Monster Arms Workout

Do not exceed more than 6 sets on the biceps and triceps and keep the
reps within the range of 6 to 10, increasing the weight each workout
for maximum results. Strict form is essential, no jerking or swinging
movements, concentrate on the arm muscles.

Biceps Exercises

Exercise 1 - 21`s

This exercise will give an incredible bicep pump. Start with a lightly
loaded barbell arms fully extended downwards. Raise the barbell to waist
height slowly and hold for 1 second, then lower to the starting point.
Repeat this seven times, on the final rep hold the barbell at waist
height then raise the barbell to just below the chin hold for 1 second
then lower to waist height repeat this 7 times. On the final rep lower
the barbell all the way down to arms fully extended then raise the
barbell all the way to just under the chin and repeat for 7 reps.

Exercise 2 - Hammer Curls

Lay on a 30 degree inclined bench, use a pair of moderately weighted
dumbbells heavy enough so as you can just manage 10 reps with full
effort. Extend your arms fully down and rotate the dumbells so that
your knuckles are facing forward. Slowly raise and rotate the
dumbells, as you get to the mid position rotate the dumbells so
that your palms are facing upward. Raise the dumbells fully and
hold for a second then lower to the starting position and repeat
10 times for 3 sets.

Tricep Exercises

Exercise 1 - Close Grip Bench

Lay flat on a bench and use a narrow grip (12 inches apart) on a
moderately weighted barbell. Lift the barbell off the stands to full
arm extension slowly lower the barbell to your chest then press
the barbell to full arm extension tensing the triceps as you do so.
Repeat this for 8 to 10 reps and for 3 sets.

Exercise 2 - EZ Triceps Extensions

Lay on a flat bench and grasp a moderately weighted EZ bar. Use a
narrow grip and push the bar to full extension above your chest.
Keeping your elbows stationery lower the bar until it touches the
brow of your head. Then keeping your elbows as close together as
possible press the bar back to the starting position and repeat
8 to 10 times for 3 sets increasing the weight each time.

After your workout have one of these Great Tasting High Protein Shake Recipes



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Monster Arms Workout

Do not exceed more than 6 sets on the biceps and triceps and keep the
reps within the range of 6 to 10, increasing the weight each workout
for maximum results. Strict form is essential, no jerking or swinging
movements, concentrate on the arm muscles.

Biceps Exercises

Exercise 1 - 21`s

This exercise will give an incredible bicep pump. Start with a lightly
loaded barbell arms fully extended downwards. Raise the barbell to waist
height slowly and hold for 1 second, then lower to the starting point.
Repeat this seven times, on the final rep hold the barbell at waist
height then raise the barbell to just below the chin hold for 1 second
then lower to waist height repeat this 7 times. On the final rep lower
the barbell all the way down to arms fully extended then raise the
barbell all the way to just under the chin and repeat for 7 reps.

Exercise 2 - Hammer Curls

Lay on a 30 degree inclined bench, use a pair of moderately weighted
dumbbells heavy enough so as you can just manage 10 reps with full
effort. Extend your arms fully down and rotate the dumbells so that
your knuckles are facing forward. Slowly raise and rotate the
dumbells, as you get to the mid position rotate the dumbells so
that your palms are facing upward. Raise the dumbells fully and
hold for a second then lower to the starting position and repeat
10 times for 3 sets.

Tricep Exercises

Exercise 1 - Close Grip Bench

Lay flat on a bench and use a narrow grip (12 inches apart) on a
moderately weighted barbell. Lift the barbell off the stands to full
arm extension slowly lower the barbell to your chest then press
the barbell to full arm extension tensing the triceps as you do so.
Repeat this for 8 to 10 reps and for 3 sets.

Exercise 2 - EZ Triceps Extensions

Lay on a flat bench and grasp a moderately weighted EZ bar. Use a
narrow grip and push the bar to full extension above your chest.
Keeping your elbows stationery lower the bar until it touches the
brow of your head. Then keeping your elbows as close together as
possible press the bar back to the starting position and repeat
8 to 10 times for 3 sets increasing the weight each time.

After your workout have one of these Great Tasting High Protein Shake Recipes



Lose Fat, Gain Muscle, Shape Up. Sign up for our Free Weekly Bodybuilding,
Fitness and Health Tips Newsletter, and you will be automatically entered
in our monthly drawing to win Free Bodybuilding Supplements and other great prizes.
Stay informed, stay motivated, win free stuff, join today!

Click Here To Sign Up Free

Please explain this to Cargill

6 September: As you can see, Monsanto keeps eyeing markets for its genetically modifed soybeans. In a joint venture with Solae, Monsanto wishes to flood the supplement market, and probably Big PhRMA products too, with their oil as a source of omega 3.  As this excerpt notes, ALA is not well converted to active omega 3 by most humans.  Remember that it has just been found that soy bean oil contributes to cataract.  This oil is also used as a "plant sterol" in margarines and many other products that allege they support heart health.

Monsanto and Solae are leading research into genetically modified soybeans containing SDA as a source of omega-3. Soybean oil is not normally a good source of omega-3 because it contains alpha-linolenic acid (ALA), which the body coverts inefficiently to SDA. Read complete article

5 July: While we know this product is highly unlikely to be non-GMO, it's also another example of corporate irresponsibility.

I've posted numerous articles on Natural Health News about the promotion of "plant sterol" products allegedly for heart health.

When doing some digging I found that it is GMO canola and soy oils used to push this agenda, and consumers are mostly unaware.

Flax seeds and flax oil are tremendous health promoting foods, but flax oil is extremely fragile and turns rancid quickly. One has to wonder will Cargill utilize GMO flax seed to make their oil. And what will they use to make it stable for nine months, non-refrigerated?.

What it's got: Flaxseed is a good plant source for a type of omega-3 fatty acid known as alpha-linolenic acid (ALA). It also contains soluble fiber and plant estrogens called lignans..
Why it's super: Flaxseed may improve heart health by lowering blood pressure, inflammation, and blood triglyceride levels and helping to prevent clot formation in arteries. Some studies suggest it may also reduce the risk of some cancers.

The major issue beyond GMO and the liver toxicity relationship to canola oil, is the inability for a vast majority of people to convert these oils from ALA to Omega 3.

Additionally, most commercial oils are produced with toxic hexane and toxic benzene.

I guess you'd better learn to read labels, your life may depend on it.

Cargill To Introduce Industry-First Healthy Oil Innovation, Clear Valley® Omega-3 Oil Made From Canola And Flax Seed, At IFT Food Expo
Revolutionary new oil delivers heart health benefits, allows ALA omega-3 label claim in low-fat, shelf-stable products

Minneapolis, MA /PRNewswire/ - Cargill will introduce a revolutionary new canola/flax seed oil blend at the Institute of Food Technologists (IFT) Food Expo July 18-20 in Chicago. Cargill recently completed a GRAS (Generally Recognized As Safe) self-determination for the ingredient, which will allow food manufacturers to make a "good source of ALA (alpha linolenic acid) omega-3" or "excellent source of ALA omega-3" Nutrient Content Claim(1) on the front of the package. The new oil contains up to 30 percent of ALA omega-3 and provides a minimum of 160 milligrams of ALA in most applications. Clear Valley® Omega-3 Oil, which is patent pending, is now available for product trial testing.

"As heart-health is top of mind for many consumers, Cargill developed Clear Valley®Omega-3 Oil to help manufacturers who want to seamlessly deliver heart-healthy products to this market," said Willie Loh, Ph.D., vice president in Cargill's oils and shortenings business. "This is not a small opportunity for our customers. Seventy-seven percent of consumers have used heart-healthy foods in the past year(2), and 63 percent of consumers are trying to add sources of omega-3 to their diets(3)," said Loh. Loh further discusses the subject of healthy oils innovation on the Cargill Innovation Exchange. Read complete article

We need to rescue our food system from corporate control

I have one very well worn, tattered, and browning copy of Diet for a Small Planet whose recipes I used over and over again from the day I first bought it over 40 years ago.

My copy of Recipes for a Small Planet disappeared to the UK on a trip my eldest daughter made one year to visit home.

I think of how things have changed over these decades and wonder if corporate greed will cease, and corporate responsibility will take hold.

It is tough to imagine. All one has to so is to look at the take over of the natural food market place by Heinz, Colgate, and others. These takeovers have shown me that the good brands and good food we used to be able to purchase has become too many boxed food items loaded with toxic canola oil and sweeteners.

You have to learn discriminating food purchasing, and get back to basics for this to have a chance.

Global Food Problems Are About Justice Not Scarcity
By Frances Moore Lappe

In 1969, as I tried to grasp the root causes of hunger, I struggled to absorb the shocking picture my simple research was uncovering: While world food experts cried “scarcity,” in truth we bright humans were—and still are—creating hunger out of plenty. We’d turned our food system into a scarcity-creating machine, and were undermining the Earth’s food-producing potential, too.

I’ll make a one-page handout, I thought. I’ll pin it up here and there and we’ll all catch on, won’t we? For no one would do such a crazy thing, if they only knew.

My handout became a book, Diet for a Small Planet, which showed how our newly emerging diet—based on grain-fed meat produced with chemical inputs—reflects neither our bodies’ needs, nor what the Earth can sustain.

That was then.

Today, hunger’s toll breaks all records, and we’re now facing another huge downside to our reductive, extractive approach to farming: a warming climate. My daughter, Anna Lappé, has just released Diet for a Hot Planet, which continues the conversation I helped to start. She shows how much our global food system now drives the climate crisis—even more than transportation.

I’m beyond proud. It’s a fabulous book (moms have a right to say what we think), shocking and empowering at once. And in June the U.N. Environment Programme released a report backing up her message, calling out industrial agriculture, particularly large-scale livestock production, as among the world’s most energy-intensive and environmentally destructive industries. Among the UNEP’s recommendations? We individuals adopt plant-centered diets to lower our own carbon “foodprints.”

The report also highlights how agriculture itself can be part of the solution: Ecological farming actually binds carbon in the soil, and its abundant crop varieties can boost biodiversity. So it’s not agriculture per se, but a certain kind of agriculture, that threatens our planet (and our health).

I could never have imagined, writing my little handout 40 years ago, that today I’d be living in a world in which earth-friendly, hunger-ending farming is proving its potential from Ethiopia to Brazil to India to the U.S.—but where citizens still go along with policies spreading hunger and the destructive, corporate-controlled industrial farming that helps to cause it.

Clearly, we have to dig much deeper.

So, while I celebrate the UNEP’s call-to-diet-action, I wish the report had framed the problem more precisely. It names population and economic growth, which increase consumption of animal products, as culprits. Ernst von Weizsaecker, an environmental scientist who co-chaired the panel, is quoted in press coverage saying, "Rising affluence is triggering a shift in diets towards meat and dairy products.”

I wish the UNEP had emphasized that population growth and our kind of economic growth (producing vast waste) are themselves symptoms of deeper problems.

Almost all population growth in the next 30 years is predicted to be in poor countries, in large measure reflecting the lack of power many women have over their fertility and the dearth of economic opportunities available to them.

And the destructive planet-heating food production and distribution we now experience are themselves consequences of a particular kind of growth—centralizing control of farmland, processing and distribution by national elites and global mega-corporations; power that both reflects and strengthens their political influence. The deepening, gross inequities that result do in fact spur consumption of animal food by the better off—animal products produced using environmentally egregious practices.

But might the UNEP’s frame emphasizing “growth” itself as the problem further distract us from the root problem, deepening worldwide power inequities?

If, by contrast, we were as societies redressing power inequities and reclaiming our democracy from private interests, and if our world’s poor majorities were gaining access to land and agroecological knowledge, enabling more local food distribution, too, then it’s possible we’d see the meat question differently. We’d see that those without access to animal food could produce and consume modest increases, integrating livestock into healthy farming—and reducing our collective climate impacts.

Of course, as author of Diet for a Small Planet, I also know that for the world’s minority who now consume much more protein than our bodies can even use, eating less animal food is great for our health and useful in sending countless messages through the market for saner use of resources.

But that’s a very different proposition than suggesting that overconsumption causes the crisis, and that less is the primary cure.

So I applaud all who are now embracing planet-friendly diets. Hurrah for us! But let such a diet serve as a daily reminder—a string around our fingers that we notice at least three times a day, reminding us of the root of our ecological and hunger crisis: the concentration of corporate power. From there, all that good plant food in our bellies can not only enhance our health, but also bulk up our courage to name this deeper challenge and take it on.

Frances Moore Lappé wrote this article for YES! Magazine, a national, nonprofit news organization that fuses powerful ideas with practical actions. Frances is the author of many books including Diet for a Small Planet and Getting a Grip 2. She is co-founder of Food First and the Small Planet Institute, and is a YES! contributing editor.

© 2010 YES! Magazine All rights reserved.
View this story online

Drug Web Sites May Not Be That Helpful

I have to admit that am opposed to drug ads on TV and elsewhere, such as the proliferation of ads that have been sponsoring Prevention magazine since Robert Rodale's death.

To add to the disease and drug mongering I think the ads promote, this article supports the need for more balanced and consistent information.

What most people today seem not to understand is the simple fact that their health care provider is required by law to give drug and side effect information every time a drug is prescribed.

Also helpful is information like we provide in our "Health Detective" and "Health Forensics" programs that includes drug interaction and nutrient depletion.

HANOVER, N.H., July 5 (UPI) -- U.S. researchers describe prescription drug maker Web sites a gray area of discourse and ethics.

Lewis Glinert, professor of linguistics at Dartmouth College in Hanover, N.H., and John Schommer of the University of Minnesota in Minneapolis examined Web sites dedicated to the 100 best-selling prescription drugs.

The researchers found consumers were expected to move in a maze of text and navigation choices and that content was unpredictable -- including difficult to discern mixes of information and promotion.

"The Food and Drug Administration has rules about direct-to-consumer print and television drug advertising, so we think it makes sense to also regulate Web sites and other marketing tools when it comes to prescription medicine," Glinert said in a statement.

"Consumers need consistent and balanced information."

The findings were presented at the Communication, Medicine and Ethics Conference at Boston University School of Public Health.

Glinert noted the search engine Google has been working with the National Institutes of Health in Bethesda, Md., to improve Internet drug searches -- including adding links to NIH content and risk data.

"Our research provides justification for Google's move," Glinert said. "Only time will tell if this is a major change for the better."

© 2010 United Press International, Inc.

How I've Trained Around Injuries

By Nick Nilsson

Being injured doesn't have to mean total rest and a loss of muscle, strength and results. There ARE good ways to train around injuries, as long as it's done SMART.

So here's the deal...an injury isn't the end of the world! They happen to the best of us, sometimes no matter how careful you are. And THAT is what this article is all about...I'm going to give you examples of how I'VE trained around a few injuries I've had over the 18+ years I've been training.

Getting these injuries didn't mean I had to completely stop every aspect of my training until I was fully recovered. In fact, continuing to train actually helped with recovery!

** Before we go any further, let me be VERY clear right up front. The examples I'm using here are from MY own experience and used only on myself. I'm not recommending you do ANY of these techniques.

I'm not a doctor (and especially I'm not YOUR doctor). I'm not a physiotherapist. This should NOT be considered medical advice. When you read this article, PLEASE use your own common sense and PLEASE consult with your doctor and get the all-clear to train if you decide to train around any injury.

Injury #1 - Twisted Ankle
The first injury I want to talk about is a twisted ankle. I was playing soccer and got my foot stuck in a hole in the field and at the same moment got spun around by another player. So basically, I tore up most of the ligaments in my left ankle.

I did all the rest, ice, elevation, etc and I went to the doctor the next day. He told me I had two choices...because the sprain was so severe I could either put it in a cast and it would get weaker, or I could just keep icing and elevating it.

I asked him if I could do other things in the gym while it was healing and he not only said "absolutely," he actually encouraged me to start using it as soon as I felt I could put weight on it.

I was back in the gym that same evening, hobbling around and doing upper body training without any problems. The next day, I was doing one-legged squats on my RIGHT leg (the uninjured side).

By working the non-injured side, you can prevent a lot of the strength loss and atrophy that you often see when a limb is immobilized. This happens because of nervous system activation.

When the right leg is used and activated, the nervous system also activates the corresponding motor units of the OTHER side. This can help prevent a lot of the muscle-wasting you see with people who are in casts - if only they would have trained their uninjured side!

The key thing to note is that even though I was working my right leg, I wasn't putting pressure on my injured side while I still had pain on it. As it healed and I was able to put pressure on it without pain, then I gradually worked it back into my training, with no loss of performance.

Injury #2 - Wrist Pain
This happened to me my very first year of training and I very quickly figured out exactly what the cause was: too much barbell curling.

Every time I picked up the straight bar to do curls, I would get sharp pains in my wrists. I even got to the point where I got a couple of wrist wraps to help ease the pain (which worked briefly).

How did I train around that injury? Easy. Dumbell Curls.

Once I figured it out, I immediately stopped all barbell training...curls, benching, rows, machines, everything that locked my wrists into position while training.

I still had some pain in my wrists while I was doing dumbbell work for several weeks after I got off barbells, but the wrist pain gradually went completely away on its own.

The key thing to note here - I had an injury as a result of getting "locked in" on barbells (especially straight barbell curls, which put a lot of pressure on the wrists, which in itself is the reason the EZ Curl bar was invested), and I immediately trained around that by switching to dumbells.

Problem solved, and I actually saw increased growth and strength because I changed things up.

Injury #3 - Pulled Tricep Muscle

This one will seem like a strange injury...I pulled the long head of my left tricep doing heavy SHRUGS. Yep, you read that right. Shrugs.

The reason I pulled the long head is because it's the only head of the three-headed tricep muscle that crosses the shoulder joint. I had been doing high training volume (shrugs every session) and heavy weight (about 600 lbs) for a number of weeks and it caught up to me.

Because of the nature of the injury, it meant some changes to my program. It meant no more deadlifts, shrugs or stiff-legged deadlifts. Also, I was off all rowing, chinning and pull-down movements. Ironically enough, I could actually do close-grip bench pressing and dips without any problem at all, which is strange for a tricep injury.

My tricep was injured but I could hardly do any BACK training because of it!

Training around it was relatively simple. I just avoided those exercises I mentioned. But that left me without many options for back training. For back, I used a bench press machine backwards, sitting with my chest towards the back pad. I then put my elbows against the bench handles and pushed back against them to get the back activated. This took the injured tricep completely out of the movement but allowed me to get in some decent back training.

Injury #4 - Strained Pectoral Muscle
This one happened to me doing VERY heavy weighted dips. I had 170 lbs hanging off my waist, had just done several sets with that weight and decided to finish with some high-rep, top-range partials to really overload the muscle.

It's a technique I'll never use again, because looking back on it, I was totally setting myself up for this injury. Very heavy weight on a stretch-focused exercise (which in and of itself wasn't so bad) but then when I did the high-rep partials, it was like tearing the muscle repeatedly until it ripped even more.

The good thing is, the moment I felt the start of the strain, I dropped to ground immediately, so I didn't get an actual muscle tear, thought I thought was pretty much done with chest training for at least a month.

Not even close...after swearing about it for awhile, I began doing one-arm dumbbell bench press (on the Swiss ball) on my right side to help keep the strength up on both sides. I avoided all exercises that caused any pain or stretch on the left pec (to give you an idea, I couldn't bench press even a 10 lb dumbbell without pain on that side).

I kept up with the one-side pressing and within a month, I was back pressing 100 lb dumbells with both sides with no pain and no real loss of strength in the injured side.

The key here is that I focused on what I COULD do and not what I couldn't. This allowed me to keep up with regular training and not see any drop in strength or mass, even on the injured side.

Injury #5 - Pulled Muscle in my Lower Back
This one I wanted to use as an example of an injury that I COULDN'T train around. I did this one to myself trying to stretch out my lower back with a twisting stretch. BAD idea. I was about do some incline barbell bench and I was sitting on the bench, rotating my torso and pushing with my right elbow against the outside of my left knee.

And then I felt and heard a "POP."

And that was that. I was doubled over on the floor and could hardly breathe. No workout that day!

It took me about 4 times as long to walk home because I could hardly hold myself upright. Sleeping was no fun at all. Luckily at that point, I still owned a weight belt. I had to wrap it tight around myself and sleep with it on in order to not be in excruciating pain.

There was simply NO way for me to train around that one. Breathing, let alone training, was painful. I couldn't support any weight. To this day, when I get lean enough, I can still see where the muscle popped through the fascia in my lower back.

A few days later, I was able to get back in the gym and do some light training but that was definitely something not to be trained around.

Conclusion:
The key to remember here is to pick your battles. I've had injuries I could easily train around and which were more inconvenience than injury. I've also had injuries where discretion is the better part of valor and have had to take time off.

In all things, if YOU decide you want to try and train around an injury, PLEASE check with your doctor first. The last thing you want to happen is to self-diagnose and find out later there was more going on with the injured area than you thought.

Yeah, it stinks to have to take time off training, but the alternative could be a MUCH longer recovery time or even chronic re-injury and weakness.

------------------

Nick Nilsson has a degree in Physical Education and Psychology and has been innovating new training techniques for more than 18 years. Nick is the author of a number of bodybuilding books including "Muscle Explosion! 28 Days To Maximum Mass", "Metabolic Surge - Rapid Fat Loss," "The Best Exercises You've Never Heard Of," "Gluteus to the Maximus - Build a Bigger Butt NOW!" and "The Best Abdominal Exercises You've Never Heard Of", all designed to maximize the results you get for the hard work you put into your training.

Be sure to grab your FREE copy of Nick's 30-day "Dirty Little Secret Program for Building Muscle and Burning Fat FAST," available at http://fitness-ebooks.rxsportz.com

Thyroid and Heart Connection: Known for Decades

UPDATE 3 July, 2010
Larry Frieders, the compounder, THYROID MADNESS DEFINITION:

1.Treating hypothyroid patients solely with T4-only meds (synthroid)
2.Dosing solely by the TSH and the total T4, or using the outdated "Thyroid Panel"
3.Prescribing anti-depressants in lieu of evaluating and treating the free T3
4.Telling thyroid patients that desiccated natural thyroid like Armour is "unreliable", "inconsistent", "dangerous" or "outdated".
5.Making lab work more important than the hypo symptoms which scream their presence
6.Failing to see the OBVIOUS symptoms of poorly treated thyroid, and instead, recommending a slew of other tests and diagnoses.

9/23/08 - I am pleased to see this topic in the medical article arena. I'd like it more if I saw it in mainstream news. This way there might be some hope that patients would pressure their doctors to run annual thyroid panels, especially for the over 35 crowd, as the AMA recommended about 15 years ago or more.

Endocrine function is closely related to heart function. This is very true for good thyroid health and good gallbladder health, among related issues.

I don't agree that the TSH alone is sufficient for good thyroid evaluation. A Free T3 and a Free T4 are very necessary. If you've never had a reverse T3 (rT3) it's not a bad idea to add that in for baseline, as it does relate to autoimmune issues that are becoming more common today.

Does Your Doctor Know About the New TSH Lab Standards?

I'd be happier too if providers would get current on the TSH et al ranges: The Clinical Endocrinologists (AACE) are currently suggesting that TSH is 0.3-3.0 mU/L.
Over 13 Million Americans with Thyroid Disease Remain Undiagnosed

It is also a good idea to refer to the National Academy of Clinical Biochemistry, part of the Academy of the American Association for Clinical Chemistry (AACC), Laboratory Medicine Practice Guidelines: Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease

"It is likely that the current upper limit of the population reference range is skewed by the inclusion of persons with occult thyroid dysfunction."

"In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mIU/L because >95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L."

"A serum TSH result between 0.5 and 2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose for primary hypothyroidism."

"Thyroxine requirements increase during pregnancy. Thyroid status should be checked with TSH + FT4 during each trimester of pregnancy. The L-T4 dose should be increased (usually by 50 micrograms/day) to maintain a serum TSH between 0.5 and 2.0 mIU/L and a serum FT4 in the upper third of the normal reference interval."

Optimally, cardiologists have a lot to gain by talking cross-specialty.

Patients have much more to lose if they don't.

From this article, ranges not current with ACCE recommendations. "Normal thyroid function (euthyroid; TSH 0.45 - 4.5 mU/L), those with subclinical hypothyroidism (divided into moderate, TSH 4.5 - 9.9 mU/L, and severe, ≥ 10.0 mU/L), and those with subclinical hyperthyroidism (TSH < 0.45 mU/L)."

3 July, 2010 - And consider this article on thyroid and heart health

From Heartwire — a professional news service of WebMD

September 22, 2008 — A new study has found that older adults with severe subclinical hypothyroidism had almost double the risk of developing heart failure (HF) compared with those with normal thyroid function over a 12-year follow-up period [1]. Dr Nicolas Rodondi (University of Lausanne, Switzerland) and colleagues report their findings in the September 30, 2008 issue of the Journal of the American College of Cardiology.

Rodondi told heartwire that these results were in line with those of the only other study to have looked at subclinical hypothyroidism and HF incidence, which also found an increased HF risk only in those with high levels of thyroid-stimulating hormone (TSH).

The findings are important to inform the debate about subclinical hypothyroidism, he says. "There is a big controversy about whether we should screen and treat people with subclinical hypothyroidism. We know that people with overt hypothyroidism with symptoms need to get treated, but about those with no symptoms and just subclinical disease, there is debate. And within this debate about whether to treat or not is another controversy about the threshold at which you should treat."

These and other results from prior studies support the recommendations of several guidelines that those with subclinical hypothyroidism and no symptoms should be treated with thyroxine only if their TSH is 10.0 mU/L or more, Rodondi says. However, he points out that some endocrinologists disagree and advocate treating such patients at lower TSH levels. The debate is important, he says, because it is has been shown that monitoring of TSH levels under thyroxine is not always accurate in clinical practice, with overtreatment having its own attendant risks.

"Indirect evidence" that thyroxine might prevent HF

Rodondi and colleagues studied 3044 adults who were 65 or older participating in the Cardiovascular Health Study, all of whom were free of HF at baseline. They compared adjudicated HF events over a mean of 12 years of follow-up and changes in cardiac function over the course of five years among those with normal thyroid function (euthyroid; TSH 0.45 - 4.5 mU/L), those with subclinical hypothyroidism (divided into moderate, TSH 4.5 - 9.9 mU/L, and severe, ≥ 10.0 mU/L), and those with subclinical hyperthyroidism (TSH < 0.45 mU/L).Over the follow-up period, 736 people developed HF events. Those with TSH 10.0 mU/L or more had a greater incidence of HF compared with euthyroid participants (adjusted HR 1.88, p=0.01). No such increased risk was seen in those with TSH 4.5 - 9.9 mU/L or in those with subclinical hyperthyroidism compared with euthyroid participants.Baseline peak E velocity — an echocardiographic measure of diastolic function associated with incident heart failure in the cohort — was also greater in those with TSH 10.0 mU/L or more compared with euthyroid participants (0.80 m/s vs 0.72 m/s; p=0.002). And over the course of five years, left ventricular mass increased among those with TSH 10.0 mU/L or more, although other echocardiographic measures were unchanged. In a further exploratory analysis, the researchers stratified people with TSH 10.0 mU/L or more into those who received thyroxine replacement therapy and those who didn't. They found that those who got thyroxine did not have an increased risk of HF, "providing indirect evidence that [thyroxine] might work to prevent development of HF in those with TSH 10.0 mU/L or more," said Rodondi. He stressed, however, that "to definitively prove a link between subclinical thyroid dysfunction and HF, a randomized clinical trial would be needed in which one group is treated with thyroxine vs placebo to see if the former reduces the risk. That would be proof of concept, but it has not been done as yet." Overtreatment with thyroxine has risks too Rodondi said their findings — that those with less severe subclinical hypothyroidism do not seem to be at risk of HF — are "important," because a high proportion of older adults fit into this category and are treated with thyroxine in clinical practice, without consistent evidence that this is of benefit. Monitoring of TSH levels under thyroxine is not always accurate in clinical practice, he explains, and it is estimated that around 20% to 30% of people receiving thyroxine are overtreated. This in itself has risks, as subclinical hyperthyroidism has been associated with atrial fibrillation and increased fracture risk. "In aggregate, our findings might help refine a treatment threshold at which clinical benefit would be expected and demonstrate a subpopulation at risk for a life-threatening condition," he and his colleagues say in their paper."Clinical trials should examine the efficacy of screening for and treating subclinical thyroid dysfunction and assess whether the risk of HF might be ameliorated by thyroxine replacement in individuals with TSH levels above 10 mU/L," they conclude.Source: Rodondi N, Bauer DC, Cappola AR, et al. Subclinical thyroid dysfunction, cardiac function and the risk of heart failure. The Cardiovascular Health Study. J Am Coll Cardiol. 2008;52:1152-1159.