My Feet Are Changing!

During the past couple of weeks my right knee has been giving me trouble.  I go at my usual breakneck speed on the cross trainer – no problem there – but when I’m lying in bed at night there’s a disagreeable ache in the back, the fleshy part, of my knee and another one along the front of my shin, not conducive to falling asleep.  I know from past experience that my knee is probably fine.  This is a job for Dr. Hoffman. 

In an earlier post, “Respect the Feet,” (10/1/2011), I have written about my adventures as a podiatry patient.  I have custom-made orthotics, built up on the right side to compensate for my slightly shorter right leg. The orthotics get adjusted several times a year and my feet are fine.  Usually the adjustments are minor and I can identify the offending spots myself.  Sometimes I tape little pieces of cardboard to the orthotics to check out my theories.  This time I had no clue.  I brought the orthotic in to Dr. Hoffman and described what was happening.  He disappeared into his workroom for a minute or two and emerged with the orthotic considerably filed down, not just a tweak but a major change, and a change in the direction of greater stability.  Something between my hip and my foot has improved and I’d love to know what and why.

Two possibilities occur to me.  One is that I’ve been working on leg strength for six weeks or so, doing the Legs and Back workout in P90X about once a week.  This workout has plenty in it for feet as well as legs and I think it has also helped my balance.  The second possibility is more intriguing:  maybe the change has something to do with diet.  About a month ago I read about new research at the University of Texas Medical in Galveston about maintaining muscle mass as you age.  The resulting recommendations were that you eat at least 20 but no more than 30 grams of protein at each of three meals a day (“Get Older, Stay Strong,” 3/18/2012).  At that point I changed my breakfast routine.  I still have oatmeal and toast but I have added cottage cheese (14 grams of protein per ½ cup).  Some days I have eggs (6 grams each).  The oatmeal and toast have protein too but only about 5 grams each.  Perhaps this new regimen is helping my muscles, including those in my right leg.

Sadie Pearl

Sadie Pearl as a Kitten

“Sadie Pearl, born to run,” was what I used to say about our older cat when she was a kitten.  Tiny enough to sit on my folded arms, she was a mischievous, rambunctious creature who, because of her poor daytime vision, sometimes crashed into furniture as she careened around the house.  She would mock-attack Presto, then a venerable 9 years old, like a tiger going after a buffalo, front legs encircling his neck.  She adored Presto and would creep up to sleep beside him after he had dozed off.

Presto is gone now and Sadie is 14.  When she got to be 10 or 11 we started giving her the same proteolytic enzymes we had given him to help her maintain muscle mass.  Lately I’ve thought that her condition was deteriorating.  She was having more trouble jumping up on the bed and her coat was looking dull and starting to separate instead of lying down smoothly.  The vet prescribed a vitamin tonic, an omega-3 fatty acid supplement, and an NSAID (non-steroidal anti-inflammatory drug) for her arthritis.  After several weeks she seems more comfortable and her coat is shiny again.  If vets are giving enzymes, vitamins, and omega-3 fatty acid to their patients shouldn’t older human beings be getting them too? With us, as with cats, the body is a proficient scavenger.  If it doesn’t get enough of what it needs from diet because of malnutrition, illness, or old age, it breaks itself down in order to keep critical processes going – bones are raided for calcium, muscles for glucose – leaving the body depleted and weakened.

Left to herself, Sadie would probably sleep all day.  Fortunately, she has Rowan, the feline equivalent of a personal trainer.  Rowan is 6, no longer a kitten but still playful and energetic.  He has plenty of toys but he’s bored with them.  What he really likes is to chase Sadie Pearl.  The two of them enact a daily cat soap opera for our entertainment.  Rowan chases Sadie.  She growls and hisses but then goes to find him after he has left the room.  They take naps about a foot apart from each other on the bed.  Sometimes they lounge tail to tail on the top of the sofa like some Egyptian hieratic emblem. 

Getting Mashed by Anne and Steve

March, 2010   It is a cold, sunny afternoon in Florida.  I am lying on a yoga mat on the floor of a suburban house near West Palm Beach. Anne Tierney and Steve Sierra sit on chairs on either side of me and pummel my leg muscles with the heels and sides of their sock feet.  This technique, called mashing, is intended to relax my very tight calves and quads so that Anne and Steve can resistance stretch my legs.  In resistance stretching I contract the muscle while they push against my leg to open up the stretch a little bit more and a little bit more….

I first learned about Innovative Body Solutions, as Anne and Steve are known professionally, from a New York Times Magazine article by Elizabeth Weil on Olympic swimmer Dara Torres.  Torres, an IBS client, who calls resistance stretching her “secret weapon,” believes that it has contributed to her being able to win medals even in her forties.  I have come to Florida with a less ambitious goal, hoping to get a bit more movement out of a leg injured five years ago and some help with stiff shoulders.  My specific goal is to be able to do the yoga pose called “Sleeping Child,” in which you kneel on the floor with your upper body folded forward against your thighs.

What Anne and Steve try help their clients to achieve is balance.  A body with muscles in balance functions more efficiently and is less likely to be injured.  They move each of my legs back and forth at every possible angle.  My quads and calves are tight, possibly the result of hours on the cross-trainer, while the hamstrings and glutes are weak.  Basically, I need to stretch out the fronts and strengthen the backs of my legs.  Also, my medial hamstring (inside of the leg) needs work, especially on the right side.  They show me how to do several exercises that will work on these areas.  They give me a booklet and a set of DVDs demonstrating the complete resistance stretching workout.

When I go back the next day Steve addresses the condition of my shoulders, moving my arms up and down in all directions.  Steve advises me that the trapezius muscles (a diamond-shaped structure running from the neck out to the shoulders and down the center of the back) are overactive and that my rotator cuff areas are weak.  Later he sent me links on the web to videos showing rotator cuff exercises.  IBS also sent me a complete report on what they had seen and what they had done about it.   As a result of the work with IBS, the range of motion in my right knee has improved, there is more flexibility in my neck…and I can do Sleeping Child.

November, 2011   This time we visit Anne and Steve at the elegant new Ki-Hara South Beach studio in Miami.  They do more work on my legs and show me a whole new set of exercises in which I lift and extend my legs in different directions.  Anne introduces me to the Trigger Point kit which I can use for rolling my muscles and getting rid of tight spots.  I leave feeling that my body has had a real treat.

Trouble Down Below 2: Problems and Solutions

From the vantage point of the patient, digestive disorders are a two-sided problem:  how to deal with the unpleasant or even dangerous symptoms that result from eating the wrong foods and how to replace the nutrients that those same foods should be providing but probably are not.  In addition, the gastrointestinal tract also plays an important role in the immune system.  Chronic digestive upsets can undermine one of the body’s main defenses against illness.  Finding solutions to some of my food-related problems has dramatically improved my health, comfort, and physical condition.  Here are a some specifics.

Getting Enough Protein     As a young person I had weak muscles.  At some point I noticed that the protein reading on my annual blood work was a bit low.  I started drinking whey protein shakes once or twice a day.  A few years later I learned about a proteolytic enzyme supplement (Wobenzym) that can help your body digest protein.  I still take both of those and I am much stronger than I was thirty years ago.  

Dealing with Fiber   Whenever I was hungry as a child my mother would always encourage me to eat fruit.  I would say that I had nothing against fruit but it didn’t really satisfy my hunger.  As an adult, I feel the same way.  Possibly the reason is that my body seems to have trouble processing fibrous foods.  Kale, collard and mustard greens, all very nutritious, are impossible for me.  A few years back we bought a juicer and started making our own fruit and vegetable juice.  This means I can bypass the fiber and still get the nutrients in these foods.  So how do I get enough fiber in my diet? For a person eating 2000 calories a day, the USDA recommends 28 grams of fiber.  I take a fiber supplement 2-3 times a day, currently a combination of a flavored psyllium product (a generic of Metamucil or Citrucel) and glucomannan.

Health columnist Melinda Beck has written many informative articles about digestive disorders, especially the ones that have been covered by recent research, such as gluten intolerance (celiac disease) and, more recently, the inability to digest certain carbohydrates (Fodmaps) found in some common foods.  I read these articles avidly, hoping they will shed some light on my own situation but they usually do not.  Gluten, dairy, eggs, and peanuts, which cause life-threatening allergies in others, pass quite happily through my gut.  The assortment of foods to which I have bad reactions is diverse, idiosyncratic and somewhat weird.  What follows is a partial list.

Probable Allergens – Foods I Absolutely Avoid     Mushrooms (alas), eggplant, black beans (other beans are OK), okra, dill, marjoram, tarragon, fresh basil (no more pesto).  

Considered Suspect – processed meats, especially sausage, any processed food with a long list of mysterious ingredients, foods that are very acid, very spicy, or very rich.  I swapped coffee for tea a few years back but I still put hot sauce on lots of dishes.  

When I was younger I used to get any type of gastrointestinal bug that was in my vicinity, a real problem when traveling.  Seven years ago Mister GreenGenes.com, a health and diet food store in Las Vegas, suggested I try Dr. Ohhira’s probiotics.  I was dubious at first but I listened to an interview CD they sent and did a little research.  This product, which was invented by a Japanese microbiologist is made from plants that are fermented for three years and contains 12 strains of lactic acid bacteria.  For me, it took a 4-6 months to work but since then I have been largely free of GI upsets.  Using this product has changed my life.

In some ways my digestive problems have been a good thing because they have caused me to look carefully at what I was eating and to find solutions that may have made me healthier than I would have been if I had never had to pay attention to my gut.

Trouble Down Below 1

Cramping, bloating, nausea, constipation, diarrhea – these are some of the delightful symptoms of the condition commonly known as irritable bowel syndrome.  The use of the word “syndrome” means that medical science doesn’t really understand what this is and probably it is lots of things, including food allergies and sensitivities, genetically and organically determined malabsorption problems, deformities of the digestive organs, any or all worsened by stress.  The condition may be discussed in an annual physical but usually nothing gets done about it, for several reasons.  Because there are so many potential contributing factors, it can be difficult or impossible to sort out what is really going on.  The condition, while detrimental to quality of life, is not life-threatening.  Finally, some of the most widely used remedies are not among the regularly prescribed medications produced by the pharmaceuticals industry but from the unregulated, and to some doctors shady, world of supplements.

The problem with not treating digestive problems is that they can have subtle and far-reaching effects on the body.  If your system is not processing food adequately, you are not getting the nutrients your body requires.  If this goes on over decades of your life the result is long-term malnutrition.  The bodies of younger people can be remarkably resilient when it comes to malnutrition.  We have all heard stories of individuals who were lost in wilderness areas or spent years in prison camps and recovered to live long and healthy lives.  In old age, however, the results of lifelong poor diet may begin to emerge in the form of illness or overall poor quality of life.

My own checkered nutritional history probably started with food allergies inherited from both of my parents.  For my father, eating the wrong food could cost a night’s sleep.  At home, my mother avoided problem foods when preparing meals but restaurant menus were a minefield of potential hazards.  On my mother’s side, when she had a (rare) glass of wine, her cheeks would sometimes flush, probably a mild allergic reaction.  Later she developed pernicious anemia, for which she had to take vitamin B12 shots.

The human body, including the digestive system, relies on a whole universe of microbes to keep all of its processes moving along smoothly.  “Your Own Personal Ecosystem,” an article in the 10/2011 issue of Wired, featured a startling and informative graphic “The Wired Atlas of the Human Ecosystem.”  Here we learn that the gut has 200 prevalent species and 1000 less common ones.  A separate box, “Antibiotics=Microbiome Killer,” illustrates the reduction in diversity in gut bacteria that results from taking these medications.  In the example cited, diversity was still reduced even two years after taking the antibiotic.

During my thirties I had a series of infections for which I was given multiple courses of antibiotics.  When I was 32 I had a complete hysterectomy and the surgeon removed my appendix as well.  Some researchers now believe that the appendix provides storage for beneficial gut bacteria, though this theory is not universally accepted.  

Given my background, it is not surprising that I wound up in my late thirties and forties with a troublesome and temperamental digestive system.  In recent years I have been able to sort out some of the tangle of problems and find solutions for them.  I will talk about that in the next post.

More on Biotin

The biotin I have been taking is definitely helping my nails; the peeling, chipping parts have mostly grown out and the new nails are much stronger.  My hair is also getting thicker, as my hairdresser noticed.  What pleases me most, though, is that a couple of unpleasant little skin conditions seem to have gone away.  
 

For several years I’ve had small bumpy areas which doctors have identified as seborrheic keratoses; just old age, they said, nothing to be done about it.  Around my elbows I’ve also had bumpy, slightly painful patches (the beginnings of psoriasis?).  Over the course of several weeks both of these have cleared up.  I can’t be sure that the biotin did this and it’s always possible that the placebo effect is operating but whatever the reason, I’m grateful.  If it was in fact the biotin then my question is: were the skin conditions caused by (untreatable) old age or by a treatable nutritional deficiency? 

Update:  Some of the keratoses are still there after all, but smaller than before.  The painful, crusty patches on my elbows are definitely gone.

Get Older, Stay Strong: Exciting New Research

Sarcopenia, a medical term based on Greek words meaning “poverty of flesh,” is applied to the loss of lean muscle mass often observed in old people.  Traditionally, this deterioration has been seen as a natural part of the aging process:  old people were thought to be incapable of maintaining their strength and building new muscle as well as young people.  Recent research is calling this view into question.  

In a video clip Douglas Paddon-Jones, PhD, describes one study in which young and old people were each given 4-ounce portions of lean beef.  Researchers were able to use a stable isotope form of one amino acid to track the process by which the food was transformed into muscle in the human body.  In both young and old subjects eating the beef stimulated the ability to build muscle by about 50% for about three hours.  The conclusion:  “Aging per se doesn’t really impair our ability to take food and turn it into muscle.”  Dr. Paddon-Jones, an Associate Professor at the University of Texas Medical Branch in Galveston, studies “mechanisms contributing to skeletal muscle protein synthesis and breakdown and identification of interventions to counteract muscle loss in healthy and clinical populations.” 

So what do we need to do in order to maintain muscle mass as we get older?  Recent research suggests that instead of consuming the bulk of the day’s protein at dinner, as most Americans do, we should spread it out over three meals, consuming 20 to 30 grams of protein per meal for a daily maximum of 90 grams.  Eating larger amounts of protein, 12 ounces of beef rather than 4 ounces, does not produce additional gains in muscle mass, according to Paddon-Jones.  Meals of less than 20 grams actually reduce protein synthesis in older adults.   The research also emphasizes the importance of exercise, including resistance work, in preventing sarcopenia.

Based on these recommendations I am going to start adding roasted soybeans to some of my meals.  A third of a cup has 13 grams of protein and 163 calories, better than many protein bars.