The Myth of Drug Expiration Dates

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Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital. Meanwhile the FDA has long known that many remain safe and potent for years longer.

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

What if the system is destroying drugs that are technically “expired” but could still be safely used?

In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.

The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

“Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media is rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston says the 240-bed facility is able to return some expired drugs for credit, but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term care pharmacies, retail pharmacies and in consumer medicine cabinets.

After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.

“Refining our prescription drug dating process could save billions,” he says.

But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

In fact, the federal government has saved a fortune by doing this.


For decades, the federal government has stockpiled massive stashes of medication, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

Maintaining these stockpiles is expensive. The drugs have to be kept secure and at the proper humidity and temperature so they don’t degrade. Luckily, the country has rarely needed to tap into many of the drugs, but this means they often reach their expiration dates. Though the government requires pharmacies to throw away expired drugs, it doesn’t always follow these instructions itself. Instead, for more than 30 years, it has pulled some medicines and tested their quality.

The idea that drugs expire on specified dates goes back at least a half-century, when the FDA began requiring manufacturers to add this information to the label. The time limits allow the agency to ensure medications work safely and effectively for patients. To determine a new drug’s shelf life, its maker zaps it with intense heat and soaks it with moisture to see how it degrades under stress. It also checks how it breaks down over time. The drug company then proposes an expiration date to the FDA, which reviews the data to ensure it supports the date and approves it. Despite the difference in drugs’ makeup, most “expire” after two or three years.

Once a drug is launched, the makers run tests to ensure it continues to be effective up to its labeled expiration date. Since they are not required to check beyond it, most don’t, largely because regulations make it expensive and time-consuming for manufacturers to extend expiration dates, says Yan Wu, an analytical chemist who is part of a focus group at the American Association of Pharmaceutical Scientists that looks at the long-term stability of drugs. Most companies, she says, would rather sell new drugs and develop additional products.

Pharmacists and researchers say there is no economic “win” for drug companies to investigate further. They ring up more sales when medications are tossed as “expired” by hospitals, retail pharmacies and consumers despite retaining their safety and effectiveness.

Industry officials say patient safety is their highest priority. Olivia Shopshear, director of science and regulatory advocacy for the drug industry trade group Pharmaceutical Research and Manufacturers of America, or PhRMA, says expiration dates are chosen “based on the period of time when any given lot will maintain its identity, potency and purity, which translates into safety for the patient.”

That being said, it’s an open secret among medical professionals that many drugs maintain their ability to combat ailments well after their labels say they don’t. One pharmacist says he sometimes takes home expired over-the-counter medicine from his pharmacy so he and his family can use it.

The federal agencies that stockpile drugs — including the military, the Centers for Disease Control and Prevention and the Department of Veterans Affairs — have long realized the savings in revisiting expiration dates.

In 1986, the Air Force, hoping to save on replacement costs, asked the FDA if certain drugs’ expiration dates could be extended. In response, the FDA and Defense Department created the Shelf Life Extension Program.

Each year, drugs from the stockpiles are selected based on their value and pending expiration and analyzed in batches to determine whether their end dates could be safely extended. For several decades, the program has found that the actual shelf life of many drugs is well beyond the original expiration dates.

A 2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

Some that failed to hold their potency include the common asthma inhalant albuterol, the topical rash spray diphenhydramine, and a local anesthetic made from lidocaine and epinephrine, the study said. But neither Cantrell nor Dr. Cathleen Clancy, associate medical director of National Capital Poison Center, a nonprofit organization affiliated with the George Washington University Medical Center, had heard of anyone being harmed by any expired drugs. Cantrell says there has been no recorded instance of such harm in medical literature.

Marc Young, a pharmacist who helped run the extension program from 2006 to 2009, says it has had a “ridiculous” return on investment. Each year the federal government saved $600 million to $800 million because it did not have to replace expired medication, he says.

An official with the Department of Defense, which maintains about $13.6 billion worth of drugs in its stockpile, says that in 2016 it cost $3.1 million to run the extension program, but it saved the department from replacing $2.1 billion in expired drugs. To put the magnitude of that return on investment into everyday terms: It’s like spending a dollar to save $677.

“We didn’t have any idea that some of the products would be so damn stable — so robustly stable beyond the shelf life,” says Ajaz Hussain, one of the scientists who formerly helped oversee the extension program.

Hussain is now president of the National Institute for Pharmaceutical Technology and Education, an organization of 17 universities that’s working to reduce the cost of pharmaceutical development. He says the high price of drugs and shortages make it time to reexamine drug expiration dates in the commercial market.

“It’s a shame to throw away good drugs,” Hussain says.

Some medical providers have pushed for a changed approach to drug expiration dates — with no success. In 2000, the American Medical Association, foretelling the current prescription drug crisis, adopted a resolution urging action. The shelf life of many drugs, it wrote, seems to be “considerably longer” than their expiration dates, leading to “unnecessary waste, higher pharmaceutical costs, and possibly reduced access to necessary drugs for some patients.”

Citing the federal government’s extension program, the AMA sent letters to the FDA, the U.S. Pharmacopeial Convention, which sets standards for drugs, and PhRMA asking for a re-examination of expiration dates.

No one remembers the details — just that the effort fell flat.

“Nothing happened, but we tried,” says rheumatologist Roy Altman, now 80, who helped write the AMA report. “I’m glad the subject is being brought up again. I think there’s considerable waste.”

At Newton-Wellesley Hospital, outside Boston, pharmacist David Berkowitz yearns for something to change.

On a recent weekday, Berkowitz sorted through bins and boxes of medication in a back hallway of the hospital’s pharmacy, peering at expiration dates. As the pharmacy’s assistant director, he carefully manages how the facility orders and dispenses drugs to patients. Running a pharmacy is like working in a restaurant because everything is perishable, he says, “but without the free food.”

Federal and state laws prohibit pharmacists from dispensing expired drugs and The Joint Commission, which accredits thousands of health care organizations, requires facilities to remove expired medication from their supply. So at Newton-Wellesley, outdated drugs are shunted to shelves in the back of the pharmacy and marked with a sign that says: “Do Not Dispense.” The piles grow for weeks until they are hauled away by a third-party company that has them destroyed. And then the bins fill again.

“I question the expiration dates on most of these drugs,” Berkowitz says.

One of the plastic boxes is piled with EpiPens — devices that automatically inject epinephrine to treat severe allergic reactions. They run almost $300 each. These are from emergency kits that are rarely used, which means they often expire. Berkowitz counts them, tossing each one with a clatter into a separate container, “… that’s 45, 46, 47 …” He finishes at 50. That’s almost $15,000 in wasted EpiPens alone.

In May, Cantrell and Gerona published a study that examined 40 EpiPens and EpiPen Jrs., a smaller version, that had been expired for between one and 50 months. The devices had been donated by consumers, which meant they could have been stored in conditions that would cause them to break down, like a car’s glove box or a steamy bathroom. The EpiPens also contain liquid medicine, which tends to be less stable than solid medications.

Testing showed 24 of the 40 expired devices contained at least 90 percent of their stated amount of epinephrine, enough to be considered as potent as when they were made. All of them contained at least 80 percent of their labeled concentration of medication. The takeaway? Even EpiPens stored in less than ideal conditions may last longer than their labels say they do, and if there’s no other option, an expired EpiPen may be better than nothing, Cantrell says.

At Newton-Wellesley, Berkowitz keeps a spreadsheet of every outdated drug he throws away. The pharmacy sends what it can back for credit, but it doesn’t come close to replacing what the hospital paid.

Then there’s the added angst of tossing drugs that are in short supply. Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available. He holds up a purple box of atropine, which gives patients a boost when they have low heart rates. It’s also in short supply. In the federal government’s stockpile, the expiration dates of both drugs have been extended, but they have to be thrown away by Berkowitz and other hospital pharmacists.

The 2006 FDA study of the extension program also said it pushed back the expiration date on lots of mannitol, a diuretic, for an average of five years. Berkowitz has to toss his out. Expired naloxone? The drug reverses narcotic overdoses in an emergency and is currently in wide use in the opioid epidemic. The FDA extended its use-by date for the stockpiled drugs, but Berkowitz has to trash it.

On rare occasions, a pharmaceutical company will extend the expiration dates of its own products because of shortages. That’s what happened in June, when the FDA posted extended expiration dates from Pfizer for batches of its injectable atropine, dextrose, epinephrine and sodium bicarbonate. The agency notice included the lot numbers of the batches being extended and added six months to a year to their expiration dates.

The news sent Berkowitz running to his expired drugs to see if any could be put back into his supply. His team rescued four boxes of the syringes from destruction, including 75 atropine, 15 dextrose, 164 epinephrine and 22 sodium bicarbonate. Total value: $7,500. In a blink, “expired” drugs that were in the trash heap were put back into the pharmacy supply.

Berkowitz says he appreciated Pfizer’s action, but feels it should be standard to make sure drugs that are still effective aren’t thrown away.

“The question is: Should the FDA be doing more stability testing?” Berkowitz says. “Could they come up with a safe and systematic way to cut down on the drugs being wasted in hospitals?”

Four scientists who worked on the FDA extension program told ProPublica something like that could work for drugs stored in hospital pharmacies, where conditions are carefully controlled.

Greg Burel, director of the CDC’s stockpile, says he worries that if drugmakers were forced to extend their expiration dates it could backfire, making it unprofitable to produce certain drugs and thereby reducing access or increasing prices.

The 2015 commentary in Mayo Clinic Proceedings, called “Extending Shelf Life Just Makes Sense,” also suggested that drugmakers could be required to set a preliminary expiration date and then update it after long-term testing. An independent organization could also do testing similar to that done by the FDA extension program, or data from the extension program could be applied to properly stored medications.

ProPublica asked the FDA whether it could expand its extension program, or something like it, to hospital pharmacies, where drugs are stored in stable conditions similar to the national stockpile.

“The Agency does not have a position on the concept you have proposed,” an official wrote back in an email.

Whatever the solution, the drug industry will need to be spurred in order to change, says Hussain, the former FDA scientist. “The FDA will have to take the lead for a solution to emerge,” he says. “We are throwing away products that are certainly stable, and we need to do something about it.”

This story was co-published with NPR’s Shots blog. Written BY: Marshall Allen

Article Source: https://www.propublica.org/article/the-myth-of-drug-expiration-dates

 

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Benefits Of Swearing: Saying Curse Words Makes You Stronger, Numb To Pain, And More Trustworthy

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We may have been taught to keep swearing to a minimum, as it’s seen as rude and vulgar, new research suggests that in certain situations, swearing may be advantageous. The research found that swearing out loud can actually make you stronger, adding to the many surprising benefits of this offensive behavior.

The study, presented at this year’s annual conference of The British Psychological Society, found that volunteers were able to produce more power and had a stronger handgrip when they swore out loud. However, closer examination revealed that swearing did not have an effect on heart rate, suggesting another reason for this sudden increase in strength.

“So quite why it is that swearing has these effects on strength and pain tolerance remains to be discovered,” explained study author Dr. Richard Stephens in a statement. “We have yet to understand the power of swearing fully.”

For their study, Stephens and his team from Keele University and Long Island University Brooklyn had 29 volunteers complete a test of anaerobic power, a measurement of physical effort during a short period of time where an individual will go “all out.” For the study, the anaerobic exercise consisted of a short intense period on an exercise bike. Volunteers did this bike exercise both after swearing and after not swearing to measure differences in strength. In a second experiment, 52 volunteers were asked to complete an  isometric handgrip test, a physiological test done to increase arterial pressure. Results revealed that swearing resulted in more strength in both experiments.

Surprisingly, increased strength is not the only benefit of swearing, as past research has also shown that swearing helps to reduce pain. According to a 2009 study, swearing triggered higher aggression and a “fight-or-flight” response. In turn, this led to increased heart rate and higher adrenaline, both of which help to numb pain. Although it’s not clear why some words have more physical power than others, researchers suggest it has to do with the high level of emotion tied to swear words. These emotional ties have a stronger physical reaction than other words in your vernacular.

Honesty is also another positive side effect of swearing, as research suggests that people are more trusting of speakers that use more swear words in their speech. According to The Independent, this may be tied to speech patterns. Liars are more likely to use third-person pronouns and negative words in their speech, where honest individuals prefer profanity. This may be because swearing is used to express yourself, and those who swear more regularly are thought to portray their true selves to others.

Source: Stephens R, Spierer D, Katehis E.Effect of swearing on strength and power performance. British Psychological Society annual conference. 2017

 

Written By: Dana Dovey

Article Source: http://www.medicaldaily.com/benefits-swearing-saying-curse-words-makes-you-stronger-numb-pain-and-more-416927

 

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Fitness Tips for 50-Plus

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Upping your daily activity level at 50-plus is more manageable when you follow these fitness tips from a Johns Hopkins fitness expert.

One of the most important reasons to exercise at 50-plus is to keep your weight in check.

By maintaining a healthy weight, you lower your blood pressure and decrease your risk of heart disease, diabetes and arthritis, says Johns Hopkins sports medicine expert Raj Deu, M.D.

Inspired to break a sweat? Before you grab your water bottle and gear bag, keep these six fitness tips in mind.

DOs

1. Strength train.

Muscular strength declines with age, so strength training is key for maintaining strength and preventing muscle atrophy at 50-plus. “Strength training has also been shown to help with bone density,” says Deu, “and that decreases the rate at which bone breaks down, which is important for reducing the risk of fractures later in life.”

2. Get an exercise partner.

“If you work out with a friend or your spouse, you generally tend to exercise more regularly because you have that person to coax you,” says Deu. “Even owning a dog will get you out and walking.”

3. Stretch regularly.

As our bodies age, our tendons get thicker and less elastic. Stretching can counter this and help prevent injury at 50-plus. Remember to stretch slowly; do not force it by bouncing.

DON’Ts

1. Start exercising without your doctor’s blessing.

Consult your health care provider if you have underlying health risks such as a cardiovascular, metabolic or renal disease. Inactive individuals who are healthy do not need an evaluation but are recommended to start slow and progress gradually. If you have any concerns or are unsure how to start, consult your physician, says Deu.

2. Sign up for an expensive gym.

If you’re on a budget, you can get plenty of exercise at home. Great fitness tips: Moderate time spent walking, gardening and even vacuuming all count as exercise. A modest investment in dumbbells and exercise bands will also allow you to do strength training at home.

3. Focus on cardio only.

While cardiovascular exercise is important, so is stretching and strength training (see the “Dos” for details) as well as core strength and balance exercises. Deu likes tai chi, Pilates and certain kinds of yoga for working on balance and core strength at 50-plus, which will help support and protect your spine and may help prevent a future fall.

TRY IT
Sit Less, Move More

Knowing you should exercise more can feel daunting, especially when you’re just starting out. Some people don’t feel they can fit in the full amount of physical activity their doctor recommends—and they give up on moving altogether. “But those recommendations are just guidelines,” says Johns Hopkins expert Kerry Stewart, Ed.D. “It doesn’t have to be all or nothing. Try to focus on being less sedentary rather than more active. For example, you do not have to reach the goal of 10,000 steps per day in a week, but this should be the goal to reach over two to three months.”

Research shows that sitting still for long periods of time can cancel out the effects of 30 minutes of exercise. “There’s good evidence that being too sedentary, such as prolonged time in front of a TV, is perhaps as harmful to your heart health as not formally exercising at all,” Stewart says. Prolonged inactivity is linked to obesity and diabetes, even in people who are active for part of the day.

Yes, daily exercise is important, but so is regularly getting up and just moving around throughout the day, Stewart says.

Article Source: http://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/fitness-tips-for-50-plus?utm_medium=social&utm_source=Twitter&utm_campaign=Health&utm_term=FitnessTipsfor50-Plus&utm_content=HealthyAging

 

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Scientists challenge recommendation that men with more muscle need more protein

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Sports nutrition recommendations may undergo a significant shift after research from the University of Stirling has found individuals with more muscle mass do not need more protein after resistance exercise.

Health and exercise scientists from Scotland’s University for Sporting Excellence found no difference in the muscle growth response to protein after a full body workout between larger and smaller participants.

Kevin Tipton, Professor of Sport, Health and Exercise Science in the Faculty of Health Sciences and Sport, said: “There is a widely-held assumption that larger athletes need more protein, with nutrition recommendations often given in direct relation to body mass.

“In our study, participants completed a bout of whole-body resistance exercise, where earlier studies — on which protein recommendations are based — examined the response to leg-only exercise. This difference suggests the amount of muscle worked in a single session has a bigger impact on the amount of protein needed afterwards, than the amount of muscle in the body.”

Experts also found participants’ muscles were able to grow and recover from exercise better after a higher dose of protein.

Consuming 40 grams of protein after exercise was more effective at stimulating muscle growth than 20 grams. This increase occurred irrespective of the size of the participants.

Professor Tipton continued: “Until now the consensus among leading sports nutritionists, including the American College of Sports Medicine and the British Nutrition Foundation, is that weightlifters do not need more than around 25 grams of protein after exercise to maximally stimulate the muscle’s ability to grow.

“In order for nutritionists to recommend the correct amount of protein we first need to consider specific demands of the workout, regardless of athletes’ size. This throws commonly held recommendations into question and suggests the amount of protein our muscles need after exercise may be dependent on the type of workout performed. These results are limited to younger, trained men so we may see different results with other groups, such as older individuals or females digesting different amounts of protein.”

Young, resistance-trained males were recruited for the study and divided into two groups, one with lower lean body mass of less than 65 kilograms and one with higher lean body mass of more than 70 kilograms.

Each volunteer participated in two trials where they consumed protein after resistance exercise. In one trial participants consumed 20 grams of whey protein and in the second, they consumed 40 grams of whey protein after exercise. Scientists measured the muscle’s ability to grow at an increased rate with metabolic tracers and muscle biopsies.

Article Source: http://www.eurekalert.org/pub_releases/2016-08/uos-scr082216.php

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Today’s men are not nearly as strong as their dads were

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You’re dad might have told you about his younger days when men were men. And he might not be wrong.

A new study suggests millennial men may have significantly weaker hands and arms than men the same age did 30 years ago.

The study was published in the Journal of Hand Therapy.

Researchers measured the grip strength (how strongly you can squeeze something) and pinch strength — between two fingers — of 237 healthy full-time students aged 20 to 34 at universities in North Carolina. And especially among males, the reduction in strength compared to 30 years ago was striking.

The average 20-to-34-year-old today, for instance, was able to apply 98 lbs of force when gripping something with his right hand. In 1985, the average man could squeeze with 117 lbs of force.

Grip strength isn’t quite the same thing as benching 200 lbs or doing a set of squats. But researchers have found it to be a great predictor of a lot of other strength and health related outcomes. So it’s a useful proxy for overall muscular strength.

The participants in the North Carolina study were recruited only from college and university settings, so they’re not representative of the population as a whole.

But it matches the findings of other similar studies.

A 2013 study found that American children today are less physically fit than they were 30 years ago.

– with files from The Washington Post

Article Source: http://www.calgarysun.com/2016/08/15/todays-men-are-not-nearly-as-strong-as-their-dads-were?utm_source=facebook&utm_medium=recommend-button&utm_campaign=Today%27s+men+are+not+nearly+as+strong+as+their+dads+were

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Nitrate In Beetroot Juice Gives Elite Athletes Competitive Edge, Among Other Health Benefits

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Before a workout, many of us will drink smoothies and eat protein bars to up our carbs and protein intake. These pre-workout snacks are meant to give us the energy and stamina to get more from our routines and boost our recovery time. Now, a recent study published in the International Journal of Sport Nutrition and Exercise Metabolism suggests adding some nitrate-rich beetroot juice to our workout plan can enhance our stamina, strength, and endurance.

In the two-part study, Dr. Peter Peeling from the School of Sport Science, Exercise and Health at the University of Western Australia and his colleagues, looked at the influence beetroot supplements had on physiological and performance outcomes in a group of elite kayakers. The performance of six national-level male kayakers was measured in laboratory-based four-minute ergometer tests. For the evaluation of female athletes, five international-level female kayakers competed in a field-based kayaking time trial. The men consumed a 70 milliliter (mL) beetroot supplement, while the women’s team drank a double shot (140mL) during a 500 meter time-trial.

The findings revealed the beetroot supplement had a small effect on how far the men could go, but improved the energy needed to maintain their speed by 5 percent. Meanwhile, the women’s team improved their overall performance by 1.7 percent. The more beetroot juice was consumed the better the athletes’ physical performance.

The researchers believe the relatively small performance changes that they recorded are “clearly relevant.” In the 2012 London Olympics, the margin between gold and silver medals in the Men’s K1-1000m and the Women’s K1-500m races was 0.3 percent and 1.0 percent, respectively.

The team attributes the boost to the inorganic nitrate content found in beetroot. Nitrate helped improve the efficiency of the processes that occur in the mitochondria, known as the cell’s energy factory. This means ATP, the molecule known as the cell’s energy currency, can rest during muscle activity due to less oxygen use. After drinking beet juice, the amount of oxygen, or oxygen cost, needed to sustain moderate exercise goes down.

Reducing the oxygen cost of any activity will help us endure more strenuous exercise for longer periods of time, according to the researchers. These results can extend beyond kayaking to any activity of a similar duration of two to four minutes, as well as cycling time trials up to 10 miles.

The benefits of beetroot juice may also have positive effects on our heart health. A 2013 study found a naturopathic approach can lower the risk of heart disease and metabolic syndrome (high blood sugar, high blood pressure, and high cholesterol). Beetroot juice can help establish healthy blood pressure levels.

The antioxidant-rich vegetable contains naturally occurring nitrates that increase nitric oxide, a molecule in the blood vessels. This helps open up the vessels to allow more oxygen flow as well as lower blood pressure. Previous studies have found inorganic nitrate and beetroot juice supplements were able to lower blood pressure by seven percent, and show systolic blood pressure (top number) to decrease the most.

So, should we eat or drink beets?

When it comes to lowering blood pressure, it’s best to drink beetroot to reap its maximum benefits. When a food, like beets, is cooked or fermented, the nutrients linked to good blood pressure diminish. However, when we juice beets, we are guaranteed to get all of the phytonutrients, or plant chemicals, linked to lower blood pressure.

The only side effects of beet juice are urine and bowel movements may produce a red color, but this is harmless. However, those whose bodies make oxalate kidney stones may want to avoid beets since they are high in oxalates.

Beets have become so popular, even in sports, that “seeing an athlete with red beetroot stained lips at an endurance event is no longer unusual,” said Peeling, in the statement.

Source: Peeling P, Cox GR, Bullock N et al. Beetroot Juice Improves On-Water 500 M Time-Trial Performance, and Laboratory-Based Paddling Economy in National and International-Level Kayak Athletes. Int J Sport Nutr Exerc Metab. 2015.

Article Source: http://www.medicaldaily.com/beetroot-juice-competitive-edge-elite-athletes-377860

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Simple Strength Test May Predict Heart Attack, Stroke

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Previous studies have suggested that reduced muscular strength, as can be measured by hand-grip strength, maybe linked to early death, disability, and illness.  The Prospective Urban Rural Epidemiology (PURE) Study investigators analyzed data collected on 139,691 adults, ages 35 to 70 years, residing in 17 countries, and followed them for an average of four years –  measuring hand-grip strength regularly through the study period. Data analysis revealed that every 5 kg declining grip strength associated with a 16% increase in risk of death from any cause, a 17% greater risk of cardiovascular death, and a 17% higher risk of non-cardiovascular mortality. Notably, heart attack risk rose by 7%, and stroke risk by 9%. In particular, a low grip strength was linked with higher death rates in people who develop cardiovascular and non-cardiovascular diseases, suggesting that muscle strength may predict the risk of death the people who develop a major illness. The study authors report that: “This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease.”

Source: http://www.worldhealth.net/news/simple-strength-test-may-predict-heart-attack-stro/

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