“Low T” Regarded as Fiction

Many clinicians are now coming out to openly say they believe Low T is an invented problem, and not really a medical condition at all. The affliction, like the gels and pills that are there to “solve” it, is manufactured.
(go to article)

We Eat Too Much—and the Calories aren't from Vegetables

In 1970, the total amount of calories consumed daily per person was 2,064. In 2010, total calories reached 2,538. That is a 23 percent increase, and the USDA has tracked that the bulk of this extra meal per day is from flour and cheese.
(go to article)

Whole Fruit—Not Juice—Lowers Diabetes Risk

A study finds that regular consumption of whole fruits significantly lowers type 2 diabetes risk in adults, as compared to people who eat little fruit. The effect was not observed for fruit juices, which increase diabetes risk.
(go to article)

Marathoners, Keep the Focus Off Yourself

The science behind the mental marathon is in its infancy, but there is a growing body of research available that suggests certain mental attitudes over the course of a race may be more beneficial than others. (go to article)

Keep Interval Intensity Steady

The goal of interval training is to spend as much time during the workout as possible at VO2max. The reason that this does not translate into all-out running on each lap is because to sustain training at maximal oxygen consumption, you must manipulate the duration of the intervals and the duration of the rest periods, rather than simply sprint until you are exhausted. (go to article)

Are You Leg Speed Training?

For a finish-line kick worthy of the free photo your race likely offers, consider leg speed training—a peculiarly narrow subset of training that will help you overtake your contenders in a triumphant, final surge. (go to article)

The Clinic

Knee Surgery Does Not Mean Retire From Running
(go to article)

Hip Surgeries Compared: Resurfacing vs. Replacement
(go to article)

An Audible Hip Click, Without Pain
(go to article)

No Running While a Stress Fracture Heals
(go to article)

The Back Page

XX-Country Coaching: Into the Post-Season

AMAA Sports Medicine Meetings –AMAA DALLAS 2013

Seen and Heard while Running this Fall  (go to articles)

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Flu Shot Controversy

Flu shots have become an annual tradition each fall it seems, as we gear up for flu season (October-March) and try to stave off what always seem to be reported in the media, at least, as worse and worse strains of influenza.

But recently our culture has been accused of overselling influenza as a disease, and in no lesser a publication than the British Medical Journal. In an essay published in May in the BMJ, the author, a Harvard University postdoctoral fellow, says we simply are not all at risk of complications from influenza, and vaccination rests on less than entirely solid scientific foundations.

The argument against "flu vaccine for everyone" is essentially this: much of the measured benefit is actually due to healthy user bias—the idea that the healthiest people are the same ones most likely to get vaccinated. So what is the evidence that vaccination may not be all that effective, and that the flu turns out to be a very low-risk concern for much of the populus?

Well, for one thing, the article points out that the CDC actually acknowledges healthy user bias in its own influenza-prevention recommendations document. Furthermore, there is clear data that deaths due to influenza decreased rapidly in the U.S. starting in the mid-20th century, well before the now-ubiquitous promotion of flu vaccination.

Are we being told, or are we being sold?

The very existence of aggressive promotion of influenza vaccines concerns the essay's author, Peter Doshi. This on the face of it is not nearly enough to draw negative conclusions, but his thoughtful analysis of the bigger picture is compelling. He points out that just 20 years ago, 32 million doses of influenza vaccine were available in the United States. Today, there are around 135 million doses of influenza vaccine annually entering the market, with vaccinations administered in drug stores, supermarkets, and even drive-throughs.

The article states, “As concern surged this January over a worse than usual influenza season, members of the media seemed unsure whether the CDC’s announcement that 'vaccine effectiveness (VE) was 62%' represented good versus disappointing news.” Quoting the CDC, Doshi writes, “'If you have a 62% less chance of getting the flu, it means less chance of being on antibiotics, less chance of ending up in an intensive care unit, and as we’ve seen from this uptick in numbers, 62% less chance of dying.'” (continue)

It Might Not Be The Gluten You're Sensitive To

The popularity of the gluten-free diet has exploded in the last few years. Apart from the small percentage of people with documented celiac disease, there are an increasing number of Americans who say they are gluten sensitive, avoid gluten, and feel a lot better gastrointestinally as a result. It's hard to argue with such vehement testimonials, and in 2011 Australian researchers conducted a controlled-diet study that boosted the case further for non-celiac gluten sensitivity. Recent research by this same team, however, points to FODMAPs as the actual source of these patients' pain. So what's going on here?

“FODMAP” is a rather clunky acronym for a certain kind of fermentable, short-chain carbohydrate: specifically, the word stands for fermentable, oligo-, di-, monosaccharides, and polyols. That is a mouthful, but the take-home message is that FODMAPs are poorly absorbed. Among these short-chain carbohydrates are such common dietary components as fructose, lactose, fructans (found in wheat), galactans, and polyol sweeteners. Patients with non-celiac gluten sensitivity do not have celiac disease but their symptoms improve when they are placed on gluten-free diets. The present study investigated the specific effects of gluten after dietary reduction of these fermentable, poorly absorbed, short-chain carbohydrates.

The double-blind cross-over trial of 37 subjects with gluten sensitivity and irritable bowel syndrome (aged 24 to 61) randomly assigned groups to a high-, low- or control dietary gluten category after giving them all a two-week diet of reduced FODMAPs. The high-gluten group received 16 grams per day, the low-gluten group just 2 grams daily, and the control groups received either 14 or 16 grams of whey protein daily.

These diets were followed for one week, after which a two-week “wash-out period” occurred. Immune-system activation and intestinal inflammation were then assessed, along with instances of fatigue. Twenty-two participants next crossed over to groups given gluten (16 g/day), whey (16 g/day), or control (no additional protein) diets for three days. Their symptoms were evaluated by visual analogue scales.

The researchers report: “In all participants, gastrointestinal symptoms consistently and significantly improved during reduced [FODMAP] intake, but significantly worsened to a similar degree when their diets included gluten or whey protein. Gluten-specific effects were observed in only 8% of participants.” In short, the study found no evidence of specific effects of gluten in patients with self-reported non-celiac gluten sensitivity who were placed on diets low in FODMAPs.

During the low-FODMAP dietary period, mean symptom scores improved significantly. However, symptoms worsened during each of the three double-blind treatments—with no differences between the high-gluten, low-gluten, and no-gluten periods. In the presence of a low-FODMAP diet, symptoms worsened just as much with the gluten-free diet as with the gluten-containing diets. Because many gluten-containing foods are also high in FODMAPs, the authors speculate that improved symptoms with a gluten-free diet actually might reflect simultaneous reduction in FODMAP intake. It's clear that our understanding of non-celiac gluten sensitivity remains incomplete.

Gastroenterology, 2013, Vol. 145, No. 2, pp. 320-328, http://www.ncbi.nlm.nih.gov/pubmed/23648697?access_num=23648697&link


editorial board

Kenneth Cooper, MD
Kevin Beck
Jack Daniels, PhD
Randy Eichner, MD
Mary Jo Feeney, MS, RD
Mitchell Goldflies, MD
Paul Kiell, MD
Sarah Harding Laidlaw, MS, RD
Paul Langer, DPM
Douglas Lentz, CSCS
Todd Miller, MD
Gabe Mirkin, MD
Col Francis O’Connor, MD
Stephen Perle, DC, CCSP
Pete Pfitzinger, MS
Charles L. Schulman, MD
Bruce Wilk, PT, OCS
Mel Williams, PhD
Michael Yessis, PhD
Jeff Venables, Editor

board of directors

Jeff Harbison, President
Bill Young, Secretary-Treasurer
Immediate Past-President
(Vacant) Vice President
Robert Corliss
Charles L. Schulman, MD, AMAA Pres.
AMAA President
Terry Adirim, MD, MPH
Gayle Barron
Sue Golden
Senator Bill Frist, MD
Jeff Galloway
Jeff Harbison
Ronald M. Lawrence, MD, PhD
Jeff Moore
Noel D. Nequin, MD
David Pattillo

Association Staff

Executive Director: Dave Watt
Project Consultant: Barbara Baldwin, MPH

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