How Scary is Acrylamide?

Beyond the disconcerting fact of its presence simultaneously in certain foods and in non-food manufacturing applications, there are several reasons that have so far led groups like the American Cancer Society to recommend limiting your dietary intake of acrylamide.
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New Guidelines for Assessing CV Risk Stir Controversy

The guidelines encompass four major areas aimed at reducing risk: obesity, overall risk assessment, lifestyle factors, and lipids. Health care analysts generally consider the biggest changes to be in lipids risk assessment.
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Meet Your New Knee Ligament

Scientists revealed in October in the Journal of Anatomy the discovery of what can reasonably be termed, if only for slight dramatic effect, a new body part.
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Revisiting Lactic Acid Confusion

Several years back, mounting evidence on the body’s various energy systems began to tell a slightly different story from the classic one about the dangers of lactate build-up in the blood during workouts.
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Talking Biomechanics with Benno Nigg, PhD

Clinic advisor Ben Pearl, DPM, recently spoke with Beno Nigg, PhD to hash out the finer points of shoe science, podiatry, and evidence-based conclusion drawing.
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The Twelve Days of Fitness

Chances are we know someone close to us that could use a little kick start down the road to fitness in the new year. Being well acquainted with the sheer joy that can be had through regular exercise, why not give what we know best?
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The Clinic

Stubbornly Hardened Heels
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Don't Ignore Clotting Problems
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Skip the Juice: Drink Water and Eat Fruit
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Diabetes and Surgery
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The Back Page

X-Country Coaching: Final Chapter, the Post-Season

Footlocker Cross Country Nationals in San Diego

XC BORDER WAR 8: The 2013 Battle of the Potomac XC Championships 
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More Bad News for Testosterone Therapy

As reported in the September/October issue, patients of any age may benefit from testosterone replacement if their levels are severely low because of endocrine tumors, hormonal deficiencies, or exposure to disruptive levels of chemotherapy. Prescription gels that are absorbed by the skin, then, were once a treatment limited to a small group of patients suffering from specific medical conditions. But like estrogen in women, testosterone normally declines as men age. The recent widespread use of the gels as lifestyle products carries risks, including for coronary artery disease and an enlarged prostate. And some clinicians have observed abnormally high testosterone levels in patients using the roll-on products.

Now, we have another reason to fear “Low T” therapy. According to a retrospective study in JAMA, testosterone supplementation by older male angiography patients significantly increases the risk of cardiovascular events. The study was undertaken in part to address concerns raised by a recent randomized clinical trial of testosterone therapy in men with a high prevalence of cardiovascular diseases, after it was stopped prematurely due to adverse cardiovascular events.  

In the new national cohort study, researchers examined outcomes among 8,709 veterans who had undergone coronary angiography between 2005 and 2011, and who also had total testosterone levels below 300 nanograms per deciliter. Fourteen percent of these men began testosterone therapy at a median of one and a half years after angiography. The most common methods for testosterone supplementation were by patch or injection.

The study established primary outcome as the following various cardiovascular events taken as a group: all-cause mortality, heart attack (MI), and ischemic stroke. Of the 1,710 outcome events, 748 men died, 443 had MIs, and 519 had strokes. Of 7,486 patients not receiving testosterone therapy, 681 died, 420 had MIs, and 486 had strokes. Among 1,223 patients receiving testosterone therapy, 67 died, 23 had MIs, and 33 had strokes. 

After three years, the primary outcome had occurred in 26 percent of the testosterone group and 20 percent of the untreated group. But after making adjustments for coronary artery disease and other confounding factors, the researchers found that the relative risk for the primary outcome was 30 percent higher with testosterone therapy.

The results of the JAMA study elucidate the limitations, and even potential harm, of only chasing so-called “surrogate outcomes” like low testosterone—in clinical trials, these are essentially biomarkers, or measures of effects of a certain treatment that may correlate with a real clinical endpoint (primary outcome). In this case, the primary outcome of suffering a cardiovascular event is a potent argument for always administering testosterone therapy with great caution.

JAMA, 2013, Vol. 310, No. 17, pp. 1829-1836,


FDA Says Trans Fats' Time is Up

In November, the FDA announced that it will require the food industry to gradually phase out all trans fats. The agency estimates that the elimination of trans fats from the American diet could prevent up to 20,000 heart attacks and 7,000 deaths annually.

Though there is presently no timeline for the phase-out, the two-month public comment period, during which food manufacturers can weigh in on the time needed to reformulate products, is nearly up. This open comment period also technically affords those opposed to the ban the chance to provide data that show a ban is not necessary and that trans fats are not a public health concern, something that public health officials think is highly unlikely to occur.

Trans fat is widely considered the worst kind of fat for heart health, surpassing even saturated fat in this regard. Trans fats are currently still used both in processed food and in restaurant dishes, many times for better texture, longer shelf life, or enhanced flavor. They are created when hydrogen is added to vegetable oil to make it more solid, giving us the well-known and now disdained phrase “partially hydrogenated.” The FDA ruling, which is technically preliminary as of now, came after the official realization that trans fats no longer credibly fall in the agency's "generally recognized as safe" category, which is reserved for thousands of additives that manufacturers are allowed to put in food without FDA review.

Research has shown repeatedly for more than a decade that trans fats are dangerous because they raise LDL levels and can lower levels of HDL, the “good cholesterol.” In 2003, the FDA began requiring that artificial trans fats are listed on food labels, a shift that prompted many large food producers to eliminate them. The bad press that trans fats have relentlessly received since then is considered a leading reason why most food manufacturers don't seem to be putting up a fight against the FDA's proposed ban.

Many cities nationwide have banned the fats in restaurants already, among them New York, Cleveland, and Philadelphia. McDonald’s found substitutes and sharply reduced the use of trans fats, to a point where the global chain is not required to list them on its menus. Along with increased public awareness of the danger of these fats, intake in the U.S. of the fats declined from 4.6 grams daily as recently as 2003 to just about one gram per day in 2012, according to the FDA. That is a significant decline, though popular processed foods like frozen pizza and pies, microwave popcorn, some margarines, and even coffee creamers continue to rely on them. Baked goods like cookies, doughnuts, and cakes have long been another major source of trans fats, but food producers in cities that already have a ban in effect have shown that given enough time, substitutes can be found for trans fats that don't increase cost or compromise taste.

FDA, Nov. 7, 2013, "FDA takes step to further reduce trans fats in processed foods,”

The New York Times, November 7, 2013, “F.D.A. Ruling Would All but Eliminate Trans Fats,” by Sabrina Tavernise,


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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