Just Walk
Just WalkIssue No.
Greetings!

Good morning! How's your week going? With the weather improving a lot of our patients have that little smile. That smile showing they're getting ready to do a lot of walking, biking, hiking, etc. We love that smile.

Have you ever had something that you wanted really bad? Maybe an article of clothing? or a gadget ? We know exactly how you feel. There's something we want really bad this week:
Peyton Manning.
We are sharing this with you first before our press conference, at 3:30 later today (yet one more benefit of the newsletter).

Walk with a Doc is officially entering the Peyton Manning race.

For those unaware, Peyton was released by the Indianapolis Colts on Wednesday, after 14 great years with their organization. While he has had multiple procedures to his neck, Peyton is healthy, and, most importantly, still has the fire in his belly.
I have just left our practice facilities after an all-night meeting with our Director of Personnel, Chairman of the Budget Committee, our Head Equipment Guy, 7 of our HR staff, and our SVP of Media Relations. As we built our case, we found we hold a distinct advantage over the Miami Dolphins, Arizona Cardinals, NY Jets, and 9 or so other teams. Here's why:
1. We have plenty of room under the salary cap (thank you Kathryn for adjusting your contract structure to make room).
2. Less physicality in practice (Peyton will soon be 36, that's 78 in NFL years).
3. No one is expecting us to contend for the 2013 Super Bowl (we've got 'em right where we want them).
4. Opportunity to play in 52 different cities and 4 different countries (NFL has only 1 country)
5. Willing to give up my corner office (sorry Mr. Quarterback, I'm keeping Buzz & Woody)
6. No one currently wears the #18
7. Plenty of readily available medical staff
8. We play the Colts twice in 2012
9. Playbook is downright easy (left, right, left, right, repeat)
10. Walking (with a Doc) dramatically reduces heart disease, cancer, diabetes, blood pressure, weight gain, depression, anxiety, and 40 other diseases.
11. Plenty of media/commercial opportunities  

While it's likely going to be another week until you choose, we remain quite optimistic you will make the right decision, Peyt (that's what I call him, Peyt).   

 

Citrus reduces stroke risk

By Laura Martin MD -- Researchers have identified a compound found in oranges, grapefruits, and other citrus fruits that may lower a woman's stroke risk.

Previous studies suggest that eating fruits and vegetables helps protect against strokes, and many believe that antioxidant compounds known as flavonoids may explain why, because they have been shown to improve blood vessel function and they have anti-inflammatory effects.

Among other things, flavonoids give fruits and veggies their vibrant colors. They are also found in chocolate and red wine. By some estimates there are more than 5,000 of them.

In the newly published study, flavonoids abundant in citrus fruits known as flavanones appeared to give the most protection against stroke.

 

Women whose diets included the highest amount of flavanones had a 19% lower risk of suffering a blood-clot-related stroke than women with the lowest intake of the compound.

"Our study supports the conclusion that flavanones are associated with a modest reduction in stroke risk," says researcher Kathryn M. Rexrode, MD, MPH, of Boston's Harvard Medical School and Brigham and Women's Hospital.


Along with researchers from Norwich Medical School in the United Kingdom, Rexrode and Harvard colleagues attempted to better understand the impact of six specific subtypes of flavonoids on stroke risk.

They did this by analyzing 14 years of follow-up data on nearly 70,000 female nurses participating in a nationwide women's health study.

At enrollment and every four years thereafter, the women were asked to fill out questionnaires detailing the foods they ate.

Among the different subtypes of flavonoids, higher flavanone intake mainly from citrus fruits was specifically associated with a lower risk.

Women whose diets included the most oranges, and orange and grapefruit juices, had the lowest stroke risk.

The study appears in the April issue of the American Heart Association journal Stroke.

Public Health Message Not Simple

Rexrode says more research is needed to confirm the findings.

"I would certainly not recommend that anyone take flavanone supplements based on this research," she says.

The public health message is further complicated by the fact that grapefruit juice and fresh grapefruit can sometimes cause dangerous interactions with medications commonly prescribed to lower heart attack and stroke risk.

For example, drinking grapefruit juice can increase the risk for liver problems associated with the use of cholesterol-lowering statin drugs.

Grapefruit juice can also increase concentrations of certain blood pressure drugs, raising the risk for side effects.

Pennsylvania State University professor of nutrition and American Heart Association spokesperson Penny Kris-Etherton, PhD, says the study reinforces the public health message that eating a diet rich in a variety of fruits and vegetables protects against heart and blood vessel disease.

She recommends getting the benefits of citrus from the whole fruits instead of juices to limit sugar and calories.

"This is very provocative research which suggests that including citrus fruits in your diet could lower stroke risk," she says.


 

Important Grapefruit Interaction Facts (I.G.I.F.)

*We received this valuable communication from Sharon Thompson, Pharm D., Pharmacy Clinical Coordinator at Mt. Carmel St. Ann's
**We want to stress - this is our opinion, please check with your doctor for their take, because we are all different (that's what makes us special) 

 

There are still misconceptions about grapefruit juice interactions.

     We've known for years that grapefruit inhibits CYP3A4 and P-glycoprotein in the gut...and that this increases levels of some calcium channel blockers (felodipine, etc), statins (lovastatin, simvastatin), anti-arrhythmics (amiodarone), and others. 
     But misunderstandings still cloud the best way to handle this. 
     Separating grapefruit from the interacting drug by a couple of hours does NOT seem to help. It takes up to 3 days for CYP3A4 enzymes to recover after drinking grapefruit juice. 
     Eating a grapefruit instead of drinking the juice will NOT avoid the interaction. Despite rumors to the contrary, the interacting substances are also in the fruit itself. 
     Predicting how much grapefruit is too much is tough.  
     Just 8 oz of juice...or one grapefruit...may affect drug levels.  
     But whether this increase will matter depends on the patient... the drug...and the disease. 
     Adjusting the drug dose to minimize the interaction is not smart. It's too hard to guess the extent of the interaction. 
     Instead, advise patients to avoid grapefruit, or try an alternative drug that doesn't interact. For example, suggest pravastatin or rosuvastatin instead of lovastatin or simvastatin. 
     Drugs given IV aren't likely to be affected...grapefruit primarily affects intestinal, not hepatic, enzymes. 
     And reassure patients that most other citrus fruits are okay...including most oranges, lemons, and tangerines.

 

 

About Us
Walk with a Doc is about making ourselves and others happy through regular exercise, and rarely by tickling.
 
Thank you!
Why do you put up with us? Ugh, we love it that you do. 150 minutes of exercise will be a breeze this week. You want more than that? Feel free - the more the better.
Have a great weekend and we will see you on the flip-side.
Stay hungry and stay foolish.
david
Please click here for this weekend's walks and times

*Due to this week's time change, there will be no 'official' walk at Polaris this Saturday

 

In This Issue
Citrus Reduces Stroke
IGIF
Ruby Reds
Inside Walk HQ this week

What we're listening to: Radio Head, The Fray, and Matisyahu

What we're reading: Narrative of the Life of Frederick Douglass

Favorite App: My Fitness Pal

Cities we're having fun with: Cincinnati, Boston, Dubai, Chennai, Plant City (FL), Sandusky (OH), Pittsburgh, and <fortunately> some others.

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