Category: Ask the Doc

This is where I address questions submitted by my readers.

Ask the Doc: Human Growth Hormone

On this site I’m unable to answer patient specific questions, but as time permits, may answer questions of a general interest.

Question:

I have been working out with a personal trainer with weight training and have been doing running on my own. I have been getting much stronger although I haven’t lost much weight. I asked the trainer why it takes longer to recover from a strenuous session at age 66 than it did when I was younger. She said that as we get older we have very little HGH in our system and that a small dose of HGH would help me recover quicker and she could push me harder. Would a small dose of HGH be beneficial for training? I know that testosterone creams etc. have a lot of side effects which are not good but how about HGH?

Answer:

Human Growth Hormone, or HGH, is a hormone that regulates growth, and decreases with age, as well as from obesity. It is one of many factors why, all other things equal,  66-year-olds aren’t as strong or fast, or recover as quickly, as when they were younger. With age lung function gradually declines, the cardiovascular system is less robust, testosterone levels fall in men, etc. In one of his movies, Warren Miller said something like, “If a 40-year-old says they sky as well as when they were 20, they are either lying, or they weren’t very good when they were 20!”

Human Growth Hormone is only approved by the FDA in limited circumstances, not including the normal decline with aging, and it’s expensive. It probably does build muscle, and for this reason is banned by the Olympics and some other sports institutions. It also has potential side effects.

Getting adequate sleep, regular exercise, eating healthy, and managing stress, are the most important things you can do to boost your growth hormone and improve your endurance.

Ask the Doc: Statins and Exercise

On this site I’m unable to answer patient specific questions, but as time permits, may answer questions of a general interest.

Question:

Let me know what you think of this article. Strenuous exercise has not seemed to bother me taking Lipitor 20 mg for several years. However, I am wondering about the effects on my muscles as I am currently ramping up exercise both running and weight lifting. Will enough exercise improve my cholesterol level enough to quit taking Lipitor? Long term effects of Lipitor? I don’t know.
http://well.blogs.nytimes.com/2012/03/14/do-statins-make-it-tough-to-exercise/

Answer:

As the article points out, about 10% of people may experience muscle aches from taking statin medications such as Lipitor. It referenced an article that showed that rats were not able to exercise as long if taking atorvastatin (Lipitor), and they showed increased oxidative stress and problems with mitochondria, cell’s powerhouses.

You should always be careful when evaluating animal studies, as they may not apply to humans. Given other data, however, it would not be surprising if there was a similar problem in people who exercise and take statins.

The questions is what to do. As with most medications, one needs to balance the risks versus the benefits. Statins clearly save lives, but the degree of benefit depends on one’s risk. The more cardiovascular risk factors one has (hypertension, diabetes, hyperlipidemia (high cholesterol), smoking, family history, etc.), the more one has to gain from medication, and the more likely I would recommend patients tolerate side effects if we couldn’t come up with a better option. For someone at relatively low risk, a statin may not be worth taking if causing side effects.

I certainly always advocate diet and exercise to manage problems with cholesterol and triglycerides (fats). The problem is that for most people, it’s easier said than done, and people either just don’t make sufficient changes, or they don’t maintain them. Also for some people, their genetics are just too strong. With the wrong genes you may have a high cholesterol despite being thin, eating vegetarian, and exercising regularly.

Another option is to take coenzyme Q10 (CoQ10) or ubiquinone if you are taking a statin. It’s known that statins decrease this enzyme in the mitochondria and it may be the reason statins cause muscle pain and weakness. It is not proven to work, though the supplements appear to be safe. A study in Japan showed that pitavastatin (Livalo) did not decrease coenzyme Q10 nearly as much as atorvastatin (Lipitor). Whether it causes less muscle problems is unknown at this time.

For patients that I feel need medications to lower their cholesterol, yet are unable to tolerate a statin, or refuse to take one, I offer other alternatives, such as niacin (Niaspan, Endur-Acin, Slo-Niacin), colesevelam (WelChol) or ezetimibe (Zetia). There are pros and cons for each option. Sometimes people tolerate one statin, and not another, or may do better with a combination of a low dose statin and another agent.

So there’s no easy answer to your question. Different patients have different solutions.