Why are Black People Black and White People White?

#MedFact: The approximate SPF (sun protective factor) of a tan in light-skinned person? SPF 4. The sunscreen SPF level that most dermatologists recommend for skin protection against the sun? SPF 30 or higher.

——————————————————————————————————————-

Medically speaking, skin pigmentation is mostly a cosmetic issue these days, but in the not so distant past the amount of melanin in your skin had rather profound medical implications. Melanin is a dark chemical that is produced by specialized cells called melanocytes and that protects your skin from potentially damaging UV light in pretty much the same fashion as today’s chemical sun blocks do. Historically, people living nearer to the equator needed more melanin in their skin because the intensity of UV light was greater at lower latitudes than at higher latitudes — UV light causes nasty sunburns and skin cancer so people exposed to lots of it needed constant protection from the sun.

Illu_skin02[1]

An artist’s rendition of normal melanin-producing melanocytes in action in the skin. In case you were wondering, “why does ‘melanocyte’ sound familiar,” it’s probably because you’ve heard of “melanoma,” which is a cancer of melanocytes (more on that below).

But UV light is both a friend and a foe, kind of like a two-faced high school friend who kisses your butt in public and then runs off to gossip about you the minute you turn your back! On one hand, UV light causes the nastiness we discussed above, but on the other hand some UV light exposure is essential for bone health. Bone health??? Yeah, I said that right, bone health. Vitamin D is essential for bone health because it promotes the uptake of calcium from the foods you eat and into your body proper. And the first step in vitamin D’s life takes place in your skin in a reaction that is powered by UV light. No UV light = not enough vitamin D = weak bones = caveman who’s likely to die an early death. To combat the double-edged sword presented by UV light (too much = bad; too little = bad) people who lived at lower latitudes packed their skin full of protective melanin whereas people who lived in higher latitudes, like Europe or Japan, evolved light complexions that allowed them to make plenty of vitamin D even in environments that had little sunlight for much of the year.

Melanoma_(4)[1]

This is a classic melanoma, a cancer of the melanin-producing skin cells. Melanoma is curable if caught in the early stages but it is also one of the most horrible cancers that you can possibly get once it starts to spread. There have been some new and promising treatments that have come out in the past two years, but melanoma still remains essentially a death sentence once it metastasizes. The take-home message is, if you have or think you might possibly have a suspicious mole (and most of them aren’t this obvious in appearance) get it checked out by your physician!!!

Today people have moved far and wide from their original habitats and this has some medically pertinent consequences. Lighter complexioned people are at higher risk of skin cancer and of sunburns when they live in environments that are sunnier than those that their skin is evolutionarily designed for. As an example, Europeans who live in sunny Australia have the highest rates of skin cancer in the world — not a reason to move in and of itself but definitely a great reason to invest in a broad-brimmed hat and to religiously wear sunblock that blocks both UVA and UVB (the cheap kinds only block UVB — but both are potentially damaging to the skin). People with darker complexions who live at higher latitudes than their skin was originally adapted too should make certain to get adequate amounts of vitamin D which, like I stated above, is essential for bone health and which recent evidence suggests may also be involved in aging and a lot of other medical processes, including the evolution of some forms of cancer. The classic example of a vitamin D deficient person in The United States is the African American child who lives in inner city Detroit or Chicago — high latitude and not very sunny cities to begin with, with high buildings that block out the sun that there is, and with high crime rates that compel the people to stay indoors more often than they otherwise would. Fortunately, most milk and soymilk (for lactose intolerant people — a common condition in anyone who isn’t of Northern European descent) products are good sources of vitamin D and of calcium. Your doctor can easily check a vitamin D level with a simple blood test if you think that you might be deficient in this important compound.

rasitizm-d-vitamini-eksikligi-nedir-275[1]

This is the classic bow-legging that is seen in severe childhood vitamin D deficiency, aka: rickets. Vitamin D deficiency in adulthood, while generally not disfiguring like rickets, is also a serious health problem because it predisposes you to osteoporosis, bony fractures, and possibly to some forms of cancer.

While we’re on the topic of regional evolutionary adaptations, let’s go ahead and talk about a few more just for kicks. Like I mentioned, just about everyone in the entire world becomes lactose intolerant at some point during their adolescence or early adulthood except for people of Northern European descent. We all have the enzyme lactase in our gut as babies to allow us to digest our mother’s milk (which contains lactose, a sugar) but most people lose this enzyme later in life because, frankly, it wasn’t historically useful past a certain age for most humans (an adult man trying to breastfeed on his mother probably wouldn’t receive a good reception!). Northern European’s are the exception to this rule because they developed dairy cows long enough ago for Northern European guts to evolve to take full advantage of this important source of calories by maintaining production of the lactase enzyme throughout their life. If you’re lactose intolerant, don’t worry, good ole’ Southern Italian doc can’t get within a mile of anything made from milk so I feel your pain (lucky Germans, damn you! — joking!). By the way, synthetic lactase is sold over-the-counter at most pharmacies in the U.S. and it works pretty well for most people — good to know if you’re lactose intolerant but still like to occasionally eat pizza or have ice cream.

imagesCAADSSTH

This is an Amish farmer milking his cow in pretty much the same way that his ancestors did for thousands of years before him. Unlike me, this lucky fellow has lactase in his bowel and doesn’t turn into a gas balloon if he eats cheese or has a glass of milk!

Sickle cell disease is more common in persons of African descent and that’s not a coincidence. Having two copies of the sickle cell gene produces sickle cell disease, a painful and truly awful disease that results in early death. However, having only one copy of the sickle cell gene is protective against malaria and results in a person with sickle cell trait, a condition that is entirely asymptomatic in most cases. Since malaria is/was so common in much of Africa, the evolutionary downside of having a few poor souls afflicted with sickle cell disease was outweighed by the benefit of having lots of asymptomatic people with one copy of the gene running around who were resistant to malaria, which also is a really terrible disease that can ravage an entire population that doesn’t have any resistance to it (the reason why American soldiers take malaria pills while they’re in Afghanistan). Thalassemia, another group of blood disorders that is common in Mediterranean peoples and in persons who hail from Southeast Asia likely also provided some protection from malaria.

malaria_baby[1]

An African child severely ill with malaria. Malaria is a parasitic disease that is spread by the Anopheles mosquito. It was originally believed to be spread by “bad air” — hence the name “mal – aria” (bad air).

Note: I believe in giving credit where credit is due! I recently read the excellent book by Jared Diamond, The World Until Yesterday, which jogged my memory about this subject and gave me the kick in the rear needed to write this blog post. I HIGHLY recommend this book to anyone who is interested in human evolutionary (both societal and biological) evolution. See below for the link (Amazon link)!

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 16-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

My Works of Fiction — Click on the Book Covers if You’re Interested!

The Life of a Colonial FugitiveThe Cannabinoid Hypothesis

Images:

Melanocytes: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=melanocytes&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1366&bih=622&sei=0yX2Uf6SIOjayAG17IGgDg#facrc=_&imgdii=_&imgrc=DbIPW2yn_F-TEM%3A%3BvLbPWm4133XDrM%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252Fd%252Fdd%252FIllu_skin02.jpg%3Bhttp%253A%252F%252Fcommons.wikimedia.org%252Fwiki%252FFile%253AIllu_skin02.jpg%3B397%3B302

Melanoma: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=melanocytes&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1366&bih=622&sei=0yX2Uf6SIOjayAG17IGgDg#as_st=y&hl=en&tbs=sur:fc&tbm=isch&sa=1&q=skin+cancer&oq=skin+cancer&gs_l=img.3..0l10.122380.131123.0.131277.24.15.6.3.3.0.208.1848.2j12j1.15.0….0…1c.1.22.img..0.24.1997.LsbSGVaNo6w&bav=on.2,or.r_qf.&bvm=bv.49784469,d.aWc&fp=21f4d9df8e5564c5&biw=1109&bih=552&facrc=_&imgdii=_&imgrc=YEMqzWovo02C7M%3A%3Brv2tZeFVqxRI2M%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252Fthumb%252Fb%252Fbc%252FMelanoma_(4).jpg%252F733px-Melanoma_(4).jpg%3Bhttp%253A%252F%252Fcommons.wikimedia.org%252Fwiki%252FFile%253AMelanoma_(4).jpg%3B733%3B600

Rickets: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=melanocytes&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1366&bih=622&sei=0yX2Uf6SIOjayAG17IGgDg#as_st=y&hl=en&tbs=sur:fc&tbm=isch&sa=1&q=Rickets&oq=Rickets&gs_l=img.3..0l9j0i10.108073.109827.2.110630.7.7.0.0.0.0.135.751.2j5.7.0….0…1c.1.22.img..0.7.749.LEqz6euDuZ8&bav=on.2,or.r_qf.&bvm=bv.49784469,d.aWc&fp=b61642a79eaf1b4b&biw=1109&bih=552&facrc=_&imgdii=ju7KSyKY9CCTHM%3A%3BxWcnuzHXNyTlLM%3Bju7KSyKY9CCTHM%3A&imgrc=ju7KSyKY9CCTHM%3A%3Bm8SrVZzB9ftYqM%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252Fc%252Fcf%252FRickets_USNLM.gif%3Bhttp%253A%252F%252Fcommons.wikimedia.org%252Fwiki%252FFile%253ARickets_USNLM.gif%3B329%3B236

Dairy Cow: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=melanocytes&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1366&bih=622&sei=0yX2Uf6SIOjayAG17IGgDg#as_st=y&hl=en&tbs=sur:fc&tbm=isch&sa=1&q=milking+cow&oq=milking+cow&gs_l=img.3..0l10.11259.12925.6.13166.11.8.0.3.3.0.111.809.3j5.8.0….0…1c.1.22.img..0.11.831.gsksgFiIqI0&bav=on.2,or.r_qf.&bvm=bv.49784469,d.aWc&fp=b61642a79eaf1b4b&biw=1109&bih=552&facrc=_&imgdii=_&imgrc=DS8kd0Uav4zSzM%3A%3Bc0DbdxVH4hFeYM%3Bhttp%253A%252F%252Ffarm9.staticflickr.com%252F8441%252F7815289690_303bbf3834_b.jpg%3Bhttp%253A%252F%252Fwww.flickr.com%252Fphotos%252Farcher10%252F7815289690%252F%3B683%3B1024

Malaria: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.fic.nih.gov%2Fnews%2Fglobalhealthmatters%2Fpages%2Fmalaria-misdiagnosis.aspx&h=0&w=0&sz=1&tbnid=hpJzP6GjXX4IcM&tbnh=213&tbnw=188&prev=%2Fsearch%3Fq%3DMalaria%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Malaria&docid=GD1iNTMC4BioEM&hl=en&ei=tif2UbTsB5LOyAHSw4CIBA&ved=0CAIQsCU

The World Until Yesterday — By Jared Diamond. http://www.amazon.com/The-World-Until-Yesterday-Traditional/dp/0670024813

The Best of Medicine on the Big Screen!

This is a list of some of the best portrayals of medical conditions on the Big Screen topped off with a sprinkling of excellent portrayals of medical conditions in otherwise non-medical themed movies. I thought that we’d have a little bit of fun today — enjoy!

The Madness of King George: King George III has recently lost the American Revolution and he now suffers from a strange form of delusional psychosis that seems to be precipitated by eating pears and that turns his urine blue! The unfortunate king, who despite the average American’s opinion of him actually was one of the more enlightened monarchs of the era, probably suffered from a rare genetic disorder called acute intermittent porphyria (AIP). AIP is caused by a genetic defect in the body’s ability to metabolize worn out hemoglobin, the iron-containing protein that enables your blood to efficiently carry oxygen to the rest of your body. People with AIP suffer from severe abdominal pain and from psychiatric symptoms. It’s a great movie that most people have never heard of — check it out!

king-george-iii-e1291998711751[1]

King George III is really a tragic figure. Unlike most other monarchs throughout history he wasn’t a womanizer and apparently had few, if any, major vices. He considered himself a man of the people and spent his free time farming in a large garden that he planted with his own two hands.

A Beautiful Mind: John Nash is one of the greatest mathematicians who ever lived, but he also suffered from a raging case of paranoid schizophrenia, a mental disorder characterized by delusions, hallucinations, and bizarre behavioral patterns. Fascinatingly, Dr. Nash actually learned to live with his disease and he functioned for years as a Princeton professor without taking any medications (this is extremely rare for a person with schizophrenia and generally a bad idea; Dr. Nash was fortunate to have exceptionally strong social support and a genius’ way of being able to work around problems, including his personal ones).

4845691040_be098082cc_z[1]John_Forbes_Nash,_Jr._by_Peter_Badge[1]

Left: Hollywood John Nash. Right: The real McCoy. Crowe’s depiction of Dr. Nash later in the movie is really, really impressive by the way.

One Flew Over the Cuckoo’s Nest and The Changeling: Two very creepy and very realistic movies about what it was like to be a patient in a mental hospital in the not so distant past, when the rights of the mentally ill were essentially nonexistent. The Changeling is particularly disturbing because it is a true story about the political commitment of an inconvenient person (a mother whose child had been kidnapped) by the Los Angeles Police Department during the 1920s. The Changeling also describes one of the first known cases of a documented serial killer of children — it’s a great flick but not one to watch with the kiddos. For a more modern and less disturbing look at the mental health professions check out Good Will Hunting, a movie about a psychotherapist saving a talented young man from self-destruction and the movie that made Ben Affleck and Matt Damon into stars.

51fqXgsB7AL[1]

Even though your girlfriend probably still hates her for breaking up Brad Pitt and Jennifer Aniston, Mrs. Jolie does a great job in this creepy film! It takes a while to really get going, but it’s worth the wait.

Rainman: Dustin Hoffman and Tom Cruise knock the ball out of the stadium with Hoffman’s portrayal of a man with severe autism and Cruise’s depiction of how hard it is to care for a loved one with this condition.

rain-man-full-1[1]

Definitely Rainman.

King of California: Michael Douglas gives a spot-on performance as a man with bipolar mania and the grief that he causes his estranged daughter. Accurate, funny, and an all around great film that was ignored by the critics.

2496544558_9756f39810_z[1]

Goodfellas and A Clockwork Orange: If you want to see a classic sociopath in action check out “Tommy” (Joe Pesci’s character) in Goodfellas. The dirt bag main character in A Clockwork Orange also hits the nail on the head and the movies description of classic conditioning techniques (one of the foundations of modern psychotherapy) is also spot-on. Trivia: What does Joe Pesci’s last name mean in Italian? Answer: Fish.

GoodTommyMoeder[1]

What you call me, prick? Fish…I got yo’ fish!!!

The Abyss: If you SCUBA then you should definitely check this movie out, which is about a crashed U.S. nuclear missile submarine and a crazy Navy SEAL who tries to blow it up by detonating one of the nuclear warheads and nearly causes war with the Soviet Union in the process. Of course, everyone else (not wanting to be blown up in a nuclear explosion — go figure) is trying like mad to stop him. The SEAL is suffering from high pressure neurologic syndrome, a risk of diving to great depths that you’re unlikely to encounter unless you’re a professional diver for an oil company or the military. With that said, nitrogen narcosis is a common side-effect of SCUBA that is a risk to all divers and that shares many of the same symptoms, including altered mental status (you feel like you’re drunk) that progresses to severe somnolence and death (you fall asleep underwater).

Star Wars: What’s Star Wars doing on this list, you ask! Well, Darth Vader’s breathing machine is the answer because it’s nothing but a souped-up version of a mechanical ventilator, aka: “life support.” Check out my article on “What the Heck is Life Support” if I’ve got you interested.

Master and Commander: The ship’s doctor performs some really cool 18th-19th century medical procedures in this Napoleonic Wars naval flick that stars Russell Crowe in one of his better performances! From amputating an arm without anesthetic (it didn’t exist yet!) to draining a cranial hematoma (blood clot under the skull) with a burr hole, this film is as accurate as they come!

master-and-commander-03[1]

Platoon and First Blood: Sergeant Barns in Platoon is a masterful depiction of untreated PTSD and Rambo: First Blood does an excellent job as well. Platoon is actually based on director Oliver Stone’s personal experiences as a grunt in Vietnam and it should be on everybody’s “to watch” list.

Superman (1978): Yeah, I’m talking about the one with Christopher Reeves and the reason that I mention this film (the only reason) is because Superman’s stepfather dies of a classic STEMI (major) heart attack at the beginning of the film, suddenly feeling short of breath and clutching his left arm in agony as he falls to the ground dead from sudden cardiac death. The classic symptoms are only present in a small minority of heart attacks, by the way — but the depiction is spot-on in this classic film.

The Dark Knight: This Batman film is remarkable for the way that Keith Ledger accurately represented tardive dyskinesia, involuntary facial tics caused by long-term use of antipsychotic drugs, in his portrayal of The Joker. Watch how The Joker’s tongue darts in and out of this mouth at random intervals throughout the film.

2432121324_1b9c3d99d6_o[1]

 

My Nonfiction Books — Click on the Cover if You’re Interested!

Intrusive MemoryMedical School 101

 

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 16-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not necessarily reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

References/Images:

King George III: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.frontporchrepublic.com%2F2010%2F12%2Fmonarchy-and-the-american-constitution%2Fking-george-iii%2F&h=0&w=0&sz=1&tbnid=02xoYSWStykotM&tbnh=204&tbnw=246&prev=%2Fsearch%3Fq%3Dthe%2Bmadness%2Bof%2Bking%2Bgeorge%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=the%20madness%20of%20king%20george&docid=u_NtVJX8aukosM&hl=en&ei=lcTtUfbBNYrA9QSwkoHIDw&ved=0CAUQsCU

A Beautiful Mind: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=the+madness+of+king+george&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1600&bih=752&sei=d8TtUbXIHMO0rgHcm4DgDg#as_st=y&hl=en&biw=1600&bih=752&tbs=sur:fc&tbm=isch&sa=1&q=A+Beutiful+mind&oq=A+Beutiful+mind&gs_l=img.3..0i10l10.2331.4975.0.5118.15.15.0.0.0.0.80.737.15.15.0….0…1c.1.21.img.7x973vvwotk&bav=on.2,or.r_qf.&fp=8bcd504da0d79f95&facrc=_&imgdii=_&imgrc=ptXC8XWenZONKM%3A%3B-IivOoQQR3aV1M%3Bhttp%253A%252F%252Ffarm5.staticflickr.com%252F4108%252F4845691040_be098082cc_z.jpg%3Bhttp%253A%252F%252Fwww.flickr.com%252Fphotos%252Fjdxyw%252F4845691040%252F%3B320%3B475

John Nash: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=the+madness+of+king+george&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1600&bih=752&sei=d8TtUbXIHMO0rgHcm4DgDg#as_st=y&hl=en&biw=1600&bih=752&tbs=sur:fc&tbm=isch&sa=1&q=A+Beutiful+mind&oq=A+Beutiful+mind&gs_l=img.3..0i10l10.2331.4975.0.5118.15.15.0.0.0.0.80.737.15.15.0….0…1c.1.21.img.7x973vvwotk&bav=on.2,or.r_qf.&fp=8bcd504da0d79f95&facrc=_&imgdii=aipfZxc4JZ0G6M%3A%3B0hh11B5Z5zdfoM%3BaipfZxc4JZ0G6M%3A&imgrc=aipfZxc4JZ0G6M%3A%3Bk_ZUFElW6stlfM%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fcommons%252F9%252F91%252FJohn_f_nash_20061102_3.jpg%3Bhttp%253A%252F%252Fcommons.wikimedia.org%252Fwiki%252FFile%253AJohn_f_nash_20061102_3.jpg%3B727%3B1000

The Changeling: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.amazon.com%2FChangeling-Angelina-Jolie%2Fdp%2FB001NFNFNU&h=0&w=0&sz=1&tbnid=ow3ht4iMPMz3-M&tbnh=268&tbnw=188&prev=%2Fsearch%3Fq%3DThe%2BChangeling%2Bmovie%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=The%20Changeling%20movie&docid=6g3vF-TQqV1JlM&hl=en&ei=88_tUd0Qhbb1BJPdgLgE&ved=0CAIQsCU

Rainman: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fthereviewbroads.com%2F2013%2F06%2Fpopular-casino-scenes-in-movies.html%2F&h=0&w=0&sz=1&tbnid=fH5gsHTDlvL__M&tbnh=165&tbnw=306&prev=%2Fsearch%3Fq%3DRainman%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Rainman&docid=2-azxDyULZZ4IM&hl=en&ei=j9DtUb7pJIHo8gSUoYGQAg&ved=0CAMQsCU

King of California: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=the+madness+of+king+george&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1600&bih=752&sei=d8TtUbXIHMO0rgHcm4DgDg#as_st=y&hl=en&biw=1600&bih=752&tbs=sur:fc&tbm=isch&sa=1&q=King+of+California&oq=King+of+California&gs_l=img.3..0l2j0i5l2j0i24l6.2777.7384.0.7579.18.16.0.2.2.0.91.953.16.16.0….0…1c.1.21.img.nyRFJraU7wI&bav=on.2,or.r_qf.&fp=8bcd504da0d79f95&facrc=_&imgdii=_&imgrc=rthdAv21zvzBkM%3A%3Bocczy-FYKaVb8M%3Bhttp%253A%252F%252Ffarm3.staticflickr.com%252F2290%252F2496544558_9756f39810_z.jpg%3Bhttp%253A%252F%252Fwww.flickr.com%252Fphotos%252Fphim%252F2496544558%252F%3B433%3B640

Goodfellas: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.gonemovies.com%2FWWW%2FWanadooFilms%2FMisdaad%2FGoodTommyMoeder.asp&h=0&w=0&sz=1&tbnid=sMtBJo4KBst4LM&tbnh=166&tbnw=303&prev=%2Fsearch%3Fq%3DGoodfellas%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Goodfellas&docid=EqubuvpxNrxE3M&hl=en&ei=RNHtUcH5H4vY9ASw8oDgCw&ved=0CAUQsCU

Master and Commander: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fnmedlock.wordpress.com%2F2011%2F04%2F26%2Fmaster-and-commander-vs-behind-enemy-lines%2F&h=0&w=0&sz=1&tbnid=tBZMrRTNt55a6M&tbnh=194&tbnw=259&prev=%2Fsearch%3Fq%3DMaster%2Band%2BCommander%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Master%20and%20Commander&docid=msPatd04cvPuvM&hl=en&ei=6NHtUbOWGpKy9gTWkICADA&ved=0CAMQsCU

The Dark Knight: http://www.google.com/search?as_st=y&tbm=isch&hl=en&as_q=the+madness+of+king+george&as_epq=&as_oq=&as_eq=&cr=&as_sitesearch=&safe=images&tbs=sur:fc&biw=1600&bih=752&sei=d8TtUbXIHMO0rgHcm4DgDg#as_st=y&hl=en&tbs=sur:fc&tbm=isch&sa=1&q=Joker+The+Dark+Knight+&oq=Joker+The+Dark+Knight+&gs_l=img.3..0l10.3867.4732.8.5406.6.6.0.0.0.0.59.274.6.6.0….0…1c.1.21.img.ti3ZH_2cu0k&bav=on.2,or.r_qf.&fp=d10fcddc5d58554c&biw=1600&bih=752&facrc=_&imgdii=_&imgrc=KCVuURdycTQhMM%3A%3B_JkBrgApy2c3eM%3Bhttp%253A%252F%252Ffarm3.staticflickr.com%252F2252%252F2432121324_1b9c3d99d6_o.jpg%3Bhttp%253A%252F%252Fwww.flickr.com%252Fphotos%252Fmorningmagician%252F2432121324%252F%3B1086%3B789

Steroids, EPO, and Other Performance Enhancing Drugs – On Creatine, Whey Protein, HMB, and Nitric Oxide Boosters. Part 3 of 3.

In the final installment of our series on performance enhancing drugs (PEDs) we’re going to shift our focus off of illicit PEDs and spend some time discussing legal PEDs, you know, the kind of PEDs that you see lining the shelves every time you stroll down the aisles of a Wal-Mart pharmacy.

419584946_2f37026552_z[1]

The Wal-Mart supplement aisle (a very small portion of it).

Whey Protein: Whey protein is one of the two major proteins that are found in cow’s milk. When milk is allowed to curdle the whey separates from the rest of the milk (the curds) and forms a watery layer on top. In short (I’m not an expert on cheese production!), whey protein is produced by pouring the whey off of the curds and then by drying it into a powder. Proteins, including whey protein, are digested in the human gastrointestinal tract into amino acids, which are then absorbed by the body and used to make new body proteins. Muscle is primarily composed of protein and water and dietary protein is essential if you want your muscles to get bigger and stronger.

 01_save_whey_3_P3120306md[1]

Separating the curds from the whey — like Little Miss Muffet.

Whey protein is prized by athletes for two reasons. First, it is easily digestible which means that whey protein goes from mouth, to stomach, to bloodstream, to muscles faster than just about any other protein on the market. This is really important because the muscles able to take up greater amounts of amino acids than they normally are during the first two hours after exercise. Athletes take advantage of this by drinking a protein shake within this time periods. Most of these protein shakes are also very sugary and the reason for the sugar is to cause an insulin spike. Insulin is a hormone that is naturally produced by your pancreas (an organ that is located near the stomach) and higher levels of insulin further increase the ability of muscles to gobble up amino acids to turn into bigger and stronger muscles.

 

Whey protein is generally safe for people who have normally functioning kidneys and for people who do not have an allergy to milk or to milk products. The idea that high protein intakes are toxic to the kidneys is probably a myth, although I guess enough of anything (including water) is toxic if you truly take ungodly amounts.  The whole “protein is harsh on the kidneys” urban myth stems from the fact that people with failing kidneys are unable to appropriately excrete the metabolic byproducts of protein and these byproducts can buildup to dangerous levels in these people (especially in people whose kidneys are so bad that they are on dialysis). I don’t know very many athletes with chronic or end-stage kidney disease and I think that it is safe to assume that whey protein is perfectly safe in most people. I have a bottle sitting in my cabinet right now! One quick caveat: if you’re lactose intolerant you can take whey protein but you’ll probably wish that you hadn’t (GI upset/severe flatulence) unless you take lactase with it. Lactase is an over-the-counter enzyme that breaks down the lactose (milk sugar) that people with lactose intolerance have trouble digesting. People with true milk allergies should never take whey protein and people with any food allergy should talk to their doctor before starting any nutritional supplement in general because you never know!

 Patient_receiving_dialysis[1]

A person with end-stage kidney disease receiving dialysis. Dialysis involves running a persons blood through a machine that is essentially an artificial kidney. The dialysis machine removes the waste products from the patient’s blood that their kidneys are no longer capable of processing. The procedure is rather miserable and has a high long-term mortality rate (due to immunosuppression, electrolyte imbalances, etc., etc., etc.).

Creatine: Is naturally found in muscle tissue in the form of creatine phosphate. Creatine phosphate is a backup fuel that your muscles use when they run out of their primary fuel, ATP, and it allows the muscles to contract for just a little bit longer than they normally would be able to when the body is really exerting itself. A good example of how the creatine phosphate backup system is useful in nature is to imagine two tigers fighting. If tiger “A” has plenty of creatine in his system and tiger “B” doesn’t then tiger “A” is able to keep fighting (or to run away) for 30 seconds or so longer than his opponent, an evolutionary safety mechanism that could understandably mean the difference between surviving a dangerous situation or becoming tiger food in the not very distant past!

 jacked[1]

Creatine may give you arms like this…if you combine it with ungodly amounts of anabolic steroids, growth hormone, exogenous insulin, cosmetic oil injections, etc. For the record, I think this dude looks clownishly terrible, but to each his own I guess…

In the early 90’s someone got the bright idea that packing your muscles full of more creatine than they naturally contain might improve athletic performance and, for sports that require short bursts of intense activity followed by periods of rest (e.g. American football and weightlifting) creatine does seem to provide some benefit. Creatine also appears to be anabolic, resulting in muscle growth, and this is possibly due to its osmotic effects — sucking greater quantities of water into muscles than would naturally be there, therefore making them bigger. The evidence is fairly robust in supporting that creatine both improves an athlete’s ability to perform a short burst activity (like lifting a heavy weight or pushing an opposing lineman) and causing muscles to become larger. Creatine is not useful in endurance activities and it is actually detrimental to endurance athletes because it predisposes them to dehydration.

4.1.1

Allowing yourself to get dehydrated during summer football camp is a good way to experience this firsthand.

Creatine appears to be safe for most athletes. Like protein, creatine should not be used by people with kidney problems because its metabolic byproduct, creatinine, can’t be excreted into the urine of people with chronic or end-stage (on dialysis) kidney disease at a high enough rate to prevent it from building up in the bloodstream. The idea that some doctors still promote that creatine is toxic to the kidneys stems from the fact that creatinine is used as a proxy for kidney damage by physicians. In order to assess how well the kidneys are working doctors draw blood and look for the level of creatinine that it contains. Creatinine is not known to be directly toxic to the body, it just happens to be a convenient marker of kidney function because we all naturally have creatine in our muscles that is naturally broken down to creatinine and then excreted into the urine at a fairly steady rate. If someone’s creatinine starts rising on their blood tests then doctors know that the kidneys aren’t working very well. The problem with creatine is that it screws up this test! The creatinine blood test is based on the assumption that you have a fairly steady amount of creatine in your muscles and that any increases in the blood levels of creatinine are due to your kidneys not excreting creatinine. Athletes throw a wrench into this whole equation by increasing the amount of creatine in their muscles which then results in elevated levels of creatinine that throw off the lab test!!!

c767d9a6[1]

Medical shorthand for a basic metabolic panel (BMP) and a complete blood count (CBC), two of the most common blood tests that doctors order. Creatinine, the metabolic byproduct of creatine, is found in the lower panel on the bottom row (third from the right).

There is no (good) evidence that supplemental creatine is toxic to the kidneys but common sense would tell you that people with kidney diseases or with other diseases that predispose them to developing kidney diseases (e.g. people with high blood pressure or diabetes) probably shouldn’t take something that is going to mess up the test that their doctors use to monitor their kidney function. With that said, as far as we know (remember, creatine has only been in widespread use for about 20 years) creatine is perfectly safe for most athletes.

Creatine is not without real side-effects and the most common of these are GI upset (it pulls water into the gut and can give you diarrhea) and dehydration (both from diarrhea and because creatine sucks water into the muscles). Anyone who has chosen to take creatine should be obsessive about staying well-hydrated, especially football players who practice for long hours under the summer sun.

Nitric Oxide Boosters: Are primarily marketed to men with erectile dysfunction and to athletes, which may seem a little bit counterintuitive since the erectile problem that most male athletes have is that they are excessively horny. Nitric oxide boosters are actually just the amino acid L-arginine, which is found in most proteins that you eat whether the protein is coming from milk, meat, beans, or whatever. In addition to being used by the body to make new proteins for your cells, the body also digests some L-arginine to make nitric oxide, a compound that causes your blood vessels to dilate (i.e. to relax and become wider). Since blood vessel dilation is what allows the penis to fill with blood to produce an erection, these supplements are often sold to men as an over-the-counter alternative to prescription erectile dysfunction drugs like Viagra (which also work via nitric oxide, FYI).

 enzyte-tshirt-swelling[1]

This is “Smiling Bob,” the notorious pitchman for a purported nitric oxide booster. The guys selling this product got into a lot of trouble with The Feds for refusing to let people cancel their recurring subscriptions without a doctors evaluation stating that the dietary supplement didn’t enhance their sexual performance!

The idea behind marketing nitric oxide boosters to athletes is two-fold. First, taking a nitric oxide booster before lifting weights can allow a greater muscle “pump” and the greater stretch on your muscle cells when a muscle is gorged full of blood is thought to provide a stimulus for growth, partly via the stretch and partly because greater blood flow to a muscle also means that more oxygen and nutrients are getting to the said muscle. Second, taking nitric oxide boosters after exercise is hypothesized to allow nutrients (i.e. the nutrients from the post-workout protein shake) to reach the muscles because all of these nutrients ultimately get to the muscles via the bloodstream.

Nitric oxide boosters are relatively new on the market (in widespread use for about 10 years) and their efficacy for both erectile dysfunction and for athletes who are trying to build muscle is highly debatable and needs more study. With that said, I think that it is quite reasonable for anyone with issues with blood pressure in general and low blood pressure in particular to avoid potentially vasodilating nutritional supplements, like nitric oxide boosters, like the plague. The same also goes for people with heart conditions. I also think that taking these supplements before a workout with heavy weights is probably not the greatest idea because passing out from having a low blood pressure with a 425lb weight on your back doesn’t sound like a very good day to me—SPLAT!!! It is a really bad idea to combine one vasodilating substance with another one, e.g. combining a nitric oxide booster with alcohol or with your blood pressure medications. In short, if you’re not perfectly healthy I wouldn’t even consider taking one of these supplements without talking to your physician first, and even if you are in great health it’s still probably a good idea to run it by your doc.

 0[1]

A severe weightlifting accident that occurred during the Beijing Olympics (I sincerely hope that he was okay) and a poignant reminder that putting a huge amount of weight on your back can be really dangerous!

HMB: Is a derivative of the amino acid leucine that is naturally found in most of the proteins in your body and in most of the proteins in your diet (which is where your body gets it from in the first place!) HMB appears to be anti-catabolic to muscle tissue and possibly anabolic as well. There are two main metabolic processes at play in your muscle tissues at all times, anabolism and catabolism. Anabolism is, in simplified terms, muscle growth and catabolism is muscle breakdown. The balance between anabolism and catabolism determines whether your muscles are getting bigger (anabolism > catabolism), staying the same (anabolism = catabolism), or shrinking (anabolism < catabolism). Both processes are essential because your proteins contain lots and lots (millions upon millions) of individual proteins and old proteins are constantly wearing out, requiring them to be digested (catabolism) and replaced with new proteins (anabolism). HMB seems to slow the rate of muscle breakdown and to possibly enhance the rate of muscle protein buildup as well.

Currently it looks like HMB probably works, although the effect isn’t massive or super quick like some of the illicit PEDs (the same is true of creatine, which has a modest effect when compared to anabolic steroids). There are no known side-effects of HMB at present. However, unlike creatine, which has been used by millions of people, HMB is a more esoteric supplement due to its rather hefty price. Please see my “word to the wise” below before considering using any of the nutritional supplements described in this article and please also consult with your physician before use.

A Word to the Wise: These four “nutritional supplements” (read: “legal PEDs”) are the main four that are currently available that actually work. There are a ton of others out there, mostly of questionable safety and efficacy. One final word on nutritional supplements that anyone who takes them should be well aware of: nutritional supplements are categorized as such because they are not regulated by The Food and Drug Administration (FDA). This means that none of these supplements are required to go through the safety and efficacy trials (studies to prove that the drug is safe and that it works) that substances that are officially categorized as drugs have to go through. Anyone can stick a label on a bottle of “substance X” and claim that it “may promote muscle growth,” or whatever. As long as “substance X” is found in nature and has not already been claimed by a drug company this is perfectly legal. Let’s just remember that poison ivy, tobacco, and cobra venom are all found in nature so buyer beware!  Let’s also remember that a lot of these supplements are produced in developing countries with questionable food safety practices—although it is rare, there have been cases of people getting seriously ill and even dying from contaminated nutritional supplements and even from nutritional supplements that were at one time perfectly legal to sell over-the-counter!!!

Mozambique-spitting-cobra-spitting-venom-at-scientist[1]

An image of a naturally-occurring substance, spitting cobra venom, and an example of the kind of person who necessitates me having a huge disclaimer at the end of every blog post (the stupidity of some people is truly amazing).

MY BOOKS!

The Life of a Colonial FugitiveIntrusive MemoryMedical School 101The Cannabinoid Hypothesis

 

REFERENCES:

Note: The first two links are to The National Institutes of Health’s excellent website, which provides an overview of the efficacy and side-effects of the most popular medications and nutritional supplements. The list is extensive but, due to the huge numbers of drugs and nutritional supplements, nonetheless incomplete. HMB is notably missing. The third link/reference is to an excellent academic review of the evidence regarding the efficacy and safety of HMB.

http://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html

http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html

Wilson MJ, Wilson JM, and Anssi Manninen. Effects of beta-hydroxy-beta-methylbutyrate (HMB) on exercise performance and body composition across varying levels of age, sex, and training experience: A review. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2245953/  Nutr Metab (Lond). 2008; 5: 1.

Wal-Mart Supplement Aisle Image: http://www.flickr.com/photos/cleanwalmart/419584946/

Image of Separating the Curds from the Whey: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fbiology.clc.uc.edu%2Ffankhauser%2Fcheese%2FRicotta%2Fricotta_00.htm&h=0&w=0&sz=1&tbnid=WW6_E2hTfajyhM&tbnh=207&tbnw=244&prev=%2Fsearch%3Fq%3DWhey%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Whey&docid=9yut4RCaXIMX0M&hl=en&ei=6kfjUcLsA4HoqgHYroFo&ved=0CAEQsCU

Person Receiving Dialysis: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fcommons.wikimedia.org%2Fwiki%2FFile%3APatient_receiving_dialysis.jpg&h=0&w=0&sz=1&tbnid=x_sU-AGSpaF2MM&tbnh=194&tbnw=259&prev=%2Fsearch%3Fq%3DDialysis%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Dialysis&docid=xN-zOG-pqhyzUM&hl=en&ei=5knjUYv5F8usqAGOnoHIDg&ved=0CAEQsCU

Guy With The Really Bad Looking Arms/Creatine Joke: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fforum.bodybuilding.com%2Fshowthread.php%3Ft%3D144515111%26page%3D1&h=0&w=0&sz=1&tbnid=ym1n2WkA2QocvM&tbnh=212&tbnw=237&prev=%2Fsearch%3Fq%3DCreatine%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Creatine&docid=jKDZvehaYMDchM&hl=en&ei=9krjUaHNDIHHrgHSyYGwDw&ved=0CAYQsCU

Ambulance Image: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.nationmaster.com%2Fencyclopedia%2FStretcher&h=0&w=0&sz=1&tbnid=oAnQGPZLcM33lM&tbnh=218&tbnw=144&prev=%2Fsearch%3Fq%3Dambulance%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=ambulance&docid=IlLQQDQd1aASrM&hl=en&ei=Y0zjUdnjF5OCrQGtuYHwDg&ved=0CAQQsCU

Basic Metabolic Panel and CBC Image: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwilliamchaseallen.com%2F&h=0&w=0&sz=1&tbnid=aS5JweRqFQ3QiM&tbnh=181&tbnw=278&prev=%2Fsearch%3Fq%3Dbasic%2Bmetabolic%2Bpanel%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=basic%20metabolic%20panel&docid=xrdDjx1BccjosM&hl=en&ei=G03jUf7IG7ObyAGJ54HIDQ&ved=0CAQQsCU#imgdii=_

Smiling Bob: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Foddculture.com%2Fweird-news-stories%2Fsmiling-bob-whistles-all-the-way-to-jail%2F&h=0&w=0&sz=1&tbnid=fg4jXqZDYd6bzM&tbnh=116&tbnw=116&prev=%2Fsearch%3Fq%3DSmiling%2BBob%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Smiling%20Bob&docid=WBqPtBZ4eP64KM&hl=en&ei=QU7jUcOACorqrAGj-oDQAw&ved=0CAIQsCU

Weightlifting Accident: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DuI0Zl-tMRf4&h=0&w=0&sz=1&tbnid=EYPK1KbCnXbh4M&tbnh=194&tbnw=259&prev=%2Fsearch%3Fq%3Dsquatting%2Baccident%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=squatting%20accident&docid=_1etUQQ9VbUCjM&hl=en&ei=bk_jUa0oiNHLAfregbAH&ved=0CAEQsCU

Spitting Cobra Image: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.arkive.org%2Fmozambique-spitting-cobra%2Fnaja-mossambica%2Fimage-G90055.html&h=0&w=0&sz=1&tbnid=XXGemoMN1jCX1M&tbnh=184&tbnw=275&prev=%2Fsearch%3Fq%3DSpitting%2Bcobra%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=Spitting%20cobra&docid=PkXecPFnBpwWzM&hl=en&ei=I1DjUYO6OsKcqgHQvYCgBA&ved=0CAUQsCU

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 16-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not necessarily reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

Steroids, EPO, and Other Performance Enhancing Drugs – On Lance Armstrong, Barry Bonds, and American Culture. Part 2 of 3.

Okay, I’m back. Wow, it’s been nuts around the hospital but life is good. Doc made a diagnosis that was missed by one of the top hospitals in the world during his absence (tooting own horn — TOOT!!!!), so I haven’t been entirely slacking. Anyway, let’s knock out Part 2 of our series on performance enhancing drugs so that we can roll on to other subjects before I’m old enough to star in Viagra commercials.

EPO: Erythropoietin (EPO) is perhaps the most notorious performance enhancing drug on the market today, and for good reason. EPO is a naturally occurring hormone that is produced by the kidneys and that causes the bone marrow to make more red blood cells. Red blood cells are essentially sacks full of the protein hemoglobin, an iron-containing protein that carries oxygen from your lungs to the rest of your body including your muscles. Not surprisingly, EPO is abused by endurance athletes (e.g. Lance Armstrong) to increase their aerobic capacity: more red blood cells –> greater oxygen reaching the muscles –> increased ability to run a marathon or to pedal away in the Tour de France.

iyer-fig2[1]

This is a popular brand of synthetic erythropoietin.

The downside of this is that red blood cells are also the primary determinants of the blood’s viscosity, e.g. how thick it is. Syrup drips more slowly than water because it is more viscous and thicker blood behaves according to similar principles. Slower moving blood is more likely to clot so people who abuse EPO are setting themselves up for a stroke or a pulmonary embolism — conditions that are (most commonly) caused by blood clots in the brain or the lungs, respectively.

saddleembolus[1]

This is a particularly nasty type of pulmonary embolus (blood clot in the lungs) called a “saddle embolus” seen at autopsy in the lungs of a deceased person that it killed. A saddle pulmonary embolus usually forms in the large veins of the legs or pelvis, breaks loose, travels through the heart, and then becomes stuck in the junction of the pulmonary arteries. The pulmonary arteries carry blood from the right-side of the heart to the lungs where the blood becomes oxygenated, travels back to the left-side of the heart, and is then pumped to the rest of the body. Saddle emboli block blood flow to the lungs and often result in sudden death.

One quick factoid about red blood cells and hemoglobin: iron turns reddish when it is bound to oxygen. Hemoglobin is an iron containing protein (the reason why low iron causes anemia) and the binding of oxygen to hemoglobin is the reason that blood is red. This principle is also the reason why rust is red colored — rust is iron that has bound to oxygen!

images[11]Blood_Smear_Texture_by_Thestrange87[1]

An image of a car covered by a thin layer of rust next to an image of a thin blood smear. Interestingly, oxidized iron in the soil is also the reason why the planet Mars is red!

 

By the way, a legal way that athletes increase their red blood cell mass is by training at high altitude for weeks to months before a competition. The low oxygen concentrations at altitude cause the concentration of oxygen that reaches the kidneys through the bloodstream to go decrease. The kidneys respond by pumping out EPO and this causes the bone marrow to naturally produce more red blood cells, red blood cells that stick around in the circulation for up to 120 days (on average) after they are produced.

The type of EPO that is abused by Lance and friends is a synthetic hormone that was designed for medical uses. Synthetic EPO has important medical uses in patients with severe kidney disease (dying kidneys can’t produce EPO) and in patients with failing bone marrows (it makes the marrow that is still viable work harder). Even in patients who absolutely need EPO it still increases the risk of blood clots, stroke, and pulmonary emboli so EPO is used much more cautiously in the hospital these days than it was in the past.

Since EPO is detectable on the specialized drug screens that are used by big name competitions like The Olympics and The Tour de France, this has led to an ingenious and medically horrifying (to doctors) alternative method of  increasing red blood cell mass by some athletes. These geniuses actually draw out some of their own blood weeks or months in advance of a competition and then store it in a freezer (usually with the help of a crooked doc). This time lag gives their body plenty of time to naturally replace the blood that is now sitting in the freezer. Come competition week the blood is unfrozen and given back to the athlete as a transfusion, a remarkably dangerous medical procedure to perform without medical supervision because improperly stored blood breaks down (partially) and releases all sorts of cytokines (chemical messengers) and electrolytes — including potentially fatal high concentration of potassium that can cause the heart to stop via the same principle that potassium chloride injections (when given quickly and in a high dose) cause cardiac arrest in felons condemned to the death penalty! And that’s on top of the risk of blood clots that go along with having too many red blood cells floating around, not even to mention the risk of infection from an improperly performed transfusion, or the risk of death from a transfusion reaction if the athlete accidentally gives themselves their buddy’s blood that happens to be of a different blood type.

article-1299787-0A8D0A22000005DC-317_468x345[1]

Preparing for a blood transfusion in the hospital, a potentially dangerous medical intervention even under the best circumstances.

Well that’s it for today, guys and gals. “Medical School 101” is free for Kindle right now (until Sunday 14 JUL 2013) so tell your college kid to go grab a copy while the getting is good!

Doc’s Books!

Medical School 101The Life of a Colonial FugitiveIntrusive Memory E-CoverThe Cannabinoid Hypothesis

 

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis.

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 12-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not necessarily reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

Images:

Procrit: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.jyi.org%2Fvolumes%2Fvolume11%2Fissue6%2Ffeatures%2Fiyer.php&h=0&w=0&sz=1&tbnid=bYJj98B-P97w1M&tbnh=195&tbnw=259&prev=%2Fsearch%3Fq%3DEPO%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=EPO&docid=YKPULwSlZdXU_M&hl=en&ei=G-viUYa_DIarqgGOu4HQDg&ved=0CAQQsCU

Saddle Pulmonary Embolus: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fcmspath.edu%2Frfc%2Fassign%2Fhemodynamic-1112.htm&h=0&w=0&sz=1&tbnid=VBuomKoweNkvaM&tbnh=275&tbnw=184&prev=%2Fsearch%3Fq%3Dpulmonary%2Bembolism%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=pulmonary%20embolism&docid=SQ5AK4M0CEuDWM&hl=en&ei=DuziUdKpHZOCrQGtuYHwDg&ved=0CAcQsCU

Rusted Car: http://www.google.com/imgres?imgurl=&imgrefurl=http://zaoxinwei.com/effective-ways-to-lessen-the-effects-of-car-rust.html&h=0&w=0&sz=1&tbnid=ws6c0VGkofyvRM&tbnh=183&tbnw=276&prev=/search%3Fq%3Drust%26tbm%3Disch%26tbs%3Dsur:fc%26tbo%3Du&zoom=1&q=rust&docid=1kicy65rc4aWbM&hl=en

Blood Smear: http://thestrange87.deviantart.com/art/Texture-Blood-Smear-126563713

Blood Transfusion: http://www.google.com/imgres?imgurl&imgrefurl=http%3A%2F%2Fwww.bioedge.org%2Findex.php%2Fbioethics%2Fbioethics_article%2F10117&h=0&w=0&sz=1&tbnid=5QUUQQTMZReRnM&tbnh=193&tbnw=262&prev=%2Fsearch%3Fq%3Dblood%2Btransfusion%26tbm%3Disch%26tbs%3Dsur%3Afc%26tbo%3Du&zoom=1&q=blood%20transfusion&docid=eA8WQ4vWAQrlkM&hl=en&ei=RO_iUYOpEIadrgHnzIDYDg&ved=0CAgQsCU