by Gary Morley

(CNN) -- The lactic acid builds up, your muscles are screaming, your body temperature sky-rockets -- trying to stay two shots ahead of your opponent proves impossible as your thoughts fragment into near delirium.

Five hours charging around a tennis court can be sheer hell even when you're winning, but if your body is out of balance then it's an even harder challenge.

Sunday's Australian Open finalists Novak Djokovic and Andy Murray once struggled with their fitness, but both have transformed their tennis careers since discovering a diet secret that is battling for acceptance in the world of mainstream sports science.

The benefits of going gluten free have been extolled for years by alternative health practitioners, but they have been brought to wider attention due to the exploits of high-profile stars such as Djokovic, whose wheat intolerance caused the world No. 1 severe breathing problems.

"I knew from my experience that asthma was not the boy's problem but rather it was reflecting a symptom of something that was going on with his digestion," says Dr. Igor Cetojevic, who worked with Djokovic for a year up until his Wimbledon triumph in 2011.

"It was his sensitivity to gluten that was compromising his lungs," he adds, citing that in Chinese medicine there's believed to be a relationship between the large intestines and the lungs.

Our diet has changed dramatically in the past century, especially in Western countries. It's a trend that's spreading around the world due to the globalization of commerce, and the food industry in particular.

"I believe one of the problems is over consumption of gluten-containing grains, especially wheat, and the fact that it is genetically different from ancient wheat," says naturopathic physician Hamish Everard.

Cutting out wheat-based foods such as bread and pasta could be the best thing you ever do, says one of his clients, tennis coach Pete McCraw, who has helped develop top players such as Maria Sharapova and Jelena Jankovic.

"The energy level that you have is something I've never experienced before. You don't ever have that crash, the high and then the low," McCraw told CNN.

"Those periods of the day when you crave carbs or sugar, feeling drowsy at work or in the car or wherever, you don't have that anymore, it's a completely different thing -- it's sustained, you don't have the foods cravings like I used to.

"It's a completely different energy source that your body's operating from. The ability to maintain a lean athletic figure is effortless."

The problem is not just wheat, but also processed dairy and sugars -- all of which we consume more regularly and in higher quantities than ever before.

"The gluten in food produces certain conditions; dairy, especially when produced conventionally, contributes to other factors to the detriment of our health," says Cetojevic, who is trained in both conventional and alternative medicine.

"Generally, milk is for babies. We don't need dairy products as we get older," he adds, and also warned against the intake of processed sugar.

"The change in food production has increased yields to the point of surplus but has not improved the quality of the food we eat. Often it contains traces of pesticides, hormones, preservatives, artificial colors, flavor enhancers and I won't even begin to talk about genetically modified organisms."

About 18 months ago, McCraw started noticing symptoms of extreme lethargy in young players he was working with.

"They were presenting chronic fatigue symptoms, although they weren't diagnosed in a traditional way, in terms of blood markers -- everything would come back reasonably normal," he said.

"Athletes would be complaining of excessive tiredness, even after light sessions. During a normal daily activity it was fine but then as soon as they began to exercise their blood sugar levels would drop significantly, and that causes concentration-behavior issues, (problems with) focus, emotional control.

"By the normal standards these were healthy teenagers and players in their early 20s, but they weren't healthy."

McCraw, who has held top coaching and development roles in his native Australia, New Zealand, Israel and at the Nick Bollettieri academy, works with players from age grade to elite level.

One of his clients had been seeing Everard to treat his celiac disease -- an autoimmune disorder caused by gluten intolerance that attacks the walls of the small intestine and makes it difficult for the body to absorb and process the nutrients that it requires.

Everard says that while only 1% of people are gluten intolerant, more than half of his clients are sensitive to it -- and 93% of them have seen benefits from eliminating gluten from their diet.

The improvements increase even further when processed sugars such as high-fructose corn syrup are taken out of the equation, says McCraw.

You might think bread and pasta are healthy foods, but essentially they break down into sugars like a chocolate bar does -- and this is not an energy source that human bodies evolved with.

"We're really designed physiologically to burn fat, it's what our body is designed to do. Shifting the major energy systems from sugar to fat is the transition you go through when you take a gluten-free option," McCraw said.

The first step in treating problems with gluten is to stop eating grain-based foods for at least four weeks, says Everard, but not -- especially for high-performance athletes -- to eliminate carbs altogether.

"We educate the patients about consuming gluten-free ancient whole grains. These include amaranth, buckwheat, corn, millet, uncontaminated organic oats, quinoa, sorghum, teff and rice. This gives the gastrointestinal tract (GIT) a chance to start repairing itself."

It needs help, and probiotics will aid restoration of the stomach's healthy bacteria and digestive enzymes, and also protect against further damage, Everard says

"The research and my clinical results have found the GIT is weakened when we are exercising, especially in hot conditions and leaves the body susceptible to illness," he adds.

"The lining of the gut is very sensitive to the intense heat that endurance athletes train under. My patients have often complained of cramping in the gut, diarrhea or nausea and an increase in colds and flus after competitions and intense training.

"As the body heats up, small cracks form in the intestinal wall, allowing bacteria into the blood stream. We monitored our patients and found that when they did extensive exercise 82% showed symptoms of gut discomfort, reduced tolerance to the heat or a decrease in immune function."

In the case of Djokovic, who clinched a record third successive Australian Open title on Sunday, he had to give up childhood staples such as pizza, pasta and pancakes while introducing more vegetables and rice, fruit and sushi for easily digestible protein."At first, it was difficult for him but he was fed up of being stuck in third place and his determination to be the champion combined with his confidence in my knowledge was all the motivation that he needed to change his diet," says Cetojevic.

"I also suggested that he cut down on his consumption of meat, particularly before a match. Coming from Serbia, that was a radical suggestion -- even more so than cutting out gluten!

"Because Novak was in very good condition from his constant training routine, the benefits were apparent almost immediately, which encouraged him to continue. The breathing problem vanished as did the frequent injuries and strains that had been hampering his progress."

McCraw says he has also seen "life-changing" results in his clients.

"Personalities changed, they were much calmer, had more clarity, better grades at school, their relationships with parents have improved, my relationship with them has matured," he said.

"Less sweating on the court, their endurance levels have increased, ability to maintain a leaner figure has improved, ability to build and hold muscle mass has improved. All of the things that an athletic trainer and coach would strive for, I've seen evidence of that on a daily basis."

However, a gluten-free diet might not suit everyone, says Susie Parker-Simmons, a sports scientist who works with the U.S. Olympic Committee as well as women's tennis players on the WTA Tour.

"There is no benefit in avoiding gluten if you do not have celiac disease or gluten intolerance," she told CNN.

"Therefore I would not recommend an athlete try this diet unless diagnosed by a medical professional."

She said that athletes might find it difficult to adhere to such a diet, especially tennis players who have to travel a lot and might have restricted food options.

"Gluten-free standards and labeling differs in each country. Before going overseas WTA players need to gain advice on the best foods to eat in their country of destination and order gluten-free meals on the airlines they are traveling with," she said.

"A large amount of carbohydrate-rich foods contain gluten in them e.g. bread, pasta, sports bars etc. An athlete with celiac disease needs to be very careful when selecting carbohydrate-based foods to ensure they receive their daily requirements."

Another problem is that many foods containing gluten are also important sources of fiber -- which the body needs to keep the intestines clear of toxins.

"Common gluten-free sources of fiber include: vegetables, fruit, brown rice, legumes, nuts and seeds," Parker-Simmons said.

She believes that while research has shown positive links between health improvement and a gluten-free diet, there is little to suggest it helps in terms of injury prevention and recovery.

McCraw, however, said that his players had shown improved ability to bounce back from intense workouts.

"There's always micro trauma in the muscles and joints, and the body has a natural anti-inflammatory response to that after exercise," he said.

"The gluten inhibits that process and therefore the onset of muscle soreness is worse. The general ability to recover and retain that homeostatic state is compromised. Your threshold of work levels is lower and your recovery rate is higher and longer."

Everard would like to see more studies into the effects of gluten, which he believes could be at the heart of many modern illnesses.

"This is a very complex area and not fully understood in mainstream medicine, however there is a huge amount of research and evidence in this field," he said.

"I see the benefits of a gluten-free diet in my patients every day through clinical experience, but there still needs to be more research done so that this can become more mainstream -- especially in the world of sport."

Many studies focus solely on the benefits or otherwise of eliminating gluten, rather than taking into account other dietary elements.

"The question is -- is it actually gluten that is the problem or is it refined grains or grains in general?" says British nutritional therapist Kate Delmar-Morgan.

"Individuals wishing to go down this route should seek proper nutrition advice and be tested if possible."

There is also the issue that many gluten-free products are processed and contain high levels of added sugars and artificial additives.

"People will look at these products and think they are 'healthy' just because they are advertised as gluten-free," Delmar-Morgan says.

"However if people stick to a wholefoods diet -- i.e. fresh fish, meats, vegetables, fruit, nuts and seeds, wholegrains which do not contain gluten, and they try to cook from scratch as much as possible and have limited pre-prepared foods -- they can then avoid this problem."

LINE DANCING IN BRADDOCK

Cardiovascular disease (CVD) is the most common cause of death in the U.S. Fortunately, the earlier people find out they have CVD, and with the many ways it can be treated, people can live healthier, longer lives. The UPMC Heart and Vascular Institute developed the Community Outreach and Cardiovascular Health (COACH) program to provide education about heart health, screening and treatment for CVD.
COACH has three components. The first is Check Your Heart, a community program that checks people for CVD. The next is FreeCare, a program to provide cardiovascular care to underserved patients who lack medical insurance. The last is the Childhood Health and Nutritional Goals and Education (CHANGE) program, dedicated to helping children be healthy.
Members of the COACH team provide free CVD screenings to adults in the community. Screenings include measures of height, weight, blood pressure, body mass index (BMI), cholesterol levels and blood sugar. Additionally, counseling is available from dietitians and cardiologists.
The FreeCare program runs a free cardiovascular clinic as part of the Birmingham Free Clinic (412-431-4280), located at 44 South 9th Street on Pittsburgh’s South Side. This clinic serves patients who have little to no health care coverage.  The free cardiovascular clinic is sponsored by the University of Pittsburgh’s Program for Health Care for Underserved Populations. Cardiovascular services provided include heart-health tests, standard treatments and follow-up visits with doctors.
The CHANGE program was created to reach children. According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years. The goals of CHANGE are to help provide educational services to address the cardiovascular health and physical activity needs of local children. CHANGE emphasizes physical activity, healthy eating and overall wellness.
The CHANGE program works with schools, communities and health care providers to promote heart health. The Urban League of Greater Pittsburgh Charter School has partnered with the CHANGE program to help their students reduce BMI and childhood obesity as important risk factors influencing heart health.
For more information about the COACH program and the UPMC Heart and Vascular Institute, visit UPMC.com/COACH or call toll-free at 1-855-UPMC-HVI (876-2484).

CANCER RISK RISING--In this July 20, 2006 file photo, a woman smokes a cigarette during a break from work in downtown Chicago. (AP Photo/Julio Cortez, File)

by Marilyn Marchione

AP Chief Medical Writer

Smoke like a man, die like a man.

U.S. women who smoke today have a much greater risk of dying from lung cancer than they did decades ago, partly because they are starting younger and smoking more — that is, they are lighting up like men, new research shows.

Women also have caught up with men in their risk of dying from smoking-related illnesses. Lung cancer risk leveled off in the 1980s for men but is still rising for women.

"It's a massive failure in prevention," said one study leader, Dr. Michael Thun of the American Cancer Society. And it's likely to repeat itself in places like China and Indonesia where smoking is growing, he said. About 1.3 billion people worldwide smoke.

The research is in Thursday's New England Journal of Medicine. It is one of the most comprehensive looks ever at long-term trends in the effects of smoking and includes the first generation of U.S. women who started early in life and continued for decades, long enough for health effects to show up.

The U.S. has more than 35 million smokers — about 20 percent of men and 18 percent of women. The percentage of people who smoke is far lower than it used to be; rates peaked around 1960 in men and two decades later in women.

Researchers wanted to know if smoking is still as deadly as it was in the 1980s, given that cigarettes have changed (less tar), many smokers have quit, and treatments for many smoking-related diseases have improved.

They also wanted to know more about smoking and women. The famous surgeon general's report in 1964 said smoking could cause lung cancer in men, but evidence was lacking in women at the time since relatively few of them had smoked long enough.

One study, led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto, looked at about 217,000 Americans in federal health surveys between 1997 and 2004.

A second study, led by Thun, tracked smoking-related deaths through three periods — 1959-65, 1982-88 and 2000-10 — using seven large population health surveys covering more than 2.2 million people.

Among the findings:

— The risk of dying of lung cancer was more than 25 times higher for female smokers in recent years than for women who never smoked. In the 1960s, it was only three times higher. One reason: After World War II, women started taking up the habit at a younger age and began smoking more.

—A person who never smoked was about twice as likely as a current smoker to live to age 80. For women, the chances of surviving that long were 70 percent for those who never smoked and 38 percent for smokers. In men, the numbers were 61 percent and 26 percent.

—Smokers in the U.S. are three times more likely to die between ages 25 and 79 than non-smokers are. About 60 percent of those deaths are attributable to smoking.

—Women are far less likely to quit smoking than men are. Among people 65 to 69, the ratio of former to current smokers is 4-to-1 for men and 2-to-1 for women.

—Smoking shaves more than 10 years off the average life span, but quitting at any age buys time. Quitting by age 40 avoids nearly all the excess risk of death from smoking. Men and women who quit when they were 25 to 34 years old gained 10 years; stopping at ages 35 to 44 gained 9 years; at ages 45 to 54, six years; at ages 55 to 64, four years.

—The risk of dying from other lung diseases such as emphysema and chronic bronchitis is rising in men and women, and the rise in men is a surprise because their lung cancer risk leveled off in 1980s.

Changes in cigarettes since the 1960s are a "plausible explanation" for the rise in non-cancer lung deaths, researchers write. Most smokers switched to cigarettes that were lower in tar and nicotine as measured by tests with machines, "but smokers inhaled more deeply to get the nicotine they were used to," Thun said. Deeper inhalation is consistent with the kind of lung damage seen in the illnesses that are rising, he said.

Scientists have made scant progress against lung cancer compared with other forms of the disease, and it remains the leading cause of cancer deaths worldwide. More than 160,000 people die of it in the U.S. each year.

The federal government, the Canadian Institutes of Health Research, the Bill and Melinda Gates Foundation, the cancer society and several universities paid for the new studies. Thun testified against tobacco companies in class-action lawsuits challenging the supposed benefits of cigarettes with reduced tar and nicotine, but he donated his payment to the cancer society.

Smoking needs more attention as a health hazard, Dr. Steven A. Schroeder of the University of California, San Francisco, wrote in a commentary in the journal.

"More women die of lung cancer than of breast cancer. But there is no 'race for the cure' for lung cancer, no brown ribbon" or high-profile advocacy groups for lung cancer, he wrote.

Kathy DeJoseph, 62, of suburban Atlanta, finally quit smoking after 40 years — to qualify for lung cancer surgery last year.

"I tried everything that came along, I just never could do it," even while having chemotherapy, she said.

It's a powerful addiction, she said: "I still every day have to resist wanting to go buy a pack."

Online:

American Cancer Society: http://www.cancer.org

National Cancer Institute: http://www.cancer.gov/cancertopics/tobacco/smoking and http://www.cancer.gov/cancertopics/types/lung

Medical journal: http://www.nejm.org

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Sudden cardiac arrest occurs when the heart suddenly, and without warning, stops beating. This event causes hundreds of thousands of deaths in the U.S. every year. Without immediate help, people who have sudden cardiac arrest can die within minutes. According to Clifton W. Callaway, MD, PhD, professor of emergency medicine at the University of Pittsburgh, it affects one person a day in Pittsburgh on average.
Cardiopulmonary resuscitation (CPR) is the first step in saving the life of someone who has sudden cardiac arrest. From 2000-2005, people in Pittsburgh were taught to give 15 chest compressions and two breaths (15:2). But Dr. Callaway’s research, and that of others, found that every time chest compressions are stopped to give breaths, the blood pressure created by the compressions drops off. Dr. Callaway and his group began preliminary testing and started training local first responders to do 30 compressions and two breaths (30:2). Researchers tracked patient outcomes before and after this change and found that they were more successful at getting pulses back by doing 30:2. Dr. Callaway and his group weren’t the only ones doing research on this, but they had helped Pittsburgh first responders switch to 30:2 well before the CPR guidelines were changed. Now, 30:2 is part of the international CPR guidelines.
One of the questions researchers are studying now is, if 30:2 is better than 15:2, would it be even better not to pause chest compressions at all and just blow some oxygen into the patient every 10 seconds or so? In Pittsburgh, first responders are now being trained to do either 30:2 (pausing to give two breaths) or continuous chest compressions while blowing oxygen. Some ambulances are doing one and some are doing the other.  Dr. Callaway and his group are tracking all the outcomes in the region to answer that question.
Because patients can’t give consent to participate in research if they are having an emergency, resuscitation researchers like Dr. Callaway have to follow particular rules. Regulations allow for exceptions from informed consent for research in emergency situations. Researchers are permitted to try things if the study meets certain guidelines set by the Food and Drug Administration, the national Office for Human Research Protections and local institutional review boards. Anyone looking for information about studies going on in the region can go to http://acutecareresearch.org/ or call 412-647-3078.
It’s also important to remember that this is emergency research. It’s taking place in a life-threatening situation. Researchers aren’t studying procedures to see if they would be cheaper or easier. They are only doing things that have a real chance of helping someone stay alive.
According to Dr. Callaway, the best way of preparing for a sudden cardiac event is to learn CPR. People don’t have to go to a class or get certified. They can learn the basics online, at a public event or even from a health care provider. Don’t be afraid to help someone. Know how to activate the emergency system, which begins by calling 911. It’s what stands between you and a bad outcome some rough day.