Muscle Media - Muscle Media Magazine May/June 2023

For the past year or so, we’ve been receiving requests for our opinion on hormone replacement.

Although we’ve had mail asking about steroids, but this is different. At the same time, I have been seeing patients (in my Private Practice) making similar requests. Many of my patients are senior amateur or professional athletes, so their needs are usually addressed by team physicians. However, I am also seeing entrepreneurs and executives seeking information about hormone replacement therapies. Please understand that, only a few years ago, such requests were made using hushed tones under a veil of secrecy. There seemed to be a stigma to admitting there may be a need for it. Not any more…

One of the most often discussed topics is “what is normal?” I am often presented standard bloodwork reports. They typically contain normative ranges to provide some

IS ENOUGH SUFFICIENT?

By Dr. Tom Fisher, Editor-in-Chief

not be wholly acceptable. There has been a paradigm shift in society regarding TRT. As mentioned, only a few years ago, there was an almost shameful stigma attached to the therapy. Today, there are a growing number of clinics, classes, and seminars de-mystifying the practice. In my own Private Practice, most (not just some) of my executives are engaged in the process. Many of the informational seminars, like the Silverback Summit, bring experts in the field together to educate and inform about the potential benefits of TRT. It seems that times are changing, and it’s no longer necessary to settle for being “average” or “normal” …

But, enough about

frame of reference for the patient, as well as the treating professional. These ranges have changed over the years, and with good reason: the population is changing. Countless studies have noted the decline in male testosterone levels over the past several decades. Many potential causes have been suggested, but that is another discussion, perhaps the subject of future articles. I wanted to briefly address those “normative ranges” cited on most bloodwork reports and the availability/accessibility of Testosterone Replacement Therapy (TRT).

At the University, I teach my students, both graduate and undergraduate, to differentiate between what is “normal” and what might be “acceptable”. If you want any evidence of this, you might want to look at the height/weight “standards” for past enlistment into the military. We first began keeping records for the First World War. Since then, height/ weight “standards” have increased

information-packed issue…?

Dr. Tom Fisher

Editor in Chief

Do you have a question?

Please just ask! We may even publish it in our "Letters-To-The-Editor" section.

Send your questions to: drtom@musclemediaonline.com

significantly. (While it may be easier to accept weight standards to increase, but height standards have also increased!) In short, the “standards” are normative. They reflect actuarial data of the current population. Just as height/weight ranges reflect what is “normal”

(read: average) for society, it may

Let’s start by welcoming a previous contributor to Muscle Media Magazine. Nick returns to explain the process involved in Platelet Rich Plasma (PRP) therapy for rehabilitation. Our resident entertainment authority, Anne, continues her regular section with an examination of some alcoholfree “spirits” available to create tasty and satisfying “mocktails”. For those of you seeking guidance in the training arena, Ella takes us through the important reasons to include an appropriate warmup into your exercise regimen. Michael explores the critical role a strong core plays in Activities of Daily Living (ADLs), as well as in athletic performance. Kaley helps us understand the reasons for, and advantages of muscle hypertrophy. Priva takes us up the mountain and examines the benefits associated with altitude training

when competing at sea level. James helps explain the process of periodization when mapping your fitness journey. Elizabeth outlines the impact of heat-related injuries and how to avoid the condition becoming serious. For a first in MMM, Jackson introduces us to the exciting sport of rock climbing. For those of you interested in physiological implications of training, Justine explains the importance of circadian rhythm and its’ effect on performance.

Alexandra gives us an overview of the importance of appropriate sleep for rest and recovery from workouts. Michael (another Michael…!) introduces us to a potentially useful, but little-known, supplement known as curcumin. Giovanna details the three major energy systems relative to their design and purpose.

Bridget introduces the importance of electrolytes and other minerals in the metabolic processes. Genevieve reviews some contents found in many popular pre-workout supplements. >whew<

-Dr. Tom Fisher Editor-In-Chief

that… What do we have to offer in this

Don’t satisfy yourself by settling for “normal”. Take some time to consider being extraordinary…

Train Hard, Train Often, Train Safe…

CIRCADIAN RHYTHM & PERFORMANCE

By Justine Renziehausen

According to a 2016 article, the circadian rhythm refers to the 24-hour cycle of biological systems in humans. The suprachiasmatic nucleus (SCN) of the hypothalamus is responsible for regulation of all bodily systems. Light exposure provides one of the primary stimuli to the SCN. This corresponds to the sleep/ wake cycle and suppresses the production of melatonin, a hormone that is produced prior to sleep onset. The SCN is also responsible for synchronizing other biological systems (e.g., body temperature, cortisol, etc.). This alignment may be individualized, where some people tend to wake earlier and have preferences to complete mentally and physically fatiguing tasks in the morning, while others prefer the late afternoon or evening times, according to a 1976 text. These preferences have been shown to correspond to physiological markers of the circadian rhythm such as body temperature, cortisol, and melatonin production. A 2015 study suggested that when individuals are forced to work outside of their preferred times, adverse health consequences are likely due to changes in schedules and behaviors. A 2016 study also suggested that circadian rhythm disruption, disturbed sleep, altered eating patterns (i.e., eating at nonoptimal times for the circadian phase, eating poor food choices for convenience, irregular eating), and altered lifestyle behaviors (e.g., smoking, alcohol use, and reduced physical activity) may contribute to impaired physiological mechanisms in shift worker.

Shift work refers to the occupational necessity to work outside of typical sleep-wake hours, therefore disrupting sleeping patterns via altered light exposure. Many occupations,

such as healthcare professions, manufacturing, and transportation services require employees to work shifts outside of typical day shifts. Working these shifts, especially for an extended period, has been shown to have both acute and chronic health consequences. Therefore, the purpose of this article is to discuss risks associated with shift work and potential mechanisms for chronic illnesses.

Shift work and extended shifts in general (more than 8 hours) are typically required in physically demanding occupations according to a 2017 study. The likelihood of injury increases substantially towards the end of a shift but may be further increased for those working outside of their optimal

times. Shift workers are reported to consistently sleep less and have poorer sleep quality than those who work the day shifts. Recent studies have suggested that this fatigue may be responsible for slips, falls, and other accidents resulting in back pain and other injuries. Sleep contributes to the healing process via growth hormone production and protein synthesis. As shift workers typically have poorer sleep quality and reduced sleep duration, it’s possible that the recovery process may be impaired, and chronic pain may result. Chronic pain and unhealed injuries may also lead to increased sedentary behavior, increasing the risk of chronic disease. Further, sleep-deprivation has been repeatedly associated with cognitive impairments (reaction time, emotional regulation, and

attention), which may contribute to the risk of injury during a shift. There are also several chronic illnesses that have been associated with shift work. A 2016 study found that metabolic disorders such as obesity, diabetes, and cardiovascular disease have been commonly linked to shift work. A 2010 study found that obesity is more prevalent among shift workers, and that time spent working shifts corresponds to higher body mass index. One potential mechanism that may be partially responsible is disruption of the feeding cycle. Activity during normal sleeping hours forces individuals to eat at irregular intervals outside of their optimal hours. This desynchronizes the circadian rhythm, alters hormone levels that are associated with metabolism (insulin), and ultimately affects the typical rhythm of glucose metabolism. Interestingly, studies from 1993, 2003, and 2010 examined the differences in eating habits between shift workers and day workers and determined that total calorie intake, as well as macronutrient intake, was often not significantly different between the groups. The differences that were commonly noted involved food selection and eating habits, such as irregular meal frequency and higher consumption of alcohol and sweets in shift workers. These metabolic disturbances may ultimately lead to other chronic disorders, such as diabetes. Studies have shown that after age 50, shift workers are significantly more likely to experience insulin resistance, which leads to the development of type II diabetes. One 2014 review discussed the risk of type II diabetes in shift workers. Researchers concluded that all five studies included in the final analysis indicated a greater risk of developing type II diabetes for those who work the day shift (although confounding factors such

“Shift workers are reported to consistently sleep less and have poorer sleep quality than those who work the day shifts.”

as age, body mass index, alcohol consumption, and family history should be reported and accounted for). The development of type II diabetes in shift workers is thought to be a result of changes in meal timing and frequency and altered insulin and glucose circadian rhythm.

Shift work is also associated with the development of hypertension and cardiovascular disorders. Several studies from 2014-2017 have reported increased risk of developing hypertension for shift workers. Additionally, the chance of developing hypertension significantly increases as time spent working non-optimal shifts increases. For example, a 2017 study determined that the rate of hypertension among individuals with 20 or more years of shift work was 16.4%, compared to 4.6% for those with 10 or less years. This was thought to also be impacted by length of shifts, overall stress, and changes in hormone production. Melatonin is a primary regulator of the circadian rhythm via light/ dark cycles and plays a role in regulating hypothalamic-pituitaryadrenal axis (HPA axis) activity. Not only does melatonin itself impact blood pressure, but so does a hormone produced via the HPA axis (cortisol). It has been hypothesized that light exposure is ultimately responsible for changes in blood pressure and the development of hypertension, however, it is more likely due to a cascade of events. Further, a 2010 study suggested

metabolic diseases/abnormalities, such as diabetes, may lead to the development of cardiovascular disease/coronary heart disease as well.

It has been hypothesized that shift work is also linked to the development of some cardiovascular diseases (CVD), although evidence is limited, as direct causal relationships are difficult to determine. While there is evidence to support a link between shift work and coronary heart disease (CHD), no studies to date have established the same relationship with CVD overall. One 2010 review discussed potential mechanisms for the development of CVD, to describe pathways that are connected to shift work and disease. Along with increased stress, less sleep, and less time to recover from strenuous occupational demands and fatigue, the authors discussed behavioral changes that may play a role in disease development such as smoking and altered nutrition. The review showed that the prevalence of smokers amongst shift workers is between 10-40%, although that number has decreased in recent years. It was postulated that smoking is a strategy to feel more alert while on the job. Additional studies have shown that shift workers tend to choose less nutrient dense foods, eat out of convenience, and eat at irregular intervals. It was also found that they also have higher cholesterol and triglyceride levels.

As previously mentioned, there are also relationships between shift work and the development of hypertension and type II diabetes.

As smoking, hypertension, prolonged stress levels, high cholesterol, high triglyceride levels, and metabolic syndrome are known to be risk factors for the development of CVD, it may be assumed that shift work and CVD have some relationship, although there may be other, confounding

factors. Individuals may also be affected by shift work differently based on several factors such as age, genetics, chronotype (preferences for certain time of the day), and physical activity levels. The length of shifts, years of shift work, and shift rotations may also impact the severity of consequences. For example, a 2015 study found those who worked only night shift as opposed to those who worked rotating shifts had higher odds

should consider all potential confounding factors. Additionally,

diseases may be due to a series of events and prolonged stressors. Future research should account for years spent working shifts. Although shift work affects many people, only a limited number of intervention strategies have been studied to mitigate adverse health effects. Melatonin supplementation has been considered to reduce some of the negative health risks and improve sleep. A 2014 study suggested that there is evidence to support improved sleep with melatonin compared to a placebo in nurses. The study also suggested that caffeine supplementation may improve alertness while working, but there is no evidence that this will impact acute or chronic injuries/ disease. Additionally, exercise interventions have been shown to significantly improve BMI and blood pressure, which may decrease the risk of the development of metabolic and CVD. Interestingly, it was also shown that increased physical activity was associated with increased consumption of fruits, indicating potential relationship between activity level and healthier food choices. The circadian disruption caused by shift work is likely to result in several adverse health effects. Extended time in circadian disruption may worsen symptoms and lead to the development of chronic diseases. Although currently limited, intervention strategies should be evaluated to help mitigate the effects of shift work. As exercise interventions may be a promising strategy, various forms of exercise and exercise timing should be further evaluated. Future studies should also be sure to include samples across all age groups and sexes, as these groups may have different responses.

References

of risk ratios. Future studies examining both effects of shift work and potential intervention strategies

many of the cardio-metabolic disorders are related to each other, and the development of chronic

Journal of Work, Environment & Health, 25(2), 85–99. https://doi.org/10.5271/sjweh.410

de Assis, M. A. A., Kupek, E., Nahas, M. V., & Bellisle, F. (2003). Food intake and circadian rhythms in shift workers with a high workload. Appetite, 40(2), 175–183. https://doi.org/10.1016/s0195-6663(02)00133-2

Dochi, M., Suwazono, Y., Sakata, K., Okubo, Y., Oishi, M., Tanaka, K., Kobayashi, E., & Nogawa, K. (2009). Shift work is a risk factor for increased total cholesterol level: A 14-year prospective cohort study in 6886 male workers. Occupational and Environmental Medicine, 66(9), 592–597. https://doi.org/10.1136/ oem.2008.042176

Horne, J. A., & Ostberg, O. (1976). A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. International Journal of Chronobiology, 4(2), 97–110. Kecklund, G., & Axelsson, J. (2016). Health consequences of shift work and insufficient sleep. BMJ, 355. https://doi.org/10.1136/bmj.i5210 Knutsson, A. (1989). Shift work and coronary heart disease. Scandinavian Journal of Social Medicine. Supplementum, 44, 1–36. Knutsson, A., & Kempe, A. (2014). Shift work and diabetes – A systematic review. Chronobiology International, 31(10), 1146–1151. https://doi.org/10.31 09/07420528.2014.957308

Lennernäs, M., Hambraeus, L., & Akerstedt, T. (1995). Shift related dietary intake in day and shift workers. Appetite, 25(3), 253–265. https://doi.org/10.1006/ appe.1995.0060

Lim, J., & Dinges, D. F. (2010). A meta-analysis of the impact of short-term sleep deprivation on cognitive variables. Psychological Bulletin, 136(3), 375–389. https://doi.org/10.1037/a0018883

Mostaghimi, L., Obermeyer, W. H., Ballamudi, B., Martinez–Gonzalez, D., & Benca, R. M. (2005). Effects of sleep deprivation on wound healing. Journal of Sleep Research, 14(3), 213–219. https://doi.org/10.1111/ j.1365-2869.2005.00455.x

Neil-Sztramko, S. E., Pahwa, M., Demers, P. A., & Gotay, C. C. (2014). Health-related interventions among night shift workers: A critical review of the literature. Scandinavian Journal of Work, Environment & Health, 40(6), 543–556. https://doi.org/10.5271/sjweh.3445 Potter, G. D. M., Skene, D. J., Arendt, J., Cade, J. E., Grant, P. J., & Hardie, L. J. (2016). Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures. Endocrine Reviews, 37(6), 584–608. https://doi.org/10.1210/er.2016-1083

Puttonen, S., Härmä, M., & Hublin, C. (2010). Shift work and cardiovascular disease—Pathways from circadian stress to morbidity. Scandinavian Journal of Work, Environment & Health, 36(2), 96–108.

Ramin, C., Devore, E. E., Wang, W., Pierre-Paul, J., Wegrzyn, L. R., & Schernhammer, E. S. (2015). Night shift work at specific age ranges and chronic disease risk factors. Occupational and Environmental Medicine, 72(2), 100–107. https://doi.org/10.1136/ oemed-2014-102292

Suwazono, Y., & Nogawa, K. (2014). [Effect of shift work on blood pressure]. Nihon Rinsho. Japanese Journal of Clinical Medicine, 72(8), 1497–1502. Thompson, B. J., Stock, M. S., & Banuelas, V. K. (2017). Effects of Accumulating Work Shifts on Performance-Based Fatigue Using Multiple Strength Measurements in Day and Night Shift Nurses and Aides. Human Factors, 59(3), 346–356. https://doi. org/10.1177/0018720816677814

Antunes, L. C., Levandovski, R., Dantas, G., Caumo, W., & Hidalgo, M. P. (2010). Obesity and shift work: Chronobiological aspects. Nutrition Research Reviews, 23(1), 155–168. https://doi.org/10.1017/ S0954422410000016

Bøggild, H., & Knutsson, A. (1999). Shift work, risk factors and cardiovascular disease. Scandinavian

Vetter, C., Devore, E. E., Ramin, C. A., Speizer, F. E., Willett, W. C., & Schernhammer, E. S. (2015). Mismatch of Sleep and Work Timing and Risk of Type 2 Diabetes. Diabetes Care, 38(9), 1707–1713. https://doi. org/10.2337/dc15-0302

Yeom, J. H., Sim, C. S., Lee, J., Yun, S. H., Park, S. J., Yoo, C.-I., & Sung, J. H. (2017). Effect of shift work on hypertension: Cross sectional study. Annals of Occupational and Environmental Medicine, 29, 11. https://doi.org/10.1186/s40557-017-0166-z

“Activity during normal sleeping hours forces individuals to eat at irregular intervals outside of their optimal hours.”

“A 2010 study found that obesity is more prevalent among shift workers, and that time spent working shifts corresponds to higher body mass index.”

Which is why we developed a take-home vitamin therapy regimen for YOU!

By

Turmeric is a spice used around the world for both medical and culinary purposes. Curcumin is a substance derived from the turmeric root system that contains medicinal properties that continue to be discovered. Curcumin can be consumed with food and in drinks. This substance can also be supplemented via oral capsules which can be purchased on nearly any grocery store. According to a 2017 published review, this substance can be used as an antioxidant and antiinflammatory as well as be used for the management of conditions such as hyperlipidemia, anxiety, and arthritis. This article will explain the effect of curcumin supplementation on the management or treatment of osteoarthritis, one of the most common progressive and autoimmune disorders in the United States.

Osteoarthritis is one of the most common chronic musculoskeletal disorders in the United States. A 2012 study found that his autoimmune condition is the leading cause of disability in the elderly population. Osteoarthritis is a progressive degeneration of articular cartilage together with the formation of osteophytes (bone spurs) within the joint spaces, subchondral bone remodeling, and physical changes to the joint capsules, ligaments, surrounding muscles, and even meniscal tears. Treatment options include physical therapy, oral nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroid injections, oral supplementation, and eventually, joint replacement. If osteoarthritis is left untreated, its’ progressive effect can be debilitating, often leading to sedentary lifestyles. According to the American College of Sports Medicine (ACSM), a sedentary lifestyle can lead to disability. This

suggests the importance of regular exercise for an individual regardless of background or physical condition. Researchers have been studying curcumin supplementation for its relative anti-inflammatory effects for several years. Ibuprofen, an NSAID that can be taken orally for the management of pain and inflammation experienced from osteoarthritis, has also been investigated. A 2014 study compared curcumin to ibuprofen on 367 primary knee osteoarthritis patients who reported a pain scale of at least 5. This group of participants was randomly assigned to either an ibuprofen or curcumin regimen group. The groups were administered either 1,200 mg of ibuprofen or 1,500 mg of curcumin extract daily for

a total of four weeks. Pain scale, joint stiffness, and functional scores were assessed throughout this study according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistically significant improvements were observed with no apparent superiority observed between either group. However, there was a report of abdominal pain or discomfort experienced frequently among participants in the ibuprofen supplementation group. Curcumin was shown to be similarly effective to ibuprofen for the management of osteoarthritis with a reduced incidence of gastrointestinal distress. Findings from this study could encourage healthcare providers to be more

“If osteoarthritis is left untreated, its’ progressive effect can be debilitating, often leading to sedentary lifestyles.”