Health for life

Hi,

I am finally seeing some weight loss progress. I actually made two changes. The first being the 16-hour fast per day and the second, about a week and a half later, was to begin to eat a couple of lighter meals during the 8-hour feed time. That Sumo Wrestlers Diet really stuck in my mind. I realized if my weight loss has stalled, then, Im eating too much. Plain. Simple.

For a long time a thought has been sitting at the back of my mind that I did not want to really investigate. Ive been wondering if all the beef and pork that I have been eating is the reason I stalled. I went back and looked at my journal over the time period in January that I was losing weight and I noticed that at that time I ate eggs and tuna for the majority of my protein. It does appear that when I started including more beef, my weight loss stalled. I had not wanted to admit that to myself because I thought beef was a good protein source that I did not have to worry about. Perhaps it is because I did not feel I could afford the grass fed variety, and was using standard beef.

So in this last week I, again, went to eggs and tuna for my protein, with a little pork, and left off the beef and in about three days I noticed a lot of water coming off of me. Dont get ahead of me... the water was coming off but my weight had not changed on the scale. I know. I was baffled, too. Then after that the scale made a five pound drop in one day. Then a three pound drop the next day. Ive now gone up a pound, but I give that over to normal every day fluctuations. I am planning on doing more of the eggs and tuna again to see if I make progress on the scale, again. Ill have beef no more than once a day and since Ill be consuming less of it, maybe I can get the grass fed beef to improve that area, too. The pork does not seem to be a problem, but Im a little tired of pork for now.

It has occurred to me that I probably could do more chicken, but, ya know, Im just not a real fan of chicken. I dont hate it, but if I buy it, it sits in my freezer for months before I eat it. I choose everything and anything else before choosing that. I should probably make some chicken soup. That is my favorite way to have chicken.

The daily 16-hour fasting has been going well. There are times when I have to remind myself that the feeling of hunger means my body is actually using the fat stores for energy. This seemed to happen a little more after I cut down on the beef, which may be the reason I did not want to stop eating it. It is very satisfying and for a very long time.

If youve been reading my blog at all you must know that I adjust things on the fly.  I have a plan, but if things happen in life, I adjust to make it work as I go. This has a good side and a bad side. The good side, is that if I notice something is not working, I can quickly adjust to make it work. The bad side, is that if I happen to let things get over into craving ville, life can get pretty wacky and my weight loss will probably stall.

I know what foods to avoid ninety percent of the time. That means that for about ten percent I can allow in a few starchy carbs. Now that I am doing the fasting Ive discovered that I can have an occasional higher carb meal without as much worry.

There is still the option of doing one or two 24-hour fasts during a week instead of doing a 16-hour fast every day. Ive not tried that, yet. I did not want to have way too many variables to factor in. If I make too many changes then I cant tell which one worked or didnt work.

The fasting really does not seem to be that hard to do. I have the time periods written down in my journal and I look forward to breaking the fast, but it is not like starvation when you dont know when you will be eating again. Thank God, I know when my next meal is. That alone, makes it much less stressful than those who are in situations where they dont know where their next mouthful is coming from.

If youve read "Eat Stop Eat" ( http://eatstopeat.com/ ) you know that there are some myths out there about dieting, metabolism, starvation mode, fasting, and other things that are just not proven by the science. ESE is a must read for anyone who struggles with their weight and wants to know the science behind fasting.

There is also very good information about the actual experience of fasting at "Intermittent Fasting, Ch. 6" ( http://www.precisionnutrition.com/intermittent-fasting/chapter-6 ). This one introduces other forms of fasting that ESE does not cover. This one is a free downloadable PDF, too.

Im still on the journey and happy about the recent weight losses. Hope all is well with you.

Be back soon,

Marcia

Heavy drinking is a health risk for many reasons, including the effects on bones.

Research shows that chronic heavy alcohol use, especially during adolescence and young adult years, can dramatically affect bone health and increase the risk of osteoporosis later in life.

What do doctors advise? Drink less for strong bones.
 

Calcium is an essential nutrient for healthy bones, and alcohol is its enemy. "Alcohol has multiple effects on calcium," says Primal Kaur, MD, an osteoporosis specialist at Temple University Health System in Philadelphia. "The bones deteriorate because not enough calcium is getting into bones -- and the body is leaching it away from bones."

How Does Alcohol Harm Your Bones?

When you imbibe too much -- 2 to 3 ounces of alcohol every day -- the stomach does not absorb calcium adequately, Kaur explains. "Alcohol interferes with the pancreas and its absorption of calcium and vitamin D. Alcohol also affects the liver, which is important for activating vitamin D -- which is also important for calcium absorption."

The hormones important to bone health also go awry. Some studies suggest that alcohol decreases estrogen and can lead to irregular periods. As estrogen declines, bone remodeling slows and leads to bone loss. If youre in the menopausal years, this adds to the bone loss thats naturally occurring, says Kaur.

Theres an increase in two potentially bone-damaging hormones, cortisol and parathyroid hormone. High levels of cortisol seen in people with alcoholism can decrease bone formation and increase bone breakdown. Chronic alcohol consumption also increases parathyroid hormone, which leaches calcium from the bone, she says.

Also, excess alcohol kills osteoblasts, the bone-making cells, Kaur adds. To compound the problem, nutritional deficiencies from heavy drinking can lead to peripheral neuropathy -- nerve damage to hands and feet. And chronic alcohol abuse can affect balance, which can lead to falls, she explains.
Drinking and Your Risk of Fracture

Heavy drinkers are more likely to suffer frequent fractures due to brittle bones and nerve damage, especially hip and spine fractures, Kaur says. Those fractures will likely heal slowly because of malnutrition.

When you quit drinking, your bones may recover fairly rapidly. Some studies have found that lost bone can be partially restored when alcohol abuse ends.

If youre a smoker, its important that you quit that habit, too. "If you are a heavy drinker who also smokes, it makes your bone problems even worse," Kaur tells . "You need to quit both habits, or osteoporosis treatment is not going to work." In fact, studies suggest that quitting smoking helps people recover from alcoholism.
Drink Less for Strong Bones

Summer barbecues, family get-togethers, after-work happy hours -- theyre full of temptations. Everyones drinking, having a good time. If youre used to imbibing, its hard to say no. But if youre goal is strong bones, these tips will help you drink less.

"Its difficult to deny yourself," says Murray Dabby, LCSW, director of the Atlanta Center for Social Therapy. "Theore, you have to find something to say yes to. ... Thats the more winning strategy."

Saying yes to healthy living is a good first step, "Take the focus off not drinking or not smoking."

As a coach and therapist, he asks people to understand their relationship to alcohol. "That relationship says a lot about how you see yourself -- Im socially awkward, Im shy, Im anxious, Im insecure, and alcohol makes me feel more comfortable."

To overcome shyness sans alcohol, heres his suggestion: "As Shakespeare would say, Life is a stage. Create a new performance for yourself. Act like the person you want to be," Dabby says.

If parties make you self-conscious, heres a positive approach: Act like youre the co-host. "Focus on making people comfortable rather than worrying about yourself," he explains. "Go around greeting everyone, asking how they know the host. Perform as if youre the friendliest person at the party. You wont need alcohol to cover up your nervousness."

Another tactic: Pretend that youre tipsy. If you love going to karaoke bars but cant enjoy it without alcohol, simply pretend, Dabby suggests. "Order ginger ale, but act like youre tipsy." Thats the approach that one person took,  "It was very successful for him. He found he could ham it up without alcohol."

If after-work happy hours are a problem, dont focus on drinking: "Focus on getting to know your co-workers. Be curious, ask questions. Focus on relationship-building, because thats a positive thing,” Dabby says. “Order ginger ale or another nonalcoholic drink. You dont have to tell anyone you have trouble with alcohol."

AstraZeneca and Ardea Biosciences today presented results from a large study of allopurinol, a treatment commonly used to lower uric acid in patients with gout. The LASSO (Long-term Allopurinol Safety Study evaluating Outcomes in gout patients) study was a multinational, 6-month, open, prospective observational study involving 1,735 patients with gout and was designed to evaluate the safety and efficacy of medically appropriate doses of allopurinol. Results of the LASSO study showed no new safety signals with allopurinol doses of approximately 300mg/day. The study also revealed that at the time of last dose fewer than half (43%) of patients taking allopurinol achieved the target serum uric acid (sUA) level of <6.0 mg/dL, the level recommended by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). Results of the LASSO study were presented today at the ACR Annual Meeting in San Diego, CA.

Allopurinol, the most commonly used treatment to lower blood uric acid levels in gout, is a generic treatment that has been available for more than 50 years. It is a xanthine oxidase inhibitor, a class of drugs intended to reduce the bodys production of uric acid. Allopurinol is recommended at doses between 100mg and 900mg per day, depending upon disease severity. The LASSO study encouraged investigators to increase, or titrate, the dose of allopurinol over the six months of the study to a medically appropriate dose. There was a high rate of adherence to therapy (97% across doses) and the most commonly used dose was 300mg. Approximately 45% of patients finished on the same dose as their baseline dose. Results show that even among patients titrated to final doses above the most commonly used dose of 300mg/day, approximately 46% did not reach target sUA levels of <6.0 mg/dL.

"Gout is a painful form of arthritis that is often misunderstood and inadequately treated. The LASSO study demonstrates that many patients with gout fail to reach the recommended treatment goal," said study co-author Nicola Dalbeth, MD of the University of Auckland. "Failing to reach the recommended sUA target leaves patients with gout at risk for further disease progression and long-term consequences of gout."

The results of this large, multinational, prospective observational study of gout are consistent with published literature confirming many patients do not reach sUA targets with allopurinol therapy as currently used.

Specific findings from LASSO include:

- The study revealed no new safety signals with allopurinol (approximately 300mg/day).
- There were no cases of allopurinol hypersensitivity syndrome in this study.
At the time of last dose 43% of all patients in the study achieved target sUA levels of <6.0 mg/dL.
- Of patients in the study at final doses above 300mg/day, approximately 54% achieved target sUA levels of <6.0 mg/dL.
- Gout is the most common form of inflammatory arthritis with a prevalence of 8 million in the U.S. Gout is commonly misrepresented as a lifestyle disease. While diet can contribute to elevated levels of uric acid, the majority of uric acid is produced by the bodys naturally occurring processes, and gout is most often caused by the inefficient excretion of uric acid by the kidneys.
- In patients with gout, abnormally high levels of uric acid in the blood known as hyperuricemia lead to deposition of needle-like crystals in joints and soft tissues throughout the body, causing inflammation. Hyperuricemia results when the kidneys do not efficiently remove enough uric acid, or when the body produces too much. A persons genetics play a significant role in their risk of developing gout. The most common symptom of gout is extremely painful arthritis. Over time, the deposits of uric acid crystals may lead to joint damage, visible nodules called tophi, and impaired quality of life. Additionally, gout has been associated with serious health problems including cardiovascular disease, diabetes and kidney damage.

Today, we continue our May Top 10 series by addressing a popular topic in both the food and personal finance blogospheres: eating less meat.

“Why in the good name of Bea Arthur would I want to eat LESS meat?” some might ask. “I don’t get enough bacon as it is. Plus, humans were meant to be carnivores, right? Otherwise, how do I explain the dead alpaca in the fridge to my kids?”

Well, sweet reader. We come not to demonize meat, but to praise consuming it in moderation. Because when raised right and chomped sensibly, beef, chicken, pork, lamb - maybe even that alpaca - can be pretty good for you. What’s more, it’s good for your wallet, your children, the Earth, the moon, the universe, other universes, the multiverse, the Rebel Alliance, Hoth, Dagoba- … Sorry. Got carried away there.

Following that line of reasoning, here are 10-plus strategies for reducing your meat intake. Some are well known. Others, less so. But all told, it’s a pretty decent list, if I do say so myself. (Note: And I do.)

Of course, if you’d like to change anything or add your own suggestion, the comment section awaits. That’s what it’s there for, after all. (Also: quoting Glee.)

1) Have one or more meatless nights per week.
It’s hard to say whether the movement began with bloggers or Johns Hopkins’ Meatless Mondays. Either way, this 15% reduction in your weekly meat can have a massive positive impact on … well, everything we just mentioned (the environment, your heart, Tatooine, etc.). The options aren’t as limited as you think, either. Vegetarian burritos, pizza, chili, and pasta are so tasty, you won’t miss the extra eight ounces of pork.

2) Buy less meat. And when you do, only purchase pricey, delicious, humanely raised meat.
You have three grand and a choice: You can go to McDonald’s every night for a year, or Babbo every night for a month. You’d choose 30 days catered by Mario Batali over 3,000 stupid chicken nuggets, right?

Buying farmer’s market meat is kind of like that. You purchase less overall (because it’s pricey, yo), but what you do buy is so delicious, it’s worth the wait.

Not to mention … imagine a world where the chicken tastes like chicken. I’m not talking about the wan, watered-down, quasi-poultry we know and tolerate. I’m erring to genuine, robust fowl that screams, “I am bird! Hear me cluck! Or roar! Or roarcluck! Whatever.” That flavorful planet is attainable, if you’re willing to go for it.

3) Don’t eat meat before dinner.
You may have heard of Mark Bittman’s “vegan before 6” diet. Essentially, the New York Times writer doesn’t eat any animal products before dinner. (Um … that may have been somewhat self-explanatory from the name of the diet, in which case, I apologize.)

While restricting cheese and eggs might be a little too much to take, dude’s definitely on to something. How simple would it be to cut the bacon out of your morning feast? Or to swap grilled eggplant in for grilled chicken on your panini? Or to buy the deli’s awesome, overlooked Italian Bean Soup instead of their admittedly lame Chicken Noodle? Try it for a few days, and see what happens. Could be easier than you think.

4) Don’t make meat the focus of your meals.
There’s nothing like a good cheeseburger, but eating one every night takes its toll. Relegating meat to side dishes or secondary ingredients ensures you still get a decent helping of beefy goodness, without the egregious bad things. Chilis and soups are particularly wonderful for this, as is everything in Joy Manning and Tara Mataraza Desmond’s Meat Lite column on Serious Eats.

5) Go ethnic.
Mediterranean, Indian, Chinese, Thai, and even Italian and Mexican food rely much less on meat than traditional American cuisine. Throw your family a culinary curveball by having a World Kitchen Night, and preparing a few simple recipes from around the globe. Beyond the obvious benefits, you’ll also open minds and create adventurous palates. Sweet.

6) Filet or pound your cuts.
The recommended serving for meat is four ounces, which is about the size of a deck of cards. If you put that in front of my brother, he’d laugh maniacally and then shove a fork into his thigh, a la Gene Wilder in Young Frankenstein.

There’s a way around that, though: Take a large piece of meat – chicken breast, let’s say – and A) slice it in half through the middle, or B) pound it super-thin. This creates the illusion of a big cut, even though the piece is essentially missing its bottom half. Bonus: it’ll cook more evenly, as well.

7) Learn to make more vegetable, grain, and pasta-based meals.
Baked Ziti. Falafel. Pizza. Easy Vegetarian Bean Chili. Lasagna. Quinoa Soup with Avocado and Corn. Ratatouille. Macaroni and Cheese. Pasta Puttanesca. Black Bean Burrito Bake. Veggie Lo Mein. Stuffed Peppers. Tomato and Bread Soup. Pumpkin Orzo with Sage. Roasted Veggie Sandwich. OH MY SWEET HEAVENS, BUTTERNUT SQUASH RISOTTO. All substantial. All delicious. None will make you crave a hot dog.

8) Find substitutes you dig.
Not everybody likes tofu. I get that. Bean curd is an acquired taste. Still, have you ever tried seitan? Done correctly, it’s scrumptious. I’m not kidding. Leigh makes these barbecue seitan bites that are practically crack.

Meat substitutes scare people off sometimes, but flavor- and texture-wise, they’ve come a long way since Tofurky. If you’re open to the idea, the trick is finding one (or two or eight) that works for you. Whether that’s Portobello mushrooms or tempeh or Morningstar Farms Chix Patties (Which? Mmm.), odds are it’s a better option than many commercially available meats.

9) Make your vegetarian friend(s) cook for you.
Two of my friends have been vegetarians for nearly 20 years each. (One is aforementioned Veggie Might genius Leigh.) Both are among the best cooks I know, presumably because they’ve been forced to experiment with a wider variety of foods to compensate for the lack of meat. If you have similar pals, watch them cook. Ask how they get by. Eat with them. Vegetarians are experts at non-meat lifestyles, and you can learn a lot just by hanging out in their circles.

10) Do the math.
Save your next four grocery bills. Add up the totals. Subtract half the money you spend on meat. (That other half will be spent on more grains, vegetables, and beans, presumably.) Imagine saving that every month, for the rest of your life. Not too shabby, eh?

BONUS: Avoid the meat areas of your supermarket.
Out of sight, out of mind, right? It works for me.


REALLY GOOD IDEAS FROM OTHER PEOPLE

These four tips are pretty sweet, and I didn’t see them anywhere but the cited sources.

Forget about protein.
Mark Bittman: “Plants have protein, too; in fact, per calorie, many plants have more protein than meat. … By eating a variety, you can get all essential amino acids.”

Use it all.
Planet Green: “Try not to throw anything away, and look around for cheaper, more interesting cuts of meat at your butcher.”

Adapt old meaty recipes.
Diet Girl: “Back when I first shacked up with Dr G, I started by taking my old standard meat recipes and finding veggie substitutes. This meant lots of beans and lentils.”

Make extra helpings of your side dishes.
Owlhavens Mary Ostyn makes only 1 to 1-1/2 small servings of meat per person, but cooks extra veggies, grains, and such. It keeps costs down, and ensures her kids don’t go overboard.

And that’s it. Sweet readers, the comment section awaits. Oh, and don’t forget: next week, our 10 Series is tackling storage and leftovers. If you have tips for maximizing either, I’d love to hear.

~~~

If you enjoy this post, you might also like:

• 1 Chicken, 17 Healthy Meals, $26 Bucks, No Mayo
• 60 Cheap, Healthy Marinades
• Angus Anguish: Is Angus Beef Worth the Money?

(Photos provided by Wheatbridge [chicken], Baby-Halloween-Costume.com [cow], and BuyCostumes.com [pig])

Hi,

Ive always thought of gastric bypass surgery (GBS) and all its cousins, as "Franken-surgery." The one and only good thing it does is force you to make the kinds of eating changes that make you lose weight. You simply can no longer eat the way you used to. You have no alternative. There are no more lies or head games. The unfortunate part of GBS type operations is that they can still eventually fail and you can still gain back the weight you once lost.  About thirty years ago, my BFF at the time, did that.

I was her support for the entire year that it took her to lose her weight. I watched her throwing up. I witnessed the pain she was in. I saw the agony she went through and I decided that I was NEVER going to do that. I would rather be fat, than to do that. Within a year an a half she had stubbornly fought her way back to eating as she used to and put the weight back on again.

Please do not misunderstand. I am not judging people who have decided to do GBS. It seems that many people are doing it and successfully losing weight from it. If that is the course a person has chosen and it has worked for them, then I say "Hooray, you did it. Way to go!"  It is just that, for me, I dont see it.

But why not adopt that "mind set" of "accepting that you must eat less," and leave out the expense and trauma of Franken-surgery? If you think about it, the whole purpose of GBS is to make you stop eating so much. Why not just decide to "stop eating so much" without the major trauma to your body and your pocket book?

I think I am thinking about this because I am still struggling to lose weight. For a long time I thought it was the "kind" of food that caused the problem. So I cleaned up my eating by cutting out carbs and eating fewer processed foods.

I got my A1C back down to a normal place and my new doctor says that I am no longer pre-diabetic. I am excited about that. But I still have high blood pressure and have not made it past the 30-pound-lost marker. I am still obese.

Ive tried the 16-hour per day fast for a few weeks and still not seen any real weight loss that lasted on my scale. After reading the "Anything Goes Diet" and focusing on it for a few days I think I really need to focus simply on eating less in a way that works for me. It now makes sense to me to eat, say, once day, and the rest of the time, just stop eating.

We dont come with a tattooed label on us that says we MUST EAT THREE MEALS A DAY, or even we MUST EAT FIVE SMALL MEALS A DAY.  There are really no rules but the ones we or someone before us has made up.

I had been considering eating as I do now and trying a once a week 24-hour fast... and I may still do that. But Im also thinking about just eating a nice normal meal once a day, with a protein snack thrown in sometime during the day, and the rest of the time, just not eating. Ive discovered that I can go for long periods of time without eating which I had thought was not possible. And not only can I do it, I like doing it. I like the way it feels. I really dont like that "bloated" feeling that comes from eating large, especially carb-laden meals. It is so much more pleasant to have an empty stomach. It provides almost an odd sense of freedom.

Maybe I could do the opposite of the 24-hour fast. I could eat once a day for six days and on the seventh day, have two, perhaps even three meals. Then go back to the once a day meals. I could eat whatever I wanted. I know how important it is to me to eat healthy, so I would make sure my one meal had both protein and vegetables. I would still eat salads for the fresh raw veggies.

I could add to the salad a moderate size of animal protein (beef, pork, chicken, fish, or eggs) plus a serving of cooked veggies with some nuts or a fist-sized portion of some carb. A small portion of carbs. And I dont have to do the carbs each day. I wonder how long it would take me to begin to see a weight loss if I did that. I wont know if I dont try it.

I feel like trying it. I feel frustrated by all the things Ive tried and not being successful at the one thing I really wanted: the weight loss. I am a human being, I should be able to lose weight just like other human beings are doing. I need to do something that I can do. I use to do Franken-surgery, (as my doctor suggested) but that does not mean I cannot focus on achieving the same kind of total calorie reduction in a way that makes better sense to me.

I am sure there are folks who will have objections to this idea. Im sure that if someone had mentioned this to me a while ago, I would never have even thought of being open to the idea. But Ive gone down the road and ended up somewhere else. I need to do something that works -- for me.

From my reading I know that cutting out food, as in fasting, does no harm to the body if done in a controlled manner. It has been scientifically proven that small daily fasting does not even lower the bodys metabolism or reduce muscle. The body will only cannibalize itself after extremely long periods of time without food. Im not talking about that. The fasting Im talking about simply gives the body a rest. Im not talking about fasting for 40 days and 40 nights. Im talking about eating a good healthy meal once a day, plus a protein snack at some other time during the day.

I think this would accomplish the goal of reducing the daily caloric intake without all the fuss and measuring and counting and control. I hate the fuss, measuring and counting and the control. When I do that my whole day is spent focused on food. Im not interested in spending my life being focused on food. Im interested in eating a good meal and then moving on to other stuff. Thank God!!

Ok. It makes sense to me. Im going to try it. I can drink unsweet tea, and water all day long. I suppose diet sodas would work, too, but I hate soda, so why even bring it up? The only juice will be watered down cranberry juice (with no sugar or other sugary fruit juice added) -- and that only when I feel it is "medically" necessary. So, water it is. And a cup of tea now and then. And that is my new plan.

Ill be back soon with any news flashes...

LOL

Hope you are well,

Marcia

Small business points at its competitor

It wasnt until the Disease Management Care Blog had read this Jan. 30 Wall Street Journal opinion piece that it realized that its "nano" corporate" status was packed with such futuristic potential. According to the editorialist, American companies should follow the DMCBs lead and be "protean" by dropping old fashioned W-2 employees and substituting 1099 contract relationships.  That way, everyone - including a single person "nano" - can enjoy the upsides of being a corporation and stay below Obamacares 50 employee pay-or-play $2000 penalty threshold.

Since the DMCB formed its own corporation more than 5 years ago, it has certainly participated in "protean" business relationships. Once things get underway, the DMCB often discovers that of the many prominent organizations that it does business with really consist of a small core office populated by a few owner-founders, a single administrative aide and one or two payroll folks who oversee the outsourcing of everything else.  While the term "protean" is certainly novel, the DMCB thinks distributed, adaptable and organic business networks have been around for years.

But the WSJ editorial opens a window into an underappreciated consequence of Obamacare and the underlying assumptions of the central planners who run Washington DC.  The DMCB doesnt necessarily think its bad, but it sure is interesting.

Read on.

While the Affordable Care Act (ACA) was intended to link employment and health insurance, what it has really done is handed many small nimble interlocked businesses another leg-up against their large traditional mainframe competitors. For example, one colleague pointed out to the DMCB that "new" pharma companies are really marketing departments that outsource manufacturing that, in turn, outsources supply management that outsources I.T. that outsources its cloud services. Its the only way they can compete. 

The new economics of health insurance will only accelerate similar trends in other manufacturing and service sectors of the economy.  Toss in the ability of people and capital to move and work across borders and the picture becomes even more dynamic. And in the meantime, Washington DC continues to implement the ACA with a legacy of large companies buying comprehensive health insurance for its employees.

Little did anyone anticipate that the ACA would hamper the success of American big business.

Image from Wikipedia

Investigators who studied a group of recreational marathon runners have established that strenuous exercise such as running a marathon can damage the heart muscle. Although they found the effect is temporary and reversible, they warn that these effects are more widespread in less fit distance runners and that recreational distance runners should prepare properly before marathons. Their findings are published in the October issue of the Canadian Journal of Cardiology.

Previous reports have established that a significant percentage of sports competitors show signs of heart muscle injury and cardiac abnormalities after prolonged exercise. In a new study designed to evaluate what kind of stress running a marathon puts on the heart, and whether this might cause permanent damage, investigators evaluated 20 recreational distance runners aged between 18 and 60 who were scheduled to take part in the Quebec City Marathon and who had no known cardiovascular disease or drug treatment. The participants were all amateur runners. Those who had run another marathon less than two months before recruitment or during the study period were excluded.

The runners were extensively observed and tested six to eight weeks before the marathon and on the day itself. They were tested again within 48 hours after completing the marathon, including a second MRI study and final blood sampling. This timeframe guaranteed adequate rehydration (assessed according to hemoglobin level) and a return to baseline hemodynamic state (assessed according to heart rate and blood pressure) after the race, but was short enough to observe any significant myocardial changes before recovery. All runners with decreased left ventricular ejection fraction (LVEF), a measure of cardiac pumping efficiency, after the race compared with baseline underwent a third MRI study after three months of rest to check whether it had reversed.

Investigators noted that the race induced a decrease in left and right ventricular function in half of the amateur distance runners. When a lot of the heart was affected, the heart also showed swelling and reduced blood flow. "We first established that marathon related segmental function decrease – observed in more than half of all segments – is associated with a decrease in resting perfusion and increase in myocardial edema," observes senior author Eric Larose, DVM, MD, FRCPC, FAHA, of the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Canada. "We also found that heart muscle changes were more common and widespread in runners with lower fitness and less training. Finally, we observed that these changes were transient," he continues.

The investigators do not believe these temporary changes are a cause for concern. "Segmental function decrease is associated with poor prognosis in the presence of CAD or cardiomyopathy. Segmental dysfunction also indicates a poor prognosis in adults without cardiovascular disease. Although we dont know whether such changes mean that recreational runners are at risk, the attendant edema, and reduced perfusion suggest transient injury," says Larose.

"The changes are more widespread among those with lower fitness levels and less training," observes Larose, who is professor of medicine at Université Laval and a cardiologist and clinical researcher at IUCPQ. "Although no permanent injury was observed in this group of runners, the findings suggest that there may be a minimum fitness level needed beyond which the heart can bounce back from the strain of training and running a long race. Furthermore, these results emphasize the need for proper preparation before recreational distance runners engage in a marathon race," he concludes.