Doctor, Tell Me The Truth About Fibromyalgia… Please!

May 31, 2008 at 02:07 AM by admin

Fibromyalgia is a common form of arthritis that is characterized by generalized aches and pains, chronic fatigue, non-restorative sleep, and often other symptoms that suggest multi-system disease. Important research findings have shown FM patients to have higher levels of Substance P- a neurotransmitter responsible for pain processing- and lower levels of somatomedin C and growth hormone, substances required for normal musculoskeletal health. Abnormalities involving the levels of serotonin, dopamine, nor-epinephrine, and muscle- related chemicals, adenosine and phosphocreatine have also been demonstrated.

Deficiencies in brain blood flow patterns as well as new genetic research indicating a mutation in the regulatory region of the serotonin transporter gene are unraveling some of the mysteries surrounding FM. Despite these exciting discoveries, a number of myths still surround this condition:

Myth# 1: “Only women get FM.” Actually more than 5% of patients are men and that number appears to be increasing.

Myth#2: “Only adults get FM.” Actually, FM probably begins in childhood. “Growing pains” may actually be a form of fibromyalgia. Approximately, two and one half per cent of children seen in a pediatric rheumatology clinic setting have FM.

Myth# 3: “FM is only a form of arthritis.” FM, while often presenting as a musculoskeletal syndrome, is a disorder that has its roots in central nervous system neurotransmitter dysfunction. This dysfunction leads to multi-system complaints. That is why FM patients often have breathlessness, palpitations, bowel and bladder symptoms along with aches and pains..

Myth #4: “FM is a wastebasket term for when a doctor doesn’t know what to call it.” This is the most damaging of myths. Patients with FM have a real disorder. While the science is lagging behind as far as providing specific commonly used tests that may assist in diagnosis, there are multiple stereotypical signs and symptoms that demonstrate true objective abnormalities and can help trained physicians identify patients who have FM easily.

Myth#5: “There is no treatment for FM.” Nothing could be farther from the truth. While there is no one individual treatment that works well for everyone, there are multiple treatments that are usually effective. Most people respond to a combination of therapies that include cognitive behavioral therapy, non-impact aerobic exercise, and medications. Other therapies that often help include; acupuncture, hypnosis, massage, chiropractic, tai chi, water exercise, nutritional supplements, and biofeedback.

Myth# 6: “Patients with FM should avoid exercise.” False! If done too quickly or vigorously, exercise can be painful. However, if a graduated program that allows the patient to ease into exercise and allows them to progress at an acceptable pace is instituted, exercise is actually a cornerstone of proper FM treatment. The key is proper technique and pace.

FM is a common problem. Patients should have hope because FM can be managed successfully. People who suspect they might have FM should be evaluated by a trained physician.

Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: http://www.arthritis-treatment-and-relief.com

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Reduce Stress By Exercising Daily

May 30, 2008 at 01:40 AM by admin

Exercise is one of the easiest ways to reduce stress. Exercise assists your cardiovascular system and blood circulation. By performing exercises consistently your overall health, including sugar levels will remain normal.

Exercise is good for mental growth. Exercise makes our mind calm and develops memory. It helps increase self-confidence and moulds our personality.

There are various forms of exercises such as aerobic as well as anaerobic exercises, which provide various benefits. Aerobic exercises are running, swimming, cycling and walking. They aim to burn your excess calories and also increase your energy. When you are following these exercises you inhale a lot of fresh oxygen. In this way they are beneficial to the cardiovascular system and keep the blood circulation process intact. If you follow a regular diet pattern and exercise schedule then you will surely burn a lot of calories. In order to get complete benefit, you must aim to exercise for about 3 to 5 times a week.
Anaerobic exercises builds your muscles and they are classified into two categories:

They are Isotonics and Isometric exercises.

Isotonic exercises involve objects that can be lifted such as weight lifting. It tones your muscles, makes the muscle fiber stronger, prevents injuries and also moulds your muscles.
In Isometric exercises you try to push a stationery object, which in turn develops your muscles.

Both the exercise types are equally important because they build your muscles strong as well as lean.

Plan exercises, which give you enjoyment as well as the above benefits. At first, plan for a short duration and then start off with a longer workout session.

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The Science of Carbohydrate Loading

May 29, 2008 at 01:38 AM by admin

A valid connection between hypoglycemia, fatigue and premature termination of exercise been firmly established and therefore carbohydrate loading is a proven form of boosting running endurance in prolonged events lasting more than two hours in duration. While there are various methods of carbo-loading, the process basically involves consuming large quantities of carbohydrate-rich food in order to saturate the body’s carbohydrate stores. It is proposed that with these increased energy stores, the competitor will be able to avoid exercise-induced hypoglycemia and continue exercising longer than if this saturation process had not occurred. This article aims to further explain how to perform carbohydrate loading and the reasoning behind its practice.

As previously mentioned in another article on this site the human body is able to store carbohydrates for energy use in the liver and the muscles in the form of a substance known as glycogen. This carbohydrate store is basically human “starch” and is able to be quickly broken down to fuel the muscles during high intensity exercise (muscle glycogen) and to maintain blood glucose levels (liver glycogen). In the unloaded/non-carbohydrate saturated state, an untrained individual consuming an average (45% carb.) diet is able to store approximately 100 grams of glycogen in the liver, whereas muscle is able to store about 280 grams. Remember also that muscle glycogen is committed to be used by muscle and cannot assist in maintaining blood sugar levels. Therefore should no additional carbohydrate be ingested during prolonged exercise, the task of maintaining blood glucose levels rests firmly on the liver’s glycogen stores and gluconeogenesis (the manufacturing of glucose from plasma amino acids). Oxidation of blood glucose at 70-80% VO2 max is about 1.0 g/min or about 60 g/hour. Therefore it can be predicted that even with full glycogen stores, a less conditioned athlete’s liver will be depleted of its carbohydrate within and hour and three quarters of continuous moderate intensity exercise. (Interestingly, the daily carbohydrate requirements of the brain and nervous system alone are enough to deplete the liver glycogen stores within 24 hours.) Once liver glycogen levels begin to drop and exercise continues the body becomes increasingly hypoglycemic (low blood sugar) mainly because blood glucose is depleted faster than it is replaced by gluconeogenesis. Professor Tim Noakes (see profile) considers liver glycogen depletion and subsequent hypoglycemia to be the primary factors affecting fatigue and performance during extended duration races and especially in instances where muscle glycogen levels are low as well.

The amount of additional carbohydrate that is able to be stored in the body is dependent on diet and athlete conditioning level. For an untrained individual consuming a high carbohydrate (75%) diet, glycogen stores may increase up to 130 g and 360 g for liver and muscle respectively for a total storage of 490g. For an athlete training on a daily basis consuming a normal (45% carb.) diet, glycogen levels approximate 55 g and 280 g for liver and muscle respectively yielding a total of 330 g. However, should this same well-conditioned athlete consume a high (75% carb.) diet, their total carbohydrate reserves may soar up to 880 g with approximately 160g stored in the liver and 720 g in the muscle. Clearly the conditioned athlete’s muscles are much more efficient at storing carbohydrates than those of his or her unconditioned competitor. In saturating the muscle by consuming of high levels of carbohydrate, the athlete automatically increases their time to hypoglycemic fatigue several fold.

Several methods for carbohydrate loading have been described in the literature. The most familiar method is the traditional “glycogen stripping” or carbohydrate-depletion/carbohydrate loading method. This method basically involves the athlete exercising to exhaustion the sixth day before a major competition and for the next three days consuming a high protein-fat, low carbohydrate (less than 10% total energy) diet. On day three the athlete again exercises to exhaustion but for the following three days consumes a high (90%) carbohydrate diet. The aim of this method is to severely deplete the glycogen reserves of the body to cause a “super compensation” effect in carbohydrate stores. Research has demonstrated however, that this glycogen stripping method may not in fact be necessary to achieve optimal carbohydrate saturation in well-trained individuals and that this super compensation effect may not even occur. Studies have demonstrated that athletes simply consuming a high (75%) carbohydrate diet for three days prior to competition resulted in carbohydrate stores comparable to those individuals who performed the glycogen stripping method. In addition, the amount of training performed before the start of the traditional regime has little effect on the resulting carbohydrate stores. Therefore, a well-conditioned athlete may need to do little more than consume a higher quantity of carbohydrates in the three days before competition to receive full benefit.

Optimal carbohydrate loading can be achieved if approximately 600g of carbohydrate is consumed daily for two to three days. It is probably of little matter if the extra carbohydrate is consumed as simple (glucose) or complex (starch) carbohydrate. Most carbohydrates are digested quickly and enter the bloodstream via the intestine much the same as if glucose had been ingested. Replenishment rates are higher immediately after exercise due to increased insulin sensitivity. The amount ingested should be about 50 to 80g starting immediately after exercise repeated 2 hourly and continuing for the first 6 hours. Full glycogen replenishment is usually achieved within 20 hours using this method; however the most rapid glycogen resynthesis is observed when glucose is infused directly into the bloodstream, yielding absolute peak muscle glycogen concentrations of near 800g (assuming approximately 20 kg of muscle) within about 8 hours. Full replenishment of glycogen after an extended event may take several days longer due to muscle damage resulting from repeated cycles of concentric and eccentric contractions.

With the benefits associated with carbohydrate loading it may be helpful to mention some possible disadvantages to following this procedure. Firstly, glycogen storage is associated with a concomitant storage of water. It is estimated that every gram of glycogen stored is associated with about 2.7 grams of water. Therefore, a well-conditioned athlete with total glycogen stores approaching 800g will find their body weight about 2kg heavier at the start of the race. This increased body weight will have implications on running economy and performance at least near the beginning of the event when energy reserves will be high. As the muscles and other organs progressively oxidize the glycogen stores during exercise, the stored water is again released into the body. This may in turn complicate the fluid requirements of the athlete, requiring them to consume less than a non-carbohydrate loaded competitor. The best advice for fluid replacement during prolonged exercise may be found on this site (see
How Much Should I Drink? ) and in Lore of Running. A possible solution for water retention and weight gain is for the athlete to load to a lesser degree and ingest a carbohydrate/electrolyte enriched drink during exercise to help maintain blood glucose and electrolyte balance (consuming carbohydrate during an event in the fully loaded state is overkill and produces no additional benefit). Another drawback to carbohydrate loading if performed incorrectly is gastric/intestinal upset. Very large amounts of ingested carbohydrate can affect the osmolarity of the intestine. In other words, carbohydrates (especially simple/processed sugars) in the intestine draw water into the gut by osmosis affecting the water balance and may cause intestinal upset and diarrhea. As mentioned, an athlete should aim to consume about 600g a day preferably in multiple meals/sittings to avoid overloading the digestive capacities of the body.

In conclusion, this article has demonstrated the many benefits associated with carbohydrate loading. This process should be viewed as an effective and simple method for improving performance and endurance during extended duration exercise events. Increasing body carbohydrate stores before competition ensures sufficient energy to avoid hypoglycemic related fatigue and early termination of exercise. Simply consuming higher quantities of carbohydrate three days before competition may suffice for most athletes, however it is important to follow the loading regimen correctly to avoid intestinal upset. Exercise science is still exploring the significance and the relative contribution of the two sources of glycogen stores to exercise performance and further research will hopefully cast more light on connections relating to fatigue.

References and further reading: more information on carbohydrate loading and a detailed explanation of carbohydrate contributions during exercise can be found in Lore of Running - a classic book in its fourth edition dedicated not only to running performance, but to cutting edge exercise physiology as well.

David Petersen is an Exercise Physiologist/Certified Strength and Conditioning Specialist and the owner and founder of B.O.S.S. Fitness Inc. based in Oldsmar, Florida. More articles and information can be found at http://www.bossfitness.com

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