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Runner’s Diarrhea: A Summertime Favorite?

A blogger friend of mine referred me to an article about a female runner struggling with gastrointestinal distress. She asked for advice regarding how to prevent the “runner’s trots” and felt fairly mystified regarding its cause. Since up to half of runners face this problem at some point (especially women), I thought I’d post some advice that comes from experience… ahem.

The urge to use the restroom during exercise is caused by increased intestinal motility, likely triggered by any (or all) of the following:  jostling of internal organs, relative intestinal ischemia (decreased oxygen getting to the intestines as blood is diverted to the muscles for work and to the skin to cool the body), dehydration, and adrenaline-related anxiety/stress hormones. I’ve noticed that hot weather greatly increases the likelihood of runner’s diarrhea as it contributes to additional blood diversion as well as dehydration through excessive sweating. Basically, don’t be surprised if you need to plan your summer runs around bathroom stops.

That being said, there are a few things that can decrease the urgency and frequency of this unpleasant intestinal drama:

1. Watch what you eat before your run – avoid fiber, caffeine, fake sugar, or anything that generally makes YOU have to move your bowels more frequently (milk and/or soy products are a culprit for some). Ideally, these things should be avoided up to 12-24 hours before you run.

2. Stay hydrated. Get ahead of the game by drinking a liter of water before your run and continue to hydrate during exercise (as appropriate for the climate and your effort level.)

3. Run at a slower pace if the weather is hot. I often find that dropping the pace by a minute or two per mile can magically reduce the intestinal symptoms.  Interval training can help you challenge your speed limits while offering active recovery periods for your body to cool down and let your gut chill out.

4. Run in the morning when it’s cooler and you’ve had less to eat. Running after a day full of eating is looking for trouble.

5. Try to evacuate your bowels before your run – this is fairly obvious, but take the time you need to get this taken care of.

If the weather is hotter than 85 degrees, I’d consider running on a treadmill in an air conditioned space.

I found this comprehensive list of strategies to avoid the trots quite helpful. Please check it out – and good luck on your summer runs and races. Perhaps we’ll cross paths at a rest stop near you!

Debunking Nutrition Myths With The Boys & Girls Clubs Of America

This year’s Fit Family Challenge competitors are smart, savvy, and full of great nutrition-related questions! I just finished a one hour conference call with 10 family finalists from across the U.S. and Hawaii. As part of their challenge to adopt healthy diet and exercise practices, they were asked to send me their most burning nutrition questions. One mom told me that her goal was “to teach her girls how to think critically” about health information. I was so pleased to see those values being promoted that I thought I’d share some of our mythbusting FAQs here on the blog:

1. I live in a community that doesn’t add fluoride to the public water supply. Do my kids need to take fluoride supplements?

Fluoridation of our water supply is considered to be one of the top 10 most effective public health initiatives of the 20th century. Enhancing the natural fluoride content of water results in up to a 60% reduction in tooth decay for kids! The cost to a community of adding fluoride to the water supply is about 50 cents per person per year, so it’s really quite affordable. I’m not sure why your community water hasn’t been fluoridated, but it’s estimated that about 1/3 of Americans still live in communities that haven’t supplemented their water with fluoride (so you’re not alone).

Our teeth use fluoride to strengthen our enamel – and we can get fluoride to our teeth in two ways: 1) from our blood stream (e.g from the water we drink, digest, and absorb) and 2) topically (e.g. from toothpaste). Studies have shown that it’s best to get fluoride via both routes for optimal enamel strength. For children living in areas where the water is not fluoridated, the American Dental Association (ADA) recommends fluoride vitamins until at least age 16. There are two strengths of fluoride vitamins, and the dosage required depends on the fluoride levels in the local water supply (you can ask your local Water Department for that information if you haven’t already). Keep in mind that most children’s permanent teeth (with the exception of “wisdom teeth”) erupt by age 13 – and before that age there is no way to get fluoride to them except via the blood stream. So digesting fluoride (via water or vitamins) is critical to strengthen those teeth that haven’t broken through the gums yet.

For more information about fluoride, see this helpful ADA guide.

2. Should parents be concerned about hormone levels in milk? Is there an advantage to buying organic milk?

All mammals release trace amounts of hormones into their milk. Cow’s milk naturally contains a small amount of bovine somatotropin (bST) which is a protein that is quickly broken down by our stomachs when we drink milk. Some farmers give their cows additional amounts of the hormone to stimulate milk production. This rbST (or BGH) is virtually identical to naturally occurring cow hormones and the decades of research we’ve collected has been reviewed by the FDA (Food and Drug Association), WHO (World Health Organization), NIH (National Institutes of Health), AMA (American Medical Association), and ADA (American Dietetic Organization) – and all agree that rbST is safe for human consumption in the levels it occurs in cow’s milk. Interestingly, studies have shown that milk hormone levels in organic milk is essentially identical to levels in regular milk. There is therefore no advantage in buying organic milk insofar as hormones are concerned.

I believe that cow’s milk is safe and nutritious for kids (so long as they have no milk allergies or lactose intolerances). The milk/hormone scare is kind of an urban legend, so I wouldn’t be too worried about it. Your girls haven’t suffered any harm from drinking regular milk – and it’s great that you all enjoy the skim variety, by the way. Lower calorie options can help you maintain your weight over your lifetime.

For more information about milk and hormones please check out this helpful link full of research resources.

3. Are there lifestyle choices that I can make to reduce my risk of getting cancer? Can vitamins help?

You are right that there are lifestyle choices that can substantially reduce your risk (and your childrens’ risk) of getting cancer. However, there is no way to guarantee that you’ll never get cancer, no matter how carefully you control your diet and lifestyle. Nevertheless it’s an excellent idea to do what we can to reduce our risks. Cancer is actually a complicated collection of different diseases, and so specific behavior changes may reduce the risk of certain cancers but not others. For example, a high fiber diet may reduce the risk of colon cancer, but not skin cancer.

Also note that it’s very hard to prove that any one dietary change (such as consuming a larger amount of one particular vitamin or herb) has a direct impact on cancer risk. What works is sometimes more general (such as avoiding becoming obese). Here are some  behavior changes that have been scientifically proven to reduce cancer risks or prevent certain cancers:

1. Smoking cessation
2. Regular use of sunscreen
3. A diet rich in fiber (i.e.lots of fruits and veggies and whole grains)
4. Maintaining a healthy weight
5. Regular exercise
6. HPV vaccines (especially for young girls – can prevent cervical cancer) and hepatitis vaccines (can prevent liver cancer)
7. Drinking very little alcohol (no more than 1 drink/day)

Screening for cancer is also important – because catching a cancer early is often the best way to cure it. The most effective screening tests are:

1. Colonoscopies (for adults over age 50)
2. PAP smears (for sexually active women and women who haven’t had hysterectomies)
3. Physical exams to check for skin cancer, oral cancer, and testicular cancers

Mammograms and prostate blood tests are less effective at catching cancers early, but they are recommended by most medical professional associations.

I recommend reading this page at the National Cancer Institute for more information about avoiding cancer risk factors:

Multivitamins are not recommended for cancer prevention. Although it would seem that vitamins could help reduce the risk of cancer, large studies have shown that they do not reduce the risk of cancer, and may even increase one’s risk (especially vitamin E.) The best source of vitamins is healthy food – and their fiber benefits are excellent as well. For a nice summary of the unhelpfulness of vitamin supplements, please see this ABC News summary of recent research.

Plastic Surgeon Weighs In On Anti-Aging Medicine

Reader Question:

Do you do anti-aging medicine? I do not see it on your web site. If not, what is your opinion of it?

I am not a fan or follower of the anti-aging medicine fad in so much that it promotes what I believe to be a false concept. An older person cannot be made into a younger version of herself by boosting certain hormones. There is really no good evidence that it works. Patients don’t live any longer. It might also be found to be harmful in the long run.

Plastic surgeons will differ in their opinions as to what works with low risk to improve things. To me Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Organic Food: Is It Better For You?

In 1952 Martin Gardner, who just passed away this week at the age of 95, wrote about organic farming in his book Fads and Fallacies in the Name of Science. He characterized it as a food fad without scientific justification. Now, 58 years later, the science has not changed much at all.

A recent review of the literature of the last 50 years shows that there is no evidence for health benefits from eating an organic diet. The only exception to this was evidence for a lower risk of eczema in children eating organic dairy products. But with so many potential correlations to look for, this can just be noise in the data.

Another important conclusion of this systematic review is the paucity of good research into organic food –- they identified only 12 relevant trials. So while there is a lack of evidence for health benefits from eating an organic diet, we do not have enough high-quality studies to say this question has been definitively answered. It is surprising, given the fact that organic food was controversial in the 1950s, that so little good research has been done over the last half-century. Read more »

*This blog post was originally published at Science-Based Medicine*

The Evolution Of The Pill And Its Effect On Sex

What role has the birth control pill played in human sexuality? Dr. Jon LaPook looks at the evolution of sex as the pill turns 50 and discusses the effect of the pill on female sexuality with sex therapist and educator Miriam Baker.

Watch CBS News Videos Online

Does The Pill Lower Sex Drive?

The pill that ushered in the sexual revolution may have also thrown cold water on women’s libido. Fifty years ago, on May 9th, 1960, the FDA announced the approval of oral contraception.

The birth control pill has allowed women to control their reproductive cycle, delay childbearing, and develop careers. But it also may have the potential to disrupt sexuality by blocking normal hormonal surges that occur in a woman’s cycle. Here’s how. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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How To Be A Successful Patient: Young Doctors Offer Some Advice

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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