He came up with it after years of studying steroid users in Boston-area gyms and comparing them not just to non-steroid users in the same gyms, but also to bodybuilders from different eras. For a 1995 study, Pope and his coauthors estimated the FFMIs of Mr. America winners from 1939 to 1959, before steroids were readily available. The group includes future B-movie star Steve Reeves, whose physique was so iconic that he was name-checked in The Rocky Horror Picture Show . The average FFMI was . (One of the highest was George Eiferman, Mr. America 1948, with a FFMI. His upper body was later the model for George of the Jungle, a 1960s cartoon character.) Even today, with all we’ve learned about training and nutrition, an FFMI in the mid 20s is still considered the ceiling for natural bodybuilders. Anything above 26 or 27 is suspect.
Vitamin D comes from the diet and the skin. Vitamin D production by the skin is dependent on exposure to sunlight. Active people living in sunny regions (Southern California, Hawaii, countries around the equator, etc.) can produce most of the vitamin D they need in their skin. Conversely, lack of exposure to sunlight, due to residence in northern latitudes or physical incapacitation, causes vitamin D deficiency. In less temperate regions such as Minnesota, Michigan, and New York, production of vitamin D by the skin is markedly diminished in the winter months, especially among the elderly. In that population, dietary vitamin D becomes more important.
Reactive arthritis (Reiter's syndrome with conjunctivitis, urethritis, and diarrhea) ( Fig. 22 ) usually follows a bout of gastroenteritis or urethritis. Implicated organisms include Campylobacter, Shigella, Salmonella, Ureaplasma, and Yersinia species. Affected patients, usually men, often have vesicles and crusted plaques on the penis (circinate balanitis) and erythematous pustules and papules on the palms and soles (keratoderma blennorrhagicum) that can mimic pustular psoriasis. More than 50% of patients have sacroiliitis, correlating with the presence of HLA-B27 antigen, but few patients have the classic triad of urethritis, conjunctivitis, and arthritis.