I would like to provide an update to the May 1995 issue on back exercises - specifically "shoulder shrugs," found on page 2. What was presented is essentially correct, but I have a couple of comments. First, the "shrug" should go as high as the bottom of your ears, if you can. When I first heard that, I thought it was impossible. I can't even get close, but if you can do it - make your neck disappear. And be sure to stretch as low as you can on the downward movement. Second, dumbbells are the preferred implement because they allow a straight up-and-down movement at your sides. A barbell, on the other hand, requires the up-and-down movement to be slightly out in front of your body, and that may result in rounded shoulders (i.e., a postural defect). [Editor's comment: If dumbbells are unavailable, a barbell may be used - keep your shoulders back, and keep the bar against your body as you move it up-and-down. It is also possible to use a barbell by holding it behind your back. Of course some of you may have a large obstruction back there which would negate this option.]
F.L., Honolulu, HA

Sorry, but I have something to say about the hip flexor. It is commonly considered to be the iliopsoas (also known as the iliacus and psoas muscles), even though it is true that there are actually five muscles that can be involved in hip flexion.
Y. F., Henderson, NV

I recently read (I'm sorry to say that I have forgotten the source, but it was legitimate.) that we should not eat runny eggs; that is, eggs that aren't thoroughly cooked. The problem is similar to the notorious ground beef problems that have surfaced in the last year or so - people died from Jack-In-The-Box hamburgers that hadn't been completely cooked. The same applies to eggs. Salmonella or botulism, I forget which, can be the result of eating eggs that are not completely cooked. The worst that can happen is death, and it doesn't get much worse than that.
G. H., Willits, CA

There has been information about the rotator cuff before in this Newsletter, but I would like to expand on what has been said before. To review, the rotator cuff is a group of four muscles which lie beneath the deltoid muscle which caps the shoulder. They are the supraspinatus, infraspinatus, teres minor, and subscapularis. The supraspinatus is exercised along with the middle deltoid. It is particularly important in throwing movements - it holds the head of the humerus in the glenoid fossa during the follow-through. It is exercised along with the deltoid muscle, and, unfortunately, it is easily overused or injured. The infraspinatus and teres minor work together, and are particularly active when the arms are pulled down (e.g., during chin-ups or rope climbing). The subscapularis holds the head of the humerus in the glenoid fossa from below. Because of its proximity to the joint, it is a relatively weak muscle, but it gets help from the latisimus dorsi, teres major, and the rhomboids. It is used in actions like chinning, rope climbing, and dips. It is developed by rowing and pullover exercises.
D. G., Salem, OR

I read in an earlier Newsletter issue about the guy who dashed out immediately after dinner to embark on a hard training run - an act which would make most of us throw up. It turns out that the more fit one is, the less impact exercise has on the gastric function. Maybe that provides a partial explanation, because, if I remember correctly, he was said to be very fit.
B. C., Mtn View, CA

I recently spent an afternoon perusing some medical journals, and came up with a few interesting tidbits to share with you. In Lancet, July 15, 1995, a brief article on weight control stated that the people of the U.S. spend thirty-three billion dollars a year on weight control. And all the while this obscene amount of money is being spent to shed the fat, obesity and fat, in general, are on the rise. It should be known by everyone who hasn't been living in a cave for the last few decades that the way to permanently lose fat is to exercise and eat fewer calories (usu ally expressed as: "cut the fat"). The Lancet suggests a way to do this. They suggest that the obesity problem could be eliminated in a few generations if children were taught, in school, to practice good eating and exercise habits. [Editor's note: But it won't happen; people would rather take a pill, and then go watch TV.]

From April 13: A study of fish consumption - you know, Omega-3 fat and its possible help in preventing heart disease - suggested that it may not help after all. The study was of a group who went from consuming fish 1-2 times a week, to 5-6 times a week. No increased safety from heart disease was found. But others point out that even if there were no protection against heart disease from eating fish (and there is no concession that the study mentioned is actually correct), it can still be a healthy part of your diet.

From the May 3, 1995 issue of JAMA comes this astonishing information: a study concluded that exercise can help reduce falls in the elderly. [Editor's note: "No kidding!"]

More French Paradox stuff from the April 26, 1995 issue. A possible reason why red wine, specifically, may lower the incidence of arteriosclerosis is that the skins of the grapes used for making red wine contain polyphenols, which seem to be the significant ingredient. White wine, by contrast, is made from grapes that have had their skins removed, hence no polyphenols, which bind with LDLs and prevent them from sticking to arterial walls. But this issue remains open. As previously stated in an earlier Newsletter, some studies have shown that any alcohol, not just red wine, has this protective property. In moderation, of course. And advice from doctors remains: if you don't drink alcohol now, don't start.

On the subject of weight cycling. It was once thought to have negative effects on one's body, but it seems that opinions have changed; it is no longer considered to be a problem. But, a letter to the editor (of JAMA) said that weight cycling should be avoided by seriously obese people. For them, there may be negative health effects [unspecified].
N. F., Henderson, Nev

In the June, 1995 issue of Nutrition Action Health Letter, there was an interesting article about how to select a breakfast cereal. First of all, cost is becoming an issue now that some cereals have reached $3.00-$4.00 a pound. This high price is attributable to the fact that the price of cold cereals often includes as much as 55% for marketing and profits - sometimes twice that for other food products. It is often possible to cut the cost in half by buying store brands, with little or no taste difference.

In addition to cost, there are some other issues in buying breakfast cereal. One is the amount of fiber, something that is inadequate in many diets. It is recommended that you look for at least 2.5 grams per serving. It is recommended that we get 20-30 grams per day: many Americans get 10 or less.

Select whole grain cereals to get the most nutrients - many are absent from more processed gains, including those that are "fortified." Even TOTAL doesn't put back everything that first gets processed out.

Minimize sugar, regardless of its source - honey, brown sugar, fruit juice, etc. Sugar is sugar.

Low or no-salt cereals are probably your best choice. If you are not salt-sensitive, this may not be a serious consideration, but we are exposed to so much salt, that we can all probably benefit by minimizing it in our diets.

Avoid fat. Some cereals (e.g., Granola, or Muesli) have enough added fat that you might as well have a fast-food burger.
C. S., San Jose, CA

I recently read, in the Berkeley Wellness Letter that bagged veggies - lettuce, spinach, salad greens, etc. - can be nutrient-savers, as well as more convenient. The packaging helps retention of nutrients. My first experiences were with packaged spinach, and I was very pleased. I have to take the experts word that nutrients are better preserved, since I have no way of actual verification. But the advantage that I did no tice was "freshness." When you buy normal spinach bunches, they have been sprinkled on-and-off all day and are soaking wet, which leads to rapid rot. In addition, they contain hidden lumps of mud. The packaged produce is relatively dry, and clean. I admit, though, that lately the veggie baggies have been pretty wet. Take a good look at what you are buying.
A. F. and J. F., Palo Alto, CA

It may be that tanning salons are not safe - no better than direct sun bathing. It is reported that doctors are seeing an increase in skin cancer among tanning salon patrons. Tanning lamps emit mainly UVA radiation, which is supposedly safer than the shorter UVB rays, which causes quicker burning; but UVA radiation is not safe. It penetrates the skin deep enough to cause premature aging, may damage blood vessels, and may inhibit the immune system. It also causes the skin to be more receptive to getting cancer from sunlight. A session under a sun lamp can result in adverse reactions for those who are taking certain medications (e.g., ibuprofen, antibiotics, tranquilizers, antihistamine, birth control pills, or oral diabetic medication. UVA rays also seem to increase eye damage - cataracts and retinal damage. Closing your eyes will not prevent damage.
T. I. I., Anchorage, Alaska

I encountered a new phrase which I think you and your readers will enjoy: "sedentary inertia".
R. M., Sacramento, CA

For those of you who get the afternoon blahs (sometimes it starts in the morning), try a little exercise, it energizes. But not too much, it can also give you the blahs if you go to exhaustion.
D. F., Palo Alto, CA

On sleepy teens. A report out of Brown University says teens may need as much as nine and a half hours of sleep per day. This at a time when they often find excuses for being up late at night. So maybe your kids really do need those marathon sleeping sessions they sometimes (often?) experience. Maybe they really are not just hiding from life, or from having to do something with/for their parents. Teens should be aware of this sleep need; especially when driving. At least one study found that falling asleep at the wheel is responsible for a significant number of accidents - so they aren't all the result of alcohol.
C. M., San Jose, CA

The old issue about taking salt tablets is still hanging around, so here is some information for you athletes who are concerned about sodium loss from sweating while exercising, especially long sessions (one to two hours, or more). The sodium loss should be considered inconsequential, according to the June, 1994, issue of the "PENN STATE SPORTS MEDICINE NEWSLETTER." The typical American diet contains many times more than the recommended amount of salt (sodium). However, if an athlete has been restricting dietary salt, it is probably a good idea to add some to the next meal after a competition or heavy practice. [Editor's note: this applies to intense exercise, not just competitive athletic competition.] The crucial need here is actually fluid replacement. Taking salt tablets at this time can retard the transfer of water to the blood and other areas where it is needed. An athlete - fitness to Olympian - should drink water before, during, and after an "event." Pre-event weight should be regained as soon after the event as possible. Dehydration can actually kill you. Use the old urine test - if it's yellow, you need more water.
P. S., Santa Clara, CA

I recently read an interesting article in the August 14, 1995 issue of FORBES magazine, titled "Lies, damned lies and medical statistics," which I would like to share with the readers of the MAF FITNESS NEWSLETTER. Its basic premise was that we should be aware of the many medical studies that hit the news media, and are immediately treated like the "second coming." Statistics can be used to "prove" (or imply) just about anything, but we shouldn't be so gullible as to believe them all. At one time or another, we have been told to avoid margarine - no, butter - no, margarine - well, maybe margarine; avoid eggs - too much cholesterol, which is bad, or is it; don't drink alcohol - but some may be good - it may help to prevent heart problems; second-hand smoke kills, or does it - no positive proof has ever been offered, just conjecture. It's hard to know what to do.

At first it seemed as if the "Lies....." article was suggesting some kind of sinister conspiracy by doctors and medical journal publishers, maybe to make money without regard to the validity of information disseminated. Then what seemed almost a militant attitude seemed to soften a bit - to get real, as it were. When I read a section titled "So what should I do?," I was left puzzled because of statements that made one claim or other, but often without substantiation.
D. F., Palo Alto, CA

EDITORIAL RESPONSE: I located and read the Forbes article and have some comments to make. First, I thought the title: "Lies, damned lies and medical statistics" was very misleading; as was the subheading "Jogging kills." The point being to capture attention, not to be truthful. For example, "Lies ...." implies that medical journals lie, they don't, at least in my estimation. They print studies which may or may not be accurate (i.e., they are preliminary studies, requiring further verification). By publishing a study, a journal is not endorsing its conclusions. In fact, many studies that I have read in journals like Lancet, the New England Journal of Medicine, and JAMA, contain a statement by the author(s) that further study needs to be done, often because of something like the limited scope of a given study. I have never read a study which claimed to have the final word on any subject. The problem is that the news media doesn't bother with details - just eye-catching headlines (e.g., "Lies, damned lies and medical statistics," or "Jogging kills"). The point of headlines is not so much to inform, as to sell. Take "Jogging kills," for instance. The ensuing article hardly mentions jogging, and when it does, it suggests that by jogging one risks being run over - cute!

Actually, quite a lot of the Forbes article is out-of-date, or incomplete - to make a point, I assume. Like the discussion of the alcohol flip-flop. It talks about how alcohol consumption had been declining (presumably for health reasons), and suddenly a study comes out and suggests that we should consider drinking a glass of wine a day. This suggestion resulted from the French Paradox (see the April 1995 issue of the MAF FITNESS NEWSLETTER, pages 9 and 10), or Mediterranean diet, epidemiological studies; where study of Mediterranean populations found high intake of fat, but low incidence of heart disease - unlike in the U. S. Hence, the Paradox. How can this be? Possibly the result of wine consumption, which is common in the area? Some studies have specifically suggested red wine (see this issue, page 3, and the April 1995 issue, page 10). Another one said any source of alcohol seemed to have the same positive effect. All relevant studies suggested moderation, and all concluded that it may not be the alcohol, but some as-yet unidentified "thing" in the diet or environment. But that, at any rate, if one was a moderate drinker, it was okay to continue; but, if you aren't a drinker, don't start. There are still too many unknowns to ignore the potential risks (see Note 1) of drinking alcoholic beverages.

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Note 1 - The known problems, including going from a light to moderate, to a heavy drinker; and the lack of absolute knowledge that alcohol has a positive effect on heart disease; in addition to potential liver damage, and all of that other nasty stuff.
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Another issue is with the epidemiology studies in general - this has nothing, directly, to do with the Forbes article. An epidemiology study goes like this" select a population, and pick out common characteristics. You can come up with some interesting statistics - an east African population eats lots of fiber, and they don't get colon cancer. Is this cause-and-effect? Another group eats a lot of fish containing Omega-3 fat, and they have little heart disease. Cause-and-effect? There are dozens of examples of these kinds of correlations, but are they significant? Who knows? But as soon as the news media gets a hold of one of these statistical relationships, they trumpet a new, major, medical discovery.

Another issue brought up in the Forbes article concerns second-hand smoke. It claims that there has never been any validated connection between second-hand smoke and health problems. I don't know about that, but my personal prejudice is to accept the allegation, whether it's true or not Smoking is almost as bad as nuclear war, as far as I am concerned.

Another issue is eggs - don't eat them - too much cholesterol, which causes heart disease. Well, does it, or not? There is a big genetic factor in one's cholesterol level. The HDL : LDL ratio may be more important than total amount of cholesterol. People who die from Coronary artery disease (CAD) are usually loaded with it. But is dietary cholesterol the real cause? Does lowering one's cholesterol level reduce your risk? Who knows? And only the yolk contains fat, so remove it and you get an inexpensive, high quality, high protein source - the egg white. I think that it is better to give up the cholesterol, even though the facts aren't all in, just to be on the safe side. Better safe than sorry may be the most reasonable approach. And most doctors seem to think that lowering dietary cholesterol intake is a prudent thing to do. But what about those egg whites?

The "Lies, damned lies.............." article lists some well-docmented "True" information - don't smoke, avoid heavy drinking of alcoholic beverages, protect yourself from the sun (both UVA and UVB) - wear a hat, use a sun block use proper sunglasses.

When the article gets into the "Maybe" area, it is on shakier ground. For example: on obesity, the article equivocates - does losing weight lead to a longer life? Maybe, maybe not; but more important is quality of life, and that can be enhanced by weight loss.

Next, saturated fat. The article suggests that it could be okay, but I personally don't feel like overdosing on saturated fat because it might not kill me.

Salt may raise your blood pressure, or not. It has been known for quite some time that some people are salt-sensitive, while others are not. But, if you don't know, do you want to take a chance? [In fairness, the article comes to the same conclusion.]

Fruits and vegetables are discussed only in terms of their antioxidant content, but they are important for many other reasons, so they are an important part of a healthy diet, regardless of the antioxidant theory. Eat Œem up!

Included under the subtitle of "Bunk," is the statement that there is no evidence that eggs are bad for you. We will ignore this, since it has already been addressed.

The statement that one should not eat margarine is more bunk; at least today.

Fish oil isn't the "cure" for CAD that it was once thought to be. Most medical sources suggest that fish itself may be better than just taking fish oil. But more recently, even fish and its Omega-3 fat, have become thought of as less important than previously. But fish is a healthy food, and it is still recommended as a good component of one's diet, whether it has CAD-fighting properties or not.

More Bunk: a cup or two of coffee a day may be bad for you. I think that it is pretty generally acknowledged that this isn't harmful; but many people who are addicted, to caffeine, presumably; and drink 10 or 15 cups a day, may be doing themselves a disservice; although this is not exactly a life threatening habit (at least not today, but who knows what the next coffee study may show).

Back to second-hand smoke. We've done it.

Another goofy report that was once circulated was that left-handed people have shorter life spans (by as much as 9 years). I don't have much to say about this, except that it was seriously flawed, methodologically. So all you lefties can relax.

Another theory in the silly category was the idea that high-tension wires cause cancer. Don't spend a lot of time worrying about this.

My favorite nonsense medical journal article mentioned in the "Lies..." article was the one that reportedly found a genetic link to SIDS (Sudden Infant Death Syndrome)based on a set of five cases which occurred in one New York family. It turned out that the children had been murdered, but the journal that published the original study, didn't bother to correct the report until 20 years later. Such is progress in the world of medical research - reporting it anyway.

My least favorite insinuation centers around the question: "Are people healthy because they exercise? Or do they exercise because they're healthy?" Again, they use longevity as the sole criterion, but quality of life is helped by exercise, and that may be much more significant than sheer longevity. It is somewhat like the question: is a great athlete born or made? Answer: both. Great athletes are born (the X-factor), but that isn't to say that they don't have to train to take advantage of their innate abilities - if Michael Jordan smoked, took drugs, didn't practice; would he still be a great basketball player? No! It takes both good genes, and work. So even if you weren't born to exercise, you can still do it. And you owe it to improve your fitness level.

The bottom line is: don't go ballistic over every medical report, because many of them would remain buried in some medical journal if not for media hype. As mentioned earlier, the "Lies, damned lies and medical statistics" article does some of this to both make a point, and to catch readers' attention. But to their credit, most of the article is reasonably well-done. [And I am sure that a collective sigh of relief just went up in the Forbes board room, to know that I more-or-less approve of their article.]
ED

It has finally happened. Some news about vasectomies has been floating circulating recently. A few years ago vasectomies were touted as a safe, permanent method of birth control. Now, a few decades later, after many men bought into this "safe and effective" - and permanent - method of birth control; new information indicates that prostate and impotency problems may be side-effects. There does not seem to be anything that can be done about it now, but for men currently contemplating such a move, you might want to think twice, and talk to your doctor.
Dr. A.L., San Francisco, CA

In the past it was thought that we needed 20-30 minute exercise sessions of fairly intense activity in order to show fitness improvements. Then in 1990, a Stanford University study showed that benefits could be gotten for men out of shorter workouts. More recently, a study out of the University of Pittsburgh using female subjects, showed that both a group using longer sessions, and a group exercising for the same length of time, but in a series of shorter sessions, achieved the same results. A significant difference between the two groups was found, however. The short session exercisers adhered to their programs for longer periods of time. That is good news for those who claim not to have enough time for regular exercise sessions. You can do short sessions on "coffee" breaks, at lunch time, before and after work, even in your office; or at home while taking care of the kids - just about anytime or anywhere.
D. C., Hayward, CA

Not long ago, My mother decided that she needed to take me grocery shopping, because she was afraid that I might not be eating enough. I didn't agree, but it was easier to accede to her wishes, rather than fight it; and, after all, it was no big deal. Each aisle was filled with goodies that she thought I should have, but I try to select food based on fat content, so we ended up skipping a lot of the good stuff. But as we passed the bread area, Mom's attention was caught by some muffins. Ah ha! Bran muffins. Those are healthy. Right? Well, probably not. Despite their healthy reputation, they are usually loaded with fat - lots of vegetable oil and other stuff. And they often have very little bran, and therefore very little fiber, which is one of their selling points. If your muffin of choice is heavy. It is probably extra fatty. Look for grease on your hands or a napkin. If they are greasy, you probably did not make the healthiest choice possible. Your muffin may be the nutritional equivalent of a Big Mac. National brand muffins are sometimes a better choice. At least they will have nutritional labels, and they will usually be fairly accurate. A couple of reasonably healthy choices are Entenmann's fat-free blueberry muffins, and McDonald's apple bran muffins.
A Son, Sunnyvale, CA

For headache sufferers, here is some possibly helpful information. For years, Naproxin - a prescription pain killer - has been an effective drug for use on headaches. More recently it has been released as an over-the-counter pain killer under the name of "Aleve." It is particularly effective, and nonsedative; although slightly less powerful than the prescription version, of course. Its effectiveness may be increased by coffee or a caffeine tablet. A normal dose is one tablet, taken with food. Limit to three tablets per day, with doses eight to twelve hours apart. Possible side-effects are stomach upset, especially for users over 40. Long-term daily use may cause liver, kidney, and/or gastrointestinal problems.
Dick, Palo Alto, CA

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