Ask Well: Walking vs. Elliptical Training

By GRETCHEN REYNOLDS

Q

How does a brisk two-mile walk compare to a two-mile run on an elliptical machine? How effective is exercise on an elliptical machine as a weight-bearing workout?

Reader Question • 941 votes

A

Walking and ellipticaling (which, if it is a word, should not be) are similar in some respects and quite different in others.

According to a number of recent studies, elliptical training results in greater activation of muscles in the buttocks and thighs than walking does, and less activation of muscles in the calf. Elliptical training also places greater strain on the lower back than walking because of how the muscles fire, a consideration for people with back problems.

It also involves less weight bearing. According to a study published this month in The British Journal of Sports Medicine, walking causes 112 percent of someone’s body weight to strike the ground with every step, while only 73 percent does in elliptical training. This slighter jarring is an advantage for people with sore joints, but less so for those who hope that exercise will improve bone health.

If, however, you wish to burn calories, walking and elliptical training seem indistinguishable. In an interesting 2010 study, college students were asked to complete two 15-minute sessions of exercise, one on a treadmill, the other on an elliptical machine. In both, they were instructed to maintain a pace that felt challenging but sustainable (the equivalent of a 4 or 5 on a 10-point scale of intensity). Throughout, the researchers monitored the volunteers’ energy consumption and found that it was the same regardless of which machine they were using. Only the intensity mattered — and you control that measure.

If your brisk walk feels less tiring than a session on the elliptical machine, pick up the pace; or alternatively, dial up or down the resistance on the elliptical machine.

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F.D.A. Approves Portable Drug Overdose Treatment

By SABRINA TAVERNISEAPRIL 3, 2014

The Food and Drug Administration on Thursday approved an emergency drug overdose treatment for use in homes and other community settings outside hospitals. Federal regulators said that the treatment, an injector filled with a medication that reverses the effects of an overdose, can fit in a pocket or medicine cabinet, and could help stem the rising number of drug overdoses.

The device, called Evzio, delivers a single dose of the drug naloxone through a hand-held device to treat someone who has stopped breathing or lost consciousness from an opioid drug overdose. Naloxone is the standard treatment for an overdose, but until now, has been available only in hospitals and other medical settings, when it is often too late for the patient.

Once turned on, the device would give verbal instruction to whoever was using it about how to deliver the medication, similar to automated defibrillators that hang in airports and other public buildings.

This is a big deal and I hope gets wide attention,” said Dr. Carl R. Sullivan III, director of the addictions program at West Virginia University. “Many people OD and die from opioids because naloxone is not immediately available to reverse the OD effects. I cannot really see a downside.”

But the new device seems likely to stir concern as well as hope among experts.“I’m worried that there will be a false sense of security” among drug users, said James Rathmell, chief of the division of pain medicine at Massachusetts General Hospital. "Like, ‘O.K., I’ve got a naloxone pen, we can party all we want, no one is going to die.'” But he added: “On the other hand, it’s a great drug. It’s extremely effective and the downside is very low.”

The drug epidemic has battered states across the country, with drug-induced deaths now outstripping those from traffic crashes. Prescription drugs have driven the epidemic, and account for more than half of all drug overdose deaths. One major category of prescription drugs, opioids, or painkillers, take the lives of more Americans than heroin and cocaine combined. Deaths from opioids have quadrupled in 10 years to more than 16,500 in 2010, according to federal data.

Deaths have continued to climb, despite efforts by states and the federal government. In January 2013, a panel of experts convened by the F.D.A. recommended that it tighten prescribing practices. Last September, the F.D.A. changed labeling requirements, proposing new language that indicates the drugs should be used only by patients who have no other treatment options for their pain.

Federal officials said Thursday that the new device may help reduce the death toll.

“Making this product available could save lives by facilitating earlier use of the drug in emergency situations,” said Dr. Bob Rappaport, director of the division of anesthesia, analgesia and addiction products in the F.D.A.'s Center for Drug Evaluation and Research. He said Evzio was the first drug-device product designed to deliver naloxone outside a health care setting.

Quick Gains After a Smoking Ban

The number of premature births and children’s hospital visits for asthmadropped significantly in parts of the United States, Canada, and Europe barely a year after they enacted smoking bans, researchers reported in The Lancet last week.

The new analysis combined the results of 11 studies encompassing more than 2.5 million births and nearly 250,000 asthma attacks. Experts called it the best evidence to date that legislation creating smoke-free public places and workplaces improves children’s health, even in the womb. The results are “very impressive,” said Dr. Brian Mercer, chairman of obstetrics and gynecology at MetroHealth Medical Center in Cleveland, who noted that half a million American babies are born prematurely each year.

“If you could prevent 10 percent, you’d prevent nearly 50,000premature babies in the U.S. alone each year,” said Dr. Mercer, who was not involved in the study.

Dr. Vincenzo Berghella, the president of the Society for Maternal-Fetal Medicine, said: “There are over a million babies dying of being born preterm every year in the world. We can make major strides in decreasing that with smoking bans.”

After an exhaustive review of relevant studies spanning 38 years, the researchers analyzed five that looked at perinatal and child health after local smoking bans in North America and six studies conducted after national bans in Europe. Hospital visits for childhood asthma and premature births both declined about 10 percent in the year after smoking bans took effect, the researchers found.

The investigators also pooled data from two studies and found a 5 percent reduction in the number of children born very small for their gestational age after the introduction of smoke-free laws.

An earlier analysis of the impact of smoking bans on adult healthdemonstrated a 15 percent reduction in cardiovascular events. The new report offers “another very good reason to institute smoking bans in public places,” said Dr. Muktar Aliyu, an associate professor of health policy and medicine at Vanderbilt University who has studied birth outcomes linked to maternal smoking. Only 16 percent of the world’s population is covered by comprehensive smoke-free laws, and 40 percent of children worldwide are routinely exposed to secondhand smoke.

Growing up, Dr. Aliyu said, he stifled coughs as his father smoked in the car. “Adults can just walk away or change their environment,” he said. “A child can’t.”

Despite fears that bans could lead to more smoking at home, studies have shown the opposite is true.

“Strong smoke-free laws change social norms about smoking, and consequently people implement smoke-free policies in their own homes as well,” said Joanna Cohen, the director of the Institute for Global Tobacco Control at the Johns Hopkins University School of Public Health. That’s probably how “smoke-free policies have such a direct impact on child health,” she added.

A 2006 surgeon general’s report declared that any amount of secondhand smoke was dangerous. Yet “we are still not doing a good enough job at protecting our children from secondhand smoke,” Dr. Cohen said. About half of Americans are protected by complete smoke-free policies in workplaces, restaurants and bars, according to the Americans Nonsmokers’ Rights Foundation, a nonprofit group. In a commentary accompanying the new report, its authors argue that strong tobacco control policies are a way to contain medical costs now, not in a decade or two, as experts used to think.

Medical expenses for asthma exceeded $50 billion nationwide in 2007. So even a 10 percent decrease in emergency-room visits for asthma could translate into roughly a $5 billion savings, said Dr. Sara Kalkhoran, an internist at the University of California, San Francisco, and a co-author of the commentary.

The new analysis did not prove that smoke-free laws caused the improvements in children’s health. And the researchers didn’t evaluate other factors, like taxation of tobacco products and advertisement bans, which could have contributed, said Dr. Catherine Y. Spong, the director of extramural research at National Institute of Child Health and Human Development.

“We can’t say that every country that does this, that it will help to this degree,” she said, referring to smoking bans in public places. But this “very well-done analysis” again demonstrated “the importance of limiting exposure to smoke for pregnant women and children,” she said.

The authors note that further studies are needed to estimate the effect of smoke-free laws on respiratory tract infections in children, a major problem of secondhand smoke. The authors also cite a “pressing need” for studies of tobacco control laws in low- to middle-income countries.

“Our hope is that this kind of work will catalyze the introduction of smoke-free laws, and as that is done, the opportunity is taken to evaluate their impact and strengthen the evidence,” said Dr. Aziz Sheikh, the senior author of the paper and a health care policy fellow at Brigham and Women’s Hospital in Boston.

Still, Dr. Sheikh and his co-authors concluded, “It is now evident that early-life protection from involuntary secondhand smoke exposure holds great potential to reduce the consequential disease burden.”

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How Safe Is Splenda (Sucralose)?

Splenda (sucralose) is being downgraded from "safe" to "caution" after an Italian animal study linked sucralose to a higher risk of developing leukemia. The Center for Science in the Public Interest (CSPI) says it awaits the Italian study's review before deciding what long-term safety grade to assign to Splenda in its Chemical Cuisine guide to food additives.

Hundreds of millions of people globally use artificial sweeteners, which are commonly found in a wide range of food and drinks, including food for diabetes, cakes, milkshakes, soft drinks, and even medications.

The steadily growing problem of obesity and type 2 diabetes in developed and middle income countries has led to rising demand for reduced-calorie foods and drinks. However, the growth of the artificial-sweetener market has brought with it concerns among consumers regarding the potential health consequences.

Italian study linked a lifetime of sucralose consumption to leukemia risk

Dr. Morando Soffritti, director of the Ramazzini Institute in Bologna, Italy, and team fed 843 laboratory mice varying doses of sucralose from when they were fetuses until they died.

Post-mortems showed an association between leukemia risk and lifetime sucralose consumption - the more sucralose they consumed, the higher their risk of leukemia.

Dr Soffritti said:

"Our early studies in rats showed increases in several types of cancer, and, in our most recent aspartame studies, we observed a statistically significant increase of liver and lung tumors in male mice. This shows aspartame causes cancer in various places of the body in two different species. Health concerns over aspartame are leading consumers to switch to the widely promoted alternative: sucralose.

Now that we have found evidence of a link between sucralose and cancer in mice, similar research should be urgently repeated on rats, and large scale observational studies should be set up to monitor any potential cancer risk to human health."

Dr Soffritti says that children and pregnant mothers should avoid consuming artificial sweeteners until appropriate studies clearly show there is no cancer risk.

On an online communiqué, CSPI added that the only long-term feeding studies on sucralose in animals, before the Italian one, were conducted by Johnson & Johnson, the makers of Splenda.

As things stand at the moment, these are the gradings CSPI gives to artificial sweeteners:

• Splenda - caution
• Saccharin - avoid
• Aspartame - avoid
• Acesulfame potassium - avoid
• Rebiana - safe

CSPI adds that it would be useful to have further testing done on rebiana.

CSPI executive director Michael F. Jacobson, said:

"Sucralose may prove to be safer than saccharin, aspartame, and acesulfame potassium, but the forthcoming Italian study warrants careful scrutiny before we can be confident that the sweetener is safe for use in food."

Diet sodas probably still better than regular ones

Even though concerns exist regarding the health risks associated with artificial sweeteners, CSPI believespeople are better off drinking diet rather than regular sugar-sweetened sodas. The CSPI says that the health consequences from regularly drinking sugar-laden soft drinks, which include obesity, gout, tooth decay, heart disease, and type 2 diabetes, are probably greater.

Water is best - soft drinks with any kind of natural or artificial sweetener commonly contain food dyes and caramel coloring that are contaminated with 4-methylimidazole, a carcinogen. CSPI encourages consumers to drink water, seltzer water (soda water, effervescent mineral water), flavored unsweetened waters, unsweetened iced tea, or seltzer mixed with natural fruit juice.

New sweeteners enter CSPI's Chemical Cuisine guide

CSPI has included some new natural sweeteners in its Chemical Cuisine guide:

• Monkfruit extract (also known as Luo Han Guo or Lo Han Kuo) - contains mogrosides. Mogrosides are 200 times sweeter than sugar. However, they can leave a licorice-like aftertaste. Monkfruit extract currently has a "caution" rating because it has not been tested scientifically.


• Monatin - derived from a South African shrub. Monatin is said to be 3,000 times sweeter than sugar. Monatin currently has a "caution" rating because it has not been tested scientifically.

Sucralose is about 600 times as sweet as table sugar (sucrose), three times as sweet as aspartame, and twice as sweet as saccharin.

Written by Christian Nordqvist from Medical News Today.

---

• References

"CSPI Downgrades Splenda From 'Safe' to 'Caution'"
Center for Science in the Public Interest