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.

Cruise Health

As I wrote about last time, I attended the ACP Internal Medicine 2012 meeting in New Orleans. Afterwards my wife and I took a cruise on the Carnival Conquest ship that left from New Orleans and stopped at the ports of Cozumel, Jamaica and Grand Caymen.

On the first day of the cruise there is a mandatory safety briefing on deck where they discuss such things as how to board the lifeboats in the event of an emergency. The announcer appropriately discussed the importance of washing hands, but incorrectly said, “the hotter the better.” When it comes to washing your hands, cold water works as well as hot water, except that if it’s cold, people won’t wash their hands as long because it’s uncomfortable. The same is true if the water is too hot. Thus warm water is recommended.

We took an excursion to see the Mayan ruins of Tulum near Cozumel, Mexico. Before leaving the ship we were warned not drink the local water. Near the ruins in a tourist shopping center I was tempted to eat at a Häagen-Dazs ice cream stand. I figured the ice cream was safe, but I worried about the water used to clean the scoops. It was probably safe, but I didn’t want to take a chance.

Obesity is a common problem in the United States and elsewhere, and is particularly a problem in the South. This was reflected in the passengers having embarked in New Orleans. Although people understandably eat excessively on a cruise, to which I’ll take the 5th Amendment, there are opportunities to do some healthy things on a cruise. I took advantage of their gym and exercised every day, though few did. Most of the time half the people exercising were crew members.

While looking for something else, I happened to walk by an ongoing talk on Secrets To A Flatter Stomach. I sat down and listened. The speaker was a personal trainer, certified by the Australian Institute of Fitness. He was buff, which automatically makes one feel he knows what he’s talking about. In fact his advice on exercise and nutrition was sound, and he did a great job explaining things. He then talked about detox and the need to get rid of toxic water trapped around fat. They invited people to sign up for a 1 hour personal analysis and consultation at a 2 for 1 special of $35. I spoke with the speaker’s colleague, a man from Scotland, and also buff. I asked if they would be repeating the lecture as I thought my wife would enjoy hearing it. He said he would cover the same material at the consultation, and more, and do an analysis with equipment not available in the United States (this model is available in the US and seems close to the 310e V8.0 they used). I was skeptical about the detox, but the cost was pretty low so I signed up.

At our meeting he first had us fill out questionnaires about our health, including what medications we were taking and why. I purposely didn’t answer the question about occupation, but admitted I was a physician when he later asked. He then went on to tell me he had a BSC degree in Sports Science from the University of West of Scotland, which he said was about equivalent to a physician in the United States. It’s not. He ran a bio-electrical impedance test attaching an electrode to the ankle and wrist. Running a very low voltage and current, that you cannot feel, through the body, it calculates body fat, lean body weight, body water and metabolic rate. The calculations require the body weight, which he asked about, but did not measure (towards the end of a cruise the actual weight is likely to be significantly higher than the stated weight!). Although the equipment he used may not be available in the US, it’s similar to the Tanita bathroom scale I have at home. My device calculates body fat, though you have to do your own calculations to derive the other numbers, and the results he obtained were very similar to my results at home.

He said I needed to lose 6.1 lbs of fat, and admitted I was among the healthiest he had tested on the cruise, but that I also had  12.5 lbs of toxic water to remove. According to his handout, that put me in the level of, “High levels of accumulative toxic waste circulating the cells of the body. Damage to Liver and Kidneys apparent. Weight gain is inevitable. Degeneration of joints and muscle tissue. High Blood Pressure / High cholesterol.” He recommended a 3 month detox program for $300. Most people, “needed” a 6 month program, which consisted of two 3 month cycles, and some needed a year’s worth. They would then do a 3 month cycle every few years or so depending, less often if following a healthy diet. My credit card would be charged that day, and the product shipped the next, so we could get started on it as soon as we returned home. The products are supposed to cleans the digestive tract, kidneys and liver. They contain various herbal products, algae, plantain seeds for fiber, and a low dose thyroid product of some sort, and one is also supposed to eat alkaline forming foods. I was naturally skeptical. He claimed that his analysis showed that I needed detoxification because I had problems with my cholesterol. He said that with his device he didn’t need to do blood tests. How did he know about my cholesterol problem? Because I told him! Actually it’s not that much of a problem, but I try to be proactive.

He said that evening there would be a nutrition class, but only for those who signed up. He encouraged me to sign up for the detox, but said he wasn’t worried because they get 60 people per week to sign up. While we were talking he was interrupted by someone asking if a person could be signed up for a consultation, even though his schedule was full.  He said he would let us think about it while he took care of something. The class was later held in the gym in a glass walled off section. I counted 19 attendees. To show the legitimacy of the program, he said his company contracts with Carnival and other cruise lines to offer the program, and has been in business for years. I asked for clinical study references to support detoxification. He said he could give it to me, but not until after I signed up. I declined.

If you take a cruise, try to get in some exercise, if nothing more than some extra walking. I advise you to save your money and not spend it on a detox program, and don’t forget your sunscreen.

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.

Rush to Judgement

Conservative radio show host Rush Limbaugh recently launched an attack on Georgetown University law student Sandra Fluke. She had testified to house Democrats in support of mandates to provide contraceptive care in insurance plans. On his show two days later, Rush Limbaugh said that Ms. Fluke  was asking for taxpayers to pay her to have sex, and that made her a, “prostitute”.

Others have chimed in that contraception is a lifestyle choice and society shouldn’t have to pay for it.  Whether or not you believe women have the right to get an abortion, it’s a flawed argument. By the same reasoning, insurance shouldn’t cover heart attacks, strokes or cancer if the person smoked or was obese. It’s one thing to incentive healthy behavior, but Rush Limbaugh’s attack is either not well thought out in regards to its health care implications, it’s misogynistic, or it’s politically motivated.

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