In This Issue

Aspirin For Cardiovascular Use

Squats-Glute/Quad Exercise

Androstenedione - Does It Work?

Menopause and Estring

Game Meat

Evista

Caffein's Effect On Running

Vegetables - Raw or Cooked?

Questions And Answers

Aspirin, that long-term over-the-counter (OTC) pain reliever has become known to reduce risk of a stroke or heart attack or angina (chest pain) in those who have previously experienced any of those conditions; or in those with recurrent blockage after a heart bypass, angioplasty, or carotid endarterectomy.

It has been observed that doses commonly recommended for cardiovascular uses have been too high, and that, as a general rule, 50-325 milligrams daily is sufficient - 75-325 for those with angina or previous heart attacks.

It is believed by scientists that aspirin's effectiveness for pain and inflammation relief and reducing risk of cardiovascular events lies with its ability to reduce the body's production of prostaglandins. They can cause blood platelets to adhere to each other (form clots), which can cause blood vessel blockages, and eventually heart attacks or strokes.

There are, of course, well-known risk factors associated with aspirin therapy, so before starting, consult with your doctor about the risks versus the benefits. The risks are:

1. Irritation of the stomach lining
2. Tinnitis - ringing in the ears, or even hearing loss. Both associated with high doses, and may disappear with a lowered dose.
3. Aspirin allergy possibly leading to facial swelling or asthma attacks, Reyes syndrome (see note 1) in children (colds or flu-like symptoms, or chickenpox should not be treated with aspirin in children).

Aspirin use is insufficient among our older population who have had a stroke, heart attack, or blocked blood vessels. The American Heart Association estimates that 5,000-10,000 lives a year could be saved by aspirin therapy for survivors of cardio "events." For anyone, regardless of age, taking aspirin at the first signs of of a heart attack [presumably a stroke as well] could be a life saver. The classic signs of a heart attack are: uncomfortable pressure or pain in the center of the chest - sometimes accompanied by lightheadedness, fainting, shortness of breath, nausea, or sweating; or pain radiating into the shoulders, neck, or arms. [Stroke symptoms may include dizziness, slurring of speech or even total loss-of-speech, or partial or full paralysis of some body parts.]

Just about anyone who has experienced a previous heart attack or stroke, or symptoms thereof in the last 24 hours can benefit from aspirin use. This does not mean; however, that you can avoid seeing a physician.

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note 1 - Reyes syndrome is characterized by inflammation of the brain, and fat accumulation in the liver. [Adapted from FDA Consumer magazine, Mar-Apr 1999]

Squats are an excellent exercise, especially for the gluteal and quadriceps muscles. You have all heard that when doing an exercise, you should really concentrate on the muscle being exercised. With squats (and leg presses) I like to concentrate on the gluteal muscles. When you feel them contract you know you have gone deep enough to also maximize the quadriceps involvement. And as you rise up to complete a rep, concentrate on squeezing those big butt muscles. A couple of other points of form are to keep your knees from projecting out beyond your toes (The knees-beyond-the-toes position increases shearing force on the knees, and may cause injury.), and to keep from leaning forward more than 45° - your legs should support the weight, not your lower back. You can accomplish both goals by using a sitting down kind of movement. Just like sticking out your butt to sit in a chair. Balance may be a problem, which is why I prefer using a Smith rack, which eliminates balance problems, and allows for perfect form. Some will argue that free-standing squats are better by virtue of requiring more concentration on form - more support muscles have to work harder to maintain balance. I agree, but still recommend a rack except for those who are preparing for competition or who can maintain perfect form without support - very few according to my observations. One other practice to avoid is using a weight plate to elevate ones heels, unless you have shortened Achilles tendons (like many women after years of wearing high heel shoes); otherwise, the tendency to lean too far forward and to project your knees too far forward is increased. And always squat and rise from your heels.

In addition, there are several variations on the squat. You can do them with feet close together or out wide, or with feet placed well forward of your trunk (hack squats) so that as you squat your butt nearly touches the floor. Then there are one legged squats. Using a Smith rack, these are actually done on one leg at a time. Without a rack, they are done by elevating one leg (like on an aerobic step gizmo) and squating mainly on the leg/foot still in contact with the floor. There are other variations, but my point is that there are a variety of squat options which can slightly change emphasis on both muscle fibers and actual muscles used.

Andostenedione (commonly called "Andro") has been big in the news since Mark McGuire admitted using it on his journey to 70 home runs last year. Now everyone from high school kids to weight lifting beginners (and non-beginners) to college and professional athletes want to use it. But what is it, and what does it do?

JAMA reported on June 2, 1999 that androstenedione (Commonly called "Andro" and thought to be a precursor to testosterone), taken orally, produced no differences in muscle strength or size beyond that attributed to the concomitant resistance training. This determination was made by comparing a group taking Andro to one taking a placebo.

It is clear, however, that this study is far from the final word on the use of Andro as an ergogenic aid. Follow-up studies are needed to at least, address a longer duration of use, size of the dose administered, and on different subjects ranging from the relatively untrained to those experienced in strength training. For those interested, future Newsletter updates on Andro will be published.

An article on menopause was included in the MAF Fitness Newsletter back in April of this year, and a reader suggested a piece on Estring, as being some-what related and appropriate. The Editor has a policy of printing reader's suggestions when possible, so here it is:

Estring is a vaginal insert consisting of a soft, flexible ring that releases a continuous dose of estradiol (a form of estrogen released during menstrual cycles, as you remember). It remains effective for about 90 days, and is for post-menopausal women having urogenital symptoms (UGA).

Estring is a newly approved, low dose treatment option that may be a replacement for currently used options like estrogen tablets, transdermal patches, or vaginal creams.

There is more data available, but its source is the manufacturer/distributor(?) so I won't echo it, but if it might be of interest to you, I recommend that you talk to a physician about it. Incidentally, it has been approved for use in Sweden since 1993, and is currently in use in the United Kingdom, Canada, New Zealand, South Africa, and Switzerland.

Is game meat (like venison) a healthy alternative to more traditional meat (like beef) for those concerned about saturated fat and heart attacks, and other scary stuff?

Venison is actually a broad term refering to meat from a variety of game animals, including deer, elk, moose, caribou, antelope and reindeer. The nutrient content and quality of the meat are relative to the age of the animal (younger usually is more tender), its diet, and the time of year it was killed (harvested, if you prefer more gentle euphemisms). In autumn, after good spring and summer feeding, the meat is typically more tender, but with more fat. But in general, wild game meat is leaner than that from domesticated animals because wild game is commonly more active.

Following are the nutrient values (for 3-oz portions*) for a variety of game meats compared with beef and pork:

The small amount of fat on game meat is strong tasting and should be removed before cooking. For maximum tenderness, cook slowly - either braise in a liquid, or roast and baste frequently.

Raloxifene (Evista), a so-called "designer drug" has been discussed in previous articles in this Newsletter, but the following information is more detailed. It (raloxifene) mimics estrogen's beneficial effects on bone density in postmenopausal women. It also mimics some of estrogen's beneficial effects on blood lipids (fats). Unlike estrogen, however, it has been shown to lower the risk for breast cancer and may lower the risk of uterine cancer.

Drug companies are searching for alternatives to estrogen replacement therapy (ERT) because, while it is well-established that ERT helps protect against bone-thinning and high cholesterol, only one in five postmenopausal women takes ERT. Part of the reason is that oral estrogens stimulate breast and uterine tissue, commonly resulting in bothersome side effects like vaginal bleeding and breast tenderness and swelling. Oral estrogen also increases the risk of uterine cancer and may increase the risk of breast cancer. (To lower that risk , many women taking ERT are encouraged to also take progestin.)

Raloxifene is in a class of drugs called selective estrogen receptor modulators (SERMs). These drugs are called "designer estrogens" because they mimic the action of estrogen where it's wanted (i.e., in the cardiovascular and skeletal systems) but avoid estrogen-like action where it's not wanted (i.e., in breast and uterine tissue). Scientists theorize that SERMs cause changes in the shape of estrogen receptors in different organs, causing the SERM to stimulate some types of tissue but not others (breast and uterine).

Long-term studies of raloxifene are now under way. Clinical trials so far, including a 3-year study published in the June 16, 1999, issue of the Journal of the American Medical Association, and a 2-year study published Dec. 4, 1997, in the New England Journal of Medicine have reported the following:

Bone density - Raloxifene increases bone mineral density significantly when compared to placebos. Increasing bone density is important to help protect against fractures of bones made vulnerable by osteoporosis. No study has yet evaluated raloxifene in a head-to-head comparison with estrogen. However, the placebo-controlled studies indicate that raloxifene increases bone density by about half what might be expected with estrogen or with alendronate (Fosamax).

Breast tissue - Women taking raloxifene have no more breast tenderness or abnormalities on their mammograms than those taking placebos. There is evidence that raloxifene decreases the risk of breast cancer, but more study is needed.

Uterine tissue - Raloxifene does not cause precancerous changes of uterine tissue, and there is no spotting or bleeding as is commonly associated with oral estrogen.

Hot flashes - Unfortunately, raloxifene does not relieve hot flashes, and there is concern that in some doses it might even make hot flashes worse.

Blood fats - It's not yet clear whether raloxifene and other SERMs will have long-term beneficial effects on the risk of heart disease, but there is reason for optimism, since like estrogen, raloxifene decreases total cholesterol and low density lipoprotein (LDL) cholesterol. Unlike estrogen, raloxifene seemingly does not increase high density lipoprotein (HDL). However, raloxifene also does not increase triglycerides (a blood fat associated with increased heart disease risk) the way that estrogen can. In general, you reduce your risk for coronary artery disease when you lower your LDL and triglycerides and raise your HDL.

The bottom line is that further study is needed to evaluate the long-term safety and effectiveness of raloxifene and other SERMs. But raloxifene is of great interest as an alternative for postmenopausal women who want to avoid the side effects of estrogen - especially women at high risk of osteoporosis. [Note that Evista is approved and on the market, so discuss it with your doctor, if appropriate.]

Caffeine became known as a performance enhancing substance for running (specifically marathons) during the 1970s. I even tried it a couple of times (in the form of No-Doz), but of course without success since I had no idea about how much to take, or even if it really worked.

The idea behind the use of caffeine was that it extended the use of fat as an energy source, to save glucose/glycogen (You can think of glucose as the energy source, and glycogen as the storage form of glucose.), which would be the body's preferred energy source, but which has a limited supply - about 90 minutes; unlike fat, which has an essentially unlimited supply. This is dependent on the training level of each athlete - at the elite level, fat is burned longer than for more average runners. You all (especially if you have actually run a marathon) have probably heard the phrase "hitting the wall."

Hitting it is when your available supply of glucose/glycogen has been depleted, and you are only fueled by incomplete burning of fats - your body's ability to function normally becomes seriously impaired. Even less-than-elite runners can avoid the wall by adequate training and diet, but they run at a slower pace, which burns more fat than glucose/glycogen (Remember that both entities are burned together under normal circumstances; in the words of Covert Bailey, glucose provides the kindling for a fat fire - more fat at slow to moderate intensity, and more glucose at greater intensity.), but use of caffeine theoretically allows fat to be used at a faster intensity, thus saving valuable glucose (for both training and racing). Basically, three studies done during the 1970's to early 1980's supported the positive effects of caffeine use on distance events (cycling events). The third study showed caffeine use to decrease use of glycogen by a whopping 42%.

Some skepticism of the results of these studies developed in more recent times, but a careful review of the data by a team of researchers has verified that use of caffeine does indeed cause fat to provide a glycogen sparing function - in rats, and only for short, high-intensity exercise.

More recently; however, it has been determined that very high doses of caffeine are needed to effect the desired results - high enough as to be toxic to humans - to possibly result in death.

While caffeine can act as an ergogenic aid (enhanced performance ); its side effects, aside from the toxicity issue, include excessive nervousness, restlessness, headaches, dirrhea, heart palpitations, and is a diuretic (not so good for runners on a hot day). But note that to get enough caffeine to be toxic it would probably have to be administered by injection or a suppository.

Caffeine in large amounts is a banned substance by both the IOC and the NCAA. But the initial studies used 2 and 1/2 cups of caffeinated coffee, so you may or may not be able to achieve the possible benefits, depending on which study is correct, and without toxicity concerns since that would take 10 cups or more. But don't forget about those other side effects.

Raw vegetables or cooked - which is most nutritious? You may be surprised to learn that the answer seems to be either, or both; depending on how you look at this question. Most of us would say "fresh" without even flinching; but that isn't always true. Fresh vegetables do retain more of their vitamin content than cooked (especially boiled); but it seems that cooking, especially some vegetables, increases the availability of caratenoids by breaking down some chemical bonds in certain vegetables. One study found that cooked carrots and spinach released three times as much beta carotene (a carotenoid - a vitamin A precursor and antioxident) as fresh. Cooked tomatoes release extra lycopene, another carotenoid.

To maximize the nutrients you get from both fruits and vegetables, eat a good variety and both cooked and raw.

(Q) I know that the latest research indicates that aerobic exercise no longer has to be done all at once to be effective. We were once told that continuous 20 minute sessions (nearly every day) were required for cardiopulmonary fitness, and 30-40 minute continuous sessions (or longer) were recommended for weight loss; but that now several shorter sessions are just as effective. That it is the total cummulative time during a day that counts, but is this true for both cardio fitness and weight loss?
J.M., San Jose, CA

(A) So it seems. I have heard the same thing for several years now from a variety of sources - the latest report being from the July/August issue of ACSM's Health & Fitness Journal. I think we have not heard the final word, but one study has shown HDL cholesterol levels rising in those who exercised in three sessions, while those who did the same amount of exercise but in one session, showed no change. Another study using overweight women as subjects showed both an increase in weight loss and cardiorespiratory fitness in those who exercised in muliple sessions as opposed to those who exercised in single (but the same duration) exercise sessions. This finding should be particularly satisfying for those with little time for long bouts of exercise.

(Q) Is there anything I can do to reduce high blood pressure other than taking a medication?
L. R., Pleasanton, CA

(A) Yes, there are several strategies, but they should not be used to replace a physician's advice. They include:

1. weight reduction
2. regular exercise
3. restrict salt - works for some who are salt sensitive, especially blacks, the aged, or those with severe high BP
4. avoid high consumption of alcohol
5. chill-out; that is, manage stress
6. maintain a calcium intake of between 800-1200 mg
7. increased potassium intake may lower slightly high BP by 5-7 points, especially among blacks
8. Increased fiber intake may help reduce high BP (4-8 points)
9. increased magnesium intake
10. stop smoking

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Send questions or comments to Michael Fenner: e-mail to Mike Fenner
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