News You Can Use
From
Janet Alexander and Chris Maund
April 2012  
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MDS 2012
Firstly an apology for the fact that April is almost over and the newsletter only just came out. We have been in Morocco having another crack at Marathon des Sables. You remember this madness, right? 155 miles of running/walking spread over 7 days all while carrying a back pack full of food for the entire race and a sleeping bag, compass, map, parachute flare, knife, anti venom pump, first aid/blister kit....you get the picture. Did we mention it's in the Sahara Desert? Look on the bright side...nobody is shooting at you. That's probably why so many soldiers enter this race!
Secondly, if you recently received an e-mail about a hip/knee workshop and really do NOT want to get any more e-mails like that please unsubscribe from our WORKSHOP list. That way you can still be on our NEWSLETTER list but off our WORKSHOP list. You'll see these two options when you click on UNSUBSCRIBE.
Updating your preferences like this should be a one time deal.
Getting Your Priorities Sorted...
Differentiating Wants and Needs
In today's world it's all too easy to get stressed and wound up over little things that really, in the grand scheme of things, do not matter at all. Having just spent 3 weeks in Morocco, including 9 days camping out under the stars in the Sahara desert, we came to the conclusion (as we always do in these situations) that all a person really NEEDS is clean water to drink, enough food to ensure you are not starving hungry every day and somewhere safe to sleep at night. Now that word "safe" is an interesting one. We're sure that many people (mainly Westerners!) would not regard camping alone in a sand dune in the middle of the Sahara as "safe". Throw in the distinct possibility of a scorpion crawling into your sleeping bag during the night in search of somewhere warm and cosy, and "down right dangerous" might seem a better description for most of you. But safety is a relative thing...if you have spent time in Iraq or Afghanistan recently then your perception of just how "dangerous" that scorpion is would be quite different from the average.
Westerners often confuse wants and needs. Do you really NEED a brand new car every 3 years...of course not. How about that new set of golf clubs or that fancy outfit that you saw at the mall last week? When you consider that the average family of 4 in Nairobi lives in a 10 foot by 10 foot room, what does that say about your perceived NEED for a 3,000 square foot house? Be thankful for the basics and don't get wound up over the rest of it...it's not worth it. Take a week off work and go and live in the mountains...completely "off the grid"...there is no faster way to get your priorities sorted.  
Making Sense Of Blood Tests Part 4      
Last month we covered C-reactive protein, creatine kinase and ferritin. In this newsletter we'll go over white blood cell count, haemoglobin A1C and 25 hydroxy vitamin D.

An elevated white blood cell count usually indicates an acute (recently acquired) infection. We don't see this type of thing very often as you are usually quite ill and in need of urgent medical attention. What we see quite frequently is a low white cell count. This also indicates infection but it reflects a chronic situation i.e. an infection that you have had for years...sometimes decades. This could be a parasite, a bacteria or a virus. Your body cannot maintain an elevated white cell response indefinitely and over time an adaptation occurs where the white cell count comes down and ends up lower than "normal". The typical causes for a chronically depressed white blood cell count are parasites, h. pylori (a bacterial infection that compromises your ability to digest red meat and other protein foods) and viruses like Epstein Barr. Additional, more specific testing is needed to identify the exact cause.

Haemoglobin A1C (HbA1C) is by far the best way to determine how effectively you are controlling your blood sugar levels. This test measures the degree of damage to red blood cells created by fluctuating blood sugar levels. If you eat too much carbohydrate i.e. things like grains, baked goods, bread, pasta, jams, fruit juices, candies and chocolate then your haemoglobin A1C will reflect this. If your reading is over 6% then you meet one of the diagnostic criteria for type 2 diabetes...this is not good! It is now possible to buy HbA1C meters and test strips from pharmacies without a prescription. Here in the US these meters cost about $35. If you have too much body fat around your belly (another sure sign of poor glycemic control) then you can bet that your HbA1C reading is on the high side. Gradually reduce the carbohydrates in your diet and gradually increase the meat, fish, eggs, poultry and fats. Re-test HbA1C every 4 weeks until you see the reading fall below 5.5 or you see clearly defined abdominal muscles in the mirror!

25 hydroxy vitamin D is the test that currently represents the gold standard for assessment of vitamin D status. Don't confuse it with the 1,25-dihydroxy vitamin D test...that's not the test you want. Make sure you get the right test. Your body makes vitamin D when sunlight gets on your skin. The problem is that most Westerners spend way too much time indoors and even when they do go outside they are so paranoid about the "dangers" of the sun that they cover every square inch of their bodies with either clothing or an impenetrable layer of sunscreen. For these reasons very few of us have optimal levels of vitamin D...yet another reason to "go native" and live outdoors from time to time.
Low levels of vitamin D are associated with an increasingly long list of health problems. In fact, the list is so long that we recommend you read the Wikipedia entry for vitamin D and go to www.vitamindcouncil.org to get a sense of just how many health problems are associated with sub optimal vitamin D levels. Only a few years ago it was thought that if your vitamin D was 30ng/mL or more then you were "healthy" but almost every year this "healthy" target has been revised upwards as better data becomes available. You should aim for an absolute MINIMUM of 50ng/mL and some experts are now looking for at least 60ng/mL. We predict that this number will rise again in the next 2-3 years as more information becomes available.
By far the best way to increase your vitamin D levels is to get outside and get sunlight on your skin on a daily basis. Stop short of creating sunburn of course! Unless you live somewhere that is hot and sunny all year round you will also need to take a supplement. There are two common forms of vitamin D, vitamin D2 or ergocalciferol and vitamin D3 or cholecalciferol. Make sure you take the D3 form.
That's it for April...next month we'll discuss how you go about embarking on a strength training program and some ways you can improve your posture.