Thursday, September 8, 2011

DrMirkin's eZine: Vitamins from food, cortisone shots, more . . .

Dr. Gabe Mirkin's Fitness and Health E-Zine
September 11, 2011

Get Vitamins from Food, Not Pills

One in three women and one in four men in the United
States take vitamin pills regularly. This month, a study that
followed 182,099 people in California and Hawaii for an average
of 11 years showed that taking multivitamin pills neither
decreased nor increased the death rate for all causes or the rates
of heart attack or cancer (American Journal of Epidemiology,
August, 2011).
A previous review of 67 randomized trials of vitamin pill
effects on life and health found that taking vitamin pills may
shorten life (Cochrane Database of Systematic Reviews, Issue 1,
2008). The authors found an increased death rate of 16 percent
in those taking vitamin A pills, seven percent with beta-
carotene, and seven percent with vitamin E. The Women's Health
Initiative study followed women for eight years and found that
taking multivitamin pills has little or no influence on the risk
of common cancers, heart attacks or death rate in postmenopausal
women (Archives of Internal Medicine, February, 2009). A review
of the world's literature shows that multivitamin use neither
increases nor decreases risk for breast cancer (Annals of
Pharmacotherapy. published online April 2011).
vitamin that appears consistently in the literature to help
prevent heart attacks and cancers, and that benefit is related
more to the fact that you can get it from sunlight (Cancer
Epidemiology, Biomarkers & Prevention, April 2011). The Swedish
Women's Lifestyle and Health cohort study followed women for up
to 15 years and found that women who got sunburned twice or more
per year during adolescence live longer than those who had been
sunburned less than that. Women who went on sunbathing vacations
more than once a year lived longer and suffered fewer heart
VITAMIN B PILLS MAY CAUSE HARM: Every chemical reaction in
your body is started by an enzyme. For your body to convert
chemical A to chemical B, you need an enzyme to start that
reaction. All eight B vitamins are parts of enzymes. When you
take large doses of one enzyme, you accumulate end products that
must be balanced by also taking large doses of other enzymes.
People who take large doses of niacin to lower cholesterol have a
marked elevation of homocysteine, a risk factor for heart
attacks. Here is how it happens: Proteins are made up of
building blocks called amino acids. The B vitamin, Niacin, is
part of the enzyme that converts an amino acid, cysteine, into
Three other B vitamins, folic acid (B9), cobalamin
(B12), and niacin (B3)} protect you from accumulating too much
homocysteine by breaking down homocysteine and converting it to
cysteine. Therefore, when you take large doses of niacin, you
also have to take large doses of the other three vitamins to
protect you from accumulating homocysteine. Nobody really knows
how to balance large doses of vitamins when you take them in
pills. I think that it is safer to depend on nature to provide
the proper balance of vitamins in foods.
MY RECOMMENDATIONS: I do not believe that taking one
vitamin pill a day is harmful. I do believe that taking large
doses of vitamins can harm you. I also believe that you do not
need to take vitamin pills. Eat a diet rich in fruits,
vegetables, whole grains, beans, seeds and nuts. Some people
need to take vitamins D or B12, but you should be able to get B12
from fish or chicken, and get your vitamin D from sunlight if


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Dear Dr. Mirkin: Should cortisones (glucocorticoids, steroids) be
injected into painful joints?

We do not know. Orthopedists inject cortisone into joints
because they know that these injections can provide immediate
dramatic relief of pain and swelling in damaged joints whether
from trauma or from inflammatory diseases such as rheumatoid
arthritis. However, a major side effect of cortisone is loss of
calcium and weakening of bones. Therefore many doctors recommend
that a person receive only up to three cortisone injections into
a joint during a lifetime.
A recent study from MIT shows that cortisone-type
injections can prevent long-term damage to injured joints
(Arthritis Research & Therapy, September 2011).
Damaged cartilage almost never heals and can eventually
lead to osteoarthritis. Bones come together to form joints, and
the ends of bones are protected by a thick white gristle called
cartilage. When you damage cartilage, the outer surface layer in
the joint breaks down and the ability to form a new outer layer
is markedly reduced, so broken cartilage does not heal. Your
joint produces cytokines (TNF, IL-1, and IL-6) that mobilize your
immune system to kill invading germs. These same cytokines also
attack the broken cartilage to cause even more damage. Cortisone
Injections reduce these cytokines, prevent further joint damage,
and restore the synthesis of new cartilage to normal levels.
Professor Alan Grodzinsky from the MIT Center for
Biomedical Engineering said, "Our results suggest that short-term
glucocorticoid treatment after joint injury may help restore
components of cartilage to pre-injury levels and consequently may
prevent the long term changes which lead to osteoarthritis."


Dear Dr. Mirkin: Is carbohydrate loading before competition more
effective in increasing endurance than taking carbohydrates
during competition?

No! This month a review of eighty-eight randomized
crossover studies in which carbohydrate supplements were
consumed, with or without protein during exercise, showed
conclusively that it increases endurance very significantly, and
the longer the event, the greater the benefit (Sports Medicine
(Auckland, N.Z). September, 2011).
The limiting factor in how long you can exercise intensely is the
time it takes to bring oxygen into muscles. Since sugar requires
less oxygen to power your muscles than fat and protein do, taking
extra sugar reduces oxygen needs and allows you to run, ski,
skate, swim, and cycle faster.
CARBOHYDRATE LOADING: Sugar is stored in muscles and
liver. Several years ago, researchers showed that athletes
could increase their sugar stores in muscles by restricting
carbohydrates seven to four days before competition, and then
eating extra carbohydrate-containing foods for the three days
prior to competition. However, all recent research show that
conditioned athletes can maximally store sugar in muscles just by
reducing their amount of prodigious training for four days and
eating a little extra carbohydrate-containing food.
that can be stored in muscles is limited. If you exercise long
enough, you will decrease sugar stores and start to burn more
fat, which will increase your need for oxygen and slow you down.
When you take sugar during competition, either in drinks or food,
you increase the percentage of sugar that your muscles use,
decrease your oxygen needs, and go faster longer. During races
lasting more than an hour, we take sugared soft drinks, whole
grain bars, and sugared apricot paste.


Recipe of the Week:

Asparagus-Shrimp Salad

You'll find lots of recipes and helpful tips in
The Good Food Book


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