Saturday, September 22, 2012

Arnold’s Heart and Other Tales of Woe by Jerry Brainum

On June 9, 2007, Kris Dim collapsed while training in a gym. The 34-year-old professional bodybuilder underwent immediate emergency surgery. He’d suffered a stroke due to an aortic dissection—that is, the large artery in the heart literally split. Since the aorta delivers blood pumped from the left ventricle of the heart to the pulmonary and all other arteries in the body, a sudden breakdown of the vessel would compromise blood flow—explaining why Dim passed out. Two types of aortic dissection are known: Type A involves the ascending aorta, which requires surgical repair. Type B involves the descending aorta, which can be treated with drugs, such as beta-blockers.
      Dim was lucky. Rapid surgery saved his life. Others with the same condition, such as actor John Ritter, comedienne Lucille Ball and Olympic volleyballer Flo Hyman, weren’t as fortunate. They died from complications of aortic dissection. Last year a 21-year-old University of Toledo basketball player succumbed to aortic dissection. Michael DeBakey, the renowned Texas heart surgeon who devised the surgical procedure for Type A in 1955, fell victim to it himself and was the oldest person to undergo surgery (his own) at age 97 in 2006. Untreated aortic dissection has a 50 percent mortality rate in the first 24 hours. Studies show that two in every 10,000 people have the condition.
      Initial rumors circulated, especially on the Internet, that Dim’s condition was related to his using anabolic drugs. After all, he was a pro bodybuilder—it seemed likely that he used steroids extensively.
Whether Dim used steroids had zero relationship to what happened to him. Although one study compared athletes who use anabolic steroids with drug-free athletes and found increased aortic stiffness in the drug users,1 several reports in the medical literature suggest that merely lifting weights could predispose people with structural deficits in their aorta to a dissection. For example, an aneurysm is a local weakness in the aortic wall. Those who train regularly with heavy weights temporarily raise their blood pressure to extreme levels, which enlarges the aorta. Some doctors don’t agree that an enlarged aorta is a risk factor; however, since connective tissue stiffens with age, people 40 or older who have the condition—or risk factors for it—need to be careful. Doctors have suggested screening would-be weightlifters via echocardiogram, which measures heart rhythm.
     Having high blood pressure may cause aortic dissection in some people, as can intense chest trauma. Most such cases occur in those aged 50 to 70. Using cocaine is a definite risk factor for aortic dissection because cocaine elevates blood pressure. Yet any type of strenuous exercise—even sneezing—may precipitate aortic dissection in a susceptible person. In 2005, researchers from the University of Texas Medical School found that having a genetic mutation in transforming growth factor beta receptor-2 predisposes a person to aortic dissection.
     One susceptibility that could result in aortic dissection is a bicuspid aortic valve. Normal aortic valves are tricuspid, having three cusps, or flaps, but 1 to 2 percent of the population are born with only two cusps. It’s the most common cardiac structural abnormality. One person in this category was none other than Arnold Schwarzenegger.
     In April 1997, Arnold underwent surgery to replace his bicuspid aortic valve. “I never felt sick or had any symptoms at all,” he told the press, “but I knew that I would have to take care of this condition sooner or later.” Since Arnold’s name was almost synonymous with huge muscularity, it didn’t take long for the rumor mill to claim that the condition was the consequence of years of steroid abuse.
    According to standard medical texts, however, problems related to bicuspid aortic valve peak at age 40. Even insurance companies, which aren’t known to give anyone a break, don’t charge extra premiums for this congenital condition, which is four times more prevalent in males than females. As for the steroid connection, there was none. As Arnold noted, in many cases there are no symptoms associated with it. The condition is just considered a structural anomaly of the heart.
     The need for bicuspid aortic valve surgery arises when symptoms do surface. Aortic stenosis, or a narrowing of the aortic valve opening that limits blood flow, is often the result of calcium buildup in the valve over time—for example, the time it takes the body to reach middle age. (Arnold had his surgery at 49.) Aortic regurgitation, the name given to backflow of blood from the aorta into the left ventricle from which it just came because the valve doesn’t close all the way, is another aspect of stenosis. The worst-case scenario is aortic dissection.
     Surgical treatment for bicuspid aortic valve varies. One option is to use valves extracted from pigs; reports that Arnold had a pig valve replacement weren’t true. He opted for a homograft—that is, an organ donation. That type of replacement often lasts 15 to 20 years before it needs to be replaced. Other options are the Ross procedure, which replaces the defective valve with a pulmonary artery. The longest-lasting replacement is mechanical, made of synthetic material rather than body tissue, but that means lifelong use of anticoagulant drugs, which may be the reason Arnold didn’t go for it.
      Arnold’s fame also spawned reports that he was a cardiac invalid. He filed lawsuits against several publications and won them all. The important point was that Arnold’s condition was so benign that he never experienced symptoms during his entire bodybuilding career or most of his acting career. Since he’s publicly admitted using steroids when he competed, it seems clear that the drugs had no effect on his valve. Of course, he probably had no idea he had the condition at the time.
      A recent study confirmed that many athletes have the same condition but that it doesn’t interfere with their training or sport participation.2 Of the 2,273 athletes evaluated in sports ranging from basketball to soccer to tennis to cycling to swimming, 58, or 2.5 percent, had a bicuspid aortic valve. Among the 2.5 percent, nine had normal valve function, 47 had abnormal valve function with mild regurgitation, and two had moderate stenosis. Their ages ranged from eight to 60.
      Asymptomatic bicuspid aortic valve doesn’t show up during normal medical exams unless the doctor hears a faint heart murmur or click. That’s rare, which is why diagnosis depends on an echocardiogram. In any case, the odds of having it are low. Contrary to Internet B.S., anabolic drugs of any kind have no relation to the condition and won’t escalate symptoms.

                                                       Can Hormones Protect Your Brain?

     You hear so many bad things about testosterone and growth hormone that it’s easy to overlook what happens to bodies that don’t have them. Public prejudice is fueled by sensationalist reports in popular media. Anabolic-drug use by professional athletes, such as baseball players, leads the uninformed to believe that such drugs are no use to “normal” people.
     Nothing could be further from the truth, which is readily available in the medical literature. The following studies—none of which rated publication in the popular media—relate to preventing degenerative brain disorders.
     In one study mice that were injected with a protein called beta amyloid, a type of which is considered the root of Alzheimer’s disease,3 developed memory loss and confusion—exactly what occurs in Alzheimer’s patients. Some of the mice, however, got human growth hormone. The mice with induced Alzheimer’s experienced an increase in free radicals, toxic by-products of oxygen metabolism that destroy the neurons that produce acetylcholine, a neurotransmitter associated with memory and learning. In the mice that got GH, those effects were blocked. Human studies have demonstrated that those who are clinically deficient in GH suffer from accelerated brain degeneration.
     The prefrontal cortex is vital for guiding behavior, thinking and working memory. Damage to it—common with aging—can result in a failure to plan and organize behavior. It partly explains the frequent memory deficits (“Where are those keys?”) that start about age 40. The prefrontal cortex is sensitive to levels of norepinephrine, a catecholamine hormone also involved in fat oxidation. In the brain, moderate levels of norepinephrine bind to alpha-2 adrenergic receptors and improve prefrontal cortex function, which means alertness and memory retention.
     Since the brain also contains beta-adrenergic receptors, a new study tested the effects of the drug clenbuterol on brain function.4 Clenbuterol is normally prescribed as an asthma drug in Europe but was never approved for use in the United States. Since it is structurally similar to catecholamines, it binds to beta-2 adrenergic receptors in the body.
     Clenbuterol was directly injected into the brains of young and old rats that showed mental deficits linked to poor prefrontal cortex function. The drug was also supplied to monkeys. Previous studies have shown that clenbuterol selectively affects the amygdala and hippocampus, which have to do with emotions and memory.
The study found that clenbuterol increased brain function. While that points to possible therapeutic uses of clenbuterol in treating brain disorders, there are some problems. Bodybuilders use clenbuterol for muscle growth and fat loss, but it can also cause bone loss, which can lead to fractures in older people. Excess clenbuterol produces such side effects as heart arrhythmia, tremors and possibly heart attacks. Less well-known potential side effects are testicular damage and immune suppression. Even low-dose clen can damage heart muscle.
     The doses the monkeys got in the study were similar to what’s prescribed for asthma. That dose doesn’t cause cardiovascular problems, though it does induce transient tremors. The initial research looks promising, but further human studies are needed to clarify whether and how clenbuterol might be used to treat human brain disorders.
     A study that examined the impact of estrogen and insulinlike growth factor 1 in the brain indicates that they partner to protect the brain against the damaging effects of cortisol, a stress hormone that attacks the sections of the brain that govern learning and memory.5 That’s why long-term stress is considered a major cause of brain aging.
     IGF-1 rises in response to exercise and a high-protein diet, as well as in the presence of growth hormone. Estrogen is produced in much greater amounts in women than in men, and some researchers think that it helps preserve women’s brains. Estrogen has beneficial cardiovascular effects, such as maintenance of high-density-lipoprotein cholesterol, and possibly long-term brain protection, although that’s not as evident in men is as it is in women.

1 Kasikcioglu, E., et al. (2007). Aortic elastic properties in athletes using anabolic-androgenic steroids. Int J Cardiol. 114:132-134.
2 Stefani, S.L., et al. Bicuspid aortic valve in competitive athletes. Brit J Sports Med.2008;42:31-35
3 Ling, F.A., et al. (2007). Protective effect of recombinant human somatotropin on amyloid B-peptide induced learning and memory deficits in mice. Growth Hor IGF-1 Res. In press.
4 Ramos B.P., et al.). Beta-2 adrenergic agonist, clenbuterol, enhances working memory performance in aging animals. Neurobiol Aging.2008;7:1060-9.
5 Garcia-Segura, L.M., et al. (2007). Estradiol, insulin-like growth factor-1 and brain aging. Psychneuroendocrin. In press.

©,2013 Jerry Brainum. Any reprinting in any type of media, including electronic and foreign is expressly prohibited.

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