Hey guys
I came across this study presented a while back at NSCA Conference. The
study found that straight bar activates the biceps MORE than E-Z Curl
bar. So if forearm strain isn’t an issue, stick to straight bar to
build bigger biceps.

Lafrenz, J. NSCA Conference Abstracts 2002

Hey guys
Here is an interesting study from Obstetrics and Gynecology that interviewed 1900 women in their 7th month of pregnancy. What they found was that in about 9 percent of the women who worked nights in their first trimester had a 50 percent increased risk of premature labor.
Now obviously we need more studies to examine this issue but it does raise an important issue about avoiding grave-yard shifts during pregnancy.

Obstet Gynecol, December 2005

When was YOUR last bitter fight with your significant other? Remember the heavy feeling afterwards. You’ve said much that you didn’t mean and succeeded in making the other party sound like a horrible monster. Research is showing what you may suspect already. FREQUENT fighting and HARSH words are damaging to your health.

MARRIED COUPLES. ARGUMENTS. BLISTERS. What do these things have in common? They were instrumental in a recent research studying 42 couples married at an average of 13 years, age ranging 22-77 years old. After an antagonistic fight, they found that BLISTERS on each person’s arms take LONGER to heal, compared to that after a calmer fight. On a bigger scale, argumentative couples heal MORE SLOWLY compared with more harmonious couples.

Researchers theorize that the stress caused by these antagonistic encounters could increase the RISK of damaging your physical and mental health.

References:
Archives of General Psychiatry, December 2005
American Academy of Family Practice, Quantum Sufficit, March 1 2006.

The morning after pill is basically a high dose birth control pill. The exact mechanism of how the pill works is uncertain at this time. Emergency contraceptives may act by inhibiting ovulation, interfering with transport, preventing the actual implantation, or by causing regression of the corpus luteum
Side effects include:
Most common are nausea and vomiting
Uncommon side effects include: irregular bleeding, dizziness, fatigue, headache, breast tenderness, and lower abdominal pain.

General consequences in women:
-Irregular menses
-Amenorrhea
-Infertility
-Incontinence

In pregnant obese women, increased risk for:
-Gestational diabetes
-Hypertension
-Delivery complications
-Congenital malformations

We all know that mammograms are the main method for detecting breast cancer. However, mammograms are not the perfect screening tool as they do miss cases on occasions. Thus, there has been a lot of interest lately in using MRI as screening tools for Breast Cancer. Some studies have shown that MRI’s can detect additional lesions that are not visible on Mammograms in as much as 27-37% of patients. 1

A recent study in the Journal of the American Medical Association looked at the accuracy of breast MRI in detecting breast cancer in patients with suspicious mammographic or clinical findings.2 What they found was that the “breast MRI has a high sensitivity but only a moderate specificity independent of breast density, tumor type, and menopausal status.” This is just technical language for saying that the MRI is a good screening test but would still need to be followed up by a biopsy to get a definitive answer.
My only problem at the moment with the MRI is the cost! As the price comes down, I think this will someday replace mammograms as the screening tool of choice.

REFERENCES
1. Liberman L, et al. MR imaging of the ipsialteral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol. 2003;180:901-910.
2. Bluemke D, et al. Magnetic Resonance Imaging of the Breast Prior to Biopsy. JAMA. 2004;292:2735-2742.

Good news, it may not be your fault that you have a craving for fat foods! and one day you might be able to rid yourself of it! A study done on rodents and published in Journal of Clinical Investigation showed that rats with normal taste buds show an inclination for fatty foods as oppose to rats with some of their fat receptors removed (CD36 receptor which is found in tissues that store fat). The authors of the study do NOT know if this taste bud exists in humans, but if it does, it can be one small factor in explaining why some people are more susceptible to weight gain than others.

Hey guys
Here is a fun little study.
Researchers founds that swimming with dolphins can reduce depressive symptoms more effectively than swimming alone. Okay now before you all jump in the ocean, let look at the numbers. The researchers ONLY studied 30 patients with MILD to MODERATE depression. All of the patients stopped their antidepressant medications or psychotherapy for at least four weeks before the study.
The results: 9 out of 10 patients who swam and interacted with dolphins stated improvement in their symptoms.
Now I wouldn’t take this study to mean an end to depression as we know it but it is interesting that a simple thing like interaction can improve one’s symptoms so much!

Reference: BMJ, November 26, 2005

Hey guys.
Consumer Reports just published its findings on 27 breakfast cereals and the results were startling. They found some cereals with the nutritional content equivalent to a donut. Here is a breakdown of the cereals they evaluated from worst to best.

Okay so let’s start with the worst offenders:

1. Golden Crisps (Kellogg’s): Each serving contains more sugar than a Dunkin’ Donuts glazed doughnut. 15 grams of sugar to be exact.

2. Honey Smacks (Kellogg’s): This one was no better. It had 14 grams of sugar per ¾ cup serving.

3. Apple Jacks (Kellogg’s) had 12 grams of sugar, < 1 gram of fiber, and 135mg of sodium per 1 cup serving.

4. Froot Loops (Kellogg’s) had 12 grams of sugar, < 1 gram of fiber, and 135mg of sodium per 1 cup serving.

5. Corn Pops (Kellogg’s) had 12 grams of sugar, < 1 gram of fiber, and 135mg of sodium per 1 cup serving

6. Cap’n Crunch (Quaker Oats) had 12 grams of sugar, 1 gram of fiber and 200mg of sodium per ¾ cup serving

7. Cap’n Crunch’s Peanut Butter Crunch (Quaker Oats) had 9 grams of sugar, 1 gram of fiber, 200mg of sodium per ¾ cup serving

Now there is something very interesting in the above list. 5 out of the 7 cereals are made by Kellogg’s. In response to this report, Kellogg’s released the statement that the company had recently reformulated five of its cereals (Froot Loops, Corn Pops, Rice Krispies, Cocoa Krispies, and Apple Jacks) to make them healthier choices. However, Consumer Reports article states that even with this reformulation, the five cereals would still score poorly in nutrition rating compared to the other choices.

Before we decide to give up cereal forever, there is some good news. 4 of the 27 tested cereals were labeled as “Very Good” breakfast choices due to their low sugar (< 9 grams) and sodium (<210 mg) content. In addition, all 4 cereals had greater than 2 grams of fiber. Alright, drum roll please.

1. Cheerios (General Mills) had ONLY 1 gram of sugar, 3 grams of fiber and 190mg of sodium. This also happened to be my favorite in college.

2. Kix (General Mills) had 3 grams of sugar, 3 grams of fiber, and 210 mg of sodium.

3. Life (Quaker Oats) had 6 grams of sugar, 2 grams of fiber, and 160mg of sodium.

4. Honey Nut Cheerios (General Mills) had 9 grams of sugar, 2 grams of fiber, and 190 mg of sodium.

The bottom line behind this article is that you do have some healthy choices when it comes to cereal for both you and your children. So the next time you are in the grocery store, put the Kellogg’s cereal down and reach for some good old plain Cheerios. Your heart will thank you for it!

Tribulus Terrestris has been used for lots of different things over the years.  In Ancient Greece and India it was used for rejuvenation. In Eastern Europe its has been used for increased muscle strength and libido. But the real question is does it really work?

The limited number of studies looking ONLY at tribulus terrestris alone (most products on the market are NOT just tribulus) show that it is NOT effective for getting more muscles or improving exercise performance. Antonio et al. did a randomized control trial using 15 athletes performing resistance training. The dose used was 3.21mg/kg of body weight versus placebo. The trial lasted eight weeks and at the end they found NO changes in body weight, percent fat, total body water or mood states that were statistically significant between the tribulus group and the placebo group.

HOWEVER, there is some MINIMAL evidennce that Tribulus may have some benefit in patients with coronary heart disease (greater chest pain free intervals), and some MODERATE evidence of its benefits in male infertility (Tribulus increases sperm count and libido as demonstrated in a study by Prtoich et al.)

As always here are the references so you can evaluate the studies for yourself.

1. Wang, B., Ma, L., and Liu, T. [406 cases of angina pectoris in coronary heart disease treated with saponin of Tribulus terrestris]. Zhong Xi Yi Jie He Za Zhi or (Chung Hsi I Chieh Ho Tsa Chih) or (Chinese Journal of Modern Developments in Traditional Medicine) 1990;10(2):68, 85-87
2. Antonio, J., Uelmen, J., Rodriguez, R., and Earnest, C. The effects of Tribulus terrestris on body composition and exercise performance in resistance-trained males. Int J Sport Nutr Exerc.Metab 2000;10(2):208-215.
3. Protich, M., Tsvetkov, D., Nalbanski, B., Stanislavov, R., and Katsarova, M. [Clinical trial of a tribestan preparation in infertile men]. Akush.Ginekol.(Sofiia) 1983;22(4):326-329

This page is taken from the National Kidney Foundation website. Here is the link:

What is potassium and why is it important to you?
Potassium is a mineral found in many of the foods you eat. It plays a role in keeping your heartbeat regular and your muscles working right. It is the job of healthy kidneys to keep the right amount of potassium in your body. However, when your kidneys are not healthy, you often need to limit certain foods that can increase the potassium in your blood to a dangerous level. You may feel some weakness, numbness and tingling if your potassium is at a high level. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack.

What is a safe level of potassium in my blood?
Ask your doctor or dietitian about your monthly blood potassium level and enter it here:

If it is 3.5-5.0………………………You are in the SAFE zone
If it is 5.1-6.0………………………You are in the CAUTION zone
If it is higher than 6.0……………..You are in the DANGER zone

How can I keep my potassium level from getting too high?
You should limit foods that are high in potassium. Your renal dietitian will help you plan your diet so you are getting the right amount of potassium.
Eat a variety of foods but in moderation.
If you want to include some high potassium vegetable in your diet, leach them before using. Leaching is a process by which some potassium can be pulled out of the vegetable. Instructions for leaching selected high potassium vegetables can be found at the end of this fact sheet. Check with your dietitian on the amount of leached high potassium vegetables that can be safely included in your diet.
Do not drink or use the liquid from canned fruits and vegetables, or the juices from cooked meat.
Remember that almost all foods have some potassium. The size of the serving is very important. A large amount of a low potassium food can turn into a high- potassium food.
If you are on dialysis, be sure to get all the treatment or exchanges prescribed to you.

What foods are high in potassium (greater than 200 milligrams per portion)?
The following table lists foods that are high in potassium. The portion size is ½ cup unless otherwise stated. Please be sure to check portion sizes. While all the foods on this list are high in potassium, some are higher than others.

What foods are low in potassium?
The following table list foods which are low in potassium. A portion is ½ cup unless otherwise noted. Eating more than 1 portion can make a lower potassium food into a higher potassium food.

How do I get some of the potassium out of my favorite high-potassium vegetables ?
The process of leaching will help pull potassium out of some high-potassium vegetables. It is important to remember that leaching will not pull all of the potassium out of the vegetable. You must still limit the amount of leached high-potassium vegetables you eat. Ask your dietitian about the amount of leached vegetables that you can safely have in your diet.

How to leach vegetables.

For Potatoes, Sweet Potatoes, Carrots, Beets, and Rutabagas:

Peel and place the vegetable in cold water so they won’t darken.
Slice vegetable 1/8 inch thick.
Rinse in warm water for a few seconds.
Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours.
Rinse under warm water again for a few seconds.
Cook vegetable with five times the amount of water to the amount of vegetable.
For Squash, Mushrooms, Cauliflower, and Frozen Greens:
Allow frozen vegetable to thaw to room temperature and drain.
Rinse fresh or frozen vegetables in warm water for a few seconds.
Soak for a minimum of two hours in warm water. Use ten times the amount of water to the amount of vegetables. If soaking longer, change the water every four hours.
Rinse under warm water again for a few seconds.
Cook the usual way, but with five times the amount of water to the amount of vegetable.

References:
Bowes & Church Food Values of Portions Commonly Used, 17th Ed., Pennington, JA, Lippincott, 1998.
Diet Guide for Patients with Kidney Disease, Renal Interest Group-Kansas City Dietetic Association, 1990.
More than 20 million Americans—one in nine adults—have chronic kidney disease, and most don’t even know it. More than 20 million others are at increased risk. The National Kidney Foundation, a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation. Through its 50 affiliates nationwide, the foundation conducts programs in research, professional education, patient and community services, public education and organ donation. The work of the National Kidney Foundation is funded by public donations.

Updated: 6/28/04

©2008 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.

Hey guys. I just got an email asking about sugar alcohols, so I thought I would share the answer with you.

Q: Hi Dr. Sean! What’s so good about fake sugar, and why does it have that horrible after taste? I don’t understand why people would ruin their perfectly good coffee with several of those blue or pink packets. Also, why would people order a super-sized meal with a diet coke?

A: Fake sugar is the latest diet craze on the market. People love sweets and have been searching for ways to avoid the calories of simple sugars. Let’s start with the newest sugar alternatives on the market: the polyols (also known as sugar alcohols). Polyols are basically sweetening and bulking agents. They come from certain fruits and berries.

The good things about them are:

1. They taste almost like sugar.
2. They provide somewhere between 1/2 to 1/3 less calories than regular sugar.
3. Their conversion to glucose is far slower so they require little or no insulin to be metabolized and don’t cause sudden increases in blood sugar (thus useful for patients with diabetes).
4. They DO NOT promote tooth decay (FDA has approved a claim of “does not promote tooth decay” for sugar-free foods and beverages sweetened with polyols).
5. They add texture to food, retain moisture and prevent foods from browning when they are heated.

Common polyols include: mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol, and hydrogenated starch hydrolysates (HSH). They can be found in candies, cookies, chewing gums, soft drinks, throat lozenges, toothpaste, and even mouthwash.

Now the bad things about them:

1. Gastrointestinal side effects such as bloating and diarrhea when eaten in excessive amounts.
2. Weight gain with overuse (as with everything else in life).
3. Large amounts increase blood sugars

Sugar Alcohols vs. artificial sweeteners:

Artificial sweeteners are your saccharin (Sweet and Low) and Aspartame (Equal and NutraSweet). The good thing about artificial sweeteners is that they contain zero calories vs. sugar alcohols with ~2.6 cal per gram. Another good thing is that artificial sweeteners do not raise blood sugars.

Here is a handy table from caloriecontrol.org that shows exactly how many calories you get from each of the polyols.

• 3.0 calories per gram hydrogenated starch hydrolysates.
• 2.6 calories per gram sorbitol.
• 2.4 calories per gram xylitol.
• 2.1 calories per gram maltitol.
• 2.0 calories per gram isomalt.
• 2.0 calories per gram lactitol.
• 1.6 calories per gram mannitol.
• 0.2 calories per gram erythritol

As for the last part of you question “why would people order a super-sized meal with a diet coke?”, your guess is as good as mine.

Hey guys
This is meant to be a fun little blog. So there is a lot of talk shows, books, magazines about women saying that men are bad listeners. Well here is a possible explanation. Enjoy!

Recently, a study in NeuroImage showed that men process male and female voices differently. Men use the VISUAL area in brain to “hear” male voices, while they use the AUDITORY area to hear female voices. MORE brain activity is required to use the auditory area. Female voices are far more complex in vibration and sound waves compared to male’s.

So the use of the auditory area makes men hear female voices MORE clearly, BUT their brains also tire quickly due to the complex processing involved. So women, please forgive us if sometimes we seem like we are not listening, its really not our fault.

1. Number of Americans age 20-74 yrs who are obese: >61% (110 million)
2. Rate of increase in obese children from 1960-1991: Doubled
3. Annual Deaths from obesity related causes: 300,000
4. Annual medical expenses and cost of lost productivity: >$100 billion per year
So here is an interesting way to jump start the economy. Make people lose weight.
5. Chronic diseases associated with obesity: heart disease, type 2 DM, HTN, stroke, cancer, gout, gallbladder, genitourinary disease.
6. Specific cancers associated with obesity: endometrial, breast, prostate, colon

References:

1. Physical Activity and Health: A Report of the Surgeon General. Washington, DC: US Dept of Health and Human Services, Centers for Disease Control and Prevention; 1996.
2. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207-2212.

Hey guys
Here is an interesting article from Journal of the American Medical Association regarding being overweight in young/middle age to Medicare expenditures in older age. The study looked at Medicare data from 1984-2002 with baseline data from 1967-1973 for 9978 men and 7623 women (ages 33-64) who did NOT have heart disease or diabetes and were either normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI 30-34.9) or severely obese (BMI>35). After the authors had adjusted for age, race, education, and smoking, they found some very amazing difference in annual and cumulative charges for men and women:

Women
Normal Weight: $6224 annual costs and $76866 cumulative costs
Overweight: $7653 annual costs and $100959 cumulative costs
Obese: $9612 annual costs and $125470 cumulative costs
Severely obese: $12342 annual costs and $174752 cumulative costs

Men
Normal Weight: $7205 annual costs and / $100431 cumulative costs
Overweight: $8930 annual costs and $109098 cumulative costs
Obese: $10128 annual costs and $119318 cumulative costs
Severely obese: $13674 annual costs and $176947 cumulative costs

Bottom line, eating healthy and exercising regularly can help save you as much as $6000 in annual healthcare expenditures in your old age
So get up and go for a run, it may be the best investment you ever make.

Daviglus M, et al. Relation of Body Mass Index in Young Adulthood and Middle Age to Medicare Expenditures in Older Age. JAMA. 2004;292:2743-2749.

Hey guys
There was a study published in the New England Journal of Medicine that looked at 47,150 men over 12 years examining risk factors for gout. They found that higher levels of meat and seafood consumption were associated with increased risk of gout, whereas higher consumption of dairy products had a decreased risk.
Just another reason why whey protein (milk protein) continues to be one of my favorites.

In case any one is wondering what is gout, here is a great definition from the Mayo Clinic website (http://www.mayoclinic.com/health/gout/DS00090): a form of arthritis that’s characterized by sudden, severe attacks of pain, redness and tenderness in joints.

Reference:

Choi, KH. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NEJM. 2004;350;1093-1103.

Hi guys
Here are some simple ways to lower your blood pressure without medications. Enjoy

1. Losing weight: did you know that each ~20 lb weight loss can reduce your blood pressure by 5-20mm Hg.
2. Switching to a diet low in saturated fats, high in fruits and vegetables can decrease blood pressure by 8-14mm Hg.)
3. Cutting your salt intake to less than 6 grams a day can drop your blood pressure by 2-8mm Hg.
4. Simply walking 30 minutes everyday can lower your blood pressure by 4-9mmHg.
5. Finally, cutting your alcohol to less than 2 drinks a day for men and less than 1 drink a day for women can decrease your blood pressure by 2-4mmHg

As you can see, the biggest bang for your buck comes from weight loss. The combination of these steps can really improve your blood pressure.

I came across a very interesting article that I wanted to share with everyone about whether or not chewing slowly helps you eat less. The idea is that eating slowly enhances the taste and enjoyment of food, gives the feeling of being full faster, and allows people to feel satisfied with smaller amounts of food.

Some of you might not be aware, but the origin of this concept came about in 1962, when Ferester and colleagues noticed that obese people ate faster than lean people. Naturally, they made the conclusion that obese people would probably eat less if they were to eat slowly. This certainly seemed logical and quickly became a standard of just about every behavioral treatment program since then. In fact, this advice has even been printed on milk cartons for students in public school cafeterias.

So what could possibly be wrong with such a convincing argument?
Well I am glad you asked. First of all, the above concept assumes that the majority of obese people eat faster than lean people. Sorry, this is a highly debatable point and various studies have shown this NOT to be the case. Second, the concept asserts that eating slower will make you eat less. Okay, so for this point I want to point out a study by Spiegel et al.

Spiegel and colleagues looked at 18 participants. 9 were lean (average BMI 25) and 9 were obese (average BMI 32). They fed the participants bite sizes of tuna, turkey, and bagels, and used EMG (electromyography) to measure the rate of their jaw movements. Sounds just like a scene from a horror movie. What they found was that there were NO differences between the lean group compared to the obese group in terms of eating behavior, feeling full, or being satisfied with smaller amounts of food. When people took SMALLER bites, they simply ended up eating LONGER. So essentially they still ate the SAME amount of food.

Now I know there are many problems with this study. It’s too small, it’s not double-blinded, some of the measurements such as feeling full are very subjective. However, the take home point from this study is simple: if you want to eat less, cut the amount of food on your plate.

References:

1. Ferster, C. B., Nurnberger, J. I. & Levitt, E. B. (1962) The control of eating. Journal of Murhetics, 1. 87-109.
2. Spiegel, T. A., Shrager, E. E. & Stellar, E. (1989) Responses of lean and obese subjects to preloads, deprivation, and palatability. Appetite, 13, 4569.
3. Speigel, T. A., et al. (1993) Bite Size, Ingestion Rate, and Meal Size in lean and Obese Women. Appetite, 1993. 21. 131-145.