Are painkillers also killing your hearing?

Frequent use may be a preventable contributor to hearing loss.

When you think of risk factors for hearing loss, over-the-counter painkillers probably aren’t among them. But a Harvard study published in a recent issue of the American Journal of Epidemiology suggest that frequent use of ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) may be an important contributor. In the study, women who took the pain relievers at least twice a week were at greater risk for hearing loss, and more frequent usage increased the risk by up to 24%. The findings are similar to a study of men and hearing loss, although aspirin was also found to contribute to risk in that study.

Researchers speculate that the pain relievers may be damaging the cochlea, the snail-shaped hearing mechanism in your inner ear. “Ibuprofen can reduce blood flow to the cochlea, which could result in cellular damage and cell death. Acetaminophen may deplete the antioxidant glutathione, which protects the cochlea from damage,” says study author Dr. Sharon Curhan, an instructor in medicine at Harvard Medical School.

Does this mean you should think twice before popping a pill for headache or back pain? “These drugs clearly have benefits with short-term use,” says Dr. Curhan, “However, frequent use of these medications and use over long periods of time may increase the risk of hearing loss and may cause other adverse health effects. Therefore, it is important to take these medications mindfully and to limit their use as much as possible.”

Talk to your doctor before making any changes in your medication use. ♥

Harvard Health Letter

Sugar Shock!

Sugar, it can make you fast .... and it can make you fat! Experts argue about how much sugar active people need, but agree on one thing: We eat too much of it for our own good.

Imagine making a life-size sculpture of yourself out of sugar, then eating the entire thing over the next 365 days. That might sound gross, but many of us do roughly the equivalent every year, according to the latest figures from the United States Department of Agriculture. The average American eats 156 pounds of added sugar annually. We’re not talking about the kind you find naturally in whole foods, but sugar that’s been poured in during processing.

Not good. The American Heart Association recommends that we eat no more than six to nine teaspoons (24 to 36 grams) daily, depending on gender. But because food manufacturers dump sugar into many packaged foods—bread, crackers, soups, sauces, and ­salad ­dressings—most of us average two to three times the prescribed amount (about 22 teaspoons, or 89 grams) without even knowing it. New York Times food writer Mark Bittman recently called added sugar “the biggest public health challenge ­facing the developed world,” likening it to tobacco’s infiltration into every nook of our society in the 1950s and ’60s. Here’s what cyclists need to know about this problem.

FAST FUEL
To be clear, you need some sugar to fuel your rides. As the simplest form of carbohydrate, it’s easy to absorb and is found in whole foods in several common natural forms, including sucrose, glucose, fructose, and lactose. The process of digestion converts all sugars into glucose, which the body then stores as glycogen­ in the liver and muscles. Most of us can store only enough to get us through two hours (tops) of high-intensity­ hammering, however. So when your stores run dry, you need to pour sugar directly into the tank to keep muscles firing. Giving your muscles regular doses (30 to 60 grams an hour after the first hour) of the sweet stuff during hard efforts helps you squeeze more gains out of training because you can push harder and longer, says Michigan-based sports dietitian Donna Marlor, BSN, RD, CSSD.

After a hard effort, sugar also quickly replenishes the energy stores you’ve depleted, not only in your muscles but also in your liver and brain. In fact, your brain operates solely on sugar. It typically uses about 20 percent of the ­glucose circulating in your blood, but when you get on a bike, it demands more to keep you focused and send command signals to the rest of your body. Some experts believe that when you’re pedaling as hard as you can and start to lose steam, it’s because your neurons, not your legs, are running low on fuel. Your brain, like your muscles and liver, adapts with training to store more glycogen for your next effort.

TOO MUCH OF A GOOD THING
The problem is that the same simple sugar that gives you a boost on your bike is bad for your arteries and organs when you do a lot of sitting around. And even though cyclists are more active than people who don’t exercise, many of us spend more time at our desks (or on couches) than we do on our saddles. During inactivity, the sugar your muscles would normally sponge up forces your body to secrete insulin, the metabolic doorman that escorts free-floating sugar from your bloodstream into your cells. The doorman can work only so fast, however. And if you pour in too much sugar, the insulin starts blocking it, leaving it in your bloodstream, where it latches onto proteins and damages blood-vessel­ walls. That leads to ­inflammation, which paves the way for hardened arteries and heart disease. In the meantime, your body still pumps out insulin to try to clean up the mess and eventually converts the excess glucose into stored fat. Repeat this process over and over again, and the doorman eventually calls it quits, which means you can no longer get sugar into your cells, and that signals diabetes.

Eating a sugar bomb (a slice of cake, a doughnut) also triggers blood-sugar fluctuations and imbalances of the hormones that regulate appetite, which can lead to overeating and fat gain, especially in your belly. Some experts, most notably Joe Friel of the Training Bible series and The Paleo Diet for Athletes, caution that eating a lot of sugar in your daily diet also hinders your fat-burning metabolism both on and off the bike, so you’re less efficient in training. “Your body is very adaptive,” says Friel. “It’ll use what you give it the most of. And the more sugar that comes in, the more your body attunes to using quick energy.” That means you don’t burn fat as readily for fuel, leading to faster energy drain.

Not only does consuming excess sugar alter your fat-burning metabolism, it also changes your brain circuitry and may even be addictive. That’s right: There’s a reason you “can’t eat just one.” Sugar lights up the same reward receptors and triggers the same cascade of feel-good brain chemicals (like serotonin and dopamine) as cocaine does. So when you’re trolling for a postride cookie even though you sucked down a gel during your ride, it may not be about restocking your energy stores as much as it is about feeding your head. And because overloading on sugar messes with the chemistry in areas of the brain that control food intake, it becomes harder to regulate how much we eat. So we end up eating even more sugar and get caught in a vicious cycle.

THE SWEET SPOT
For the greatest on-bike benefits, fuel your riding by sticking to whole foods made with no added sugar. Nature delivers what you need in packages that meter out the doses in a healthy, sustained way. Fructose found naturally in fruits and vegetables is fine, for example, because the fiber in those foods slows the speed by which sugar enters your bloodstream. The protein in milk does the same for lactose, the natural sugar found in dairy.

Cut out foods with added sugar from your daily menu. The most obvious are sodas, bakery goods, and candy. But as noted earlier, you’ll also find sugar in most processed foods that come in a box, jar, carton, or can. Watch for added sugar in a multitude of names and incarnations, including beet sugar, corn sugar, corn sweetener, corn syrup, fruit juice concentrate or puree, high-fructose corn syrup, honey, malt sugar, molasses, syrup, and maple syrup. Ingredients ending in “ose” are all forms of sugar. If any of those are among the first three to five on the list, that’s too much.

Older Does Not Mean Slower

Don’t Let Age Slow You Down

By Dr. Jordan D. Metzl, M.D

As I was pedaling as fast as I could in the middle of Ironman 70.3 Eagleman, a strong-looking fellow blew by. I glimpsed the number on his calf as he charged ahead. “You just got totally dusted by a 59-year-old,” I said to myself.

When he and several others from his wave also passed me, it made me think: Am I getting weaker or are these guys getting stronger?

There are two main variables to consider when looking at aging and athletic ability: cardiovascular capacity and functional strength. The stronger the heart, the more blood gets pumped out to the lungs and muscles, and the more cardiovascular capacity an athlete has. This number determines the VO₂max, the maximal amount of oxygen that the body can exchange over a specific time.

Functional strength, the strength generated by muscle groups, determines the power an athlete can generate. The greater the functional strength, the more power and speed the athlete will have.

After age 25, both the cardiovascular capacity and functional strength variables start to decline. This starts slowly, a little bit each year—and then accelerates quicker in the 50s, 60s and 70s.

If that is true, why was I getting my butt kicked by a 59-year-old? The answer: These guys are fighting their physiology by doing a few key things:

1. Lactate threshold training. As an athlete ages, hitting the same VO₂max is impossible, but he or she can push their lactate threshold at any age with interval training. Pushing your cardiovascular limit and then returning to baseline several times per workout helps the body to better tolerate longer periods of exercise.

2. Functional strength training. I’m a huge fan of plyometric-based strength training. The muscles can gain strength at any age. Fighting the natural process of muscle atrophy only occurs with hard work. Strength training sessions twice per week, in addition to regular triathlon training, results in improved power and functional strength.

3. Regular medical care. Seeing your doctor for regularly scheduled visits is important for everyone. Athletes are generally healthier but are still prone to the everyday problems of aging.

Jordan D. Metzl, M.D., is a nationally recognized sports medicine specialist at Hospital for Special Surgery in New York City. Dr. Metzl is a 29-time marathon runner and nine-time Ironman finisher. His new book is titled The Athlete’s Book of Home Remedies. Drjordanmetzl.com

Arthroscopic shoulder surgery

When the minimally invasive procedure is warranted.

Arthroscopy is a popular technique for shoulder surgery because it involves a small incision. While it used to be the case that surgeons could see the shoulder tissues better with traditional open (large-incision) surgery, that has changed. “Our techniques have advanced to the point where sometimes we can see what’s happening better with the scope than with open surgery,” says Dr. Eric Berkson, director of the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital. But when your surgeon will use arthroscopy depends on the particular condition that requires surgery.

The Surgery

With arthroscopy, the surgeon makes a small incision and inserts long, thin surgical instruments, including one with a video camera that provides the inside view. “Because you can see better with arthroscopy, you can accomplish a repair without risking damage to the nearby deltoid muscle,” says Dr. Berkson. “That cuts down on complications.”

Traditional benefits of minimally invasive surgery are smaller incisions and faster recovery times than open surgery. But shoulder arthroscopy is different. The incisions may heal faster, but Dr. Berkson says there’s not much difference in the total time for recovery. “It’s the same as open surgery because the work being done on the inside is the same,” he explains. In addition, he says that research has shown the strength of the repair is the same, whether you have open or arthroscopic surgery, and that there’s no difference in the rate of infection after surgery. Recovery lengths vary depending on the condition being treated. For example, a rotator cuff repair may take six months of recovery, including physical therapy.

When it’s warranted

Arthroscopy is recommended most often to repair torn rotator cuff tendons (which keep your arm bone in your shoulder socket), a dislocated shoulder, and torn ligaments, as well as to remove bone spurs and loose cartilage. Open surgery is recommended for larger operations, such as a shoulder replacement, or replacing bone in the shoulder socket.

What you should do

If your doctor recommends shoulder surgery, Dr. Berkson advises not to worry if it will be open or arthroscopic, “It’s more important to find a surgeon who can do the procedure the right way, no matter which approach it is,” he says. That means going to see an orthopedic surgeon who is a specialist in the shoulder, who has experience doing that surgery on a daily basis. Remember, too, that it’s not just how the surgery is performed that makes a difference. The rehabilitation program after surgery is also very important. “It’s the quality of the assessment and the ability to work in a coordinated rehabilitation program that lets a minimally invasive approach be truly successful,” says Dr. Berkson.

Harvard Health Letter

April 2013

Tips for Running in Humidity

It's not (just) the heat that matters! How to cope with the muggy weather.

By

Liz Plosser; Image by Mark Matcho

Published July 10, 2013 In Runners World

 

Runners often obsess over weather reports, tracking the coolest time of day in which to run. But as anyone who's ever tried to finish a five-miler in steamy conditions knows, it's not just the temperature that matters, it's the humidity.

"Of all the climate measurements we take to assess heat risk for our runners, humidity is the biggest factor," says George Chiampas, D.O., the medical director of the Chicago Marathon. Humidity makes warm summer runs even more taxing because the higher the moisture content of the air, the hotter it feels. An 88-degree day with a relative humidity just under 40 percent, for example, will feel like 88 degrees. Hot, yes, but when humidity reaches 70 percent, that same 88 temperature feels like 100 degrees.

Unless you're lucky enough to live in Paradise, Nevada—the least humid city in the U.S.—here's how to cope when running in steamy conditions.

Why Humidity Matters
When you run, your core body temperature naturally rises, and your sweat glands produce droplets that carry excess heat to the surface of the skin, where it evaporates. But humidity prevents sweat from evaporating, so the heat stays put. "On a hot, humid day with no breeze, you have lost a key way to get rid of your building body heat, which can make running dangerous," says Michael Bergeron, Ph.D., a professor at the Sanford School of Medicine of the University of South Dakota.

If your body heats up and gets more and more dehydrated, it goes into survival mode, maintaining blood flow to your essential organs (to keep you alive) and to your skin (to regulate temperature). Less blood will flow to your GI tract, which will make the digestion of sports drinks or gels difficult, and you may feel nauseous as a result. You may also find you are more prone to side stitches when you are overheated—especially if your breathing becomes shallow and uneven. And your heart rate will escalate as your ticker and lungs work overtime trying to deliver oxygen throughout your body, Dr. Chiampas says.

But wait, there's (ugh!) more. If you continue to gut it out, your brain temperature will rise, which makes matters worse: Your ability to assess your own body temperature will become difficult (runners often report feeling chilled or goosebumpy when they're overheating). You can also start to lose control over body mechanics (your form and footing will get sloppy), and your mental abilities may start to break down (you may feel dizzy or disoriented).

"Your temperature can spike in minutes," Bergeron says. "If you're running a 5-K or a 10-K on a hot day, you can jack up your body temperature quickly." Also, it's a myth that newbies or not-fit-enough runners are the ones who suffer in hot, humid conditions. In fact, competitive athletes may be more prone to heat-related illnesses because the faster you run, the more body heat you generate. "As humidity increases, thermal strain and premature fatigue increase exponentially, and so running at your normal pace will feel very difficult," Dr. Chiampas says. It's also important to recognize that feeling sluggish on a sticky day doesn't indicate a lack of fitness or a lapse in mental toughness—it's your body's physical response to a stressful environment.

Of course, some people handle heat and humidity better than others. Body size is one factor—the more body mass you have, the more insulation and load you carry and the more heat your body generates, which makes it easier for you to overheat. Age is another variable—over time, your body becomes less adaptable to heat; age-related changes to sweat glands can decrease sweat production and reduce the body's ability to cool itself effectively. Also, sweat content varies: Some people lose more sodium in their perspiration than others, and that can impact performance and increase risk of cramps if these salty sweaters don't take in enough electrolytes. Where you live also plays a role: It takes generally 10 to 14 days to acclimatize to hot and humid conditions. People who train in humid parts of the country will become naturally used to muggy conditions and probably fare better at, say, an August East-Coast race than someone who travels in from the West Coast, where humidity is generally lower.

Slogging On
You might think the best times to run are early morning or evening, or cloudy, rainy, or not-crazy-hot days. But all of those can be incredibly humid. When you check the weather report, don't pay attention to just the temperature. The Heat Index combines temperature with relative humidity to give you apparent temperature—how it actually feels outside. Relative humidity doesn't become a factor until it reaches about 40 percent—below that, you'll have a comfortable run; above that, it could impact your performance. For example, a 75-degree day with zero percent humidity will feel like 69 degrees. But in 100-percent humidity, 75 degrees will feel like 80. (Though there is no simple formula for calculating Heat Index on your own, it's easy to find on weather Web sites and apps.) The National Weather Service issues a Heat Advisory when the Index is expected to exceed 105 for at least two consecutive days.

In those conditions, if you are intent on getting in a quality workout, your best bet is a treadmill in an air-conditioned room. Otherwise, opt for a shaded path (versus heat-absorbing roads), run close to water (bodies of water offer breezier conditions), and take walk breaks. It's essential to hydrate properly and let go of any time-based goals—run by feel instead of pace. When temperatures go from 75 to 90 degrees, heart rate can increase by 10 to 20 beats per minute, which will make your perceived effort much greater. Add humidity to the mix, and the effect will be even more significant, Bergeron says.

Be mindful of the early warning signs of heat exhaustion and heat stroke: fatigue, nausea, dizziness, headaches, tingly skin, and confusion. Call it quits if you experience any of them—even if you haven't reached the end of your run or the finish line yet.

The good news? You can teach your body to respond more efficiently in the heat. Signing up for a race in the second half of the summer will give you a few weeks of heat training under your fuel belt, so you'll struggle less than you would at the beginning of the season. And any training you do now will only make your fall runs all the more enjoyable.