It was a nagging pain, much like a trapped eyelash or a pebble in your shoe.  The problem is that I was a runner and this pain was in my knee.  It was as if the pain fairy had sprinkled pepper flakes in my right knee joint overnight, and the resulting burn was not enough to put me on bedrest, but I couldn’t run.  And for me this was the equivalent of telling a shrimper he couldn’t fish.

     Running had become a large part of my identity.  I was a doctor, a husband, a father, and some

would even say a writer, but at my core I was a runner. I had heard that the difference between a jogger and a runner is a race entry, and I had my share of those.  I was training for my 46th marathon/half marathon and I didn’t have the time or frame of mind to be sidelined by an injury.

     I had previously researched alternative approaches to inflammatory issues (which was the diagnosis for my knee pain) and found that omega 3 fatty acids were the most rigorously studied natural substances that successfully addressed the causes of inflammation.  I decided to "experiment" on myself and started a regimen of a specific supplement, Omega XL, an omega 3 fatty acid supplement I knew something about.  I was impressed by the quality, omega 3 content, manufacturing, and purity of this particular supplement, so I felt confident as both a physician and patient in its use.

     The literature supporting the anti-inflammatory properties of the omega 3 fatty acids is voluminous and diverse.  First, a brief biochemistry primer. Omega 3s are essential fatty acids, absolutely necessary for proper immune function, brain development, cell metabolism, and other functions vital to health and well being.  They aren’t made in the body so you have to get them from food, and a deficiency can result in many health problems like heart disease, fatigue, and even mood disorders.  Another link in the chain of good health is an appropriate balance between the omega 3s and their evil twin, the omega 6 fatty acids.  If this ratio becomes unbalanced (too much omega 6 or too little omega 3) inflammatory changes in the body can actually be magnified.

     I understood that for optimal functioning, having enough omega 3s was essential; however, with my injury, I was most concerned with the information on the treatment of various disorders with formulations of omega 3 fatty acids.  Here is where the research got interesting.  I found over 17 studies looking at omega 3 fatty acid use in inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease, and even menstrual cramps with the majority showing a positive effect manifested as either a reduction of pain or in inflammatory markers in the blood.  What I didn’t expect was the wealth of literature on omega 3 fatty acid use in disorders ranging from depression to prostate cancer.  Granted, some studies showed minimal benefits, yet I was encouraged by the level of scrutiny.  Unfortunately many supplements are either poorly tested or not adequately tested and depend solely on anecdotal evidence to tout their effectiveness.  This was not the case with the omega 3s.  

     The number of illnesses and chronic conditions related to inflammation seemed to be expanding at a logarithmic rate.  Inflammation had been shown to be one of the contributing causes of heart disease, senile dementia, auto-immune disorders,  ADHD, asthma, macular degeneration, and even depression.  We seemed to be in the infancy of the research describing how inflammation influences these processes, but I was convinced that omega 3 fatty acids played a huge role in both prevention and treatment.

     Within three weeks of beginning the Omega XL my knee pain was minimal and I was back training again.  I had employed various other healing techniques like stretching, massage, and ice, but after examining the research, I was convinced that the omega 3s had played a role in my healing.  Since that time I have continued to run, having completed 57 marathons/ half marathons injury free, and I haven’t missed a day of my supplements.

     Pain can sometimes be a warning sign pointing towards disease, injury, or imbalance.  Rarely is the solution simply a pill or potion, but more often than not it is a combination of lifestyle changes, appropriate supplements, proper nutrition, and a positive outlook.  The cure is not always easy, but the work is worth it and always more lasting than the Band-aid, quick fix. 

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     Men and women are different.  I realize this may not be a ground breaking revelation but aside from certain anatomical variations, the differences are not always noticeable.  

     Women certainly have a different hormonal milieu than men, and some of the internal variations can be directly attributed to such; however, laying everything at the feet of the hormonal hooligans is both simplistic and unfounded.  In other words, men and women are not solely their hormones, but a complex interaction of gender specific, unique physiology.  Let’s look at some examples.

Women are at a greater risk of developing problems from alcohol use than men.  This applies to simple health risks as well as severe consequences.  The National Institutes of Health state that, based on current research, female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics, including deaths from suicides, alcohol-related accidents, heart disease and stroke, and liver cirrhosis.  Even though there are more male alcoholics than female, the women fare worse overall.  This is related to how alcohol is metabolized in the female system.  Women are more likely to develop liver damage from excessive alcohol consumption even when compared to similar intake for males.  In addition, having more than 2 drinks a day can increase the risk for breast cancer for a woman.  Why do these differences exist?  In general women have less body water than men of similar body weight, so that women achieve higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol.  In addition, women have smaller quantities of the enzyme dehydrogenase that breaks down alcohol in the stomach. A woman will absorb about 30% more alcohol into her bloodstream than a man of the same weight who has consumed an equal amount.  There is a push by many organizations, especially on college campuses to educate women as to these differences.  The consequences later in life can be substantial.

     For years medical research on heart disease and risk factors was done exclusively on men.  The vast majority of major work done in the earlier decades purposely excluded women for reasons ranging from potential pregnancy to volunteer recruitment.  What resulted is a plethora of data that is extremely useful, but biased.  Only with the advent of multiple studies including women have researchers realized that heart disease risk factors, occurrence, and prognosis are different for men and women.  Heart disease has taken a back seat to breast cancer, for example, largely due to media attention and breast cancer awareness programs; however, heart disease is the leading cause of death in women over 50.  A woman is more than ten times as likely to die of cardiovascular disease as she is to die of breast cancer. This is partly due to the fact that the survival rate for breast cancer is quite high, whereas over 40% of women do not survive their first heart attack.   Women’s hearts are anatomically different from men, and they also function differently.  A woman’s heart on average is smaller than a man’s, and it also tends to have smaller blood vessels supplying it.  Researchers from Columbia University and New York Presbyterian Hospital believe that women also have a different rhythmicity to the pacemaker of their hearts, which causes them to beat faster. These same researchers believe that it may take a woman's heart longer to relax after each beat. Some surgeons also hypothesize that the fact that women have a 50 % greater chance of dying during heart surgery than men could be related to some fundamental difference in the way women's hearts work.   These differences have led to a bias in how physicians viewed heart symptoms in women.  Several studies indicated that if a woman and a man presented to an emergency room with identical symptoms, the man would be more likely to be evaluated for heart problems than the woman.  Luckily with the new data, this trend is reversing and early disease is being suspected and detected in women, hopefully reducing both death and disability.

     Most would agree that men and women think differently.  This may have a physiologic basis as research indicates that men’s and women’s brains are structurally different.  There are variations in grey and white matter, which leads to differences in things such as verbal abilities and connectivity between the two sides of the brain.  These anatomical peculiarities can lead to a number of behavioral differences once thought to be social or environmental. 

     It’s important to understand there is no advantage or disadvantage with these variations, it’s just that being aware of the differences may help in promoting each individual's health. 

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      “I’m not kidding; it’s Miracle-Gro for the brain!”  The statement reminded me of some ridiculous infomercial infecting late night TV.  In this case however, it was generated from the mouth of a world class neurobiologist, so I took notice.  He was speaking of a substance called Brain Derived Neurotrophic Factor (BDNF).  What immediately intrigued me was he claimed that BDNF was the link between exercise and improved brain function.  For years I had read articles in both the medical and running journals touting the psychological benefits of fitness, yet here was proof that fit folks were happier folks.  Dr.John Ratey, a clinical professor of psychiatry at Harvard, outlined in his amazing book “Spark: The Revolutionary New Science of Exercise and the Brain” how exercise increased the production of BDNF which in turn stimulated nerve cells to grow and connect in the Hippocampus, a tiny area in the brain responsible for a number of high level functions. This growth of new cells actually translated into better memory and quicker learning.  He went on to claim that certain other chemicals were released by exercising muscles that improved functioning in the amygdala, the emotional center of the brain.  The implications of this and other research are monumental. 

     Twenty-five years ago when I was in medical school we were taught that we were born with a set number of neurons (brain cells) and there were no more to be made…period.  I remember joking in college about taking another late night excursion to the disco (yes, I am that old!) to “kill some brain cells” with Singapore Slings and Jack and Coke.  We didn’t fret about the wholesale slaughter of brain cells as we all knew from biology class that we only used 20% of our brain anyway.  In our way of thinking, that gave us a pretty good cushion!  It was the unlucky folks born with fewer brain cells, and we all knew a few of those, who had the most to fear.  We were wrong on all accounts.  Now research is proving that new brain cells can be created, and formed in areas that have a major effect on cognition and emotions.  Don’t take this as permission to guiltlessly get plastered; I don’t need to tell you of the disastrous effects of that, but it does open the door for medical miracles.  The study of such alphabet soup as BDNF, IGF-1, and VGEF and other neuropeptides has given hope to developing successful treatments for senile dementia, Alzheimer’s and Parkinsonism.  Medicine is not there yet, but we can conclude that getting fit by exercising regularly can reduce the incidence of these diseases as well as certain cancers and diabetes. 

    

 The great news is that you don’t have to train for a marathon to reap the benefits of fitness. The studies indicate that a brisk walk for 45 minutes three to four times a week can elicit these life enhancing outcomes.

    

One of the most exciting applications of this knowledge is illustrated by the Naperville school district.  A middle class suburb south of Chicago, Naperville has been the focus of a real-life experiment documenting the benefits of fitness in kids.  It is no surprise that kids who are active are more physically fit than their sedentary counterparts, but what has been found in Naperville is that these fit kids are also smarter!  Over the past seventeen years the school district, consisting of 11 elementary schools, five junior high schools and two high schools, has made physical education an integral part of the school day (unlike the national average where only 6% of high schools have a daily PE program).  Their gym class is not your typical dodge ball, basketball, softball curriculum (the average student in the typical hour long PE class spends 16 minutes actively moving).  It is a program that promotes and measures fitness, not competition, and grades based on effort, not ability.  They regularly run or ride bikes using donated treadmills and stationary bikes measuring effort by heart rate monitors. And they do it at a lower cost per student than comparable school systems!  The results have been amazing.  In 2002, 97% of entering freshmen were at a healthy body mass index (BMI) as compared to the national average of 65% and most striking was the impact that fitness had in the classroom.  In that same year 96% of the eighth graders took the Trends in International Math and Science Test, an instrument designed to compare student’s knowledge level in different countries around the world.  On the science part of the test the Naperville students scored the highest…in the world!  Through a strict and comprehensive analysis it was shown that regular physical activity and fitness level correlated with the academic success of the Naperville students!

     

The message is clear.  For adults and kids alike, regular aerobic exercise is not only good for the body, but it is great for the mind.             

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         Norman Cousins, while struggling with a severe neuromuscular disease, said, “Laughter is like internal jogging. Ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep.” Those of you who regularly scan Reader’s Digest remember a column titled, “Laughter is the best medicine”.  Indeed it is, and sometimes we forget that.  So here is my prescription for surviving everyday stress…laugh three times a day!  Some of the most effective laughter is that which we do at ourselves.  The less serious we take ourselves, the less burdensome everyday stresses and strains.  For example, I recently attended a local high school football game and quickly lapsed into a flashback when the bands took the field for the halftime entertainment.  No, I wasn’t in the band in high school.  The idea of walking backwards in circles while reading music was a bit overwhelming, but my mother was convinced that I had the potential to be the next John Philip Souza.  She felt that one way to navigate the treacherous waters of a new high school was to join their celebrated band.  I had just been uprooted from a comfortable middle school existence in Memphis to the mountains of East Tennessee , replete with orange painted outhouses, to begin my high school years.  I was the size of a Hobbit, and about as good-looking, so my social integration options were vastly limited.  I certainly was not a candidate for football (a religion in Knoxville) although; in retrospect, I would have made a wonderful tackling dummy.  Track was not an option as I had the speed of an anemic sloth.  Basket ball…well let’s just say dribbling at the level of other’s knees didn’t fare well for a stellar career.  So maybe the band was a way that I could find my niche in an otherwise niche-less existence.  At least my mother thought so.  So the first day a school she set up an appointment with the band director to discuss my future musical career.  Unfortunately, she made me come along.  Once we arrived in the hallowed sanctuary known as the “band room” , Mr.Jenkins, the band teacher, granted us an audience. 

     “Now exactly what instrument does your boy play?”, he asked condescendingly.  I felt this was a rather appropriate question and a reasonable place to start the discussion until it dawned on me that I didn’t play an instrument.  I suspected that my mother also knew this as she had not seen or heard me with anything other than a kazoo since kindergarten, but she was not fazed by the inquiry. 

     

     “He doesn’t…yet”, she confidently replied.  This obviously was not the response Mr. Jenkins was expecting as he stared at her with a look that said, “Well what in the name of Beethoven are you doing here then?”  Mom, ever the perceptive sort, picked up on his incredulity and explained that before we invested in lessons or instruments, she wanted to get his impression as to which instrument I was best suited to play.  At this point I was busily plotting both my escape and my plan for putting mom on medication.  I had read of studies that looked at a person’s likelihood of being a criminal based on their physical traits, you know, beady eyes, big forehead etc, but I had yet to see any research correlating a person’s physical appearance and their ability to master a band instrument.  I felt myself slowly sinking into “Music Man” hell.  Mr. Jenkins composed himself, obviously trying to pacify the crazy woman sitting before him, and shot a glance at my face, as if to say, “Is she serious?” I cocked my head, subtly conveying the dual message that yes, she is serious and she may be armed, so do what she asks.  He then proceeded to survey my mouth, fingers, eyes and anything else he could possibly think of that would indicate the ideal instrument for me.  It was like being scrutinized for lice after being accused of infecting the whole school.  

     After what seemed like hours, he stopped, grunted, and said “trumpet…yes, trumpet”.  A huge grin crossed mom’s face as this seemed to validate her quest.  All I could think of was Dizzy Gillespie, that huge, old guy who puffed out his cheeks to the size of a steroid laced chipmunk whenever he played his horn.  I didn’t want to walk around school with the cheeks of a bloated rodent, so I instantly expressed my apprehension.  Of course, my protest fell on deaf ears as mom was already negotiating horn rentals and lesson fees.  

     How was I supposed to get the girls playing something you have to clear spit out of every few minutes?  Neil Diamond never wooed a woman with his classic marching tunes!  As I walked out of the room, visions of chapped lips and elastic cheeks dancing in my head, I realized that maybe I needed to find a better way to fit in.  I wonder if girls dig science projects?

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