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[IP] Re: leg cramps & Heart Bars...

	Forgive the length of this post, but I hope those of you who are interested
will find this helpful....
	Leg cramps can certainly happen for many different reasons, including
electrolyte imbalance (as is common just prior to a diabetes dx or may be
exercise-induced).  Intermittent claudication, however, is a direct result
of peripheral vascular disease (PVD), or more appropriately termed PAD -
peripheral arterial disease, & affects people both with and without
diabetes.  It is a chronic and often extremely painful condition caused by
blockages in the arteries that feed the leg muscles.  Although more common
as we age, it is certainly not restricted by age.  I am currently working
with a young man (36yrs old) with severe claudication.  This PAD leg pain is
quite predictable, and almost always occurs with weight-bearing activities
only.  Of the many patients I've worked with, even those with the most
severe degree of disease on the treadmill do not seem to be affected (or
only minimally) while biking or swimming.
	In exercise physiology & in the field of vascular medicine, we have
specific exercise training protocols for PAD/PVD.  These are not pleasant,
but what we do (after a cycle warm-up) is have people walk until their leg
pain begins.... and then continue walking *WITH* that leg pain, until it
gets so bad that they can't take another step... and we say "you can punch
me later but... take *TWO* more steps" and then stop & stand until that pain
goes away.  We note how long they could walk before stopping, and we also
note how long it takes for the pain to go away.  Once it's gone, we put that
person right back on the treadmill and repeat our procedure.  The goal is to
complete a 20 minute walk protocol.  (We stop the timer at each rest &
restart as walking begins again.)  As I said, it is not pleasant, but over
time and with this type of training we can increase the "time to
claudication" and allow that person to walk longer & eventually at slightly
faster speeds before the pain stops them.  From a physiologic standpoint, we
are hoping to force the growth of "collateral" circulation - new vessels
around the blockages.  Unfortunately, biking or swimming, although great
exercise, will not improve walk time or decrease claudication pain.
	We've had some experience with Heart Bars (L-arginine) in our
cardiopulmonary rehab & wellness facility and have seen amazing results that
I would be happy to share as well.  The premise of the Heart Bar is that the
amino acid L-arginine is a precursor to "nitric oxide", which occurs
naturally in the body & works as a potent vasodilator (opens the blood
vessels thereby increasing circulation).  It appears that in persons with
PVD (& in diabetics, some of the research is saying) levels of nitric oxide
are low.  HeartBars contain a high level of L-arginine & other antioxidants,
including vitamin E, C, soy proteins, etc.  The taste is a little odd....
but if I had PVD like some of my patients do, I could certainly manage 2
bars a day, which is the recommended intake.  They DO have about 30 grams of
CHO in each bar, so those of us with diabetes have to consider this.  As
well, for those on protein restrictions.  My Type 2's are instructed to
utilize this in place of carb exchanges at breakfast, or as a
pre/post-exercise snack.  Pumpers simply bolus for it.  I do believe that
the company is working on a lower carb version.
	We have observed dramatic increases in walk time as a result of HeartBar!
Many of our PVD patients now swear by these bars.  Considering that there
are NOT many medical options out there that address claudication, outside of
angioplasty/stent or surgical bypass... this medical food avenue may be
worth a try.  As for the diagnostic tests for claudication, ("arterial
pleths", I believe) they are actually relatively simple, utilize Doppler
ultrasound and leg blood pressure cuffs, are done on an outpatient basis
usually by diagnostic imaging or EKG techs, & are covered by most
insurances.  (My father-in-law just had one done.)  Btw, I don't work for
the HeartBar company, but I have certainly been impressed by the clinical
results.  You can check them out yourself at http://www.cookepharma.com.
They can be purchased (or ordered for you) over the counter at most drug
store chains.  Sorry for the length of this post... if I can be of more
assistance to anyone, I would be happy to.

Delaine M. Wright, MS, CDE
Clinical Exercise Physiologist
Cardiopulmonary Rehab, Prevention & Wellness

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