NSAIDs Are Harmful for Athletes and the Rest of Us

Slowly people are letting go of their love of NSAIDs (ibuprofen, ADVIL, Naproxen, NAPROSYN, etc). They are far from benign painkillers. Many people mistakenly view “inflammation” as an enemy. With that mistaken understanding, they love the idea that Non-Steroidal-Anti-Inflammatory Drugs (NSAIDs) block inflammation. As I’ve been writing and telling patients for years, “inflammation” is also known as the physiological recovery process. Sure, too much of anything, including inflammation is bad, but too little is also not healthy. NSAIDs start damaging your kidneys and raising your risk of a fatal heart attack from the very first pill. NSAIDS have now been shown to block the muscle developing impact of exercise. Another article published in the August 21, 2017 issue of Acta Physiologica (a prominent physiology journal, nearly 130 years old) included: “young individuals using resistance training to maximise muscle growth or strength should avoid excessive intake of anti-inflammatory drugs”. I would add that the impacts are even worse for older individuals. One reason I enjoyed working the medical tent at major US marathons (Boston Marathon, USA Olympic Trials, Houston Marathon, Marin Corps Marathon) was that it was the only place my colleagues shared my concerns about NSAIDs. Those not-so-benign over the counter pills are a major risk factor for serious and even fatal problems for endurance athletes. When I was Medical Director of the Santa Rosa Marathon, I banned NSAIDs from the medical tent. Runners often think they should take ibuprofen or some other NSAID before a race and they would come to the medical tent asking for some. When I refused them,the runners were annoyed, but I explained that I didn’t want to see them later that day for a heart attack or hyponatremia (the most common cause of marathon deaths). The adverse effects of NSAIDs are less immediately evident outside of endurance events, but the impacts are no less severe. Remember that popping NSAIDs is just not good for you. Use them rarely and be aware that there are many better options....

HIIT - The Missing Jewel Of Your Exercise Regimen

Our bodies are designed for movement. There are many different ways to move, each good for us for different reasons. Most people know about cardio workouts, exercise that pumps up your heart rate. Stretching is another and, important as it is, maybe the only kind of exercise that is over rated. Although less popular, most people are still aware of strength training, and some even know that balance training is a good idea. The power that exercise, in whatever form, has to transform our health and our bodies is practically magical. Unfortunately, perhaps the most magical type of exercise is the most often overlooked. The great majority of you are missing out on this form of exercise. You should change that because this kind of exercise turns out to have uniquely beneficial effects and those effects are gained very quickly. Ok, what am I talking about? The answer is High Intensity Interval Training (HIIT). Even those who know something about HIIT nearly always have the wrong impression. The worst mistake is that they assume HIIT is only for strong athletes. That is completely wrong. HIIT has long been a part of serious athletic training. When I was a high school soccer player, we began our two-a-day summer trainings by jogging down the street a mile to the soccer field at an elementary school. In those days soccer was displaced by the football team that got all the fields on campus. Every practice session ended with a dreadful set of interval sprints, the point of which seemed to be as much about proving that the coach was in charge as it was about any fitness boost we might achieve. If you watch the movie, “Miracle On Ice”, the story of the USA gold medal hockey team of 1980, you can experience (thankfully from the comfort of your couch) the “Herbie” intervals that tormented the USA players. This style of HIIT was, not so lovingly, named after their brilliant and determined coach, Herb Brooks. History shows that worked out pretty well. As I am certain many of you with athletic pasts can recall, intervals were NOT fun. That does not need to be the case. Actually, I find HIIT particularly useful for the very individuals one would think would have the biggest reasons not to do it - people with serious joint trouble and other fitness limitations. That probably doesn’t make sense, so I need to explain a bit more. What exactly is HIIT? HIIT stands for High Intensity Interval Training. Some...

Use It Or Lose It

The prevailing, common sense, advice in medicine used to be that if some body part was weak, you should rest it. It made sense, that is unless you thought about it a bit more deeply. People who had suffered heart attacks were told to rest, even sent to bed for the first two weeks. If you hurt your neck in an auto accident, we would slap a soft foam collar around your neck to give it a rest and make you feel better. If you strained a tendon, the advise was (and sometimes still is) just rest and it will get better. The problem is that sitting around is not a long term solution. I mean, how many athletes achieved world domination by sitting on their butt, resting all day? EVERY one of those examples, has lots of brother, sister and cousin diseases/injuries where the same approach, the common sense of “just give it a rest”, has been proven wrong. The concept is entirely mistaken. The latest discovery along these lines has to do with lung disease. Chronic obstructive pulmonary disease (COPD) is a common condition caused by cigarette smoking and diseases such as emphysema and chronic bronchitis. With the passage of time, patients suffering from COPD develop progressively worsening breathing problems. Understandably, these individuals become increasingly inactive. A study published last month, of 6,000 California patients who were hospitalized for COPD in 2011 or 2012 gives us hope about a simple intervention to improve the health of these individuals. Those who got any moderate or vigorous exercise where 30% less likely to end up back in the hospital. If they got more than 150 minutes of moderate or vigorous exercise a week, they were even less likely to be readmitted. The bottom line is that “use it or lose it” is the truth. For the sake of complete disclosure, we can’t forget that this is a balance. There is a time to cut back, A BIT and FOR A LITTLE WHILE or to CHANGE. My damaged joints prevent me from pursuing the kinds of exercise I used to love doing every day. They send me to the gym, to the pool or to some other place where I can get the exercise I MUST do to preserve the physical capabilities I still have. Those capabilities are lessened in some ways, but greater in others. I can’t dream of running marathons any more but I am much more useful at moving heavy furniture. There is wisdom in recognizing your limits....

Lessons About Community from the Boston Marathon

As many of you know, I often volunteer at endurance events, especially marathons. My wife, as well as she knows me, still doesn’t fully understand why I like to do that. That must be because she sees me staggering and bleary-eyed at the end of the races. She asked me about this before I traveled to Boston, which then sent me on the journey thinking a great deal about her question as events transpired. As I reached the answers for her, I also found some insights pertinent to your health.   There are many reasons I like to be involved. Most are centered around learning from these unique experiences, the camaraderie of the event and maintaining at least some peripheral involvement in athletic competition. If I can no longer reach for the same sort of athletic achievements, I can still help others as they reach for their own, or help them recover safely. Endurance athletes can appear to be self-centered narcissists. But from Boston, I realized that, at the most fundamental level, it is all about community. The importance of community for the wellbeing of all of us really shone through.   Any endurance event is a big deal for the participants, because of the work they put into it long before the race. Usually an individual’s performance on the day is the realization of a very long term goal. A teensy percentage of the runners are there with even the slightest chance of winning. The winners are immortalized but every runner is a hero on that day. The event is special personally and communally.   The Boston Marathon is uniquely special. The Boston Marathon is unique because it IS THE BOSTON marathon. Not only is Boston the most prestigious marathon, it is the oldest annual marathon in the world (2014 was the 118th). Any marathon runner, anywhere in the world, dreams of someday running Boston, overcoming Heartbreak Hill and the finish on Boylston Street.   Most marathons draw modest crowds along the 26.2 mile route. The Boston Marathon takes place on a state holiday (Patriot’s Day) and has deep roots in the community. The Red Sox traditionally have a game the morning of the race and, at the end of the game, the baseball fans walk to the marathon route to cheer on the runners. Towns along the way have their own special celebrations, including the “Scream Tunnel” and “Kiss me” signs at Wellesley College. The crowd at Boston is huge, typically over 500,000. This year, a very...