In This Issue

• No Water for Hydration?
• More On HRT
• McDonald's False Promises
• Calcium Sources
• Are Low Carb Diets The Answer?
• Exercise For Arthritis
• Unhealthy Health Care Products
• Exercise Corner: Leaning Triceps Extension
• Questions And Answers
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I recently ran across an article that questioned the need to drink water to prevent dehydration. The point being that it isn't necessary to drink water -- all liquids (except alcoholic drinks) satisfy our hydration needs -- fruit juices, juice "drinks" (those healthy sounding drinks that don't actually contain fruit juice), coffee, tea, even the food we eat contains water. And that is perfectly true if hydration is the only concern. But it isn't. One very important reason to drink water is that it contains zero calories, which is significant if weight management is a concern. You don't get fat from drinking water. If cost is a factor, water is the perfect choice, unless you are hooked on those "designer" water products.

Fruit juices, coffee, etc. are alright in moderation, but don't eschew water. The eight-glasses-a-day mantra is not necessary, but won't hurt you either. Water from all liquid sources other than just water requires some metabolic activity to extract the water, so it is a little slower and requires some organs to work a little harder. The bottom line is that we don't need to obsess over drinking "enough" water, but that it should probably be thought of as the preferred liquid.

Back in July of 2002, there was a big uproar over HRT (Hormone Replacement Therapy) because a major study (The Women's Health Initiative) of hormone therapy was cancelled early because it revealed that healthy women's risk for heart disease and breast cancer was increased, and the researchers did not want any more of the study subjects to experience heightened risk factors needlessly. The study did validate the use of HRT for less than four or five years was relatively safe, but that was much less than expectations.

Before the use of HRT, ERT (estrogen replacement therapy), was used and there were many questions about its safety, and it was ultimately replaced by HRT (estrogen and progestin) because estrogen alone was found to be a factor in uterine cancer. At the start of use of HRT there were still questions, mainly that it caused breast cancer. Consequently, some physicians hesitated to prescribe HRT to women already at high risk for breast cancer. But there was still the thought that HRT was effective against osteoporosis and cardiovascular disease (CVD).

I should mention that ERT/HRT was initially intended to help protect postmenopausal women from osteoporosis, maybe CVD, and to help protect against classic postmenopausal symptoms including: night sweats, vaginal dryness, hot flashes, and mood swings.

Lots of questions remained, partly because no well-designed, large-scale clinical study had ever been run to validate the use of hormone therapy to prevent disease in healthy women -- until the National Women's Health Initiative, which was scheduled to last for eight and a half years, but was cancelled after only a little over five years, mainly because of the discovery of the increased risk for breast cancer.

It is important to note that the results of the study were not the stunning, dramatic results that many promoted. The HRT-breast cancer link was long suspected. The CVD link was the big surprise.

What the study actually found was:

1. During the course of the study there were slightly more heart attacks, strokes, and blood clots; however, the increased risk was quite small -- and without extra deaths.
2. HRT slightly increased risk for breast cancer if continued for more than four years.
3. HRT only reduced fractures a small amount, and only as long as HRT continued (i.e., no permanent results).
4. HRT lead to slightly less colon cancer.
O.K., so what is the bottom line here? It is that there are better options than HRT to treat or prevent both bone density and CRV. HRT works well against common menopausal complaints such as hot flashes or vaginal dryness, but short-term use is best, certainly no more than four or five years. Options for all of these problems include:
• Healthy postmenopausal women taking HRT only to prevent chronic disease should stop. [Note that one should discuss any changes in an HRT regimen with a physician. That advice is essential for all information in this article.]
• A bone-density test revealing high risk for osteoporosis is an indicator that you need to start taking bone-builders such as Fosamax, Actonel, Evista, or calcitonin; and/or start a bone strengthening exercise program, but be sure to talk to your physician.
• Have regular colonoscopies to help prevent or cure colon cancer.
• Annual mammograms are essential to help with early detection of breast cancer
• HRT for menopausal symptoms should not exceed four to five years.
• Because of unresolved issues, maybe plain old fears about HRT, many women will likely turn to supplements such as soy products, isofavones, oil of evening primrose, flaxseed oil, and others; but these supplements are more of a mystery than HRT. Very little is known about them.
• Vaginal dryness, a common complaint, can be mitigated by prescription estrogen creams, tablets, or rings; or there are O-T-C lubricants like Replens, Astglide, or K-Y jelly.
• If you have had a hysterectomy and are on HRT, there is no known reason to stop.
• For hot flashes there are several treatments, including "natural" estrogens such as Estrace or TriEst. Also, low doses of esterfied estrogens (i.e., Menest or Estratest) seem to be effective. Estrogen patches are effective. Progestin is effective for about 70% of women, but safety of long-term use is unknown, as is true of many of these options -- that's one of the reasons why a physician's input is necessary. Antidepressants and antihypertension drugs may help. In addition, you should dress in layers, go easy on alcohol use (eliminating it might be best), avoid hot beverages, spicy foods, and the combination of an exercise program and a healthy diet may be quite effective.
I'm starting to duplicate a lot of what is in the July 2002 MAF Fitness Newsletter, so read that article along with this one and see if your questions are answered. One thing that hasn't changed much is that before the CVD/breast cancer bombshell, most of the advice about ERT/HRT was to learn all you could about the subject, talk to a physician, and then make your own decisions. It doesn't seem to be much different now, except that there seem to be more factors to take into consideration.
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McDonald's restaurants have a nasty habit of reneging on highly promoted healthy choices on their menus. First a healthy choice is introduced with much fanfare, then dumped without so much as a whimper. The first time I became aware of this was after their well-promoted "one calorie milkshake". It was obviously made with low- or nonfat milk. I thought that was a good deal, and had a few until I learned that they had switched back to the old high fat stuff, but without bothering to mention it.

Then along came the McLean burgers. I tried them abut three times at different locations, and found that the employees just kind of gave me a blank stare when I ordered one. Kind of like they had no clue about what I had ordered. Apparently McDonald's did a better job of promoting them to the public than to their own employees. Consequently, each time I ordered one it was different, and required enough time that "fast food" no longer applied, and I was always asked if I wanted cheese, which kind of defeated the purpose of a lower calorie burger. But this meant-to-be healthier choice was soon dropped.

The latest fiasco followed an announcement (formal press release and all) that the fat in their French-fries, harmful ingredients like saturated and trans fats, would be reduced by nearly half. Furthermore, that they would do the same in some of their other products, including Filet-O-Chicken and McNuggets; but surprise, surprise, they reneged on that promise.

McDonald's likes to talk about an interest in producing healthier foods, but talk is about as close as it gets.

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Many Americans simply do not get enough calcium. A reasonable goal is 1000 mg per day. For women over age 50, and men over 65, 1500 mg per day is recommended. Sources include:

Food	Milligrams of Calcium
Yogurt, plain, nonfat, 1 cup	450
Sardines, with bones, 3 oz.	370
Orange juice, calcium fortified, 1 cup	300-350
Yogurt, fruit-flavored, 1 cup	300
Milk, 1 cup	300
Swiss cheese, 1 oz.	270
Salmon, with bones, 3 oz	225
Collard greens, 1 cup	225
Cheddar cheese, 1 oz.	205
Turnip greens, cooked, 1 cup	200
White beans, canned, 1 cup	190
Ice cream or ice milk,1 cup	175
Oatmeal, fortified, 1 packet	165
Cottage cheese, 1 cup	160
Soybeans, cooked, 1/2 cup	130
Tofu, 2 oz. (some)	115
Kale, cooked, 1 cup	95
Almonds, 1 oz.	70
Broccoli, 1 cup	70
Bread, 1 slice	20-40

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Are low-carbohydrate diets the answer to weight loss? Not likely, even though low-carb diet books are currently stuffing bookstore shelves.

One obvious problem with that theory is that not all carbohydrates are the same. Vegetables, fruits, whole grains and cereals provide important nutrients but are not necessarily fattening. Highly processed carbohydrates, on the other hand, can be fattening because of too many calories, not to mention too little nutritional content -- products like pastries and over processed breads and cereals.

This entire issue of blaming food types (i.e., carbohydrates, fats, and protein) for the fattening of America is a lot of nonsense. Calories, too many of them, are the cause of increasing numbers of over-fat/obese individuals. More calories in than are burned yields increased body fat.

First it was fat intake that was blamed for our increasingly fatter population. But going "low fat" has turned out not to be the solution. Low-fat/nonfat foods often contain more calories than the original item. Another problem is that people often eat more of a food because it is "low fat" -- hence, not a problem. Calories are simply ignored.

So now carbohydrates are considered to be the "bad guy" by many so-called experts. Fat presents some special problems, mainly that it is calorie-dense. But some fat is necessary for good health. And the bottom line is still "more calories in than out equals increased body weight."

Commonly, supporters of low carbohydrate diets use "insulin" as the culprit. Claiming that carbohydrates raise one's insulin level too high, too fast, and cause weight gain.

Insulin is a hormone , they say in effect, that causes food to be stored directly in fat cells; thereby bypassing its potential use as energy. [To clarify, little chunks of pizza, for example, do not float around in your bloodstream. Glucose, which is metabolized from carbohydrates, is transported in the bloodstream, and if not needed for energy production, is stored in limited amounts in the form of glycogen in muscles and liver.] Any not used or stored is converted to and stored as fat.

But there is research (using one group on a high carbohydrate diet and another on a low carbohydrate diet) supporting the contention that insulin levels, whether from high or low carbohydrate diets, differ relatively little -- insulin levels in the bloodstream, that is. And, furthermore, that the higher carbohydrate diets did not produce any more fat individuals than the low carbohydrate diet. Again, total calories matter more than food category. Weights were similar for both groups, given similar heights.

According to Jean Kerver, PhD. At Michigan State, insulin does not divert "food" to fat cells. Higher levels of circulating insulin can be a precursor to diabetes, and only eating more calories than you burn is what causes fat gain.

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Exercise for arthritis has become a common recommendation, but is one kind of exercise better than another? Yes. It is often recommended that arthritis sufferers get out and walk, since knee and hip joints are most commonly afflicted. But there is a potential problem. For those that are carrying an excess amount of fat, walking can aggravate these joints, leading to a halt to a walking program -- too much pain. For each step you take, each pound of body weight puts about three pounds of pressure on your knees and hips. Stepping down going downhill puts about six pounds of pressure on those joins. If you have knee or hip arthritis and are over-fat, strength training is a better option, along with cleaning up your diet to help lose the excess baggage. Strength training (squats, lunges, knee extensions, or leg presses) can all help improve one's mobility, whether walking, sitting/standing, maneuvering up/down stairs, even balance. Muscles do, after all, function as shock absorbers to decrease arthritic pain.

Specific exercises are performed as follows:

Squats: Stand with feet just outside of shoulder width [Note that there are a variety of foot positions from very wide (Sumo squats) to very close to each other -- all variations work the muscles in the thighs and buttocks, but each variation works different muscle fibers and some different thigh muscles.], raise your arms to shoulder height and pointed forward. Now squat -- push your buttocks out as if you were about to sit in a chair (In fact, you may want to position a chair behind you and "sit" until you lightly touch it, then slowly stand up.) and at the same time raise your arms. You should not lean forward more than 45 degrees, your knees should not project out past your toes, and your weight should be concentrated on your heels. Your thighs should not go deeper than parallel to the floor, and depending on the degree of arthritis-generated pain, may be quite shallow -- do what you can.

Moving your arms up helps you maintain balance while trying to maintain a relatively vertical back while "sitting" back.

A useful aid for home use, is a balance ball. Put it at the level of your lower back between you and a wall. As you perform multiple repetitions, the ball rolls up and down. This is particularly useful if you don't have a smooth wall to slide up and down against.

Knee extensions: Wearing ankle weights (the adjustable type), sit up straight in a chair with your feet on the floor, knees at approximately 45 degrees. Flex one knee (straighten) and squeeze the thigh muscles (quadriceps), then, slowly (under control, but not slow motion) lower it to the starting position. Do 12 repetitions on each side. Initially, you may use no weight, depending on level of fitness and severity of pain. The point is to start very gently and progress to 12 reps at a degree of difficulty where you exert some effort. You don't want to strain to do 12 reps, but you also do not want to do 12 and feel as though you could easily do several more. Progressively add weight until you can do 12 with effort, but without straining.

Note that there are some exercise professionals (mainly physical therapists) who don't like knee extensions. They talk about chained versus unchained exercises. The difference in this case being that knee extensions are unchained (feet are unsupported), while squats, leg presses, and lunges are chained (feet supported), and, as such, are thought to be safer. Leg presses are good alternatives to knee extensions, but can not usually be done at home because they require a leg press machine, although they are available for home use.

Lunges: From a standing position, step forward and bend your knee as far as you can (knee over your ankle), and simultaneously bend and lower your back knee. Ideally, the front thigh would be parallel to the floor, and the back knee would nearly touch the floor, but we aren't in a perfect world here, so a much shorter range of motion is perfectly acceptable. Again, do what you can. Then step back to the initial position and repeat on the other side. Do 8-10 repetitions on each side. Dumbbells can be used eventually, but start with simple body weight.

Again, the point of these exercises is to increase muscle strength, but don't push yourself into increased pain. Do what you can, and always start from where you are.

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Here is some interesting information about health care products that have a down side. Whenever a family member, or yourself, gets a cut or. . . someone rushes to the medicine cabinet to get something to put on it. But as it turns out, many favorite O-T-C remedies don't work, and may actually cause problems.

Mercurochrome or merthiolate both contain mercury, a highly toxic substance, and are not designated by the FDA as either effective or safe. Rubbing alcohol kills microbes, but also damages and dries out skin. It should not be applied to a wound. And is not good for "rubdowns." It is useful for cleaning a needle, tweezers, or for cleaning skin prior to an injection. Hexylresorcinol, hexachlorophene kills microbes but damages skin. Hydrogen peroxide damages the outer layer of skin and may retard healing. It really has no medical use, either internally or externally. Betadine also contains mercury, but is probably safer than iodine, and is an antiseptic --probably safe for cleaning wounds, but used on large ones may cause iodine poisoning. Antibiotic ointments (bacitracin or neomysin) can cause skin irritation or allergic reactions. May help prevent infections in minor wounds. [See Q&A for what to do in the case of a small wound.]

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Exercise Corner -- Leaning Triceps Extensions. This exercise as illustrated is difficult, and is not for beginners. But it is the goal if you are highly motivated to get there. But, realistically, there are a number of modifications to make it easier.

First let's look at the ultimate version:

What you see here that is important is the hands about 12 inches apart, and that the elbows are not allowed to "fly" out. You don't have to bend your elbows as much as shown, you can walk your feet closer so your body isn't so flat, and you can use a chair or couch back to rest your hands on (i.e., your head doesn't have to "duck under" anything. The idea is to feel your triceps do some work. You will maximize muscular involvement by doing this exercise as shown, but you have to start where you are. And even when you reach the final goal, you can alter the angle of the body to make the exercise easier or harder. [See Q&A for more.]

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QUESTIONS AND ANSWERS

Wound medications conclusion. For small wounds, scrapes, cuts you should first stop any bleeding by pressing a tissue or clean cloth to the area; with the exception of a small puncture, which should be allowed to bleed awhile to aid cleansing. Second, if possible, cleanse the wound by running cool water over it. Or use a clean wet cloth to swab it. Don't get soap on the wound, and remove any remaining dirt with tweezers. Third, apply an adhesive bandage if the wound needs to be protected.

Exercise Corner -- conclusion. When done properly you will feel a major contraction of the shoulder muscles, back muscles, leg and thigh muscles, and abdominal muscles all working to keep the body straight, along with a major effort by the triceps.

This exercise is especially good for those who work out at home and don't have much equipment.

(Q) I'd like to lose a few pounds, but without going on a formal diet. Are there any reasonable steps to take?
R.L. Avalon, CA

(A) There are quite a few options including selecting water-packed over oil-packed tuna, use salsa on a baked potato instead of sour cream or butter, Buy sherbet rather than ice cream, switch from whole or 2% milk to nonfat, instead of eating a fruit pie for dessert, eat the fruit itself, trim portions, walk more, and on-and-on.

(Q) I am on a high school football team, and we frequently play in very hot weather. I want to drink lots of ice-cold water to cool off, but my coach says that is a bad idea. Is it?
J.P., Las Vegas, NV

(A) Your coach is behind the times, there is nothing wrong with drinking ice-cold water to cool off. Cold fluids are emptied from the stomach faster than warm ones, making them better for replacing water lost from exercising.

(Q) Is there any advantage to using sea salt?
R,D,. Mountain View , CA

(A) No, despite what those who sell it might say. Sea salt comes from evaporated sea water, which would typically contain small amounts of magnesium, sulfur, and calcium; however, it is cleaned and processed before being sold for consumption, making it virtually identical to common table salt, although it is much more expensive, even though it lacks the essential mineral iodine, which is often added to common table salt.

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Send questions or comments to Michael Fenner: email to Mike Fenner
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