Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (9 page)

DRINK UP

Let’s talk about hydration. Remember that time-honored advice to drink eight glasses of water a day? It’s the scientific equivalent of an urban myth—you won’t ever find a study that came up with that figure. But the general idea is correct— proper hydration is absolutely essential for every body process you can think of, including muscle function and the lubrication of joints. But it doesn’t have to be water; with the exception of alcohol, any kind of fluid will do. The popular line that coffee, tea, and caffeinated soft drinks don’t count because caffeine is a diuretic—
that is, it promotes urination—is overblown. They count. The real problem with many of these drinks is the calories. Every week, people routinely consume gallons of soft drinks, fruit drinks, coffee drinks, flavored teas, smoothies, and enhanced waters, all of which do little to cut appetite and a lot to worsen the problem of an overweight America. And diet beverages may be no better, introducing possibly harmful chemicals to the body.

The National Academy of Sciences has come up with some fluid-intake benchmarks: most men should try to drink about 101 ounces a day, most women, about 74 ounces (based on each gender’s average weight). But in the real world, how much you drink should depend on your size, your activity level, how much you sweat, and the climate you live in. A more useful guide is to take in fluids at regular intervals, before and after exercise, and whenever you feel the slightest bit thirsty. (You might want to taper off your consumption in the evening so you don’t have to keep waking up to go to the bathroom.) If your urine is light-colored and plentiful, mission accomplished. If it’s darkish in color, drink up.

EATING FOR YOUR MUSCULOSKELETAL SYSTEM

Skolnik advises both the Giants and her female clients at the Hospital for Special Surgery on eating habits to preserve musculoskeletal health for the long haul. For women entering the menopausal years and beyond, getting enough calcium to protect bone density and reduce the risk of osteoporosis is a special concern. (The government recommends 1,000 milligrams for adults ages nineteen to fifty, 1,200 milligrams for adults fifty-one or older, and 1,200–1,500 milligrams for postmenopausal women.) A diet with plenty of (mostly low-fat) dairy products should do the trick (see the box on page 46). If not, a calcium citrate supplement can make up the difference. Besides calcium’s bone-strengthening properties, evidence suggests that it helps to regulate blood pressure, and intriguing, preliminary evidence suggests that it may stimulate the body to burn fat more efficiently. No matter how good you think your diet may be, if you’re a woman over forty, you should get a bone-density test and a full blood and urine test workup to see if you’re at risk for osteoporosis. Senior men can also be at risk.

It isn’t enough just to consume calcium. The body has to properly absorb it, and here vitamin D plays a crucial role. During the warm-weather months, your

PUTTING CALCIUM IN YOUR DIET

(Chart figures mostly from USDA National Nutrient Database for Standard References, Release 21)

body manufactures vitamin D when your skin is exposed to sunlight. During the colder months (or all year if you don’t go outside much or wear strong sunblock religiously when you do), your stores of vitamin D drop. Foods such as organ meats and cold-water fish such as sardines and herring have some vitamin D, but you’d have to eat like a Siberian fisherman to reach the government’s recommended daily intake of 400 international units. The usual route is fortified foods (milk is usually fortified with 125 IU) and supplements (a good multivitamin should have 400 IU, but make sure it’s the more potent vitamin D3 form). Because a hip fracture can be a life-threatening trauma for the elderly, especially elderly women, Skolnik recommends for them a daily intake of at least 800 IU and, depending on the individual, as high as 2,000 IU. Have your vitamin D levels checked and consult with your doctor. (Vitamin D deficiency can result in muscle pain, and recent studies have linked low vitamin D intake with an increased risk of cancer, among other diseases.
That should get your attention considering 41 percent of men and 53 percent of women in the United States are vitamin D deficient.)

Supplementing with omega-3 fatty acids to reduce inflammation and protect muscles and connective tissues is also a sensible choice. (Skolnik suggests a twoto-four-gram daily intake, taking the pill with food and splitting up the dosage over the day.)

There are other joint-friendly supplements out there with some supporting science on their side (if not the research pedigree of omega-3) that may be worth looking into. SAM-e (S-Adenosyl-methionine) is derived from the amino acid methionine; Zyflamend combines two spices with confirmed anti-inflammatory effects, ginger and turmeric. Enthusiasm, and positive study results, has waned for another combo supplement, glucosamine and chondroitin. In a 2006
New England Journal of Medicine
study, the supplement did not reduce pain overall, but did benefit one subgroup of patients with moderate to severe pain. In a smaller 2008 study published in
Arthritis and Rheumatism
, the supplement scored no better than a sugar pill placebo. (Check with your physician before beginning any supplementation program.)

FITNESS

In
the previous two chapters, we’ve discussed how to relax the body and how to fuel it. Now we’re ready to take it out for a spin. If you’re not exercising, we’ll provide some safe, smart ways to get moving. If you’re already a recreational athlete (a regular jogger or tennis player, for instance), we’ll discuss how to modify your routine so you can perform at a satisfying level and minimize the chance of injury.

WHY EXERCISE?

Beginner or veteran athlete, you reap a host of physical benefits when you exercise. When you push your body against the “resistance” of gravity and the ground (walking, jogging, playing tennis, etc.) or your own weight (push-ups, pull-ups, etc.) or a piece of exercise equipment (rubber cables, elastic bands, dumbbells, free weights, weight machines), you stress your entire musculoskeletal system. Provided you don’t overdo it and overwhelm the system, this is healthy stress. The blood pumps more vigorously, oxygenating your tissues; the synovial fluid that lubricates
the joints gets a boost. Muscles, bones, and connective tissues adapt and become stronger and better able to handle the challenges of everyday life. Later in life, there’s less chance of osteoporosis and bone breaks, less chance of taking a fall because your muscle strength or your balance fails you, and a greater chance of being able to right yourself if you do fall.

Body weight is an issue. Many people, especially in their middle years, have trouble maintaining a healthy weight through diet alone. Aerobic or endurance work is an excellent way to burn calories. And the muscle tissue you build doing strength work burns more calories than fat does, even at rest. (Only 4 more calories per pound per day, but it also increases the body’s fat-burning potential.)

Exercisers carry many benefits with them into their middle and senior years. They are better able to avoid the extra pounds that are a risk factor for diabetes and heart disease. The aerobic exercise they do tones and strengthens the entire system: the heart beats more efficiently and the levels of HDL, the “good” cholesterol, go up, both of which protect against heart attack; and the cells stay more receptive to insulin, so the body is more resistant to diabetes. Some evidence even suggests that exercise can help ward off certain types of cancers.

THE EXCUSES

So why do half the people in America fail to meet the government recommendation of thirty minutes of moderate activity most days of the week. Let’s put it another way: if you’re in this camp, what’s wrong with you? We don’t have to read the latest government study to answer that one; we talk to our patients every day. In our experience, they fall into two groups. The first is the “it’s hopeless” group: “Doctor, it’s hopeless; my knee hurts so I can’t run”; “My shoulder hurts so I can’t swim”; “I’ve got an artificial knee so I can’t exercise, and now I’ve gained weight so there’s another reason I can’t exercise.” Our answer is, all people can do something if they’re willing to push a bit beyond their comfort zone.

The key is starting small and building up as you can handle it. Consistency, getting into a groove and staying there, is more important than any single heroic performance that you’ll have a tough time repeating. If you can’t jog, swim. If you can’t swim, ride a bicycle or a stationary exercise bike. If you can’t do that, try one of those gym hand-bikes (arm ergometers), where you get the aerobic benefit
by working your upper body, rotating the pedals with your hands. (American distance-running great Joan Benoit Samuelson had knee surgery two weeks before the 1984 Olympic marathon trials but was able to maintain her aerobic fitness on the hand-bike. She went on to win the women’s marathon at both the trials and the Olympics.)

Dr. DeStefano

If anyone has a good reason not to get out and go for a run or go cycling, it’s my friend Paul Martin. He lost his left leg below the knee in a car accident in ’92. Since then he’s become a world-class handicapped athlete with a closet full of medals in international triathlons, and he competes even-up in open competitions. So don’t tell me you can’t get any exercise because your knee hurts. Find a way.

Our other nonexercisers tend to fall into the school of “the road to hell is paved with good intentions.” They’re the optimists who have every intention of rescheduling their lives around the exercise they never had time for before. “I’m going to join a gym near the office and work out every lunch hour” is a typical bold plan. Unfortunately, most people don’t make the jump from sedentary to gym rat in one giant step, and most people’s jobs are good at generating reasons for staying glued to the office chair. So start slow and, whenever possible, modify your routine, don’t try to change it overnight. For example, you might set aside a half hour as soon as you get home from work to go on a brisk walk. It’s likely you’ll feel like going to bed earlier, you’ll sleep more soundly, and life will seem better in the morning. This is a modified routine you can build on. (Check out the box on page 51 for more routine “tweaks.”)