides are fats that occur in food and in the body. Both dietary fat and carbohydrates contribute to
the formation of triglycerides in the body but in different ways. Excess consumption of calories from
fats, proteins, or carbohydrates—including starches and sugars—promotes accumulation of body fat.
Research suggests that chronic elevation of triglycerides in the bloodstream may increase the risk for
insulin resistance and coronary heart disease.
Research in humans has shown inconsistent effects of sucrose and fructose on triglycerides in the
bloodstream. The variable effects may be related to factors such as the amount of fructose consumed,
body weight status, and also baseline blood triglyceride, insulin, and glucose levels. An elevation in
blood triglycerides has been seen mostly in sedentary overweight and obese subjects and with test diets
that are high in both fructose and total carbohydrate and low in dietary fiber and fat.
What of a Study’s Findings, Then?
In the UTSMC research, six healthy individuals went through three tests where they had to drink a fruit
drink mix. In one test, the breakfast drink was 100% glucose, similar to the liquid doctors give patients
to test for diabetes — the oral glucose tolerance test.
In the second test, they drank half glucose and half fructose, and in the third, they drank 25% glucose
and 75% fructose. The tests were random and blinded, and the subjects ate a regular lunch about four
hours later.
Remember, pure fructose is 100% fructose and 0% glucose. HFCS, on the other hand, refers to
sweeteners that contain a mixture of fructose and glucose. The most commonly used types of HFCS are
HFCS-55, which contains 55% fructose and 45% glucose; and HFCS-42, which contains 42% fructose
and 58% glucose. In comparison, sucrose—common table sugar—contains 50% glucose and 50%
fructose.
One problem, then, is that experimental studies use atypical sources and amounts of fructose. A few
studies in humans have used sucrose and/or HFCS-55 in experimental diets but most studies have used
pure fructose in the absence of glucose—and most studies have fed fructose (whether from pure
fructose, sucrose, or HFCS) at abnormally high levels compared to usual dietary intakes. Humans rarely
consume pure fructose in the absence of glucose—there are almost no sources of pure fructose in the
diet—but many human experiments have fed pure fructose at 17 to 30% of total calorie intake. Such
experimental conditions are completely irrelevant to the normal consumption of food and thus the results
of those studies are of very little value.
Though the UTSMC study found that the process by which sugars are converted into body fat “increased
significantly” when the mixture fed subjects was 50%-fructose-50%-glucose, this is as compared to
100% glucose, which is a fact that is already widely known about sucrose (the other 50%-fructose-50%glucose mixture). Framing fructose as a special, more dangerous case in the world of fat-synthesis and
storage, then, looks tougher and tougher to pull off.
The primary sources of fructose in the human diet are sucrose and HFCS—both of which contain a
mixture of fructose and glucose in approximately a 50:50 ratio. A diet containing 17 to 30% of total
calorie intake from fructose would equate to 34 to 60% of calories coming from sucrose and/or HFCS.
Such diets are highly unusual, to say the least.
The report on the study states, “Fructose given at breakfast also changed the way the body handled the
food eaten at lunch. After fructose consumption, the liver increased the storage of lunch fats that might
3
have been used for other purposes.” Again, there is nothing to suggest that this would be any different
from what we already know about, and expect from, sucrose.
Similarly, the somewhat founded claim that “[f]ructose converts to fats faster than other sugars” isn’t
really a practical measure of anything, because fructose percentages in foods are almost always about
equal to those found in table sugar, which we already know to use sparingly.
Conclusions
Does the evidence warrant the singular focus on the role of fructose—regardless of dietary source—in
the development of obesity and chronic disease risk? No. Apples contain a higher concentration of
fructose than table sugar, but the former has many nutrients, as well as high amounts of fiber, that make
it an excellent snack, while the latter has almost no nutritional value at all.
The widespread confusion over pure fructose, glucose, HFCS, and sucrose led the Agricultural Research
Service of the United States Department of Agriculture (USDA/ARS) and the International Life
Sciences Institute of North America (ILSI) to convene a roundtable of nutrition and health experts to
address the state of the science on dietary sweeteners containing fructose. Held in March this year in
Beltsville, Maryland, the workshop covered topics like the chemical composition, properties, and food
supply availability of dietary sweeteners that contain fructose; sources and amount of fructose in the
diet; how the body metabolizes fructose; and research on the physiological effects of dietary sweeteners
that contain fructose.
The workshop’s discussions suggest that consumers, nutrition communicators, and those who
recommend nutrition policy should be aware that HFCS is not the same as pure fructose but is
essentially the same as sugar (sucrose), and it is in turn very similar to sugar in its physiological effects.
The fact remains that Americans are eating too many calories for their activity level. We’re overeating
fat, protein, and all sugars.
Human studies that have directly compared sucrose and HFCS-55 show no meaningful differences in
ratings of hunger and fullness, fasting or post meal blood levels of glucose, insulin, triglycerides, or
leptin and ghrelin (hormones related to satiety) as would be expected based on the simple chemistry.
The American Medical Association (AMA) recently conducted a review of the literature and concluded
that because the composition of HFCS and sucrose are so similar, particularly with regard to absorption
by the body, it appears unlikely that HFCS contributes more to obesity or other conditions than does
sucrose.
As for evidence published in the peer-reviewed literature that directly links HFCS to overweight or
obesity, very little exists and what does exist is inconclusive. Studies that describe associations between
the availability of HFCS in the U.S. food supply and prevalence of overweight and obesity do not prove
cause and effect. Results from cross-sectional and longitudinal epidemiologic studies and randomized
clinical trials of soft drink intake (a proxy for HFCS) and weight status are mixed. Furthermore,
overweight and obesity worldwide are increasing even though HFCS is rarely used outside the U.S.
IFIC, Food Insight, “What Science Says about Fructose,” July/August 2008,
www.ific.org/foodinsight/2008/ja/fructosefi408.cfm; “High Fructose Corn Syrup: The Sweet Facts,”
July/August 2007, www.ific.org/foodinsight/2007/ja/sweetfactsfi407.cfm
Fountia, “How High Fructose Corn Syrup Makes you Gain Weight,” www.fountia.com/high-fructosegain-weight
4
American Society for Nutrition, www.nutrition.org
IFIC, Questions and Answers About Fructose, 2005, www.ific.org/publications/qa/fructoseqa.cfm
For Weight Control, Energy Balance Still Works Best
Dieters: with all the recent concerns about fructose, good vs. bad carbs, and even food-satiation-factors,
how do we construct a long-term diet plan that can shed those pounds even through the winter, with its
holiday traditions of sitting, eating, and drinking? With a little help from the scientific community, as
always (if ironically), it helps to simplify.
Fructose Revisited. The current Dietary Guidelines for Americans recommend “choosing and preparing
foods and beverages with little added sugars or caloric sweeteners.” Because fructose is a component of
most added sugars, moderating the amount of added sugars in the diet will automatically moderate
fructose intake. Added sugars do not include the fructose found naturally in fruits and vegetables, which
is covered under the consumption levels recommended by the Dietary Guidelines of 4½ cups per day: 2
cups of fruit, and 2½ cups of vegetables. All sugars, including fructose, can be included in a healthpromoting diet if eaten in moderation.
Not So Sweet. Try to choose and prepare foods with little added sugars or caloric sweeteners. The
primary concern is that diets high in added sugars tend to be higher in total calories and lower in
vitamins and minerals. However, according to the 2005 Dietary Guidelines for Americans,
“discretionary calories” can be consumed, which means some foods with sugar or high fructose corn
syrup (HFCS) can be eaten as part of a healthful diet. Discretionary calories are those that can be added
after all nutrient needs are met, as long as one stays within individual calorie needs. Depending on a
person’s body weight, caloric requirement, and physical activity, discretionary calories can be added.
Au Natural. Although little in the literature indicates that HFCS is any worse for you than sucrose,
there is enough debate to warrant avoiding the ingredient, particularly given that more sugar, in any
form, is not the answer to a healthy diet. And certainly it’s a good idea to limit processed foods for a
variety of reasons; popular foods that contain HFCS tend to be processed. Here are some ways around
consuming these foods:
1. Juice Cocktails: If a juice drink is not made with 100% juice, it generally contains a large amount of
HFCS, along with other artificial ingredients and flavors. Opt for buying drinks that are 100% pure
juice. Even better, eat the fruit. This will give you the fiber benefits as well.
2. Soda: Believe it or not, even sodas containing some juice have HFCS. Try mixing 100% juices with
seltzer for a sweeter, more natural alternative.
3. Breakfast Cereal: Even seemingly healthy breakfast cereals contain HFCS. Read nutrition labels
carefully when in doubt. Some good brands to try include Kashi and Nature's Path.
5
4. Yogurt: Often, HFCS is found in those that contain “fruit,” and other sweetened varieties. Opt for
plain varieties and mix fresh or frozen berries into them to add some natural sweetness. You'll also
benefit from the fiber.
In short, when possible, eat whole foods. If the food isn't processed, you’re taking the real shortcut—to
maximizing natural nutrients, fiber, and wellness that will last a lifetime.
IFIC, Food Insight, “High Fructose Corn Syrup: The Sweet Facts,” July/August 2007,
www.ific.org/foodinsight/2007/ja/sweetfactsfi407.cfm
IFIC, Questions and Answers About Fructose, 2005, www.ific.org/publications/qa/fructoseqa.cfm
American Society for Nutrition, www.nutrition.org
DOMS and What to do About it
Muscle discomfort, a decreased range of motion, and a loss of maximal strength—these are the bedrock
symptoms of Delayed Onset Muscle Soreness (DOMS). We’ve all felt these symptoms, but what do
they really mean, and what are the current best paths to alleviating them?
DOMS is an acute inflammatory condition that occurs in athletes most often at the onset of a regimen, as
in spring training. Muscle discomfort peaks sometimes as late as two days after exercise and is
characterized by a decrease in range of motion, shock attenuation, and peak torque. The causes include
inflammation and muscle tissue damage.
Though exercise is an effective analgesic in the short-term relief of DOMS, there may be an increased
risk of injury with a premature return to vigorous activity. And since the pain-alleviating effect of
exercise is temporary, there is currently a need for the discovery of treatments that restore maximal
muscle function and alleviate DOMS-associated discomfort. While several studies have looked at
various promising treatments for DOMS, at least four treatments have proved considerably less than
effective. Among the least advisable treatment options for DOMS are hyperbaric oxygen therapy, during
which oxygen is delivered at up to twice than normal atmospheric pressure, and bromelain, a substance
found in abundance in pineapple and long-implicated as a treatment for certain inflammatory conditions.
Omega-3 fatty acids have been shown to reduce joint tenderness in arthritic patients. They have also
demonstrated an ability to inhibit the release of pro-inflammatory cytokines during the early stages of
heart disease. As a third attempt at treating DOMS, however, researchers recorded no difference among
subjects who received fish oil supplements or a placebo, suggesting that the mechanism involved in
triggering DOMS may differ significantly from these conditions.
In a fourth study, 24 males were randomly assigned to receive either three doses of acetaminophen
(totaling 4000 mg), three doses of ibuprofen (totaling 1200 mg), or placebo capsules indistinguishable
from the other pills. DOMS was induced with eccentric knee contractions. The drug doses were
administered at the onset of the injury protocol, and then at six-hour intervals, with a fourth dose the
following morning. A muscle biopsy was taken five hours later to assess repair indicators like
inflammatory cell concentration and the presence of neutrophils.
Neutrophil concentrations were not significantly altered 24 hours after exercise, nor were inflammatory
cell levels affected by either treatment. Furthermore, both acetaminophen and ibuprofen reduced protein
synthesis, suggesting that these drugs may negatively regulate muscle growth after eccentric exercise.
6
The researchers conclude that maximal over-the-counter doses of ibuprofen or acetaminophen do not
show signs of aiding the muscle repair process 24 hours after inducing soreness, and may even diminish
muscle strength in the long run.
A fifth treatment, arnica, is a promising topical homeopathic medicine that is also sometimes ingested.
But while the herb seems to elicit positive anecdotal feedback, one London study found it to be
ineffective as an anti-inflammatory following long distance running. Over five hundred marathoners
were randomly assigned arnica or a placebo cream in a double-blind experiment monitoring their muscle
soreness every morning and evening for five days post-race. There was no distinguishable difference
among the 400 runners from whom results were obtained. Yet in an earlier study, Oslo Marathon
participants reported less stiffness with an oral regimen of five pills twice daily for five days, starting
two days prior to the event. This study, though double-blind, calls for a larger sample size since there
were only 36 runners total, half of which received a placebo.
Arnica, also known as leopard's bane, has traditionally found use as an anti-inflammatory in the
treatment of bruises, sprains, and rheumatism. It is believed that the substance helenalin found in the
flower heads of the plant stimulates phagocytosis, the process by which cells clear out waste and repair
tissue damage.
One seemingly effective treatment for DOMS is muscle massage. In one small study, 18 volunteers were
randomly assigned to a massage or control group; DOMS was induced with six sets of eccentric
contractions of the right hamstring. Two hours later, either 20 minutes of classical Swedish massage or a
"sham massage" were administered. Peak torque and mood were assessed four times up to 48 hours
post-exercise. Range of motion and intensity of soreness were assessed at 6, 24, and 48 hours.
Neutrophil count (the repair indicator) was assessed at 6 hours and again at 24. Intensity of soreness was
significantly lower in the massage group, at 48 hours post-exercise. Thus, though hamstring function
was not improved, massage remains a promising treatment for the pain associated with DOMS. The
mechanism for the improvement in soreness now needs to be identified.
Topical NSAIDs may be the most effective treatment for DOMS. In particular, transdermal ketoprofen
has performed well. One double-blind placebo-controlled examination of 32 males 18 to 35 years old
found that DOMS-inducing quadriceps exercises induced significantly lower levels of muscle soreness
on the legs immediately administered the topical ketoprofen versus the placebo cream. Between
ketoprofen users and those receiving the placebo, the difference was greatest in the right leg after 48
hours, with a mean DOMS reduction of 45%. Notably, systemic absorption of the topical NSAID was
minimal, and unlike some instances of oral NSAID use, no adverse reactions were recorded.
Clinical J. Sports Med., 2008, Vol. 18, No. 5, pp. 446-460
Sports Med., 2003, Vol. 33, No. 2, pp. 145-164
Br. J. Sports Med., 2003, Vol. 37, No. 1, pp. 72-75
Med. Sci. Sport Exerc., 2003, Vol. 35, No. 6, pp. 892-896
Periodizing Your Diet—The Preparation Period
Periodization is the training principle by which we build over time into an optimal state of readiness to
compete, and then cool down from it as the competitive season ends. Each cycle of training places
different demands on the body, and therefore calls for different dietary needs as well. In the last issue we
discussed the four mesocycles in the periodization of your training. They are: the Foundation period, the
7
Preparation period, the Specialization period, and the Transition period. We focused last time on the
dietary needs of the first mesocycle. Here we’ll look at the three-month Preparation period in detail.
Now that you’ve performed roughly four months of base-building by exercising moderately several
times a week, you’re ready to start intensifying your workouts a bit more. The main goal of the
Foundation period was to build up your oxygen efficiency and to increase the length of time you can
perform an activity before fatigue. Now it’s time to build upon the gains you’ve made in aerobic
conditioning and strength.
In the Preparation period, the ratios of carbohydrate, healthy fats, and protein remain unaltered. The
greater demands on your system merely call for more overall calories from each. Remember, you are
striving to attain a faster pace or greater power before your anaerobic system takes over. You will be
training now with an eye toward performing more quickly and with less recovery. But it’s worth
mentioning that most athletes will naturally eat more during this intensified training period, without
willfully trying to do so. It is a common pitfall to overeat; therefore you’re best off not considering the
added calories at all. Approximate three grams of carbohydrate per pound of body weight, and one-sixth
grams of protein. This is, for most people, a carbohydrate increase of only 60 to 90 grams per day.
The nutrient ratios in the Preparation period remain: 65% carbohydrate, 22% fat, and 13% protein. Let’s
look at the weeklong micro cycles to see how this diet stacks up against training load.
Athlete:
135-pound runner
Sample Training Week:
Sunday
Monday
Tuesday
Wednes
day
Thursda
y
Friday
Saturda
y
2 hours
long
slow
distance
Rest
45 min
moderate
running
60 min
running
(45 at
tempo
pace)
45 min
moderate
running
15 min
warmup; 6
strides; 5
x3
intervals;
5x3
cool
downs in
between;
15
minute
jog/cool
down
Rest
4 strides
4 strides
Sample Week of Meals:
8
SUNDAY
BREAKFAST
Toasted cinnamon/raisin bagel w/ jam; cup of honeydew melon; 6 oz. low-fat yogurt; cup green tea
SNACK
48 oz. sports drink; equal amount of water; 1 PowerGel; 1 energy bar
LUNCH
Tuna salad sandwich on whole grain bread; small baked potato; 1 pc. Fruit; water
SNACK
6 oz. yogurt; handful granola; 12 oz. fruit juice
DINNER
1/6 lb. pasta in olive oil w/ 3 oz. chicken breast; cup tomato soup; large handful whole grain crackers
SNACK
½ cup whole grain cereal; small handful almonds; ½ cup strawberries; ½ cup skim milk
MONDAY
BREAKFAST
Cup oatmeal, skim milk; 2 slices whole grain toast w/ jam; 1 pc. Fruit; 12 oz. juice
SNACK
Muffin w/ honey spread; cup mixed fruit
LUNCH
1/6 lb. spaghetti, sauce, broccoli, whole grain roll, 12 oz. juice
SNACK
Handful crackers, 2 TBSP peanut butter
DINNER
3 oz. grilled beef sirloin; medium baked potato w/ yogurt topping; 2 cups salad, low-fat dressing; 2
dinner rolls
TUESDAY
BREAKFAST
1.5 cups whole grain cereal, skim milk; oat muffin w/ 2 tsp. jam
SNACK
16 oz. sports drink; 16 oz. water; 1 PowerGel
LUNCH
Chicken salad sandwich, spinach on whole grain bread; ¼ cantaloupe; smoothie
SNACK
9
Cup of grapes
DINNER
1/6 lb. bow-tie pasta, eggplant, mushrooms, goat cheese; 2 slices garlic bread, 1.5 cups low-fat Caesar
salad, cup skim milk
SNACK
6 oz. yogurt w/ handful almonds; fruit cup
WEDNESDAY
BREAKFAST
smoothie
SNACK
2 TBSP peanut butter, 1 TBSP honey sandwich on whole grain bread
LUNCH
4-6 oz. honey mustard chicken; cup brown rice; ¾ cup corn; 8 oz. juice
SNACK
Energy bar; 30 oz. sports drink; water
DINNER
1/6 lb. pasta w/ artichoke and sun-dried tomatoes; 3 oz. boiled shrimp; 2 cups Greek salad w/ oil and
vinegar
SNACK
1 cup skim milk; 1 chocolate-covered graham cracker
THURSDAY
BREAKFAST
1 cup oatmeal w/ 1 cup blueberries; 12 oz. fruit juice
SNACK
Oat bran muffin; 1 pc. fruit
LUNCH
Chicken sandwich w/ American cheese; 1 cup boiled green soybeans; 1 pc. Fruit; can of cola
SNACK
Handful mixed nuts; 1 pc. Fruit; 1 PowerGel; 36 oz. sports drink; water
DINNER
Couscous w/ roasted vegetables; baked sweet potato (1 cup); 2 cups Greek salad; 12 oz. soy milk
SNACK
6 oz. yogurt; banana; cup of raspberries
10
FRIDAY
BREAKFAST
2 slices whole grain toast w/ jam; 1 cup cantaloupe; 12 oz. juice
SNACK
Multi-grain bagel; 6 oz. yogurt; ½ cup sliced peaches
LUNCH
Lentil soup w/ asparagus tips; 1 slice French bread; 2 cups salad w/ 2 TBSP low-fat dressing
SNACK
Handful whole wheat crackers; 12 oz. vegetable juice
DINNER
1/6 lb. Gnocchi w/ marinara sauce; 2 slices garlic bread
SNACK
16 oz. smoothie
SATURDAY
BREAKFAST
Smoothie; bagel w/ cream cheese
SNACK
32 oz. sports drink; water; energy bar
LUNCH
Black bean/roasted pepper burrito w/ black bean salsa; 1 cup brown rice; handful tortilla chips; 1 pc.
Fruit; water; cup green tea
SNACK
Oat bran muffin; large banana
DINNER
Broiled herb chicken; 1.5 cups rice pilaf; 1 cup mixed vegetables; 1.5 cups garden salad; whole grain
roll
SNACK
1 scoop ice cream
Average Daily Calories:
2,611
The Specialization period follows this three-month cycle. In the next issue, we’ll examine that training
phase, when competition hits and you are athletically at your most capable. The dietary needs at that
time will adjust to reflect even more specialized training and recovery.
Chris Carmichael’s Food for Fitness, 2004, G.P. Putnam’s Sons, New York, NY, 414 pp.
11
Fit While Flying
Many regular exercisers find it difficult to follow their normal exercise plan while traveling. We
change time zones, and we too often change comfort zones. Unfamiliar environments, tightly
scheduled conferences and business meetings, or lack of exercise equipment and even jet lag
may hamper the fitness enthusiast’s best intentions for staying fit while on the road. The
following strategies for fighting detraining during travel periods come from certified personal
trainer Kristal Richardson, a professional bodybuilder who spends a great deal of time on the
road. Whether you’re planning a business trip or gearing up to fly home for the holidays, these
tips can help keep you healthy both on the way to, and once you’ve arrived in, your new
environment.
Eat right, fly right. If you've worked hard to establish a good fitness routine, going on a trip doesn't
have to mean your healthy habits will be derailed. The first rule is, keep the water flowing to keep the
endorphins flowing. Drink a minimum of eight 8-ounce glasses of water each day. Airport food, sitting
on a plane, and jet lag all contribute to bloat. The best way to fight it is to stay hydrated.
Next, in trying to eat three meals a day, remember to maintain a balanced diet and eat plenty of fruits
and vegetables. If you're going to eat a high-fat meal, eat a smaller portion, or order an appetizer instead
of a main course. Split desserts with a friend.
On the plane and beyond, watch your alcohol intake. At high altitudes, alchol dehydrates you even
further. Stick to fruit juices and water in flight. Once you land, if you will be drinking alcohol at
business mixers, drink a lot of water between events. It’s easy to over consume in social settings with
strangers or at work functions where everyone is shy or nervous. Be sure to drink water or other nonalcoholic beverages in between those glasses of wine.
Pack snacks. One of the best ways to maintain your healthy diet is to take it with you! Bananas and
apples, yogurt, and protein bars make great, healthy snacks and also travel well. These are foods that can
not only accompany you on the plane, but even on the way to the boardroom or family sightseeing day
trip.
Stay flexible while you fly. Air travel may be fast and convenient, but for many of us, particularly
during the upcoming holidays, it can be uncomfortable and restrictive due to cramped cabins and
sardine-like seating. Passengers carry gifts in addition to their packed bags, or simply bring more
luggage for extended stays, leaving everyone less overhead space, and so ultimately less leg room. The
following tips can help you make the most of your next airplane trip by helping you stay flexible and fit
while you fly.
Deep breathing is an instant relaxer and can be done anywhere at any time. Try taking five deep,
cleansing breaths several times during your flight.
Relax your shoulders. As many long distances runners know, the internal reminder to relax the shoulders
during that marathon can often yield improved performance. Similarly, on a marathon flight, try bending
forward slightly with hands on knees and rolling your shoulders in a circular motion five or six times.
Repeat the roll in the opposite direction, then finish up by shrugging your shoulders up and down five
times.
12
Relax your back. While waiting for that restroom to free up, reach overhead holding your elbows, and
bend side to side. Repeat this five times in each direction.
Back in your seat, stretch your legs by alternately lifting your knees toward your chest and bringing your
body toward your knee to the count of eight. Finally, stretch and relax your feet by "drawing" the
alphabet with one foot then the other.
Improvising weights. Most hotels, resorts, and cruise lines have fitness rooms with free weights, but
when you don’t have time to hit the gym, there’s plenty of ways to get that workout in right in the
privacy of your own room. Fill up two 16-ounce water bottles to serve as one-pound dumbbells. Jumbosized shampoos and conditioners can weigh up to 3 pounds each – just make sure you have an equal
amount on both sides! Bring a resistance band in your bag. Most of them take up almost no room, and
resistance can be adjusted to meet your weight needs.
Cardio is where you find it. Getting your heart rate up for about 20 minutes four times a week can help
burn the extra calories from constantly eating out on vacation. Here are a few easy ways to spend 20
minutes of quality cardio.
If your hotel lacks a gym, try 20 minutes of continuous swimming in the pool. Even more convenient:
use the stairs. Ideally, you’d create a stair workout, spending 20 minutes going from top to bottom and
back. But even deciding to take the stairs once or twice a day instead of the elevator can help provide
that needed activity when your schedule keeps a full workout elusive. You can also skip the escalator in
the airport, and walk instead of glide on the people mover. Take a scenic stroll instead of using the bus
or subway. Walk as much as possible and not only will you shed unwanted pounds but you’ll keep your
fitness levels up so you don’t have to start from scratch when you get home.
BodyWell Nutrition, www.bodywellnutrition.com
Cranberries: A Natural Choice for Heart Health
Heart disease is the leading cause of death in America, beating out both cancer and stroke. The Centers
for Disease Control & Prevention reported over 652,000 heart disease deaths in 2005 (the last year for
which final, not provisional, data appears). Nearly 80.7 million people in the United States have one or
more forms of cardiovascular disease. Health care costs in the United States were estimated in 2006 to
be $400 billion in direct and indirect costs. The need to develop a multi-faceted approach to managing
this chronic condition is therefore growing. A recent report from Tufts University demonstrates that the
cranberry is emerging as part of an arsenal of healthy food options to reduce the risk of cardiovascular
disease.
In January the university conducted a review of existing research on cranberries, and found that they
contain a greater concentration of antioxidants than other fruits. The report finds that cranberries may
offer a range of benefits that work to promote cardiovascular health. For example, cranberries were
found in some studies to contain more health-protective procyanidins than those found in red wine.
Several studies found that cranberry juice increased circulating levels of “good” HDL cholesterol. Other
studies found that cranberry lowered "bad" LDL cholesterol when consumed in increasing amounts over
a period of weeks. Cranberries are among the highest in phenol content of the 20 most consumed fruits
and vegetables in the United States. Phenols are known to increase resistance to LDL and to oxidation,
which can further reduce the risk for cardiovascular disease. There is some experimental evidence that
13
cranberry may act to reduce the formation of blood clots and reduce blood pressure, possibly playing a
role in a lower risk of stroke.
Cranberries have been shown in the past to help prevent urinary tract infections and aid in
gastrointestinal and oral health. The new role they seem to play in reducing the risk of heart disease puts
them as a top candidate as part of a healthy diet replete with fresh fruits and vegetables.
Nutrition Reviews, 2007, Vol. 65, No. 11, pp. 490-502
CDC&P, “Deaths: Final Data for 2005, Table C,” www.cdc.gov/nchs/FASTATS/lcod.htm
Cranberry Institute, www.cranberryinstitute.org
Fall into a Winter’s Hike
The American Hiking Society estimates some 170,000 miles of trails in the U.S. ready for climbing,
walking, or jogging. Picture-perfect foliage and crisp weather make autumn and winter the perfect time
to explore running's distant cousin: hiking.
Hiking is a weight-bearing exercise and like running, it helps prevent osteoporosis, but it's much easier
on the joints. And like its cousin, the most important piece of equipment in hiking is shoes. Any shoes
designed for day hiking will likely have good support, plenty of cushioning, and lots of traction. It's up
to you to decide whether your feet will be happy in them after hiking several hours. To ensure proper fit,
shop late in the day, after you've walked considerably. This simulates the feet-swelling conditions of a
daylong hike. Be sure to shop for shoes in the socks you plan to hike in! Also, it’s a good idea to
purchase waterproof hiking shoes.
Before purchasing, take your possible purchases for a lap around the shoe store, kicking at the ground to
make sure your toes have ample room. Remember you'll be doing a substantial amount of walking
downhill. For this reason, sports stores often sell separate tongue pads that you can insert to keep your
foot from sliding forward in the shoe. The shoes should be snug, but comfortable. After purchasing
shoes, break them in for a week or so around your neighborhood before heading for the mountains.
In planning your trip, note that the American Red Cross recommends hiking in groups, but if you must
head out alone, let someone know your planned route. Make sure you've got enough daylight ahead of
you: estimate 20 minutes per mile. Always apply sun block and drink plenty of water before you go.
Dress in layers of bright clothing, especially if there’s hunting in your area. Temperatures vary during
the day as you move in and out of the sun and reach higher and higher altitudes. Even if the weather is
mild enough for shorts, always pack a wool sweater and a lightweight, waterproof jacket. An extra pair
of socks may come in handy, too. Store these items in a backpack along with the following:
General:
Area map with trail distances
Handkerchief or bandana
Watch, money, ID, cell phone
Sunglasses
Pocketknife
Spare shoelaces
Matches in a waterproof tin
Flashlight
14
Food:
Apples, energy bars, and trail mix to keep your blood sugar levels stable
Enough water to allow you to consume 16 ounces per hour of hiking
First aid:
Sun block
Lip balm
Insect repellent (DEET)
Band-Aids
Alcohol wipes
Tweezers
Ace bandage
Neosporin
Ibuprofen
Pepto-Bismol
Calamine lotion
Biodegradable toilet paper
Saline or contact lens drops, if applicable
Insect sting and/or seasonal allergy medication, if applicable
Whistle to signal for help or scare away animals
Beware of poison ivy, which grows along the ground or climbs vine-like up trees. Poison oak, by
contrast, grows like a bush and is therefore more confined. Poison sumac has much thinner leaves and
grows into a tall shrub—but only in wet, swampy areas. If you come into contact with any of these
plants, wash your skin and any clothes you were wearing in hot, soapy water as soon as possible. If you
encounter a squirrel or skunk that appears injured or is acting aggressively, it may be rabid and should
be avoided.
For more information on finding great trails near you, visit www.americanhiking.org. To learn more
about identifying poisonous plants, visit http://poisonivy.aesir.com/view/welcome.html.
American Red Cross, www.redcross.org/services/hss/tips/hiking.html
Runner's World Complete Guide to Trail Running by Dagny Scott Barrios, Rodale, 2003, 228 pp.
Hike Smart: Playing it Safe on the Trail, American Hiking Society,
http://www.americanhiking.org/news/pdfs/safety.pdf
Know Artery Disease, Peripherally
The American Heart Association estimates that peripheral artery disease (PAD) affects approximately
eight million Americans. Coronary artery disease is its better-known counterpart, and while even the
latter can often fall within the realm of the asymptomatic, PAD, particularly for those over 50,
represents an even less documented and more misunderstood phenomenon, but one with real health
repercussions.
PAD is a condition similar to coronary artery disease and carotid artery disease. In PAD, fatty deposits
build up in the inner linings of the artery walls. These blockages restrict blood circulation, mainly in
15
arteries leading to the kidneys, stomach, arms, legs, and feet. In its early stages a common symptom is
cramping or fatigue in the legs and buttocks during activity. Such cramping subsides when the person
stands still. This is called "intermittent claudication." People with PAD often have fatty buildup in the
arteries of the heart and brain, and so most people with PAD have a higher risk of death from heart
attack and stroke.
The most common symptom is painful cramping in the hips, thighs, or calves when walking, climbing
stairs, or exercising. The pain usually goes away after exercising stops, although this may take a few
minutes. When muscles are being used, they need more blood flow. Therefore a blockage due to plaque
buildup can mean that muscles won’t get enough blood during exercise to meet their needs—this then
causes the pain.
Many people with PAD have no symptoms or mistake their symptoms for something else. For example,
the nerve damage associated with late-stage diabetes, or diabetic neuropathy, can masquerade as PAD
and vice versa. But atherosclerosis—hardening of the arteries—is the most common cause of PAD.
Symptoms of severe PAD include: leg pain that doesn't go away when you stop exercising; foot or toe
wounds that won't heal or that heal very slowly; gangrene; or a marked decrease in the temperature of
your lower leg or foot, particularly compared to the other leg or to the rest of your body.
PAD is common in those over 50, but people who smoke or have diabetes are at especially high risk.
Certain risk factors for PAD can't be controlled, such as aging or having a personal or family history of
PAD, cardiovascular disease, or stroke. However, you can control the following risk factors:
Cigarette smoking. Smoking is a major risk factor for PAD. Smokers may have four times the risk of
PAD than nonsmokers.
Physical inactivity. Physical activity increases the distance that people with PAD can walk without pain
and also helps decrease the risk of heart attack and stroke. Supervised exercise programs are one of the
treatments for PAD patients.
Obesity. People with a body mass index (BMI) of 25 or higher are more likely to develop heart disease
and stroke even if they have no other risk factors. Calculate your BMI and learn healthy ways to manage
your weight.
High blood cholesterol. High cholesterol contributes to the build-up of plaque in the arteries, which can
significantly reduce the blood's flow. This condition is known as atherosclerosis. Managing your
cholesterol levels is essential to prevent or treat PAD.
Diabetes mellitus. Having diabetes puts you at greater risk of developing PAD, as well as other
cardiovascular diseases. If you are diabetic, it’s essential to learn more about how to manage the
disease, which is progressive but can be counteracted. Visit the American Diabetes Association at
www.diabetes.org.
Hypertension. Sometimes called the “silent killer" because it has no symptoms, high blood pressure
contributes to PAD. Work with your doctor to monitor and control your blood pressure.
Many people dismiss leg pain as a normal sign of aging. You may think it is arthritis or sciatica or just
“stiffness” from getting older. PAD leg pain occurs in the muscles, not the joints. Those with diabetes
might confuse PAD pain with neuropathy, a burning or painful discomfort of the feet or thighs. If you're
16
having any kind of recurring pain, talk to your healthcare professional and describe the pain as
accurately as you can. If you have any of the risk factors for PAD, you should ask your healthcare
professional about PAD even if you aren't having symptoms.
PAD diagnosis begins with a physical examination. Your doctor will check for weak pulses in the legs.
The ankle-brachial index (ABI) test is a painless exam that compares the blood pressure in your feet to
the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes
only a few minutes and can be performed as part of a routine exam. Normally, the ankle pressure is at
least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.
As stated earlier, PAD often goes undiagnosed. This can be dangerous because PAD can lead to painful
symptoms, loss of a leg, or increased risk of coronary artery disease and carotid atherosclerosis. Because
people with PAD have this increased risk for heart attack and stroke, the American Heart Association
encourages people at risk to discuss PAD with their doctor to ensure early diagnosis and treatment.
The most effective treatment for PAD is regular physical activity. Your doctor may recommend a
program of supervised exercise that you begin slowly. Simple walking regimens, leg exercises, and
treadmill exercise programs three times a week can result in decreased symptoms in just four to eight
weeks. Exercise for intermittent claudication takes into account the fact that walking causes pain. The
program consists of alternating activity and rest in intervals to build up the amount of time you can walk
before the pain sets in.
American Heart Association, 2008, www.americanheart.org/presenter.jhtml?identifier=3020252
American Diabetes Association, “Managing Diabetes,“ 2008, www.diabetes.org/for-parents-andkids/diabetes-care/managing-diabetes.jsp
THE CLINIC
MRI Sooner than Later for Ankle Assessment
I sprained my ankle severely four months ago when I
landed on someone's foot while playing basketball. Even though my ankle
swelled up, there was no ligament damage or fractures. However, a week later, the inside of my ankle
began to really hurt. All of the
other pain and swelling has subsided, but I have this pain on the inside of
my ankle, and the trainer from my team says it’s cartilage damage. They have
me taking pain medication since we are about to start the playoffs, but I
was wondering if there was anything else I could do before this problem gets
worse. If I wear a boot, would that help also? Our
trainer said that after the season I should rest a month or
two and it would get better. If not, then I would get an MRI and go from
there. He said I don't need an MRI now because it’s cartilage
damage.
Tamara Wright
Reseda, CA
With pain persisting at
this point after your injury I agree that you likely have a cartilage injury
17
or what is sometimes called an osteochondral defect—which is damage to the
cartilage as well as the underlying bone. An MRI is an excellent way to
assess this, but I'd recommend doing it sooner than later. A walking cast, or “boot,”
can sometimes help decrease the pain but will also promote weakness and
stiffness of the ankle; therefore it is not good for more than a couple weeks of use.
Unfortunately I have seen these injuries improve with rest only to flare right back again
after activity is resumed.
Paul Langer, DPM
Minneapolis, MN
My
first question would be how do they know it is cartilage damage? A regular
x-ray may show the injury but cannot determine the extent of the injury.
In persistent ankle injuries like osteochondral fracture or injury, what happens is that there is
bleeding, then an area of dead bone forms just under the cartilage.
This can cause extreme pain and lateral erosion in the joint. The other
alternative could be a loose piece of cartilage that broke off and is
causing pain in the joint. Both of these problems are best evaluated on
MRI.
Since your injury has been present four months, I would say you were past
due for an MRI. Typically with athletes that we see, if the pain persists
more than three to four weeks or it is an in-season injury, we get MRI studies. A
boot in between games and practices would help some. Steroid injections or
anti-inflammatories such as ibuprofen would also help. I have had good
success using electrical bone stimulators which is a non-painful device
that you wear while sleeping or rest. It helps to regenerate new bone in
the area.
While one or two months rest may help the problem, it
may not. Sometimes these injuries require surgery (arthroscopic). My advice would be to get an MRI
ASAP
either in Europe or once you return. Then get evaluated by a podiatrist who
specializes in sports medicine or an orthopedic surgeon who specializes in
foot and ankle injuries.
Patrick J. Nunan, DPM
18
OA Options, Self-Administered and Otherwise
What are the latest and best self-administered treatments for arthritic
joints (especially ankles and hips)? Do you know of any effective herbal remedies, over-the-counter
medications, hot/cold treatments, or the like?
Frank Burman
Phoenix, AZ
Although it seems like new treatments for every medical condition seem to
appear every week, there are not a great deal of new treatments for
osteoarthritis (OA) in the past year or so. My recommendations to patients
include:
1. Maximize flexibility and strength. Other joints in the same limb are
affected by the loss of motion in an arthritic joint. As muscle strength
increases, there is decreased stress on the joints. Although stiffness and
pain are usually present when exercise is started, symptoms commonly subside
during the course of exercise.
2. Try both heat and ice. Some people get much more relief with one
compared to the other; a pattern of heat prior to activities and ice
afterwards works for many people.
3. Maintain an appropriate weight. Too much weight means greater stress on
joints.
4. Appropriate footwear. Shoes should have good support and cushioning.
5. Braces. A simple knee sleeve may provide some improvement in comfort. An
unloader brace applies valgus stress to the knee and may be beneficial for
someone with medial compartment arthritis.
6. Medications and supplements. The data on supplements is mixed. There was
good support for the use of glucosamine, though a meta-analysis study in the
New England Journal of Medicine last year did not demonstrate positive results. I have a
number of patients who report improvement in joint pain while taking
glucosamine. The form of glucosamine—pill vs. liquid—does not seem to
matter, but liquid is much more expensive. Studies are being performed on
chondroitin, ginger, and multiple other supplements. There is some reported
improvement in pain with these supplements. NSAIDs are effective for
decreasing pain, but chronic use increases the risk of renal or hepatic
toxicity. Lab tests should be monitored if NSAIDs are taken on a chronic
basis. Acetaminophen plays a role in pain control. Chronic use may cause
hepatic toxicity, especially when used in conjunction with alcohol.
7. Injections. Cortisone injections may provide temporary relief from pain
(weeks to months) and can be beneficial in ameliorating symptoms. This treatment should be used
sparingly, however.
19
Hyaluronic acid injections (Synvisc, Supartz, Hyalgan) can be quite helpful
in decreasing pain. At this time, these are only approved for use in knees, so
insurance will not cover this treatment for injection into other joints.
8. Surgery. When pain is severe and other measures have not been working,
this is a long-term solution. Prostheses are being improved and have a
longer life span.
Cathy Fieseler, MD
Tyler, TX
As far as self-administered, non-prescription treatments,
the first and foremost treatment would be glucosamine/chondroitin, two
triple-strength or three double-strength tablets per day. Capsaicin, ibuprofen
(Advil, Aleve, Nuprin, Mediprin), Tylenol (Extra-Strength or
Arthritis-strength), and topical salves like Tiger Balm, Ben Gay, or Mobisyl
could also be considered. Heat brings blood to an area and is a vasodilator,
so it can help before exercise or activities, while ice acts as a
pain-reliever by vasoconstricting, and is therefore best used after
Activities, or if the joint is too painful.
There are also homeopathic remedies such as Arnica (in pill or gel
form) that can be purchased in health food stores and/or homeopathic
pharmacies.
Mark McKeigue, DO
Flossmoor, IL
Hypertension Drugs and Waning Athletic Performance
I have been taking the blood pressure medication atenolol for a few years.
Since I started taking the drug my running has gone downhill. In the past
I have run 13 marathons; now if I run more than three miles I get fatigued.
I have continued to gain weight and it has been difficult to lose it. I
have read about atenolol potentially causing weight gain and fatigue among other things.
Have other runners experienced this with atenolol and is there a substitute
medication that does not have these side effects?
Dave Calhoun
Devon, NH
There are essentially four classes of medications that can be used as
first-line agents for the treatment of high blood pressure: beta blockers,
calcium channel blockers, diuretics, and angiotensin converting enzyme (ACE)
inhibitors/angiotensin receptor blockers (ARBs). In general any of these
classes of medications represents a reasonable choice for the treatment of
hypertension. A certain agent may have more benefit in an individual
depending on additional characteristics of that patient. For instance, beta
blockers have additional benefits in patients who also have had a heart
20
attack or heart failure, calcium channel blockers in patients with angina,
diuretics in patients with ankle swelling, and ACE inhibitors/ARBs in
diabetics. One agent may also be more effective than another based on
patient demographics (age and race). Cost may also influence medication
selection (in general generic beta blockers and diuretics are cheaper than
calcium channel blockers and ARBs).
Atenolol is a beta blocker. It can cause the side effects that you mention.
Beta blockers generally do not impair performance in people engaged in
moderate (leisure) physical activity, but many athletes performing at a
higher level find the side effects to be intolerable and to have a negative
impact on athletic performance.
From a biochemistry standpoint, beta
receptors exist in the heart and blood vessels as well as in other tissues
throughout the body. Stimulation of the beta receptors with chemical
substances like adrenaline that get released during exercise cause the heart
to beat faster and stronger (more forcefully). Beta blockers bind to these
beta receptors, thereby partially blocking the effects of adrenaline,
resulting in a slower heart rate and less forceful contraction of the heart
muscle. These effects are desirable in someone who has had a heart attack
but are undesirable during athletic competition since maximal cardiac
performance (and hence athletic performance) depends on the increase in
heart rate and increase in contractility of the heart muscle during
exercise.
You should never stop any blood pressure medication on your own. This
caveat is especially true with beta blockers, since these medications may
need to be gradually tapered rather than abruptly terminated when
discontinuing. I would suggest that you discuss with your physician the
side effects that you have noticed and the possibility of changing from
atenolol to a different class of medication. With the large number of
blood pressure medications that are currently on the market, it is usually
possible to find an effective medication or combination that controls blood
pressure adequately with minor or no side effects.
Beta blockers are the class of medication that stand out as being not well
tolerated in athletes. The other three classes are pretty much a toss-up.
Theoretically athletes might want to avoid diuretics if training/running in
hot weather as diuretics could predispose towards dehydration. I would
lean towards using an ACE-inhibitor/ARB or calcium channel blocker,
especially if you are still doing marathons. The major disadvantage is cost but
there are generic ACE-inhibitors and calcium channel blockers on the market,
which helps.
Todd Miller MD
Rochester, NY
21
Cramps: Overload, Fluid Imbalance, Fatigue—or Nerve Compression?
My wife, who is 48, is a distance runner. She has run nine marathons and five half-marathons. Last
March at the Atlanta Marathon she experienced calf cramps that made it impossible to run, though she
was able to walk. The cramps hit her at 20 miles. This Feb. at another marathon the calf cramps hit her
at 17 miles; she was able to walk the other nine miles. A month later the cramps started at the finish of
the local Half-marathon. Both marathons were very warm, in the 80- to 90-degree range. She was wellhydrated, however, especially in the second marathon. She runs 25 to 30 miles per week and has been in
perimenopause for two to three years. Calf cramps never hit her until she was 47. Any ideas? What do
you think of performing blood tests for minerals or electrolytes?
Steven Taylor
Rome, Georgia
I feel there are several things that may be causing your wife's cramps. Perhaps she is having electrolyte
difficulties but I am not so sure that this is the real issue. Being perimenopausal could be contributing to
this but I am not familiar with a specific link between the two.
More likely, the cause is muscle fatigue for one of two reasons, or even both.
First, in slower runners there is a tendency to overload the calf muscles eccentrically (while her foot is
planted and she is moving her body over her foot). This causes the fatigue, and cramp. Second, if she
has any compression of nerve roots from her back she may be reducing the available power supply to
her legs and causing the fatigue to happen sooner than it normally would. Compression would happen in
people with a disc
protrusion (new or old), spinal arthritis, or both. Does she have any history of back problems? Even if
she doesn't, sometimes this phenomena can be silent as far as the back is concerned. Because running is
a high demand activity, the problem may be mild enough that it only shows up when there is high
demand placed on the nerve.
So, what I would suggest is that she see a sports medicine physician who is capable with the problem I
outlined above. You might also check in with physicians in your area familiar with athletes who cramp
due to excessive sweating and electrolyte
loss.
John Cianca, MD
Houston, TX
Cramps can happen for a number of reasons, including dehydration, Over-hydration, electrolyte
abnormalities, and muscle fatigue. You didn't mention any problems on her long training runs so we
need to look at what is different on race day. If she is running at a faster pace than on her training runs,
fatigue is a problem. She should perform runs at her planned marathon pace during training; too often,
pace is faster than this on short
runs and slower on long runs. She should gradually increase runs at marathon
pace from 8 miles to 15 miles.
Sweat rates are variable from person to person and will change with acclimatization and weather
conditions. Your wife should weigh herself nude prior to a long run and again following the run. Each
pound that she lost is a 16 ounce fluid deficit; she needs to add the amount of fluid that she consumed
22
during her run to this to estimate her sweat rate. Repeating this in various weather conditions can
provide a good range in sweat rate. A
runner who is a little under- or over-hydrated should not experience problems. It is possible to consume
too much fluid while running, causing blood sodium levels to drop. This can cause swelling, cramping,
nausea, vomiting, seizures, and worse. Salty snacks or supplements may help prevent this, but avoiding
over-hydration is the key factor.
The fact that your wife can continue walking without a problem when she starts cramping leads me to
believe that fatigue may be the more significant factor. Incorporating strength training may also be
helpful. To work on calf strength, raises should be performed at the edge of a step, dropping the heels
down below the step and then rising onto her toes.
Cathy Fieseler, MD
Tyler, TX
The Back Page
Cutting the Meat, not the Fat: The Wrong Approach
University of Delaware aims to shutdown Men’s Cross Country and Track & Field
Promoting running for youth is at the tip of the spear in the ARA campaign to improve the physical
activity levels of America’s Youth. The sport of Cross Country is one of our platforms to showcase
how running can make you more fit, a better student and help you set lofty goals. So when I read that
another college administrator could be sharpening the budget axe to let it fall on the men’s’ cross
country and track & field programs, it makes me fume. I’m not an alumnus at Delaware. I am not an
alumnus of James Madison University (JMU) in Harrisonburg VA. I was just as perturbed and
dumbfounded two years ago, when the Board of Regents at JMU decided to drop 7 men’s sports,
notables being men’s’ cross country , track & field, and swimming. These are life sports. That’s what
we call running and swimming. They stay with you for life and can form a basis of vigorous exercise
well into your senior years.
Do you know what it costs to operate cross country and track & field year-round at a mid-major
university? Would you be surprised to know that the figure at Delaware is less than $100K? When
administrators explain their budgetary reasons behind a sports program’s cut, the convenient excuse or
punching bag is Title IX. The landmark 70s education guidelines have had their positive effect on the
growth of women’s sports. Those of us who competed at the earliest stages of Title IX would agree that
it has greatly expanded sports participations for girls in high school and women in college.
Unfortunately, Title IX is the fall guy when it comes to collegiate athletic department cuts. Why does
Title IX even get brought into the discussion when a college or university wants to adjust, cut or move
around budgeted monies in an athletic department?
Football is often the answer. If a college or university wants to expand its program and lure more
alumni donations, increased spending is inevitable. If the decision is made to upgrade the football
program and there is no endowed fund to cover the non-revenue sports, then out comes Title IX to assist
the Athletic Department in making the necessary budget adjustments.
As advocates for running for both boys and girls, men and women, American Running is firmly in favor
of equal opportunities to run. Cross country, indoor track and outdoor track. Nothing is more pure
with such a wide open door for participants. Let’s not let the non-runners dictate points of access for
the boys, girls, men and women who want to compete in a sport that is a life sport.
23
Put away your axe Delaware. Find ways to raise funds to keep the cross country and track programs
going. That’s the way to keep a sport alive.
Seen and Heard
Newton’s Laws: Have you heard of the POSE method of running? Picture yourself leaning forward
and lifting your legs with your quads vice your hamstrings. Try to shorten your stride and plant your
feet flat. Now that may be an oversimplification of the POSE method but it is part of the reason for the
emergence of a specialty running shoe that incorporates the POSE method in its sole. NEWTON
running shoes are moving beyond their Boulder Colorado beginnings and have landed in some smaller
retail establishments. I caught up with the co-founder Jerry Lee at his booth at the NYC Marathon. I
have to admit, an old guy runner like me is not the target market. The colors of the shoes are vibrant
and the structure and engineering are solid. They also have a few elite athlete endorsers now. In the
booth that day was Josh Cox. He talked about the initial awkwardness of running in the Newtons. We
also talked about training barefoot and how the way we run barefoot is exactly how you would run in the
Newtons. It makes sense. The one area that may hurt Newtons is the price of entry. Shoes range
from $140 to $175. Word has it that the Newtons sold well at running event Expos. Upon my return to
Bethesda MD, I happened to check out the new City Sports retail store. It did not take long to spot the
Newtons on the shelves with their bright vibrant colors. I also heard that Newton execs tried for years
to sell their concept to the few large running shoe companies and got the polite no thanks. Now that
some elite runners are wearing Newtons and winning in these shoes (check out the shoes on this fall’s
IRONMAN race winner), more shoe industry experts may take notice.
Wave Starts: It started in Boston and now it is reaching the NYC Marathon: The Wave. It’s not quite
like the “wave” in baseball or football stadiums. The basic wave start concept is to split the race field
into two halves. The first half is the faster of the two halves. The second wave will typically start 30
minutes after the first wave. If you have run a marathon with a wave start, it’s no big deal given the
commonplace use of the timing chips or RFID (radio frequency ID) timing devices. The one downside
is the continued desire by some race directors to increase the field size of their marathons. Why? The
simple answer is to satisfy the demand. Well, what would happen if you keep the race field capped and
still incorporate the Wave start? Don’t you think your runners would be happier, medical personnel
would be less stressed and sponsors still happy? It’s time to stop growing the already mega-sized
marathons. The wave works> Just don’t let it be the reason to allow more runners to fill your crowded
streets.
Expanded partnerships at American Running.
Youth Runner (YR)and American Running (ARA) are gearing up to share more stories and information
as both entities move into more web-based offerings. Youth Runners’ Dan Kesterson has beefed up this
magazine with a slick, attractive e-Youth Runner magazine. His company’s website has moved to a
more powerful web platform that will greatly add more features to pages for youth teams and groups.
ARA will post content and share sports medicine information while Youth Runner will provide pages
for clubs, teams and school groups. ARA’s Walk-Run training programs will be made available plus
the free sports medicine information. YR and ARA will promote the 2nd year of “National RUN A
MILE Day” in May.
ENJOY THE RUN…
--Dave Watt
Executive Director
24