After leading one of my typical, long, difficult hikes, 16 miles with over 4400 feet of total elevation gain, one of the participants posted his pictures and said he hoped Advil and 12 hours of sleep would help him recover.  A club member, not on the hike, posted back that there was evidence Advil might interfere with his recovery, giving a blog reference.  This is not new information: non-steroidals, like Advil, have been implicated in slowing of recovery, slight intestinal compromise (coliforms in the blood), and effect upon renal blood flow which might be detrimental if one were dehydrated.  The blog link was posted with a comment that the writer, a physician, was still riding a bike in his eighties, “so he must know what he is talking about.”

I bristle at this sort of stuff, because I’m a doctor with a blog, too, and while I’m not riding a bike in my eighties, I’m doing a lot of hiking in my late 60s, and that makes me an expert in….maybe math or eclipses, but not much else.  Just because somebody is an MD and rides a bike in his 80s doesn’t make him an expert any more than a guy who speaks 5 languages can teach them.  Or a former neurosurgeon can run housing and urban development.  Doctors tend to think they’re experts in non-medical fields, too, so be careful what is taken away from my writing.  Let’s be clear.  I’m still hiking because I inherited good genes, and along the way I’ve tried to take care of myself.  The genes matter a lot.  The right genes make Olympic athletes, Tour de France riders, Track and Field champions in Eugene, and decent hikers.  Yes, we all have potential, which we reach by eating properly and training properly, eschewing bad things.  But make no mistake: all the training in the world isn’t going to make me into an Olympic athlete.  Miss a few key alleles, and you end up eighth in the Olympic trials—national class, but not on the Olympic stage, even if you trained harder than the winner.  I could no more run or perform at their speed with any amount of training than I could play the piano well with any amount of instruction and practice.  I tried the piano for three years.  I played in a couple of recitals.  It was good to be able to read and to play music.  But you never found me in an orchestra.  All men and women are created. Equal they are not.

I bristled again when I later read the link to the doctor’s blog, which detailed how NSAIDs can lessen recovery of muscle and hardening of bone with resistance.  The cohort was 90 post-menopausal women who for nine months were given resistance training three times a week followed by Advil.  To extrapolate this study to a 65 year-old man who took Advil once after a long hike—a very different sort of exercise—one time only, is inappropriate, because frankly the implication that he wasn’t going to have benefited from the hike was wrong. I commented on the study, left the comment up for all of 10 minutes and then deleted it.  I like the person writing and didn’t want to get into a discussion about inappropriate extrapolation.  I try to do all the right things in life in hopes that by improving the probability of a good outcome, I will live healthier and longer.  In fairness to the doctor, he did say more research was needed.  He’s right.

The fact that someone in the club immediately stepped in with advice not surprising, not only here, but in most instances where I have been doing group activities. I tend not to give advice unless asked, and even then I’m wary.  Most people neither want it nor take it, and these days there is too much to argue about.  I’m disappointed that many club members belittle my vegetarian diet (which thankfully no longer makes me bristle too much), when their consumption of meat is clearly harmful to both them and the environment.  I continue to be asked how I could possibly be getting enough protein, which I obviously do, or why I shouldn’t eat apple seeds (I eat the whole apple, with an occasional seed.)  It’s not arsenic, as I was mistakenly told, but cyans, which aren’t an issue unless one eats thousands. I’ve been asked how I manage my electrolytes (I don’t; that’s my kidney’s job, and I would be well advised to let them do it). I’ve been told my walking stick will make my legs weaker (really!), why I should have this or that energy/protein/carbohydrate drink, and how much and when I should drink water. I’ve been told to read such and such or such and such, enough to make me wonder how I could hike a 26.6 mile trail last year, set a pace for my partner, and get in 2 hours faster than everybody else, not counting the hour on the trail we waited, drive home that night and wake up the next morning feeling fine.  Genetics. Training for it.  Moving along steadily.  Not arguing about what I ate, using my mouth to breathe and not gab.

It’s easier to hike alone, and I’d do more of it, but there are some women and others in the club who want to do long, difficult hikes and also feel safe doing it, so I lead a few hikes for them. I feel alive by going out there and covering ground, getting deep in the back country, seeing what is out there, which is a lot, and coming out the same day.  If it is 20 miles, I don’t waste time.  If it is scenery, I go hard to get to the right place then enjoy it.  I’m grateful I can do these hikes; I don’t know how much longer I can.  In the meantime, there’s a lot of wild country to explore, far more interesting than discussing Advil, electrolytes, and diet.

My reply:

What sports medicine really needs is to get clear answers to a lot of questions like this, nutrition, and various trainings-du-jour or d’année. There are far too many conflicting studies (fat good/bad, carbo(hydrates) good/bad), protein good always, which it isn’t, especially in women, regression analyses of dubious value that people treat as gold standards (e.g. max heart rate that became a competition when I was on the bike). We need to get away from the idea that if some super star does something, it must be right. Most of them are genetically gifted. (To those who doubt me, I would reply that anybody can do mental math if they just work at it hard enough). As Joe Average, I do what seems to work for me. I try not to take Advil afterward any more, and I seem to be less sore, but that’s hardly a study. 

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