Monthly Archives: January 2013
Garlic linked to blood pressure
- January 9, 2013
Health Editor, Sydney Morning Herald
IT’S been said to ward off vampires, cure colds and improve vitality. But now researchers believe garlic could benefit thousands of Australians with high blood pressure.
A daily dose of two pills containing high potency aged garlic extract seems to help lower blood pressure, according to a study of Adelaide patients published on Wednesday in the European Journal of Clinical Nutrition.
The study leader, Karin Ried, said many people had difficulty with high blood pressure despite taking medication.
”What’s exciting is that the garlic was able to reduce blood pressure in that medication-resistant group,” she said.
The garlic extract could work by stimulating nitric oxide in cells, which dilated blood vessels, reducing blood pressure.
”But it doesn’t just have one possible mechanism of action and that is probably what makes it superior to other medications, which only have one mechanism,” said Dr Ried, who undertook the research while at the University of Adelaide and is now the research director at the National Institute of Integrative Medicine in Melbourne.
Her study, of 79 patients, compared the garlic extract to placebo pills, and found a reduction in systolic blood pressure over a 12-week period.
About a quarter of participants reported side effects such as bloating, ﬂatulence or a noticeable garlic taste.
The clinical issues director at the Heart Foundation, Robert Grenfell, said the early findings were interesting.
”The problem is many Australians who have high blood pressure do not know about it or are not taking treatment,” he said.
He said most people who did not respond to treatment would do so if they added a second or third medication, but it could be difficult to encourage people to keep taking them, particularly if they did not understand the risks of going unmedicated.
The study was funded by a grant from the Royal Adelaide Hospital and the garlic capsules used were provided free by the manufacturer.
- THE INFORMED PATIENT
- January 5, 2010
The Hidden Benefits of Exercise
Even Moderate Physical Activity Can Boost the Immune System and Protect Against Chronic Diseases
By LAURA LANDRO
- Like this columnist
As millions of Americans flock to the gym armed with New Year’s resolutions to get in shape, medical experts are offering an additional reason to exercise: Regular workouts may help fight off colds and flu, reduce the risk of certain cancers and chronic diseases and slow the process of aging.
Physical activity has long been known to bestow such benefits as helping to maintain a healthy weight and reduce stress, not to mention tightening those abs. Now, a growing body of research is showing that regular exercise—as simple as a brisk 30- to 45-minute walk five times a week—can boost the body’s immune system, increasing the circulation of natural killer cells that fight off viruses and bacteria. And exercise has been shown to improve the body’s response to the influenza vaccine, making it more effective at keeping the virus at bay.
“No pill or nutritional supplement has the power of near-daily moderate activity in lowering the number of sick days people take,” says David Nieman, director of Appalachian State University’s Human Performance Lab in Kannapolis, N.C. Dr. Nieman has conducted several randomized controlled studies showing that people who walked briskly for 45 minutes, five days a week over 12 to 15 weeks had fewer and less severe upper respiratory tract infections, such as colds and flu. These subjects reduced their number of sick days 25% to 50% compared with sedentary control subjects, he says.
Medical experts say inactivity poses as great a health risk as smoking, contributing to heart disease, diabetes, hypertension, cancer, depression, arthritis and osteoporosis. The Centers for Disease Control and Prevention says 36% of U.S. adults didn’t engage in any leisure-time physical activity in 2008.
Even lean men and women who are inactive are at higher risk of death and disease. So while reducing obesity is an important goal, “the better message would be to get everyone to walk 30 minutes a day” says Robert Sallis, co-director of sports medicine at Fontana Medical Center, a Southern California facility owned by managed-care giant Kaiser Permanente. “We need to refocus the national message on physical activity, which can have a bigger impact on health than losing weight.”
Regular exercise has been shown to combat the ongoing damage done to cells, tissues and organs that underlies many chronic conditions. Indeed, studies have found that exercise can lower blood pressure, reduce bad cholesterol, and cut the incidence of Type 2 diabetes.
2:33Watch how Joy Johnson, the defending 80-and-over champion in the New York City Marathon, cranks up her training regimen. WSJ’s Matthew Futterman reports. (Oct. 30)
Building on that earlier research, scientific studies are now suggesting that exercise-induced changes in the body’s immune system may protect against some forms of cancer. For example, Harvard Medical School’s consumer Web site (hms.harvard.edu/public/consumer) notes that more than 60 studies in recent years taken together suggest that women who exercise regularly can expect a 20% to 30% reduction in the chance of getting breast cancer compared with women who didn’t exercise. While researchers are still studying the molecular changes caused by exercise and how they affect cancer, the studies suggest the outcome could be due to exercise’s ability to lower estrogen levels.
One study of 3,000 women being treated for breast cancer, published in the Journal of the American Medical Association, showed that for those patients with hormone-responsive tumors, walking the equivalent of three to five hours per week at an average pace reduced the risk of dying from the disease by 50% compared with more sedentary women.
Researchers are also investigating whether exercise can influence aging in the body. In particular, they are looking at whether exercise lengthens telomeres, the strands of DNA at the tips of chromosomes. When telomeres get too short, cells no longer can divide and they become inactive, a process associated with aging, cancer and a higher risk of death.
In a study published in November in Circulation, the medical journal of the American Heart Association, German researchers compared two groups of professional athletes (32 of whom were in their early 20s, and 25 who were middle-aged) with two groups (26 young and 21 middle-aged) who were healthy nonsmokers, but not regular exercisers. The athletes had significantly less erosion in telomeres than their more sedentary counterparts. The study concluded that physical activity has an anti-aging effect at the cellular level, suggesting exercise could prevent aging of the cardiovascular system.
Wake-Up Call for Couch Potatoes
The federal government, which issued its first physical-activity guidelines for Americans in 2008, is developing a national plan to encourage their use. Here are recommendations for adults:
- At least two hours and 30 minutes a week of moderate-intensity, or one hour and 15 minutes a week of vigorous-intensity aerobic physical activity, or a combination of moderate and vigorous activity. Aerobic-activity episodes should last at least 10 minutes, preferably spread through the week.
- Additional health benefits are gained from as much as doubling the minimum recommended time spent each week in moderate or vigorous aerobic physical activity.
- Muscle-strengthening activities for all major muscle groups two or more days a week.
- Moderate activity can include ballroom and line dancing; biking on level ground or with a few hills; canoeing; gardening (raking, trimming shrubs); tennis (doubles); brisk walking; water aerobics.
- Among vigorous-activity exercises are aerobic dance; biking faster than 10 miles an hour; heavy gardening (digging, hoeing); tennis (singles); jumping rope; swimming laps; hiking uphill; race walking, jogging or running.
— U.S. Dept. of Health and Human Services
Efforts are underway to get sedentary Americans moving. The federal government issued its first national exercise guidelines in 2008. Now it is working with a number of medical and fitness groups to develop a National Physical Activity plan, to be released early this year, to encourage Americans to adhere to the guidelines.
The guidelines, developed by the Department of Health and Human Services and available online at health.gov/paguidelines, recommend that adults get at least two hours and 30 minutes weekly of moderate-intensity aerobic physical activity, or one hour and 15 minutes a week of vigorous-intensity aerobic exercise, or an equivalent combination of both. The guidelines also say that additional health benefits can be had from as much as doubling the minimum recommendation for aerobic exercise. Also recommended: muscle-strengthening activities two or more days per week, which protects against a decline in bone mass, especially that experienced by post-menopausal women.
Kaiser Permanente’s Dr. Sallis also is chairman of Exercise is Medicine, a two-year-old program developed by the American College of Sports Medicine and the American Medical Association to encourage doctors to assess and review each patient’s physical activity program at every visit. A survey by the ACSM, whose members include physicians and exercise-science professionals, found that only four out of 10 doctors talk to their patients about the importance of exercise, and they don’t always offer suggestions on the best ways to be physically active.
Kaiser Permanente’s California facilities last year began rolling out exercise counseling to eight million members as part of their regular doctor visits. The company also has set up a toll-free telephone line to help members create a personal-fitness plan incorporating favorite activities like gardening. “Exercise can be used like a vaccine to prevent disease and a medication to treat disease,” says Dr. Sallis. “If there were a drug with the same benefits as exercise, it would instantly be the standard of care.”
While some patients may have risk factors such as heart conditions that could lead to heart attacks and sudden cardiac death with physical exertion, physicians can screen for such risks before prescribing an exercise program. Also, the exerciseismedicine.org Web site includes videos and self-assessment tools for consumers on how to start an exercise program, including how to exercise with diseases such as asthma and heart disease, and exercise following a stroke or heart attack.
Starting an exercise program can have benefits at any age, but is particularly important for those over 40, when physical strength, endurance, flexibility and balance begin to decline, says Pamela Peeke, a Bethesda, Md., physician and fitness expert who is the author of “Fit to Live,” an advice book on how to create and stick to a fitness plan.
Naomi Henderson, 66, says Dr. Peeke gave her an exercise prescription several years ago, when she weighed 220 pounds. The plan called for Ms. Henderson, who owns her own market-research company, to start by walking on a treadmill five minutes a day and gradually increase the duration as her fitness level improved. Eventually she was able to walk in a marathon. Ms. Henderson says she has slimmed down to a size 12 from an 18 and says she is rarely ill. “I look at exercise as no different than a drug I have to take to stay healthy,” she says.
Lisa Callahan, co-director of the Women’s Sports Medicine Center at New York’s Hospital for Special Surgery, says her patients are often only partially aware of the benefits of exercise.
They may know that it is helpful in reducing their risk of osteoporosis, for example, but they usually don’t know that a combination of strength training, aerobic exercise and balance training is most effective at staving off the disease, says Dr. Callahan, who is the author of “The Fitness Factor,” a guide for women.
Dr. Nieman, of Appalachian State University, says that during exercise, two types of immune cells circulate more freely in the blood, neutralizing pathogens. Although the immune system returns to normal within three hours, the effect of the exercise is cumulative, adding up over time to reduce illness rates, he says. He compares the process to “a cleaner who comes in for an hour a day, so by the end of a month, your house looks much better.”
But, Dr. Nieman says, high-intensity exercise over long periods, like running a marathon, can “take a good thing too far.” Such exertion can induce the release of stress hormones in the body that damp some functions of the immune system temporarily, increasing susceptibility to infection for short periods. He cites a five-year study he conducted on 350 athletes who completed an ultra-marathon 160-kilometer race in the Sierra Nevada mountains. Among the contestants, one out of four reported sickness in the two weeks following the races.
Still, says Robert Mazzeo, a professor in the department of integrative physiology at the University of Colorado in Boulder, although a single bout of intense exercise can suppress the immune system, long-term training in marathoners and other athletes can boost their baseline immunity and ability to respond to the stress of intense exercising.
Rather than worrying about super athletes, however, “my concern is the sedentary people who start out pumping the Stairmaster too hard, then get sick and stop working out,” says Dr. Mazzeo. “If you’ve made a New Year’s resolution to get in shape, don’t try to do it all at once,” he says.
This Week’s News That Could Actually Change Your Health
Photo by Marissa Angell
With so many headlines to read, news articles to sift through, and tweets to favorite, it’s nearly impossible to read every story that affects our health. So we’re making it easier for everyone by rounding up our top story picks that could seriously change some health behaviors.
Do this: For a longer life, cut down on alcohol, red meat, and TV time. Eat more fruits and veggies, and exercise.
Want to see how health behaviors really affect our life? A new system was created that assigns certain lifestyle behaviors to “microlives” to see how much time certain choices are adding or subtracting from our lives. The verdict? Bad habits like smoking and excessive drinking can knock off 30-minutes for each day of indulgence, reports Science Daily. On the flip side, every day of eating green and and hitting the gym could add to two hours to a life. While there are definite limitations to this system, it does illuminate that even during the holidays, over-indulging can take a significant toll on our health.
Do this: Ditch the texting and tweeting in the bedroom for a healthier and happier sex life.
Mashable unveiled some less-than-sexy stats last week: 15 percent of people who surf the net before bed admit they are also having less sex. On top of that, browsing the web – whether on a computer, tablet, or smartphone — can lead to getting to bed 90-minutes later than planned. So if you’re looking to boost your relationship with some intimate moments before bed, keep the phone out of sight.
Do this: Get enough sleep — seven to nine hours a night — in order to boost pain tolerance.
Not catching enough Zzz’s has been connected to weight gain and feeling depressed and irritable. But now a new study explained in The New York Times shows another downside to sleep deprivation: feeling more pain. In the study, participants who slept the most were able to hold their finger on a source of heat for the longest amount of time. The reason? Scientists are still unsure, but sleep loss may lead to increased inflammation in the body. Just another reason to work on getting more sleep.
Do this: Hit the salad bar and the fruit bowl to help improve well-being.
Need some more science that shows the link between psychological health and diet? New findings reported by MSN Today Health did just that. Researchers found that eating five to seven servings of fruit and veggies was associated with happiness and over well-being. Scientists aren’t sure if some salad actually boosts mood or if happier people just eat healthier, but with all the health benefits associated with eating green, it doesn’t hurt to see for yourself.
Do this: For a healthier meal, skip supermarket meals and recipes seen on TV and cook for yourself!
With food shows popping up left and right, researchers wanted to take a closer look at what our favorite celebrity chefs were cooking up. What they found, explained in Science Daily, was super surprising: The chefs’ recipes were actually more unhealthy (containing more fat and sodium and less fiber) than ready-made meals from the grocery store. But before we head to the nearest “grab and go” section in the supermarket, these meals also fail to meet health standards for a balanced diet. So maybe it’s best to find a healthy recipe and cook at home.
Do this: Take a chill pill to reduce blood pressure and LDL cholesterol, which could prevent major heart problems.
We all know that a pack of cigarettes comes with some serious health risks. But a new report on a selection of studies found that being stressed can also raise your risk of a heart attack by 27 percent, according to Salon. Researchers explain that stressing out can increase blood pressure and LDL cholesterol (the bad kind) which could up the risk for a heart attack. Scientists equate high stress levels to smoking five cigarettes, so quit the Camels and try to manage stress for a healthy and happy heart.
I have discussed this before. (Blog June 20th ). While there is a question mark over the safety of calcium supplements, I recommend not to take them, but to make sure you get enough calcium from your food. Remember, 50% of women over 50 will die of heart disease, so anything that reduces this risk has to be good.
Harvard Health Blog » Link between calcium supplements and heart disease raises the question: Take them or toss them?
Here we go again. First it was vitamin E. Then it was beta carotene. Now calcium supplements are being called on the carpet after researchers claimed they may do more harm than good.
The flap comes in the wake of a German study that found a significantly increased risk of heart attack among women taking calcium supplements, but not among those who got their calcium from food. The study appears in the June 2012 issue of the journal Heart.
Since calcium supplements are recommended to prevent osteoporosis for virtually everyone over age 50, this leaves millions of people wondering whether they should ditch their daily calcium pills. Three Harvard professors weigh in on the issue.
Calcium and the heart
Over time, calcium can accumulate in arteries. It makes them stiffer and less responsive to the demands of the body. Rigid arteries contribute to high blood pressure, angina (chest pain with exertion or stress), and heart failure. Calcium also builds up in plaque, the cholesterol-filled pockets that grow inside arteries like tiny pimples. By narrowing arteries, plaque can choke off the supply of blood to heart muscle and other vital tissues. If a plaque bursts open, it can trigger a heart attack, stroke, or sudden cardiac arrest.
What researchers don’t know is whether this process is influenced by the amount of calcium a person takes in each day from supplements.
Supplements are okay…for now
A decision to stop taking calcium supplements should not be made on this study, says Dr. Deepak Bhatt, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital.
“The study did not provide iron-clad evidence of a connection between calcium supplements and heart attack. Although it’s not the first report suggesting this connection, no study has definitely proven that excessive calcium intake contributes to plaque formation and heart disease,” Dr. Bhatt told me.
He questions the researchers’ explanation that excess calcium is deposited in the arteries, because the bones have limited ability to absorb calcium given in larger doses than found in foods. “We know that calcium in plaque is a response to injury, an effort to wall off an area of the artery that has been damaged by cholesterol or smoking, for example. It can happen in people whose calcium levels are in the normal range,” he says.
Dietary calcium is important, as it helps to build strong bones and keep them healthy. That’s why Dr. Bhatt would support people who, on their doctor’s advice, get some of the recommended 1,000 to 1,200 milligrams of calcium a day through supplements because they can’t get that amount from food.
“It’s perfectly reasonable to stick with these recommendations regarding calcium intake for now,” he says.
Calcium-rich foods are better
Dr. Richard Lee, co-editor of the Harvard Heart Letter and a cardiologist who specializes in finding new approaches to treating cardiovascular diseases, is more cautious. Because calcium supplements have not been proven safe without a doubt, and most people can get enough calcium through diet, he suggests that people try to get their daily allowance of this mineral from food.
“I don’t think people should take calcium supplements unless they understand there may be a heart hazard that appears in the future. When people really pin me down, I tell them to take a once-a-day multivitamin and eat a balanced diet. That is plenty for almost everyone,” he says.
Supplements are just that
Dr. David Slovik, an osteoporosis specialist at Massachusetts General Hospital, agrees with Dr. Bhatt that the research connecting calcium supplements with heart attack does not provide enough clarity to challenge current recommendations.
He suggests people not rely on supplements as their primary source of calcium.
“I tell my patients to try to get as much calcium from food as possible. They should also exercise and take vitamin D to help maximize and maintain their bone strength,” he says.
Q. I know someone who swears by Vaseline as a face cream. What do you think?
A. There are two important differences between the skin on your face and the skin on the rest of your body. First, the skin on the face heals much faster. Cosmetic surgery is possible because facial skin heals so well and so fast, even in older people. Second, facial skin has more pores than skin elsewhere. Pores allow sebum, the oily substance produced by sebaceous glands, to reach the surface. Vaseline is 100% white petrolatum, an ingredient in many skin moisturizers. White petrolatum is a very effective occlusive, a substance that blocks evaporation and can help keep skin moist and supple. But I wouldn’t recommend using it as face cream because it might clog up pores and perhaps make the skin look shiny. There are dozens of face creams. Some are exceedingly expensive. I’m sure they’re very nice creams, but the difference between them and far less expensive products is mainly a matter of marketing. Some face creams also function as sunscreens, which is a good idea because sun exposure is so damaging to the skin. I don’t think there is any particular magic ingredient or mix of ingredients to look for in a face cream. You just want to use something that feels and smells right and isn’t too oily.
— Kenneth Arndt, M.D.
SkinCare Physicians, Chestnut Hill, Mass.
Harvard Health Letter Editorial Board
8 January 2013, 4.19pm AEST
Bushfires are quite appropriately dominating our nation’s concerns during the current Australian heatwave. But for many, the struggle to sleep through soaring temperatures is a personal inferno that dominates conversation around offices and homes across the country.
Sleep and body control of temperature (thermoregulation) are intimately connected. Core body temperature follows a 24-hour cycle linked with the sleep-wake rhythm. Body temperature decreases during the night-time sleep phase and rises during the wake phase. Sleep is most likely to occur when core temperature decreases, and much less likely to occur during the rises.
Our hands and feet play a key role in facilitating sleep as they permit the heated blood from the central body to lose heat to the environment through the skin surface. The sleep hormone melatonin plays an important part of the complex loss of heat through the peripheral parts of the body.
At sleep onset, core body temperature falls but peripheral skin temperature rises. But temperature changes become more complex during sleep as our temperature self-regulation varies according to sleep stage.
Research has shown how environmental heat can disturb this delicate balance between sleep and body temperature. An ambient temperature of 22˚ or 23˚ Celsius is ideal. Any major variation in this leads to disturbance of sleep with reduced slow wave sleep (a stage of sleep where the brain’s electrical wave activity slows and the brain “rests”), and also results in less dreaming sleep (rapid eye movement or REM sleep).
Indeed during REM sleep, our ability to regulate body temperature is impaired so in a clever sort of way the body “avoids” this stage of sleep during extreme cold or heat. A heat wave may cause several nights of fragmented sleep with less slow wave and REM sleep. This will certainly cause a correct perception of bad, restless sleep with consequent negative effects on mood and alertness.
In theory, it may also have subtle effects such as problems with complex memory retention, higher judgement (poorer decision making and increased risk-taking behaviour), blood pressure control and regulation of glucose in the body. The clear message is this: if you’re going to make some big decisions during a heatwave, sleep in a carefully controlled air-conditioned environment.
But apart from air-conditioning, what can you do to sleep better during a heatwave? Sleeping in the lateral position (on your side) with less contact with the mattress may be good but the body tends to do this anyway during sleep, in response to rising temperatures.
Cooling the central body with a wet cloth or towel makes sense. A cool shower may also help. It is important to avoid doing anything too strenuous in the hours before bed-time as this will make it harder for the body temperature to fall during sleep. And when you wake up hot, sticky and irritated because you don’t have air-conditioning or believe such devices are environmentally unsound, remember those fighting bushfires – it could be a lot worse.
If I’m honest, I never really liked running, but every new year when I was in high school, I made the resolution to try out for the track team. We started training before snow was off the streets of Detroit by “running the stairs” – run down the hall, up three flights of stairs, back down the hall, down…
If I’m honest, I never really liked running, but every new year when I was in high school, I made the resolution to try out for the track team. We started training before snow was off the streets of Detroit by “running the stairs” – run down the hall, up three flights of stairs, back down the hall, down three flights.
They worked us hard and within a couple of weeks every one of us was hobbling around with shin splints.
We all recovered, but we clearly had an effective recipe for injury. What we didn’t know was that our shin splints were actually the early stages of stress fractures.
Most research into exercise-induced injuries involve military recruits who undergo intense exercise in their basic training. Injury rates in this group can be over 35%, but they’re highly variable and dependent on the training regime, as well as the level and type of previous exercise.
It’s not necessarily the intensity of exercise that seems to produce injuries. Rather injuries are more likely with a change in intensity or loading.
First peak for injuries
It might be expected that the frequency of injury would decline with time after the load increased, but this in not necessarily the case. Rather, there are two peak times for injury – one in the first two weeks and one in the period between eight and 11 weeks.
The first peak includes a high incidence of stress fractures, just like in my high school story. Bones get stronger and re-model in response to increased exercise, but the process takes time. Increased load produces stress on the bone and stimulates remodelling to build up bone strength.
The process of remodelling begins with re-absorption of old bone and results in the temporary weakening of the total bone structure. If the same high level of loading is repeated, then the weakened bone can be stressed and possibly even damaged. And this leads to a downward spiral that can culminate in a stress fracture.
Similar processes occur for other systems of the body, where the very loading that stimulates the capacity of a tissue to increase, frequently also results in a transient reduction in tissue strength.
It’s the second peak of injury – at two to three months – that’s more reminiscent of many of the injuries we see in clinical practice. To understand this peak, we need to consider how the body responds to exercise. Allowing for the effects of age, disease or accident, generally if we keep doing what we’re doing we will maintain our capacity.
If we reduce the challenges in a particular area, its capacity reduces; increase the challenges, and capacity increases. So, for example, if your goal is more strength and muscle bulk, then high muscle load is necessary. If your goal is endurance, duration of exercise is important. For improving bone density, the activity needs to load the bones. To increase cardiovascular capacity, the cardiovascular system needs to be challenged.
Exercise is often thought of as having an effect on muscle strength and cardiovascular capability, so we build up our activity levels as our strength and cardiovascular fitness improves. Effective strength can increase within minutes or days due to neurological adaptations while actual muscle strength starts to increase within two weeks. Similarly, cardiovascular fitness starts to increase within three weeks.
Connective tissues such as tendons and ligaments also strengthen in response to load. Although their response is more rapid than bones, connective tissues respond much more slowly than muscles with changes only starting to occur over a period of months.
When we use our newfound muscular and cardiovascular capacity to ramp up the exercise load, the load is also increased on the other structures that haven’t had time to remodel. It’s typically these connective tissues, such as tendons and ligaments, where injuries start to occur after six or eight weeks of exercise.
A recipe for injury
Say you want to produce an injury. Start with a new type of exercise with plenty of speed, impact, and fatigue. Increase hard and fast, and add in some awkward positions and near maximal loads. Alternatively, be pushed by a friend or personal trainer who you trust against your better judgement.
Continue for a month or so. As you’re starting to have a better cardiovascular response and feel stronger, ramp up the intensity to tolerance.
The tendons and ligaments that haven’t built up yet can then be expected to start to break down. The tissues are subjected to the downward spiral of structural stress, reduced integrity prior to remodelling, more stress on weakened structures – your injury is ready.
Just like clothing or food, exercise goes through fashions. In the 1980s, it was aerobics. When the injury rates as high as 58% to 66% were recognised, low impact aerobics were introduced and the injury rates dropped somewhat.
Today, there are a wide variety of fashionable exercises some of which follow the recipe for injury even more closely than aerobics. Look for these elements: an unfamiliar type of exercise, repeated high levels of impact or high levels of effort, particularly those performed at high speed in unusual or awkward positions, continue when fatigued. Repeat frequently, don’t allow time for recovery and keep increasing as tolerated.
A cautionary tale
A man in his late 60s came to see me recently. He and his wife had started boot camp-type exercises twice a week about six weeks previously. The exercise program was such that they would just be recovering from the pain after their previous workout when it was time for the next one.
In the previous week, he had developed three separate problems – tennis elbow, a rotator cuff problem and knee pain. He asked me if I thought he was doing too much. Once he said the question out loud, I didn’t need to answer him and he didn’t end up needing any specific treatment. He just needed to back off and apply a common sense approach rather than his following his previous recipe for injury.
So, is “no pain, no gain” a recipe for injury? Not on its own and probably not for highly trained individuals who have built up to their level of exercise. But for the rest of us, more is not necessarily better.
Returning to that new year’s resolution. Perhaps the pain is not essential and, for most of us, a motto of “no brain, no gain” might be more appropriate.
10 simple steps to help de-stress
There is no shortage of angst-inducing news these days: natural disasters, economic woes, political unrest. Add to this backdrop stresses in our personal lives, layoffs, illness, money woes, temper tantrums, and traffic jams, and it is clear that stressful situations are constant and inevitable.
Just as serious as the stressors themselves are the adverse effects stress can have on your emotional and physical health. Many well-respected studies link stress to heart disease and stroke — the No. 1 and No. 3 causes of death, respectively, in the United States. Stress is also implicated in a host of other ailments such as depression and anxiety, chronic lower respiratory diseases, asthma flare-ups, rheumatoid arthritis, and gastrointestinal problems.
Stress is not all bad. Your perception of a real or imagined threat can spark the stress response, which prepares the body to fight or flee. That swift reflex was encoded in you for survival. Thanks to the stress response, you might suddenly jump out of the path of a speeding car or flee from a burning house. But when your stress response is evoked repeatedly, your body experiences unnecessary wear and tear — such as high blood pressure — that can lead to poor health.
Even if you only have a few minutes to spare, the stress-busting suggestions described below can make your days calmer, if not easier.
Take the sting out of 10 common stressors
Sometimes just thinking about embarking on a program of stress control can be stressful. Rather than freeze in your tracks, start small and bask in the glow of your successes. Give yourself a week to focus on practical solutions that could help you cope with just one stumbling block or source of stress in your life. Pick a problem, and see if these suggestions work for you.
- Frequently late? Apply time management principles. Consider your priorities (be sure to include time for yourself) and delegate or discard unnecessary tasks. Map out your day, segment by segment, setting aside time for different tasks, such as writing or phone calls. If you are overly optimistic about travel time, consistently give yourself an extra 15 minutes or more to get to your destinations. If lateness stems from dragging your heels, consider the underlying issue. Are you anxious about what will happen after you get to work or to a social event, for example? Or maybe you’re trying to jam too many tasks into too little time.
- Often angry or irritated? Consider the weight of cognitive distortions. Are you magnifying a problem, leaping to conclusions, or applying emotional reasoning? Take the time to stop, breathe, reflect, and choose.
- Unsure of your ability to do something? Don’t try to go it alone. If the problem is work, talk to a co-worker or supportive boss. Ask a knowledgeable friend or call the local library or an organization that can supply the information you need. Write down other ways that you might get the answers or skills you need. Turn to CDs, books, or classes, for example, if you need a little tutoring. This works equally well when you’re learning relaxation response techniques, too.
- Overextended? Clear the deck of at least one time-consuming household task by hiring help. If you can, hire a housecleaning service, shop for groceries through the Internet, convene a family meeting to consider who can take on certain jobs, or barter with or pay teens for work around the house and yard. Consider what is truly essential and important to you and what might take a backseat right now.
- Not enough time for stress relief? Try mini-relaxations. Or make a commitment to yourself to pare down your schedule for just one week so you can practice evoking the relaxation response every day. Slowing down to pay attention to just one task or pleasure at hand is an excellent method of stress relief.
- Feeling unbearably tense? Try massage, a hot bath, mini-relaxations, a body scan, or a mindful walk. Practically any exercise — a brisk walk, a quick run, a sprint up and down the stairs — will help, too. Done regularly, exercise wards off tension, as do relaxation response techniques.
- Frequently feel pessimistic? Remind yourself of the value of learned optimism: a more joyful life and, quite possibly, better health. Practice deflating cognitive distortions. Rent funny movies and read amusing books. Create a mental list of reasons you have to feel grateful. If the list seems too short, consider beefing up your social network and adding creative, productive, and leisure pursuits to your life.
- Upset by conflicts with others? State your needs or distress directly, avoiding “you always” or “you never” zingers. Say, “I feel _____ when you _____.” “I would really appreciate it if you could _____.” “I need some help setting priorities. What needs to be done first and what should I tackle later?” If conflicts are a significant source of distress for you, consider taking a class on assertiveness training.
- Worn out or burned out? Focus on self-nurturing. Carve out time to practice relaxation response techniques or at least indulge in mini-relaxations. Care for your body by eating good, healthy food and for your heart by seeking out others. Give thought to creative, productive, and leisure activities. Consider your priorities in life: is it worth feeling this way, or is another path open to you? If you want help, consider what kind would be best. Do you want a particular task at work to be taken off your hands? Do you want to do it at a later date? Do you need someone with particular expertise to assist you?
- Feeling lonely? Connect with others. Even little connections — a brief conversation in line at the grocery store, an exchange about local goings-on with a neighbor, a question for a colleague — can help melt the ice within you. It may embolden you, too, to seek more opportunities to connect. Be a volunteer. Attend religious or community functions. Suggest coffee with an acquaintance. Call a friend or relative you miss. Take an interesting class. If a social phobia, low self-esteem, or depression is dampening your desire to reach out, seek help. The world is a kinder, more wondrous place when you share its pleasures and burdens.
Mosquito-borne disease is a serious concern, with millions of people worldwide impacted by pathogens spread by these blood-sucking insects. In Australia, there are more than 5,000 cases of human illness caused by the mosquito-borne Ross River virus and Barmah Forest virus every year.
When mosquitoes bite, they inject saliva into the skin. Our bodies react to this mozzie spit, causing a skin irritation. The severity of the “itchy bite” varies from person to person and, in some cases, severe allergic reactions can occur.
Mosquito control programs can reduce the rates of human disease but the first line of defence remains personal protection measures: avoiding known mosquito habitats (such as wetlands) and peak biting times (dusk), wearing protective clothing (often treated with insecticides) and using bed nets and insect repellents.
But not all mosquito repellents are equal. There are over 60 individual repellent formulations currently registered including aerosols, creams, lotions, pump sprays, wipes, wrist bands and sticks. Despite this diversity of products, there are only a handful of active ingredients, the most common of which are DEET (diethyltoluamide) and Picaridin.
All topical insect repellents sold in Australia must be registered with the Australian Pesticides and Veterinary Medicines Authority (APVMA). The APVMA assess products for their efficacy and safety. This also means the label must display the active ingredients and their concentration.
DEET has been shown to be effective at preventing bites from a wide range of pest mosquitoes. It’s considered the gold standard in mosquito repellents. But there is still not unanimous agreement on how DEET works. While it’s generally thought to prevent bites by inhibiting the host seeking stimuli, there is also some evidence that the mosquitoes smell, and are repelled, by DEET.
Picaridin works just as well as DEET and is generally considered to be a more pleasant product to use as it is odourless.
There is some resistance to the use of these chemical repellents because they’re unpleasant to use, are thought to damage clothing or belongings or are perceived to pose adverse health effects. But despite the widespread use of DEET, and increasingly picaridin, there are very few serious adverse reactions reported. As such, the two products have been endorsed by health authorities internationally as a safe way to avoid mosquito bites.
There is often confusion about how the concentration of a repellent determines the level of protection: the concentration of a repellent relates to the duration of protection, not the amount of mosquitoes that are kept at bay.
Repellents containing DEET at concentrations of 80% or 10%, for example, will both protect against mosquito bites for about two hours. While the protection provided by the 10% formulation may stop after a few hours, the 80% formulation will continue to provide protection for over ten hours.
When choosing a repellent, it’s worth keeping in mind just how long you’ll need to protect yourself. For a quick trip to the park, a low-concentration repellent will do the trick. But if you’re off on a major bush walk or fishing trip, a higher concentration repellent will be required. Alternatively, you’ll need to reapply a lower concentration repellent more frequently.
So does formulation matter?
Probably not. The choice of active ingredient is really the most important decision. The choice of formulation is probably best guided by the ease of application. Sprays are generally most effective for arms and legs while creams and wipes are good for the face.
For complete protection, the entire surface of exposed skin must be covered. For this reason, it is probably best to apply repellent to your hands first, and then rub into exposed skin. A spray “here and there” won’t offer protection. Spraying repellent on clothes and/or belongings won’t help either.
What about ‘natural’ repellents?
Products derived from plants are often considered a safer alternative to the chemical products such as DEET and picaridin. Homemade concoctions of essential oils, particularly Eucalyptus and Melaleuca oils, are often promoted as suitable repellents.
First, it’s important to note that these products have the potential to cause skin reaction.
Second, studies have shown that essential oils provide only limited protection from biting mosquitoes. Registered commercial products that contain botanical extracts offer some protection but will need to be reapplied far more frequently than even the low concentration DEET- or picaridin-based repellents.
Despite its popularity, citronella has repeatedly been shown to be less effective than DEET.
The Australian native plant Corymbia citriodora (lemon-scented Gum) plant sits in an interesting position among botanical repellents. While the essential oil from this plant doesn’t demonstrate substantial repellent activity, the by-product of the hydrodistillation process has been shown to be a very effective repellent. The active ingredient is p-menthane-3, 8-diol (PMD). In Australia, PMD is listed as, “Oil of Lemon Eucalyptus being acid modified extract of lemon eucalyptus (Corymbia citriodora)”.
Although patches or plastic wrist bands are registered as repellents by APVMA, these only offer very limited and localised protection (generally only immediately around the product, if at all).
Ultrasonic repellents have been sold in many forms for many years. The most recent incarnation is smartphone apps. The failure of sound to repel mosquitoes has been shown time and time again. They simply don’t work.
A group of experts recently reviewed the benefits of a range of strategies, from insecticides to taking vitamin B supplements.
Their conclusion? As well as insecticide-treated bed nets and clothing, topical insect repellents provide the best protection. DEET- and picaridin-based repellents are a cheap, safe and effective way to prevent mosquito-borne disease.