Bovine Colostrum

This article has been provided by guest author Kyle Wood known as one of the best among up and coming Melbourne personal trainers.  Kyle has a keen interest in new and more effective training for himself and his clients and he believes exercise should contribute to your life and make it more fruitful rather than detract from it. He currently runs a blog in his spare time called Kyle’s Fitness Facts so take a look there if you want to know more...

Exercise for Fat Loss

Diet is very important when losing weight. The best training system in the world cannot out do a terrible diet filled with junk food, irregular meals and no veggies. However, as you reduce your caloric intake your body adapts to that caloric intake and the weight loss will plateau. This is where a lot of people will give up, however for those who continue, more calories must be cut and so on. This reaches a point where the calories are cut so low that you begin to starve your body.

A better solution to making that second cut in calories (or even the first) is to add exercise. If you are already exercising regularly then I suggest adding more intense workouts to your training schedule.  Here are some great ideas (that can all be done without a gym membership):

Sprint Intervals

Find your local track or oval (soccer pitches work excellent). Start off by doing one or two laps to warm up and then follow this cycle:

• Jog 50m
• Sprint 50m
• Walk 50m

Repeat this 4 times. Each week add an additional cycle until you reach 10 cycles. When you can do that move onto something new.

Note: A full size soccer pitch is 50m wide and 100m long so you can complete 2 cycles in one lap.

Circuit Training:

I’m not talking about walking around in a circuit on weight machines for 30 minutes, I’m talking all out circuits that will get your heart pumping through your chest and your fat cells dropping like flies. For these circuits you will need a railing or play equipment bar about 1.2m (4 feet) off the ground and a low bench or steps.

Circuit 1:

• Feet elevated push up x12 (on knees if unable to do on toes)
• Bodyweight squat x12
• Crunches x 12
• Butt Kick Jumps x12

Repeat 2 times before moving onto circuit two

Circuit 2:

• Burpees x10
• Inverted row (on railing) x10
• Forward Walking Lunges x5
• Reverse Walking Lunges x5
• Pushups x10

Repeat 2 times. Each week add an extra circuit to one of the circuits until you reach a total of 10 circuits.

Hill Sprints

Find a small hill. Sprint to the top, walk back down, rinse, repeat. You will be amazed at how awesome this simple activity is for cardiovascular fitness and fat shedding. Do this 5 times and then add an extra sprint each week.

Remember to warm up thoroughly beforehand and then warm down and stretch afterwards. This applies when doing any exercise.

You want more?

If you work your way up to doing all of that in a week then you can add low intensity recovery cardiovascular work to your off days. This kind of exercise is excellent at promoting blood to muscles to aid in recovery from your previous workouts. Good ideas are swimming, bike riding or brisk walks with your partner/family/dog.

Give these high intensity techniques a go. Stick to them for at least 6 weeks before you truly give them your analysis. I believe by then you will be addicted to high intensity training. Not only will they help you lose weight faster but you will also have more energy and feel more alert. Before I go, some great fun facts:

• Muscle requires more energy to exist, so the more muscle you have, the faster your metabolism.
• 20-30 minutes high intensity training burns more total energy (calories) over 24 hours than 60 minutes of low-moderate total training.
• Recent studies are continuing to show that the lactic acid system (shorter bursts of energy like sprinting and circuits) is a far greater channel for fat oxidizing (fat burning) than the aerobic study (longer low intensity training) which might explain why sprinters are so ripped.

This guest article was provided by my friend David Huckabay from HowtoBurnStomachFat.netwho believes in a sensible approach to losing weight. Just see how successful he was himself with this.

Hi all – I'm going to show you how I got back into shape without beating myself up.

If you will just take a few minutes to read this, I believe that I can show you how to make a lot of progress very quickly – without much of the waste of energy, self doubt and guilt that can be part of a diet program.

Once you read this, you will be able to move forward with any plan and make better progress with less stress!

First of all, remember that none of us are perfect. Forget the celebrities (they have trainers and dieticians), forget the weight loss gurus (they do this full time) and remember that you do have a life outside of your weight loss program. You are not a “professional weight loser” so don’t judge yourself as if you were. My technique is all about being as kind to yourself as you are to others.

The technique that I used to drop 43 pounds of weight back in 2006, and keep it off since is simple. 90% compliance. That’s it. Simply do what you are supposed to do about 90% of the time, and you will see progress. Will you burn stomach fat as quickly as you would have with 100%? Probably not, but there won’t be all that much difference.

At this point you may be thinking “So what? I cheat all the time and sneak a snack or two.” Exactly. You call it cheating because you are breaking the deal you made with yourself to lose weight and get in shape. So you cheat, feel guilty, slip again, and eventually give up altogether. Why do this to yourself?

Let’s take a look at a weight loss plan implemented with the 90% rule:

For the sake of simplicity, we’ll assume that you are eating three times per day, and working out three times per week. So we have 21 meals per week, about 90 meals per month. We have 12 workouts per month.

Right off of the bat, we know that we can go off of our plan for 9 meals! Awesome!

Now, we need to define what I mean by this. I’m not saying that you should go to some buffet and attempt to eat an entire cow. More like this: You are at a cookout, and yes, you can have a normal plate of food just like everyone else. A burger, some chips, some salad. This helps more than you can imagine. Just knowing that if you find yourself at your niece’s birthday party, you can have a piece of cake like everyone else is a tremendous help. Feeling like an outcast, who has to do things differently from everybody else is no fun, especially at a party. The rest of the time (80 meals!) we stick to our plan.

Personally, I saved my special meals for times when I was out with friends or parties. If I was having dinner at home, I stuck to my plan.

Exercise is even easier to handle with this technique. A lot of it has to do with actually counting all of your activity. Ok we have 12 workouts set for this month. So we know we can only skip one or two. But there is a lot of leeway when it comes to exercise, and we can make up workouts fairly easily.

Let’s say I missed my workout on Wednesday of week two this month. Fine, but then on Friday I mowed the lawn – continuous walking and pushing for over an hour! Does anyone want to try and convince me that that is not a workout? Then on Saturday, we went to the zoo. We walked, looked and laughed for 3 hours. Again, does anyone doubt that we burned up a lot of calories doing that?

I give myself half of a workout for my activity in these situations. In the case above, I would actually have my 3 workouts for the week! Take stock of your activity, and be honest with yourself. I think you will see that you are doing a fair amount of uncounted exercise.

Friends, I’ve shown you how to apply the 90% rule to your diet, and to your workouts. It’s up to you to do it – but I know you can. This is a way to take the pressure off, enjoy family outings and parties, and still meet your weight loss goals. So stop beating yourself up for little slips, and give the 90% rule a try. You’ll be glad you did.

David Huckabay

The coming tsunami of baby boomers means physicians are destined to see an increase in the number of elderly patients in their offices. Preparing to do well by them could require a change in attitude as well as office furniture.

It won't be business as usual, according to the Institute of Medicine's 2008 report "Retooling for an Aging America: Building the Health Care Workforce."

Only about 7,000 physicians in the nation are certified geriatricians, but 36,000 will be needed to provide care for the aging population by 2030, according to the report. The consensus is -- that's not going to happen.

Instead, what will occur is that more and more elderly people will turn to internists and family physicians for care, and the best course of action for these physicians is to prepare for and embrace the inevitable, say a number of geriatricians who offer a variety of pointers.

For starters, "you need to get a sense from them as to what their goals are," said Rosanne Leipzig, MD, PhD, professor of geriatrics and adult development at Mount Sinai School of Medicine in New York City. She also is an adviser to the American Medical Association on aging issues.

Dr. Leipzig works to help her patients live the life they want . She said this mind-set can lead to approaches that vary widely, because older people are a heterogeneous group. "When you've seen one, you've seen one."

Taking the time upfront to consider level of care will save time in the long run. "Is this someone you are going to think about as a robust elder, or someone who is frail, or someone who is in the last stages of life?" Dr. Leipzig asked.

"Some 85-year-olds you would treat as aggressively as you would a 65-year-old," said Jerome Epplin, MD, a family physician who cares for predominantly older patients in Litchfield, Ill.

David Mehr, MD, a professor of family and community medicine at the University of Missouri School of Medicine, in Columbia, noted that "with an 80-year-old you can have a competing athlete or someone with significant disabilities."

Regardless of the patient's level of ability, the treatment goal remains the same: "Keep them functioning independently and having a good quality of life," said Judah Ronch, PhD, professor at the University of Maryland's Erickson School in Baltimore. The school focuses on improving services for older people.

Rewards and attitudes

Caring for this population is a rewarding way to spend the day, said several physicians who do just that. "Geriatrics is going to be the fastest-growing segment of primary care practice, and this is good, because taking care of older people is one of the most thrilling experiences in medicine," said Bill Thomas, MD, also a professor at the Erickson School.

M. Mayes DuBose, MD, a geriatrician who established the first geriatrics-only medical practice in Sumter, S.C., also revels in his work. "I think I got into it for the right reasons. Otherwise I think I'd be burned out." And the right reasons? "The desire to provide high-quality care to America's older adults. And the desire comes from the recognition that they are such a vulnerable population," Dr. DuBose said.

Only about 7,000 U.S. physicians are certified geriatricians.

Caring for older people is "one area of medicine where you can practice the true art of medicine," Dr. Epplin said. The goal is maintaining a proper balance between treating enough to make a difference without overtreating, he said.

Plus, "you have to have an interest in it," Dr. Epplin said. Developing that interest may require an attitude adjustment. Some physicians may see patients older than 70 and assume they are on a downhill course, he said. A conversation may include: "Your knee hurts? You're old, what do you expect?" The biggest complaint Dr. Epplin hears from his patients is that other physicians dismiss their concerns. "Remember that these are very viable people who have a future as well as a past. Then you look at it in a more positive way."

At the same time, legitimate concerns surround the time commitment necessary to care for these complex patients. The primary care physician who is going to care for a significant number of America's elderly has to be willing to change his or her standard of practice, Dr. DuBose said. "There has to be more time taken, and it has to be a slower process than the typical office visit."

Sharpening communication skills is one way to use limited time effectively, several doctors said. Poor communication can cause the entire medical encounter to fall apart, noted John C. Houchins, MD, assistant professor in the Dept. of Family and Preventive Medicine at the University of Utah School of Medicine, and others in a 2006 article in Family Practice Management.

Their communication tips include avoiding distractions, sitting face-to-face with a patient, maintaining eye contact, listening and sticking to one topic at a time.

Patients also may be unable to hear well, whether because of a hearing loss or the loss of the ability to hear higher frequencies. Women doctors may have to enlist the help of male colleagues with lower-frequency voices to improve a patient's ability to hear them, Dr. Leipzig said.

But Dr. Thomas cautions that not all older patients are hearing-impaired, and physicians shouldn't assume they are. "I like to first speak in a normal voice to all older people."

Doctors also should be aware that their oldest patients may not be forthcoming with information because they don't want to cause the doctor any problems, Ronch said. "They might not be comfortable communicating issues that are important for the physician to know about."

Caution also should be taken to ensure that patients can read the materials they are provided. Use large font sizes and high contrast, so the letters are black and the paper is white and nonglare, Dr. Leipzig said.

The top priorities

Some concerns loom as exceptionally important when caring for older patients, and among them is the elimination of medication errors.

Geriatricians agree that all patients should bring a bag of their medications to each visit. Included should be prescription and over-the-counter items, vitamins and herbal products.

Eliminating medical errors is a top priority when caring for older patients.

Dr. DuBose likes to have patients bring the bottles, rather than a list of medications, so he can write on the bottles if a change is required. "Medication errors are very common," he said. "So a doctor or a nurse needs to make a dedicated effort to review all their medications."

Having a good, online resource to check for dosing information and drug interactions is also invaluable, a number of physicians said.

Another top priority is the ability to diagnose dementia and differentiate between dementia and delirium.

Dementia isn't always obvious at earlier stages, Dr. DuBose said. But once it is diagnosed, doctors can prescribe medications to slow its progress. Financial and health safeguards can be put in place for patients' protection.

A primary care physician doesn't need to be able to deal with every complicated patient with dementia, but they should have a good basic approach to follow if a family member expresses concern about an individual or if a patient comes in and says they are concerned about their memory, Dr. Mehr said.

Preventing falls is another area of importance. "One of the most devastating things you can help prevent is falls and resulting hip fractures," Dr. Leipzig said. An evaluation of gait, balance, vision and use of psychotropic medications is necessary.

A "get up and go test" is a fairly simple way to determine an individual's capability, Dr. Mehr said. "Ask a person to get up from their chair, walk across the room and walk back. You want to see if they use their hands to get up."

Doctors also should be sensitive to incontinence, he said, which is common in older women.

Caring for this population is a team effort. Physicians often enlist office staff to carry out many evaluations, and they should also be aware of community resources so they can help connect their patients with services such as visiting nurses, senior centers and entitlement programs. "You don't need to be a social worker, but you need to refer," Dr. Leipzig said.

Changes to the office layout also can make a difference to older patients. Ease of entry is a help to patients of all ages, Dr. Thomas noted. "People living with disabilities will thank you, as will younger people who have torn their Achilles tendons and are on crutches.

The print version of this content appeared in the May 11, 2009 issue of American Medical News.

Two physician groups are urging the federal government to update policies related to HIV infections, charging that the policies were drafted years ago when infection with the virus equaled a death sentence.

Now, with appropriate treatment, people infected with HIV can live a near-normal life span, noted Michael Saag, MD, chair-elect of the Infectious Diseases Society of America's HIV Medicine Assn. He spoke during an April 17 press briefing to introduce a joint position paper of the American College of Physicians and the HIVMA. The paper was released online April 16 and is to be published in the May 15 Clinical Infectious Diseases.

In their paper, the groups call for earlier identification of those infected with the virus, expanded access to treatment and stronger national leadership to respond to HIV's spread in the United States and abroad.

Gains on HIV diagnosis and treatment have made it more important to identify people carrying the virus as early as possible, the position paper said. Yet recent estimates by the Centers for Disease Control and Prevention say that of the 1.1 million people in the U.S. infected, one in five is unaware of his or her status.

Because of near-universal testing and implementation of effective treatments for infected mothers-to-be, transmission to infants has basically stopped, Dr. Saag said. "Now this same concept needs to be applied to the entire population."

1 in 5 of the 1.1 million people in the U.S. with HIV is unaware he or she has it.

Another reason for rapid identification and treatment is a recent finding that the AIDS virus is now more virulent, and damage to patients' immune systems is occurring earlier.

A paper published May 1 in Clinical Infectious Diseases found that 25% of patients diagnosed with HIV in recent years already had CD4 cell counts of less than 350, which is the threshold for implementing antiretroviral therapy, compared with only 12% of patients in the late 1980s.

"Unfortunately, it may no longer be true that there is a time period of several years between diagnosis and the need for treatment -- instead, this time span is shortening," said study author Nancy Crum-Cianflone, MD, MPH, an infectious diseases specialist at San Diego Naval Medical Center.

Broad screening urged

Although the CDC put out a call in 2006 urging widespread HIV screening, the response has been spotty from the nation's hospitals, clinics and physicians' offices. The AMA also recommends that physicians routinely test adult patients.

Among the changes requested by the ACP and the HIVMA are those allowing reimbursement for the screening of all patients in federal health programs. "Although the Centers for Medicare & Medicaid Services are considering reimbursing the cost for testing high-risk patients, we would recommend they expand this policy to cover all Medicare beneficiaries," said Jeffrey Harris, MD, ACP's immediate past president.

The federal government does not support needle-exchange programs.

The cost of treatment increases dramatically in later stages of infection, he noted. With early treatment, the cost is less than $14,000 per year, but that figure increases to more than $36,000 annually, he said.

The groups also request the expansion of proven prevention strategies. "It's time to support evidence-based transmission prevention efforts such as needle-exchange programs and comprehensive sexual education," said Kathleen Squires, MD, HIVMA vice chair. Despite studies showing the effectiveness of needle-exchange programs, the federal government does not support them, she said.

J. Fred Ralston, MD, president-elect of the ACP said work force issues also must be addressed.

Screening is going to be done by primary care physicians, and that network is "in critical condition as we speak," he said. "It has been shown that the collapse of primary care is going to lead to higher costs, lower quality, diminished access and decreased patient satisfaction, which is certainly not the direction in which we want to head."

The print version of this content appeared in the May 11, 2009 issue of American Medical News.

Tight control of blood glucose levels, the bedrock of diabetes care for some time, may not be the best option for all patients with the type 2 form of the disease. The burden of complex treatment regimens, risk of low blood glucose, possible weight gain and expense of reaching these goals may not always be worth it. In addition, hemoglobin A1c targets should be individualized, according to a review of recent studies in the June 2 Annals of Internal Medicine.

"It's time to look at the patient with diabetes as an individual who has more issues than just blood sugar," said Victor Montori, MD, lead author and professor of medicine at the Mayo Clinic in Rochester, Minn. "It's key that we change the emphasis from blood sugar to well-being, adequate preventive care and adequate cardiovascular risk reduction."

Researchers pooled several large randomized trials comparing effects of working toward various glycemic targets. Tight control made no impact on all-cause mortality, cardiovascular death, stroke, amputations or microvascular complications. This diabetes care strategy also increased the risk of hypoglycemia and weight gain.

Aiming for ever-lower blood glucose levels has been the emphasis of diabetes care from several organizations because of evidence indicating the approach reduces the risk of long-term complications. Most urge that the majority of patients achieve hemoglobin A1c numbers around 7% or lower.

This paper is the latest to suggest this strategy may not always be proper. Results of projects released in the past year, such as the Action to Control Cardiovascular Risk in Diabetes, the Veterans Affairs Diabetes Trial, and Action in Diabetes and Vascular Disease -- Preterax and Diamicron Modified Release Controlled Evaluation, noted that efforts to tightly control blood glucose levels may not mean lower risk of cardiovascular disease. They may even increase the risk of death for some.

"Hypoglycemia can be very dangerous in the older population, particularly for older patients who have co-existing illness and are on numerous medications," said William Duckworth, MD, director of diabetes research at the Phoenix Veterans Affairs Health Care Center and VADT's principal investigator.

In response, the American College of Cardiology, the American Diabetes Assn. and the American Heart Assn. published a statement in their respective journals last year saying most patients should still aim for an A1c of 7%. Those with a history of severe hypoglycemia, short life expectancy and advanced complications may not need such intense glycemic control. A commentary in the April 15 Journal of the American Medical Association also suggested that younger patients who have not had the disease long and do not have many cardiovascular risk factors are most likely to benefit from tight control. "The goal for the majority of people is a hemoglobin A1c as close to normal as possible," said Bruce Bode, MD, a spokesman for the Endocrine Society and associate professor at Emory University School of Medicine in Atlanta.

Response to this more recent paper varied. Some praised it for bringing attention to the fact that tight control may not be best for everyone.

"We are treating people, not numbers," said Rodney Hayward, MD, co-director of the VA Health Services Research and Development Center of Excellence in Ann Arbor, Mich. "People have different goals in their life. For them to check their blood sugar multiple times a day may come at a huge cost and may not really be valuable. It may even be dangerous."

But the findings also drew criticism. Some experts questioned the conclusions because researchers lumped together several trials focusing on very different populations. Many also expressed concern that worries about the patient burden of getting to low numbers may have been overblown.

"I agree that glucose targets need to be individualized. I don't necessarily think it's appropriate to combine all of these studies together," said Irl B. Hirsch, MD, professor of metabolism, endocrinology and nutrition at the University of Washington School of Medicine in Seattle. "I disagree with some of the conclusions about the burden of care on the patient."

The authors say tight blood glucose control is a good option for some patients but, because it is not for all, advocate that A1c numbers not be used for pay-for-performance and other quality measures.

The print version of this content appeared in the May 11, 2009 issue of American Medical News.