Toning upper arm “flab”

An eDoc client recently wrote in asking about ways to reduce excess fatty tissue in the upper arm region that she referred to as “chicken cutlets”. Several factors should be taken into consideration in regard to firming the upper arms:

1. Is overall weight reduction needed? If general weight reduction is needed, improvement in overall weight will also be reflected in the upper arm region. To lose fat anywhere on your body you need to burn calories by following a program that involves both cardiovascular
   training and weight training. In doing so, you will decrease fat stores throughout your entire body, including the problem areas. Sometimes following a significant weight loss, people have problem areas that won't go away despite aerobic and toning exercises. In these cases, consideration may be given to body contouring plastic surgery.
   
2. It’s hard to fight genetics. You have to consider the effects of genetics on your body composition since it is very difficult to change something that has been genetically programmed. This means that some people may carry more fat in certain locations that they would like even with overall weight loss. And unfortunately, “spot reduction”, or losing weight in a specific area of the body is almost impossible to achieve. Sit-ups, for example, will definitely strengthen your abdominal muscles, but sit-ups alone will not get rid of the layer of fat that is covering the muscles. Everyone is a structured differently, and achieving a “movie star” physique may simply be unrealistic.
   
3. Exercise to help “tone” the upper arms. As mentioned previously, exercising a specific area of the body in order to decrease the amount of fat just doesn’t work. Nevertheless, there are benefits to performing strengthening exercises, both for the body in general, as well as for the upper arms. “Toning exercises”, those that typically involve lighter weights and higher repetitions, can easily be performed at home with improvement in upper arm strength and endurance. Strengthening exercises can also help with overall weight reduction and in maintaining bone density. Here are a few example of simple upper arm exercises:

• Triceps kickbacks---Use a small dumbbell or some substitute (such as a can or bottle). Bend over at the waist, resting your hand on a chair, so that your back is flat. Grasping the weight in the other hand, bring your bent elbow up to your side and keep it there. This is the start position. Now, keeping your elbow close to your side, extend your arm back until the elbow is straight, then lower and repeat 12-15 times. Do two to three sets. As this gets to be too easy, increase the weight.
• Standing Biceps Curl with Dumbbells--- Stand with your feet shoulder-width apart and knees slightly bent, or sit in upright position. Grasp the dumbbells with an underhand grip (palms facing forward), arms hanging down at your sides. Flex at the elbows and curl dumbbells up to approximately shoulder level. Keep elbows close to the side throughout movement. Pick a weight that allows you to complete between 8 and 12 repetitions. Perform two to three sets of each exercise before moving on to the next exercise.
• Lying Triceps Extension with Dumbbells---Sit in an upright position on a flat bench. Rest the dumbbells on each thigh. Then lie on your back and bring the dumbbells to your chest. Press up so they are directly over your shoulders with your palms facing in. Lower dumbbells toward your forehead by bending elbows to 90° with the elbows remaining pointed forward.
• Bench dips---Sit up straight on the edge of your bed or a sturdy chair with your palms planted on each side of your hips and your feet flat on the floor. Move your feet slightly forward so your buttocks just clear the edge. Use your arms to lower yourself until your elbows are at 90 degrees and your upper arms are parallel to the floor. Then push yourself back up to starting position. Continue to raise and lower yourself 12-15 times for two to three sets.

While “spot reduction” of excess fat in the upper arm region is unlikely to be successful, overall weight loss and toning exercises can make a significant impact on the upper arm “jiggle factor”.

OTC Medications, Getting Too Much of a Good Thing

The availability of over-the-counter (OTC) medications, that at one time could only be obtained by prescription, has allowed thousands of people to treat minor illnesses on their own. This benefits consumers by avoiding unnecessary doctor visits and offering a less expensive alternative to
prescription drugs. It is important to remember, however, that just because a medication has become available without requiring a prescription, it still carries all of the risks that it had previously. It has been estimated that up to 200,000 Americans are hospitalized each year because of inappropriate use of OTC medications.

The blame for this inappropriate usage is due to a number of factors. Sometimes, the consumers using these medications do not carefully read the instructions for use. Doctors, not realizing that patients are taking certain OTC medications, may prescribe medications containing the same agent resulting in overdosage. Additionally, once a prescription medication becomes available OTC, manufacturers may be less conscientious about pointing out potential side effects when advertising their product.
In today’s Health Tip, we’ll look at some of the most commonly used OTC medications and risks involved if not taken appropriately.

Acetaminophen---(Tylenol, Dayquil, Midol, Excedrin, others) Acetaminophen is one of the most commonly taken medications. Taking too much at any one time, however, can have serious health consequences. In the U.S., overdosing on acetaminophen is the leading cause of acute liver failure. More than 600 prescription or OTC medications contain acetaminophen, so it is important to carefully read labels in order to see if you could be taking it from multiple sources. If an OTC form of acetaminophen is taken along with a prescription medication containing acetaminophen (Percocet, Vicodin, Lortab, others), one could quickly exceed the adult maximum of 4000 mg dosage per day.

Nasal decongestants (Afrin, Neo-Synephrine. others) These OTC nasal sprays work by constricting the blood vessels in the nose. This can be of great benefit with the common cold by reducing swelling, irritation and sniffling. Nasal decongestants are generally safe when used for only 3 to 4 days. Used longer than that, however, they can cause a condition in which the nasal passages become even more swollen that they were originally (rhinitis medamentosa). Also, in some people, overuse of nasal sprays can raise heart rate and blood pressure.

Ibuprofen ---(Advil, Motrin) Ibuprofen is in a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs) which also includes aspirin and Aleve (Naprosyn). When used for longer than necessary or at too high a dosage, NSAIDs can cause stomach ulcers or kidney problems. Children and teens under 18 should not take aspirin for a febrile illness because it has been linked with a rare but potentially fatal condition called Reye's syndrome.

Proton Pump Inhibitors (PPIs) (Prevacid, Prilosec, Zegerid) These OTC products are marketed primarily for treating frequent heartburn. Taking PPIs for a long period of time has been linked with an increased risk of osteoporosis and fractures, particularly involving the spine, hip, and wrist. Also the low-acid environment in the stomach caused by PPIs is linked to the development of vitamin B12 deficiency which can cause nerve damage.

Multisystem Cold Medications (Delsym Multi-Symptom, Tylenol Cold Multi-Symptom, Theraflu Multi-Symptom, others) The active ingredients in these products vary depending on the symptoms they are designed to treat. Most of them contain some combination of pain medication, decongestant, antihistamine, and/or cough suppressant. The decongestant (pseudoephedrine, phenylephrine, oxymetazoline, etc.) included in these medications can be a particular concern for people who have high blood pressure. As mentioned previously, with so many different medicines containing acetaminophen, care must be taken to avoid overdosing. Multisystem cold medications can simplify treatment of a cold, but in many cases it is better to direct treatment toward specific symptoms, e.g. gargling with salt water for sore throat or using a nasal decongestant for stuffy nose.

Many other OTC medications, including laxatives and antihistamines, pose risks when taken inappropriately. While their availability has been a benefit to medical consumers, it must be realized that like any other medication, OTC products also carry a risk for causing serious side effects.

Om, My Aching Back!—Yoga for relief of low back pain

According to a 2006 report released by the Centers for Disease Control (CDC), one in four U.S. adults say that they suffered a day-long bout of back pain in the past month, and 1 in 10 say the pain lasted a year or more. Standard treatment recommendations for acute low back pain currently include the use of medications (Tylenol, NSAIDs, muscle relaxers, etc.), advice to remain as active as possible, application of heat, and spinal manipulation (Chiropractic care). With this treatment, the great majority of cases of acute pain resolve with no long-term consequences. In some cases, however, the pain lingers and becomes chronic in nature.

What is chronic low back pain? The causes for chronic back pain—defined as pain that lasts more than three months—often remain unidentified with limited treatment options. Possible exceptions to this are when symptoms, such as fever, loss of bowel or bladder control, pain when coughing, or progressive weakness in the legs are present. Those symptoms could indicate that the chronic back pain is due to a serious condition, such as inflammatory arthritis, herniated disc, infection, fracture, or cancer. In the majority of cases, surgery is not thought to be an appropriate treatment option.

Since treatment options are limited for most chronic low back pain sufferers, many have turned to alternative and complementary therapies in search of relief. These therapies include acupuncture, spinal manipulation, Pilates, massage therapy, and yoga. While there is little evidence for the benefit of yoga in the management of acute lower back pain, there is a growing body of research supporting the use of yoga in the treatment of chronic back pain.

Which yoga practices appear to help? Yoga is a mind/body practice with historical origins in ancient Indian religion. Various schools of yoga exist, but most have in common the blending of meditative practices, breathing techniques and physical postures to achieve strength, flexibility, and inner peace. Many people practice yoga in order to maintain their health and well-being, improve physical fitness, and enhance their quality of life, but yoga also has an application in the treatment of specific health conditions such as chronic pain, anxiety, and hypertension. One type of yoga that has been evaluated specifically in the treatment of chronic low back pain is a method based on the teachings of B.K.S. Iyengar (pronounced eye-en-gar). This is a form of hatha yoga that places emphasis on the physical alignment of the body in its poses. The Iyengar method employs the use of props, such as pillows, blocks and chairs to help the student achieve perfect alignment in a gradually progressive manner.

What is the evidence for the benefits of yoga? A meta-analysis (pooling data from multiple studies) looked at 10 randomized controlled trials to assess the effectiveness of yoga in the treatment of chronic low back pain. The parameters that the researchers sought to asses included: 1) relief of pain, 2) reduction in disability, and 3) health-related quality of life. Following an analysis of the data, strong evidence for short- and long-term relief of pain and moderate effectiveness in regard to reduction in back pain-related disability was found. No effect on health-related quality of life was noted.

A more recent study, funded by the National Center for Complementary and Alternative Medicine (NCCAM) that was not included in the meta-analysis mentioned above, looked at the effect of Iyengar yoga on chronic back pain. The researchers were also interested to see if practicing yoga had an effect on depression or the use of pain medications among study subjects. The researchers conducting this study concluded that Iyengar yoga decreased functional disability, pain, and depression in people with chronic low-back pain. A second NCCAM-funded study found that once-weekly yoga classes relieved pain, improved function, and reduced the need for pain medication in low-income populations with chronic low-back pain.

The predominance of scientific evidence indicates that people with chronic low back pain stand to benefit from practicing yoga. The Iyengar School of yoga may be particularly appropriate since it appears to take more gradual approach in performing its poses. Of interest also is that no adverse events from practicing yoga were reported from any of the studies mentioned. In order to achieve best results, it is advisable to practice yoga under the guidance of a qualified teacher.