Blog Archives

Jan 24

If last week was the "setup", this week we're "in the thick of things". To recap, Lindsay (my wife) and I have pledged to wear a continuous glucose monitor for 30 days and trial a handful of strategies (1 every 5 days) known to support better metabolic health. The hope is that by smoothing the spikes and drops of blood sugar that tend to be exaggerated when we consume highly processed and/or sugary foods, and therefore lead to both energy drain now and health and injury risk in the future, we will learn something, feel better and maybe see some beneficial outcomes. The first 5 days were to establish a baseline with the first "hack" - vinegar consumption before our biggest meal of the day, in our case dinner - added at day 5. All types of vinegar are known to blunt the sugar spike through a variety of mechanisms, but we chose apple cider vinegar in hopes it would taste a little better.

We've already learned a ton...but here are a few of our biggest takeaways so far:

1. Seeing Is Believing - Seeing the rapid rise and drop in blood sugar has made it MUCH easier to question, think about and ultimately change eating and snacking habits that aren't ideal. For me, it has meant quickly abandoning the honey in my cup of sleepytime tea before bed - a sleep hygiene habit I lean on to remind myself to slow down before trying to actually sleep. Now, to be honest, this one made me a little sad. As a beekeeper, I have grown to LOVE honey and as a health professional, I'm partial to the evidence that says it actually helps blood sugar control (among other great health benefits). However, the takeaway was timing. Having a sharp rise in blood glucose right before bed was not ideal...and so, while I still use and enjoy honey in tea, I just avoid it before bed. Anecdotally, my sleep quality according to my Garmin's sleep score and HRV, has trended in a positive direction since going to bed fully empty...always a welcome improvement.

Lindsay's take: "Using the monitor has definitely had an influence on food choices - I have altered what I eat because I want to avoid spiking or going above my upper threshold.".

2. It's Nuanced....and could easily be misleading. Metabolism is complex; we want it to be simple, straightforward, and maybe even easy to influence, but it isn't. Foods can be BOTH generally healthy AND still cause blood glucose to rise rapidly (certain types of fruit for example), while other foods that might generally be accepted as "less healthy" can actually blunt the sugar response. So there are definitely priorities to consider. For example, seeing the flattening of the curve or even drop in blood glucose after having a beer or glass of wine was surprising to me...even after being told to expect this exact phenomenon from a friend with experience in monitoring. While the mechanism isn't super well understood, the effect has been documented, especially when alcohol AND sugary meals are combined. Some suggest it is the liver effectively "slowing" its blood glucose functions in order to "switch on" and prioritize the alcohol processing function - not necessarily a good thing.  We had dinner out over the weekend and I had a black bean burger, fries, and a couple pints of Guinness...not a healthy meal per se, but certainly not the worst combo on that menu. And, you know, it's for science! Seeing the difference in my blood glucose overnight that night compared with my typical was a jolt. It was high (for me) all night long.

Lindsay's take: "I was surprised to see such a minor jump from a glass of wine. I guess I expected it to really spike my readings. However, seeing the delay, with a spike long after eating and even while sleeping has been super interesting and something I hope to understand better when this is all over."

3. Exercise is REALLY impressive - whether it's strength-oriented work which taxes and primes the muscles to "soak up" and use sugar or aerobic effort which quickly burns what is available, the effect has been strong and obvious. This is not meant to let the cat out of the bag on "hack 3" which is more about the deliberate timing of movement, it's been unmistakable even as part of our normal routine. I suppose it's not a huge surprise, the effect is well documented, especially when both strength and aerobic exercise are combined, but knowing that almost any routine movement can induce a blunting effect (even something as low intensity as stretching) is useful in the more wholistic effort of feeling energetic throughout the day and making a small investment in future health.

Lindsay's take: "I was surprised how strong the exercise effect really is. Strength exercise has been especially impressive for me, but even a light walk makes a notable difference in the shape of the curve."

4. Not the tastiest but still kind of cool - As expected the vinegar + water preload hack isn't particularly tasty. We've been using a ratio of 1 tablespoon of apple cider vinegar to 8-12 oz of water which waters it down just enough to be palatable and easy, but not something most would look forward to. The results however have been pretty cool to see. Instead of a rapid rise after eating, the blood glucose curve seems to either slowly climb in a gradual but steady pattern - as if it was giving a more sustained release effect - or bounce up and down a little if the meal was heavier in carbs.

Lindsay's take: "Kind of gross and it hasn't been as strong as exercise for me, but the effect is pretty consistent and easy enough to do".

We are now onto hack 2, which is to change the dinner preload to low glycemic veggies (fiber first!), and will move the vinegar to lunchtime so we can, at some level, compare. The devices are living up to daily life so far (they're estimated to last 15 days per) and, although I'm sure it'll be easy to slip backward when the data isn't staring us in the face, there are some early signs of health risk improvement (weight, body fat %, etc). Super interesting stuff so far. Stay tuned for more.

Have a great weekend,
Mike E.

Jan 10

It always feels so validating when a major news service points to the same essential message as we do here. This time, it was the New York Times in their New Year's series on health and wellness, which featured a couple of articles (here and here but unfortunately both behind their firewall) covering the topic of how to live healthier for longer, with both scientific evidence and interviews with experts. 

In one article they pointed to a really cool study from last year which looked at the health records of nearly 1M US service veterans' to determine the full potential of a healthy lifestyle. That is, they looked at the number of years of life gained (on average) in those who followed an "ELEMENTS+ Lifestyle" throughout adulthood and found that the investment paid off in about 2 decades of extra years of life. Said another way, those who did the hard work of Move, Fuel, Recover, Endure, Connect (and stayed clear of unhealthy add-ons like alcohol, tobacco, and drugs) on average gained 2-3 years per habit resulting in 20 extra years for men and up to 24 extra years for women. Said yet another way, and although NYT was careful to point out their belief that "super agers" (those who will live to 90's and beyond) likely have some genetic advantage, stacking all the same habits resulted in enough years gained to get the chance to meet another generation of the people we care about most - pretty amazing stuff.

For those interested in the specific behaviors that scored points the authors described it as "adhering to a whole-food, plant-predominant eating pattern, having regular consistent physical activity, managing negative stress, not smoking, having restorative sleep, no excessive alcohol consumption, no opioid use disorder, and having positive social connections". Specifics can be found on pages 128 & 129 of the study.

In the second article, they describe the "7 Keys to Longevity" which...although didn't use the same exact terms certainly got close: 

1. Move More

2. Eat more Fruits & Vegetables

3. Get enough sleep

4. Don't smoke and don't drink too much

5. Manage chronic conditions (blood pressure, blood sugar, etc)

6. Prioritize relationships

7. Cultivate a positive mindset

There's really no surprise here, the evidence on each is overwhelming. However, since just knowing something to be true doesn't make it easy to turn into a lifelong habit, the question remains - where should we start?

One doctor quoted in the article said "Do some version of physical activity...if you can't do that, then focus on being positive". Researchers at The University of Iowa Health Center might agree. They surveyed 7,000 patients on their movement habits, which they called the "Exercise Vital Sign" by asking 2 simple questions between 2017 and 2022.

1 - On average, how many days per week do you engage in moderate to vigorous exercise (like a brisk walk)?" (0-7 days)

2 - On average, how many minutes do you engage in exercise at this level?

They found that those who reported physical activity that achieved guidelines (about the same as the amount advocated above) had significantly lower odds of nearly 20 different diseases in the future. Amazing.

However, while getting "out there" for a walk might be inviting when the weather is gorgeous, it's easy to find reasons not to during a cold blast like the one we've been facing in many of our territories. What then?

Well, according to a research team who published findings showing substantial effects on the second target area for 2025 we identified last week, the microbiome and metabolic health, the answer might be Elderberry juice. 

In a randomized, placebo-controlled trial, drinking 12 ounces per day for a week significantly improved the gut and metabolic health of those studied. While, not nearly as well-studied as the more common but similarly low-sugar, nutrient-dense blueberry (perhaps because eating elderberries raw can be poisonous), the results showed a double-digit blood sugar reduction, a nearly double-digit insulin reduction, a significantly improved biome, and even some evidence which suggested a better ability to burn fat as fuel.

There are only 355 days left in 2025, the time to return to the groove is now.

Have a great weekend,
Mike E.

Dec 27

Well riders, we're there. By this time next week the roller coaster we called "life in 2024" will be pulling back onto the platform and those of us lucky enough for another round will be ready to check our seatbelts and tuck our hands inside the car for the first climb of '25. About the only thing we can say for sure is...this little ride goes FAST and sometimes it's easy to miss moments along the way. And so, with that in mind, we bring you the 2024 Summary Edition.

First, let's lay the foundation - if you ever wonder why we always (and only) seem to talk about the same 5 domains (MOVE, FUEL, RECOVER, ENDURE, CONNECT) and how they relate to health, it's because these are the only 5 areas where the evidence is convincing enough for us. In fact, only 1 bit of research which didn't fit was interesting enough to make the cut. Unfortunately, the punchline was, interesting as it may be, it's nowhere near conclusive enough to talk about often (or maybe even ever again). Yes, on March 1st we talked about the relative importance of finger length, specifically ring finger length as a predictor of high fitness potential. 35 other weekly issues fit within the 5 ELEMENTS framework, which left 14 issues covering 2024's most popular topic.

Starting from the top:

MOVE: This year we dedicated 11 weeks to bolstering the case that our patterns of movement - from our ability to actually coordinate it (pain-free, fluid, and fast hopefully), to the frequency, intensity, timing, and environment we do so in - play an oversized role in our health.  The key themes were: (a) it doesn't take much to kickstart a benefit, (b) it has an impact on all our systems, but increasing attention was given to how it calibrates our nervous system (from thinking and concentration to pain tolerance) and (c) like compounding interest, the earlier you start, the more you'll have to work with in retirement.

Next up, FUEL was our 3rd most popular topic area by volume in 2024 with 10 weeks in the limelight. The big takeaways weren't particularly new, but the case got stronger. First, ultra-processed foods and sugar are both more conclusively detrimental to our health. Next, counterbalancing this risk with low-inflammatory foods and healthier dietary patterns (more plants) can help, and last, it is SO much more than weight management. The case got even stronger for brain health, joint health, and even athletic performance which were all impacted by our consumption patterns.

RECOVER fell down the leaderboard a bit this year. It wasn't as commonplace in 2024 as it has been previously - although reasonably frequently mentioned, it only grabbed the headline 4 times this year. The message didn't change all that much - sleep is a big factor in future health and therefore is a critical area to focus on. I thought this study, which we referenced in late April, was particularly cool. It presented an easy way for us to "score" sleep and showed that those with at least 3 points did significantly better than those with low scores. Give yourself 1 point for each of the following: (a) bedtime between 10P and 12A daily, (b) sleep duration of at least 7 but not more than 8 hours regularly, (c) daytime sleep (napping) is 60 minutes per day or less or (d) you rate "sleep quality" as at least "fair" on a four-point scale of "very poor, poor, fair, or good".

ENDURE, that is, how we can safely handle spikes in stress, made a far more regular appearance this year than in previous years. We dedicated 7 weeks to the topic and could've easily added more. Just like the engine in our car has a preferred setting for the idle, so does our physiology. Living rev'd up (including for reasons outside of our control) impacts our ability to live healthily and fight off disease, so learning to monitor and manage it matters. There are of course nuances; Because any type of stress that pushes us closer to our personal limits (physical, mental, social, emotional, thermal, chemical, etc) can be detrimental AND because those limits are malleable and unique to each of us, this is a topic area we can ALL benefit from knowing about.

Last on the list, CONNECT was the ELEMENT we spoke about least frequently this year, dedicating only 3 weeks to the topic. While on the surface this feels a little light to me, it's a topic that is only starting to get the level of attention it deserves. We know conclusively that our health journey is impacted by the people who are with us along the way, the places we stop, pause, or pass through, and ultimately, the sense of security, hope, and even optimism we enjoy when this domain is strong. With any luck, 2025 will see an uptick in research in this area.

So if these weren't the most common, what's left? 

The punchline in 2024...that is, the topic our stats suggest was the most important in 2024 as measured by frequency, was... "all of the above." It turns out that we spent more than 1/4 of the year (14 weeks) talking about the power of ELEMENT-stacking; that is, the benefit of combining 1 or more of the 5 above into an even more powerful approach toward thriving.

While we promise to stay on the lookout for a 6th ELEMENT in 2025, until then, it seems it seems we'll keep MOVE, FUEL, RECOVER, ENDURE, CONNECT and "All of the Above" on the center stage.

Have a great weekend, Happy (almost) New Year,
Mike E.

Dec 13

Last week we reiterated what might be the most powerful theme in the science of prevention and one that has gotten lots of attention from us again in 2024 - a little can go a surprisingly long way. Women who successfully transitioned from no vigorous movement to even a few minutes (as in literally 3) per day cut their future heart risk in half. The effect was present but smaller in men. 

Of course, since everything that we do impacts all of our systems, it shouldn't surprise us that it isn't only heart health that improves. We know that physical activity gives us a brain boost, allowing us to think more clearly, make fewer mistakes, and generally perform better overall. This week, new research showed that in those over the age of 50, the effect lasted as long as 24 hours when 30 minutes of physical activity was achieved.

It's also not "only" physical activity. The evidence continues to clearly show that similarly little changes to improve dietary quality can also yield big payoffs. Findings from a team in Australia out this week showed that diet quality was related to chronic pain, especially in women. Simply put, as healthy food consumption went up pain went down. Specifically, those who consumed more "core foods" which included vegetables, fruits, grains, lean meats, dairy, and alternatives had less pain, and this was regardless of body weight.  While this likely relates to the body's inability to handle constant high inflammatory loads, a mechanism that another study out this week connected to ultra-processed diets and the risk of colon cancer, the authors acknowledge that more research is needed to know exactly why. 

It doesn't change the punchline though - eating more of the good stuff and less of the not-so-good stuff today dramatically increases your odds of a healthy tomorrow. Not convinced it's worth the effort? Wait, there's more...if this mouse study turns out to be true in humans our dietary choices likely impact our kids' and even grandkids' from a future health perspective. 

Talk about paying it forward!

2024 has once again shown that change doesn't have to be big to work...it just has to be.

Have a great weekend,
Mike E.

Nov 29

A few days ago, I saw this clip from 1985. Being old enough to remember 1985, I remember the comedian. Of course, this time, it wasn't his timing or the punchline that drew me in. Instead, it was the emotion in his eyes, how genuine his message was—one simple word that we now know can have a major impact on our lives.

There are a handful of topics we try to "check in" on every year. For example, a month or so ago, we did an update on coffee and its impact on health. If you missed it, the punchline was "it depends." For generally healthy folks and in a reasonable amount (3-5 cups), it isn't bad and might even be good. For special populations (like those with high blood pressure), it may not be as great.

Gratitude is another topic that lives on the check-in list. Over the years it has become clear that being thankful and expressing it can have surprisingly positive impacts on health - for both the receiver of the "thanks" and the giver (check your gratitude score with THIS simple 6-item questionnaire where a higher score means more gratitude). So, with this being the week of Thanksgiving, it seems only natural to perform the check-in now. 

Here's the good news - there continues to be a growing base of evidence that it can be good for us. In 2024 alone, more than 20,000 articles included the topic according to Google Scholar. Here are a few worth knowing about:

- It relates to our mortality. In a large study (45,000 participants) who were tracked over time, those who had high levels of gratitude at baseline had a nearly 10% reduction in the risk of dying and 15% lower risk of dying of heart disease specifically.

- It is impacted by sleep. In a small study (90 young adults randomly assigned), those who had restricted sleep over a 1 week period experienced meaningful declines in gratitude (along with resilience and flourishing), while those with extended sleep experienced meaningful improvements in the same areas. Similarly, another study out around the same time showed that the effect seems to travel in the other direction as well - positive psychological traits which included gratitude among others (mindfulness, self-compassion, and optimism) predicted better future sleep quality and quantity. While optimism was particularly powerful (independent of the others), collectively they were related to future sleep health.

- Last, the effect may not be limited to this world. In an article that described a series of 4 separate studies, gratitude directed at a higher power (referred to as God in this particular article) was found to not only be powerful in its ability to cultivate well-being and gratitude in general but it was found to be different and unique unto itself. For those who believe in a benevolent higher power, there is benefit in saying thank you for its goodness toward you.

The comedian had it right. It may not seem like much, but it's a powerful string of six letters. As we round the final turn and enter the homestretch of 2024, may we all have a moment to pause and tap into that power.

On behalf of the Pro-Activity team, "thanks".

Have a great weekend,
Mike E.

Nov 15

"If you find yourself in a hole, stop digging".

- Will Rogers

Plain and simple (as in "not that complicated"), a healthy lifestyle isn't easy (as in, "takes effort"). Sadly, the prevailing narrative in most health-oriented conversations, which isn't without evidence (here and here), is that as effective as it is, Americans simply won't do it. We know the risks and take them anyway. As the story goes, we would rather pay a 16.5% "tax" (the cost of healthcare per dollar generated in the US economy), of which close to 1 Trillion dollars per year is preventable, than spend 30 minutes getting the heart pumping and/or trade some of the 73% of what sits on US shelves for 5-9 servings of daily fruits and veggies. Of course, it's not just a price paid in dollars. Convenience frees up time...which can be spent in front of screens...which has been intimately tied to mental health concerns. In this study, it was a 40% increased likelihood of depression in girls and more than 2X the likelihood of self-harm in boys. Most of us know this and many of us are frustrated by it. If you've been reading this blog for any amount of time, you can imagine the rollercoaster ride this week's dive into the research brought.

The headline instantly hooked me. It read "New Discovery May Lead to More Effective Treatment for Cardiovascular Disease" - I dove right in. The first paragraphs of the press release told the story of the discovery of a new molecule that appears to play a big role in giving a healthy lifestyle its known beneficial and preventative effect. While this could definitely help prove how important it is and maybe even helping those putting in the work to measure gains under the surface and therefore build sustained healthy habits, sadly, that's not where the story led. Instead, it talked about a provisional patent filing and that the research team "are now taking steps to translate ITA-LNP to the clinic, including engineering a pill form of the treatment, which they believe will not only be convenient for patients but also transformative".

[Insert groaning sounds here]

Instead of finding ways to help more Americans get to and change the root of the problem (lack of daily healthy actions and making THOSE more convenient), the goal is to create another convenient quick fix? What!?. [Continued groaning].

Truly, this is an amazing discovery, and for a very small percentage of the population with no alternative, it might be a game-changer. For everyone else, it looks like another version of the convenience trap where we trade money for our quality of life. [Final groan].

OK, rant over, thanks for letting me get that off my chest....next week back to our regularly scheduled program :)

Have a great weekend,
Mike E.

Nov 1

I've spent most of my career in and around pain and injury. Sometimes a cranky body part just couldn't be ignored any longer, but more commonly as the first professional contact after an incident where something went wrong. Both experience and research have clearly shown that those first few moments (and even days) are critically important to the outcome. The balance between assessing the facts of the situation and managing the emotions that tend to go with any incident can be a tightrope. More often than not when calm and logic prevail over panic and fear, things turn out much better.

Last Saturday was shaping up to be a big game. Ranked 3rd, my daughter's team was up against the team sitting 4th. As every rugby fan hopes, it was a battle from the opening kick and things were tense. About 10 minutes into the second half my daughter was tackled in a dangerous (and unfortunately illegal) way which, although didn't seem intentional, was no less risky. It was clear by her body posture and the determination by the trainer, that this was more than a bump or bruise. Of course, the blood was also a solid clue. In one way or another, most parents have been there before. Whether a simple scrape or a high likelihood of a broken nose such as in this case, those close to the situation can easily add to or calm the fear. I tried to show calm as I made my way to the sideline ready to provide logic to a clearly emotional situation. Two new studies out this month have provided greater insight into why this is so important. 

 First - a team in England tracked children who had experienced a traumatic event (e.g. motor vehicle accident, injury, etc). It showed that the child's perception of the event's severity mattered more than the actual measurable facts. Said more simply, the story we remember (whether it is accurate or not) has significant power over our future health. Pain combined with panic and fear was also a potent predictor. On the positive side, only social support (i.e. CONNECT) had a protective effect...which brings us to the second study. 

On the other side of the world, a team in Australia showed that the type of support we have through stress has big implications. In a study of couples where 1 member was navigating a chronic and progressive disease (one of the most challenging known stressors), those who worked closely together to learn and problem-solve the situation (dyadic coping), did far better than those who didn't have the same level of teamwork and support. As it turns out, having someone we can trust there to help us sift through the information was a major benefit. When things go wrong, the people around us matter.

Over the next three days as the emotions settled, my wife and I continued the conversation with our daughter. The two black-eyes were getting some strange looks on campus but we were all happy the signs were pointing in the right direction. It wasn't easy at first to keep the worry of the "the hardest hit she'd ever taken" from lingering but the fact that she was strong, didn't have any major injuries, and was on the mend was assurance. We were happy to see the emotions of the moment be replaced by renewed excitement of getting back out there with her team....maybe even a bit more resilient than before.

Life doesn't always go according to plan. The people around us in those moments are critical voices in how we process them. It is always an honor to play that role. Call us if we can help.

Have a great weekend,
Mike E.

Oct 18

Are you a Halloween or a Thanksgiving person? That is, if you were only able to celebrate with the foods associated with one of these two popular holidays this year which are right around the corner, which would you choose? Would it be the (often) big and complete meal of "turkey day" or the rush and nostalgia of the sweet treats on Halloween? It turns out this general idea, what types of foods we gravitate toward, may tell us more about our future health risks than we ever thought. Although the headlines aren't super surprising - health-conscious eaters, by and large, did better than those who gravitated toward unhealthy foods - this new study got us closer to knowing exactly how much.

At the risk of oversimplifying, a research team in England looked at the health survey data of 180,000 individuals which included food preferences. They then grouped into one of three categories - "health conscious" (people with a low preference for animal-based or sweet foods, and a high preference for vegetables and fruits), "omnivores" (high preference for all foods), and "sweet tooths" (high preference for sweet foods and sugary beverages) and compared each group in a variety of ways ranging from detailed blood analysis to disease risk. While some of the results weren't a big surprise - those who preferred sweets struggled more with their weight and inflammation than those who preferred healthy foods - others stood out. The difference in depression risk was particularly powerful.

Members of the health-conscious group appeared to get a protective benefit of as much as 31% as compared to the sweet-tooth group. They were also less likely to have heart disease, diabetes as well as a variety of other conditions which ranged from rheumatoid arthritis to kidney disease. The omnivores fared somewhat better than the sweet-tooth group in most categories, but not nearly as much as those who preferred healthy foods.

Of course, there's a lot more to be done here. Exactly how cravings take root and to what extent they can be changed is not clear. It has been shown that cravings are related to our gut biome and how the microbes that live there communicate with the brain, so it's reasonable to think they can be influenced, but how much and how lasting are still open questions.

Until then, it may be best to have some strategies to bolster our resilience to the seasonal stress we're about to face. It's a perfect time to feed the healthy microbes - grab some plants and get ready for the holiday rush...it's only 2 weeks away.

Have a great weekend,
Mike E.

Oct 4

It wasn't that long ago that one of my kids explained to me that the little blue shadow extending from the "you are here" blue dot on my phone's mapping app was actually showing my orientation. "Whoa!" was about all I could say, as I turned around in circles to see it change direction. I had no idea this feature existed, something that definitely could've come in handy during more than a few previous uses. If only such a thing existed for our health. One of the trickiest parts about using healthy actions (aka lifestyle) to their fullest potential in an effort to thrive is finding our personal blue dot & directional shadow, our starting point and heading, wherever we are on the journey. Without this understanding it is very hard to know which routes will get us there in the first place and which might be the most desirable because there is no traffic, is free from tolls, or has great scenery along the way.

For example, if after years of commitment and consistency your blue dot is in the lofty elevations of a strong fitness foundation (training regularly, aspiring toward an athletic goal perhaps) your suggested routes would look very different than someone just getting started. For those who are just getting started or are having a hard time sticking with it once going, the message that "consistency beats intensity" and the advice to "try to develop a habit" is usually a feature. This can be tricky for those who feel too busy to log the 30 minutes per day required to achieve the critical dose of 150 or more moderate minutes per week. If this is you, we have good news. 

While there is ALWAYS more to learn and probably not for everyone, especially those who use physical activity for immediate effects such as stress relief, mind fog relief or tight blood sugar control, etc, or are working toward very specific athletic goals, for those who want to improve or maintain health but are pressed for time, most of the benefit of regular physical activity can be gained by winning the weekend. 

A data analysis of nearly 90,000 middle-aged individuals which looked for associations between physical activity patterns and the incidence of almost 700 different conditions across 16 different types of disease (including mental health, digestive health, neurological health, and others) found that Weekend Warriors did nearly as well as steady exercisers, lowering their risk for almost 200 different diseases compared to those who were inactive. Published by the American Heart Association late last month, this study showed that those who exhibited the "weekend warrior" physical activity pattern, that is fitting an entire week's worth of exercise into the weekend, got almost the same risk-lowering benefit for a variety of diseases as those who exercised more regularly to achieve the critical dose. The greatest impact was on high blood pressure and diabetes, a 23% and 43% lower risk respectively which was only slightly better in the regular exercisers (28% and 46%).

When health is the destination, consistency does appear to beat intensity...however when it comes to MOVE, "something" is so much better than "nothing" that taking the alternate route to avoid the weekday time tolls can still get us there.

Make it a great weekend...add some MOVE,

Mike E.

Sept 20

I never quite understood the "reductionist" approach to nutrition. Although it has been the dominant approach in the research for, well, ever, it gets less applicable as the years go by. The idea that a single "part" somehow holds more importance than the "whole" struggles when the idea is tested against the known harms being done by diets heavily loaded in manufactured foods which may contain those important parts but are leading to disease nonetheless. 

For example, this new study which looked at the consumption patterns of more than 300,000 individuals for more than 10 years, found a clear link between the food types people consumed (on a spectrum from minimally processed to ultra processed) and metabolic disease risk, specifically Type 2 diabetes. For every 10% increase in consumption of ultra-processed foods (i.e. the assembly of "food-like" substances which often contain healthy nutrients made to be hyperpalatable), the risk of diabetes went up by 17%. On the other end of the spectrum for every 10% decrease in these same food types, there was a 14% decrease in risk. Said more simply, those who ate real food had less risk. Yet the question for many is "how can we make this more practical to know where we stand for our day-to-day habits?". A second study out this week may have shed some more light. 

This new study, published only a few days ago, looked at whether a simple dietary score where higher scores indicated an eating pattern closer to a well known "brain health" diet (the MIND diet) could predict future brain health as we age. The short answer was yes. When researchers looked at dietary patterns of nearly 15,000 individuals for around 10 years, they found that those in the top 1/3rd of scorers (who had an average score of 9) had a significantly lower risk of cognitive decline compared to peers in lower groups. Try scoring your typical diet to see where you stand.

From the American Academy of Neurology press release:

“One point was given for each of the following: three or more daily servings of whole grains; six or more weekly servings of green leafy vegetables; one or more daily servings of other vegetables; two or more weekly servings of berries; one or more weekly servings of fish; two or more weekly servings of poultry; three weekly servings of beans; five daily servings of nuts; four or fewer weekly servings of red meat; one or fewer weekly servings of fast or fried foods; one or more weekly servings of olive oil; and one or fewer tablespoons of butter or margarine daily; five or fewer weekly servings of pastries and sweets; and one glass per day of wine. The total points possible was 12.”

How we FUEL is critical to our future health. It often feels complicated but it doesn't have to be. It seems the following general rule of thumb continues to have strong evidence backing it up: Eat less of the sugary/processed food-like stuff and more of the fresh "actual food", we can survive on the first for a while but we thrive on the second.

Have a great weekend,

Mike E.

Sept 6

Think of the last time you felt really stressed. Was it a good thing or a bad thing? Did you grow from the experience or feel knocked backward by it? Did you have a strategy to overcome the sensation or did your natural fight/flight/freeze tendencies take over? If you could go back and do something differently, would you? These are really tough questions, the kind very few people enjoy thinking about, but almost 2 years ago, sitting in a small group hosted by a few heroes I had previously only seen play on TV, they were central to the topic of conversation. 

 Walking into the session it seemed safe to assume that being a member of the New Zealand All Blacks, the winningest national rugby team on earth, has to be stressful. While winning more than 3 of every 4 games played for the last 100 years carries a well-earned pride, it also carries heavy expectations and therefore stress as was made perfectly clear by the two players at the front of the room. This stress had the power to harm their performance and in some cases had, but as the conversation went on, and they recounted tactics they were taught by their mental skills coach, it didn't always. When they fully developed the skills needed to return to (cool) "blue" when things were getting too hot (and they were "seeing red"), the lingo their team used for getting overstressed, they could perform at the level required to win. 

 Although hard to fully grasp exactly how stressful it must have been as the last few moments of a 1-point World Cup victory ticked down (number 8 and 20 in the video here), the utility of such a skill, a tactic that could kickstart the emotional recalibration needed in stressful circumstances, seemed obvious. Some research suggests that whether through changes in breathing patterns, such as slowing our breathing or other means not related to breath, distracting ourselves from the situation long enough to reset can actually make a difference. As it turns out and published a few weeks ago, a research team at Michigan State found that this approach could even work in pill form.

 Amid the COVID-19 pandemic when stress levels were running particularly high, a small group of individuals were randomly assigned to either act as members of a control group or to receive a non-deceptive placebo pill - meaning they were told that the pills they were going to receive had no active ingredients but might still have a beneficial effect and were encouraged to take them anyway. Participants were then asked to watch 2 videos (here and here) that explained "the placebo effect" in greater detail. 2 weeks later, the group who took the non-active pill had greater reductions in stress, anxiety, and depression than the control group. Having some way of intervening, even in the form of a knowingly inactive ingredient, was enough to help reset faster and see cool blue in a red-hot situation...another great learning from a very hard period of time.

 The stress of the season (Halloween to New Year's Day) will be here before we know it. Whether a breath counter or a double-exhale(r) or, like one of the two all-blacks, a "push your toes into the ground to remind yourself to get grounded" kind of person, having something that interrupts the moment and allows us to reset, is a great strategy to help us ENDURE...and now is a great time of year to hone the skill. Let us know if you need a few other ideas.

Have a great weekend,

Mike E.

Sept 6

Think of the last time you felt really stressed. Was it a good thing or a bad thing? Did you grow from the experience or feel knocked backward by it? Did you have a strategy to overcome the sensation or did your natural fight/flight/freeze tendencies take over? If you could go back and do something differently, would you? These are really tough questions, the kind very few people enjoy thinking about, but almost 2 years ago, sitting in a small group hosted by a few heroes I had previously only seen play on TV, they were central to the topic of conversation. 

 Walking into the session it seemed safe to assume that being a member of the New Zealand All Blacks, the winningest national rugby team on earth, has to be stressful. While winning more than 3 of every 4 games played for the last 100 years carries a well-earned pride, it also carries heavy expectations and therefore stress as was made perfectly clear by the two players at the front of the room. This stress had the power to harm their performance and in some cases had, but as the conversation went on, and they recounted tactics they were taught by their mental skills coach, it didn't always. When they fully developed the skills needed to return to (cool) "blue" when things were getting too hot (and they were "seeing red"), the lingo their team used for getting overstressed, they could perform at the level required to win. 

 Although hard to fully grasp exactly how stressful it must have been as the last few moments of a 1-point World Cup victory ticked down (number 8 and 20 in the video here), the utility of such a skill, a tactic that could kickstart the emotional recalibration needed in stressful circumstances, seemed obvious. Some research suggests that whether through changes in breathing patterns, such as slowing our breathing or other means not related to breath, distracting ourselves from the situation long enough to reset can actually make a difference. As it turns out and published a few weeks ago, a research team at Michigan State found that this approach could even work in pill form.

 Amid the COVID-19 pandemic when stress levels were running particularly high, a small group of individuals were randomly assigned to either act as members of a control group or to receive a non-deceptive placebo pill - meaning they were told that the pills they were going to receive had no active ingredients but might still have a beneficial effect and were encouraged to take them anyway. Participants were then asked to watch 2 videos (here and here) that explained "the placebo effect" in greater detail. 2 weeks later, the group who took the non-active pill had greater reductions in stress, anxiety, and depression than the control group. Having some way of intervening, even in the form of a knowingly inactive ingredient, was enough to help reset faster and see cool blue in a red-hot situation...another great learning from a very hard period of time.

 The stress of the season (Halloween to New Year's Day) will be here before we know it. Whether a breath counter or a double-exhale(r) or, like one of the two all-blacks, a "push your toes into the ground to remind yourself to get grounded" kind of person, having something that interrupts the moment and allows us to reset, is a great strategy to help us ENDURE...and now is a great time of year to hone the skill. Let us know if you need a few other ideas.

Have a great weekend,

Mike E.

Aug 23

Suppose you like business, economics, investing, the idea of having financial stability (or wealth someday), or even the idea that simple and consistent over the long term often outperforms other strategies. In that case, you've probably heard a few Warren Buffet quotes. Some of the most famous are simple & logical and tend not to evoke a lot of emotion...maybe even boring, which, in a way seems to underpin his success; a long lifetime of "slow and steady wins the race".

I think one of the reasons why quotes of his like "don't bet on miracles" tend to resonate with me is because they seem to be applicable not only finance but other "assets" we could all probably use more of. They work for time, maybe the most valuable asset and even health, the asset we so often talk about here. This week, 2 new studies reiterated the power in applying a simple and consistent approach like this, once again adding evidence to the statement that "more and less" is, well, more when it comes to investing in personal health.

The first study explored getting a little more MOVE in the day and whether a focus on short bouts of activity, using a mobile app designed to make it engaging and fun could get people doing a little more (at least 15 minutes) over the course of a 6 week period. The short answer was "yes". In nearly 12,000 participants in Australia, New Zealand and the UK, physical activity substantially improved and several self-reported health measures also improved. The stat that stands out most to me however is that participants tended not to stop at the goal (15 minutes of physical activity) and instead stretched it out to nearly 45 minutes on average and nearly 75% of participants hitting physical activity guidelines which are known to sharply drive down injury/illness/disease risk.

The second study was a much much bigger study - like 164X bigger - in terms of participants and it showed, again, less is more. In this case, it was a study of several large datasets (across several countries and nearly 2M lives) done by a team at the University of Cambridge which showed that 50 grams per day of processed meat (about the same as 2 slices of ham) increased the risk of metabolic disease (DM2) x 15% over 10 years, 100 grams of red meat per day (a small steak, even if unprocessed) added 10% risk and the same amount of poultry added only slightly less (8%).

The news is more and less the same. Bet on adding more minutes of MOVE and replacing a meal per day of FUEL with a healthier (low process/high fiber) alternative to build the health assets needed to thrive. Or, in very practical terms, as the 90+ year old Buffet is known to have said: "You get exactly one mind and one body in this world, and you can’t start taking care of it when you’re 50. By that time, you’ll rust it out if you haven’t done anything.”

Have a great weekend,

Mike E.

Aug 9

Despite the fairly consistent findings that ultra-processed foods and excessive sugar almost always have a negative impact on health AND that fresh fruit and veggie consumption almost always has a positive impact, nothing seems to get people talking like the latest-greatest nutrition fad or dietary supplement. The idea of a quick-fix pill or potion has such a tug on our psyche that market researchers project a continued rise from the roughly $165 Billion being spent worldwide. One recent question revolved around drinking baking soda water to improve athletic performance and/or lower disease risk. Although my first reaction was "yuck", there are an increasing number of studies poking at the idea and it doesn't take long to find people promoting it. But why?

Without diving too deep into the physiology, the short answer seems to be related to "Dietary Acid Load", the capacity of the foods we eat to drive our pH lower - a measure that has increasingly been correlated to the risk of several diseases including cardiovascular, metabolic and even musculoskeletal dysfunction since the muscles and bones act as some of our best buffers against acid (read more here). It seems reasonable then that if we could simply neutralize this acid with a tall glass of "Arm & Hammer-ade", maybe it'd be worth it...it might even bump performance some, since in athletic endeavors the accumulation of acid is thought to impair performance. Unfortunately, results are very mixed when it comes to performance. Some have found no benefit (even though blood markers changed), some have found benefit and others have found a placebo effect - so, probably not worth it. On the health end of the spectrum, the idea of lowering dietary acid load seems to have merit. For example, this study from a few years back showed that eating in a way known to promote muscle health and alkalinity with age (getting enough plant-sourced protein out-performed animal-based sources) had a strong positive effect. Getting the same impact through ingestion of baking soda, however, has far less impact. A study out this week added some additional clarity.

A US-based research team tested 2 different strategies to lower dietary acid load in people with chronic kidney disease and heart disease. The first was the tried and true...eating more fruits and veggies as the basis of a more alkaline (pH raising, "base") diet. The second was ingesting bicarbonate pills (a possibly more direct way of lowering pH). Both slowed the progression of kidney disease, which seemed promising. Still, only increased fruit and veggie consumption lowered the risk of cardiovascular disease and abnormal blood pressure, which was believed to be driving the risks.

Whether you do so for the inflammation lowering or the pH-raising effects, opting for the basics (fresh fruits, veggies, and other plants) over the quick fix can build the nutritional "base" needed to thrive.

Have a great weekend,

Mike E.

July 26

It’s easy to run a little “hot” this time of year; both literally and figuratively. Climbing the summer peak is as if for 100 days we are required to walk steadily uphill in everything we do. No matter how routine the task, it is just that little bit more challenging when our systems are straining to manage the extra load. Of course, it isn’t always (or “only”) thermal strain. Many of us are managing increased work volumes, changes to our routine which can easily add stress (such as kids at home from school), and the always tricky business of ensuring that vacations we often look forward to are as restorative as possible. It doesn’t take much for us to find ourselves run down, achy, or even battling a cold this time of year.

 
There is nothing particularly mysterious or profound here. As we approach the peak of our capacity, even routine stress and strain, which we would normally absorb without issue, can send us toward injury/illness/disease. If the evidence on the subject holds, it’s a reasonably safe bet, for example, that upper respiratory infections will be on the rise in Paris over the next few weeks as the athletes competing there struggle to find the balance between peak workloads and recovery. While we tend to emphasize recovery this time of year by reiterating sleep hygiene tactics, cooling strategies, and low-inflammatory food and beverage choices, a new study that looked at the immune response after exercise in newly diagnosed cancer patients suggests we shouldn’t forget that a little MOVE can go a long way, especially important for those of us who are office based or not doing a ton of physical work. 

A research team in Finland found, in a random sample of individuals, 30 minutes on a stationary bike at a self-selected pace and resistance could kickstart a very specific change in the immune system including ramping up cells known to fight cancer cells and tamping down those known to promote it. It’s not a 1 for 1 of course – being rundown is certainly NOT cancer – but the principle remains; we can use MOVE to ask our immune system to ramp up a bit, and for those of us not already at our physical strain limit, the body typically responds. Or more simply, moderate exercise once again gives us an immune boost.

There are still +/-30 days of unofficial summer (Labor Day is 9/2) and +/- 50 of actual Summer (Fall Equinox is 9/22), that's too long to let our health wilt in the heat. Work in some MOVE and give yourself a boost.

Have a great weekend,

Mike E.

July 12

There's a lot to complain about these days; or, at least it seems that way if you pay attention to popular media sources. While we know bad news is better at getting our attention (and therefore sells) due in part to our human tendency toward loss aversion, there are good stories to tell if we look for them. One of them, which drew a pretty clear line on an age-old question...that is, something that actually works in our favor if we hope to age until we are actually "old", was tucked away in the Journal of the American Medical Association last week admittedly among many that seemed a lot less positive, including 5 headlines that are probably worth knowing about, negative as they may be.

The Not-So-Good News

(1) There is now a confirmed connection between sleep disorders like obstructive sleep apnea, stress disorders, and poorer mental health. Again, RECOVER matters, a lot. 

(2) There was a lack of support for multivitamin use to increase longevity in a study of almost 400,000 people over 20 years. If there really is a longevity "hack" it doesn't seem to be in pill form yet. 

(3) Moderate Physical Activity (>=7,000 steps per day) alone was enough to impact health risk for individuals with normal blood sugar but not in folks with prediabetes. Ultimately this suggests that the power of MOVE may not be enough for those with more advanced risk. Therefore a more intensive approach (including nutrition, sleep, stress, etc) is likely required to lower risk as shown here, which might safely include fasting, as shown using a 5:2 ratio here.

(4) Every 2 hours of TV (or presumably screen time) reduced the likelihood of healthy aging by 12% in a study of 45,000 women at or near middle age over the next 20 years. Thankfully, there was a silver lining on this one. Much of that risk could be offset by replacing screen time with light physical activity; moderate physical activity was even better, and for the under-rested, trading the screens for sleep also had a positive impact.

(5) Perhaps not surprisingly, "Body Roundness Index", a new calculation that tries to differentiate between "healthy mass" (e.g. muscle) and particularly unhealthy mass (e.g. visceral body fat) is an effective risk predictor and may help us deal with some of the shortcomings of the more well-known body mass index which doesn't differentiate. In a sample of more than 30,000, those with the lowest and highest BRI were at higher risk than those in the moderate range. Unfortunately, this index has generally gone in the wrong direction over the last 20 years. 

But there is good news and it's relatively simple: In a study that compared nearly 1500 people who lived to be 100 (which is sort of amazing in itself) compared to age-matched controls (i.e. those born at the same time but died before 100 years) the odds of getting there were dramatically increased for those who practiced 3 healthy lifestyle behaviors including (1) not smoking, (2) being physically active and (3) eating a diverse diet (which included fruits, veggies, fish, beans, and tea).  

What is especially cool about this study is that even after poking at the data with a variety of statistical methods to refine their findings, the effect mostly stayed the same. There was a 61% better chance of living to 100 for those who practiced the healthy behaviors as compared to those that didn't. Yet, and maybe this is for those of us who might naturally wonder whether the quality (ability to function) in those years was high or just the quantity (time on earth)...the likelihood of getting to 100 years old AND doing so generally healthy was 54% greater in the healthy lifestyle group. As it turns out this stuff works for a VERY LONG TIME.

We've known for a while that the human body can live much longer and healthier than most do - now we have the basic plan for those who are interested. Maybe you'll be one to meet someone from 4 or 5 generations in the future - if you haven't already, the best time to start is today.

Have a great weekend,

Mike E.

June 28

The text was simple enough "Is there any chance I can grab a few minutes for a consult?". What ensued was a conversation I've had too many times to count over the years. The pain was severe, making it, even for a healthy and fit individual, a little scary; something that can't go away fast enough and ideally never returns. After we went through the potential red flags and found none were present, we concluded that it was following a well-known pattern, one that was big on "hurt" but, thankfully, not as big on "harm". It was safe to MOVE.

Now came the hard work, coaxing the body to do so and understanding the need to strike a balance between "enough" to stimulate but not "so much" to aggravate or set things back. In this case, the idea was first to control inflammation and normalize movement (as quickly as able) but still watch for signs of overload in the irritated area, what we often refer to as "optimal loading", which is relative to the person, rather than just "rest". Before we got off the phone I made the last and maybe most important point - this kind of back pain doesn't have to happen again, but without effort, it almost always does for those who don't stay ahead of it. Within 96 hours, this individual was golfing.

Back pain is common and can be severely debilitating. With the right information and a willingness to build up the body's resilience through optimal loading, it doesn't have to be. While the number of times we've seen this over the decades is almost uncountable, it's always nice to see the finding in print, this time in one of the most prestigious research journals on the planet. 

After following 700 randomly assigned individuals with debilitating (but not structurally worrisome) lower back pain, getting a consultation and a professionally guided loading schedule, in this case using walking as the movement of choice, lowered the risk of recurrence by 28% and nearly doubled the time between flare-ups compared to those who were in the control group.

Bodies are far more likely to bark at us as we inch closer to the edges of our capacity (and therefore resilience). Peak Summer can be one of those times. With a little guidance and the willingness to "walk it off", maybe this year it doesn't have to be. Reach out if we can help.

Have a great weekend,

Mike E.

June 14

Imagine you wake up one day with a stiff knee. Maybe it presents with some slight but nagging discomfort; more annoying than worrisome. If you're anything like most you'd probably not think much of it and might even try to ignore and "push through" it. 

But what if it was there again the next day or even the next 15 in a row.

Would you tend to want to get it moving or would you be more inclined to avoid movement and give it rest? Would it worry you?

Although the worldwide statistics would suggest that for as many as 4 of every 5 people (or more) this situation is only hypothetical, they are critical questions for the remaining 20% because, for nearly 1 of every 5, there was a day or days just like this that acted to signal a warning sign, possibly that something "wasn't right" with someone's knee(s). The stiffness may have been formally labeled "knee osteoarthritis" (OA) but even if not, the likely feature was discomfort, at least initially, with movement.

The irony of course is that despite it often being uncomfortable and sometimes fatiguing to move with knee OA, the condition usually responds favorably to movement. In fact, various forms of exercise are at or near the top of the recommendation list endorsed by groups like the American Academy of Orthopedic Surgeons in their clinical practice guidelines.

So if we know it works, why doesn't everyone do it?

This is the fundamental question that a research team in Australia pondered. Their hypothesis was, in an oversimplified way: when we are in discomfort long enough, our beliefs about it (and what effects it) might change; even though we consciously know movement is good for us, we might actually fear it deeper in our subconscious.

In a really cool experiment that, if you have 10 minutes and are at a computer you can take for yourself at this link, they found that below the cognitive surface, people with painful knee OA were significantly more likely to associate movement with danger (as in, something to avoid) than those without pain or knee OA. For many, this could be a very big deal because if our day-to-day actions are rooted in our beliefs, this may present a significant barrier for those with stiff knees. It may even be one of the reasons why so many gravitate away from movement, which might actually make things worse. This is, of course, all very preliminary...but interesting nonetheless.

There was a time when health care recommended rest to help manage knee osteoarthritis because they weren't sure movement was the answer, but that changed at least 30 years ago. Today, we know it as "the best, non-drug treatment for improving pain and function in OA", just like it says front and center on the Arthritis Association's website.

Keep those stiff joints moving - let us know if you need a nudge.

Have a great weekend,

Mike E.

May 31

Like most teams and groups, ours at Pro-Activity has a text string...well several, because also like most groups and teams, ours is always running in different directions and doesn't get to be together to trade stories, compare notes, and get information in person very often. It's equally likely to get a birthday wish or funny story as it is to get a research article, podcast recommendation, or account of a self-experiment. Today it was Aaron sharing a self-experiment he may not have meant to run when he was out for, well, a run last week. In essence, some of the normal indicators he tracks (via Garmin wearable) were telling him that his system was a bit more stressed than expected. He found that the temps (> 80 deg. F) had gotten just hot enough to place extra strain on his heart. Although this change is exactly what we know to expect, is something we often talk about this time of year and, if handled correctly can be beneficial, it's also easy to not recognize and maybe even ignore when not front of mind. It's one of the reasons why we reintroduce the following mantra every single year around now: "heat stress is heart stress" - even in well-trained athletes.

A recent article in the Journal of Occupational and Environmental Hygiene which outlined the risk factors associated with fatal heat-related illness made this very clear. The authors reviewed data and records from the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) and found 9 cases of heat illness that led to death. Almost all of the risks related back to heart stress and the health required to handle it.

Of those who died, all of them were men under 50 years old, 8 were performing physical work at a moderate or heavier level in the heat, and 6 were overweight or obese. 5 were using stimulants which are known to stress the cardiac system and 4 had a history of heart disease of one type or another. The authors concluded that 4 major risk factors were present: Lack of Acclimatization, Inadequate Training, Underlying Cardiovascular Disease, and Stimulant Drugs. They went on to say that in at least 4 of the cases, fluids and air-conditioning, which were provided, were not enough or used too late.

This all leads to one really important conclusion in my opinion - it doesn't have to be this way. With an effort to ramp appropriately, an effort to understand where we are in that process, and the ability to make small adjustments along the way, we can be ready for what we know is coming in, officially in the next 3 weeks if it doesn't get here sooner.

So what should we do NOW to be ready for Summer - which officially starts on June 20?

1. Graded exposure is key. It is generally accepted that the body will adapt after +/- 2 weeks of exposure to heat. While doing so naturally by spending progressively more time in temps greater than 70-ish degrees will usually do it, in some cases other exposures such as hot baths and/or saunas as studied here may speed up the process. Unfortunately as a stand-alone strategy (without working on fitness for example) the results may be temporary.

2. Ramping Up Takes Energy. Anything that forces the body to adapt draws on our resources. For those who don't have a wearable to see the change in cardiac balance (HRV) or resting heart rate, changes in sleep, or the desire to be more sedentary might be an easy tip-off that your body is ramping as shown here. This is one of the main reasons we often emphasize getting a little more rest when able this time of year.

3. There are Benefits. The beauty of our physiology is that as long as we don't expect instant changes (number 1 above) and we respect the process (number 2 above), we will adapt and our health will actually improve some. As shown here, it's reasonable to expect that once we are through the acclimatization period, we will show increased signs of fitness, like a lower resting heart rate, which may be one of the simplest and most consistent predictors of future health. The average reduction was 6 beats per minute. To put that into perspective, one recent study showed that when taken lying down even a 1 beat per minute change signified a measurable cardiac performance change as measured by exercise testing.

It's unofficially Summer...which means it's time to ramp up our cardiac fitness to be ready for the actual Summer season again. If we embrace the warmth now and respect the adaptation process, we will be far more ready for the heat later.

Have a great weekend,

Mike E.

May 17

I got a chance to watch the "Hack Your Health" documentary on Netflix last night. Although the title made me a little skeptical, it was an interesting big-picture review of one of the most exciting areas of health research today, the trillions of microbes we work with every day to get through life - the microbiome. 

There were interesting stories (ever wonder what 20 years of competitive eating actually does to a person?), well-known experts including a bestselling author, and several of the key voices in the space (such as researchers from Stanford U, and UC Cork, IRE) and confirmation of key themes many may already know at some level.

Here are the six that stood out to me:

(1) What we feed and cultivate flourishes, what we neglect struggles to survive.

(2) High microbe diversity (i.e. lots of different types in an ecosystem) is linked with health

(3) Since most people living in the US are not even close to consuming enough of what feeds the healthy microbes (fiber), our biome is getting less diverse and closer to a profile linked with disease (high-inflammatory, etc).

(4) This isn't just a US problem. The more "Western" daily intake becomes (i.e. high sugar, high fat, high process) anywhere in the world, the less diverse the biome becomes.

(5) There are quick responses (even in 1 day the body responds) but no quick fixes (it takes MONTHS to make changes permanent)

(6) And so...lifestyle, especially one with LOTS of plant varieties consumed each day is the best next step for most of us.

So while it's never easy to thread the needle of "infotainment" which both appeals to a broad audience and is scientifically rigorous, the latest research continues to point generally in this same direction - the claims appear accurate.

For example, one study in the British Medical Journal this month showed an increased risk for those who consume a heavily processed diet with high processed meat consumption linked to the greatest increased risk. Another in the journal Nature showed that as traditionally rural cultures urbanize (and intake shifts toward a Western diet), the microbiome demonstrates a pattern associated with disease. Finally, and further along in the risk spectrum, as reported in the Journal of the American Medical Association on May 1, men with early-stage prostate cancer who consume the most plant-based foods have the slowest progression in the disease over time, about half the rate of those who eat the least.

And if one of the researchers featured in the documentary and at the forefront is right - most of what is knowable in this area is still unknown - so perhaps his simple tips toward eating better is a good starting point. 

It's gardening season - maybe you will be the one to decode either the remaining ingredients or the recipe for a better-tasting 60-plant super-smoothie - if so, let us know!

Have a great weekend,

Mike E.

May 3

One of the upsides of having put most of a career into a single focus is that you get to witness change happen. Sure, many of us who are at or nearing the peak of our "earning years" (generally mid 40's to mid 50's, data here) might also be resisting the transition from "seasoned veteran" to "old timer" but with any luck, tucked within those titles, is a bit of wisdom gained along the way. For me, and although a few generations ago in terms of health information and trends, it seems like only yesterday when a fair amount of our effort was directed at debunking myths that questioned the value of healthy habits like exercise. Despite mountains of evidence to the contrary, some of the most common misconceptions like "I have arthritis and so I've been told exercise will make it worse" and "I strained my back and was told bed rest was best" were hard to crack, but it was nice to see them make their way to the rearview. A few that are a bit more nuanced, like "my work is all the exercise I need" and "I've heard running is bad for your knees" have hung on longer than they should've, but in general, also seem to be getting closer to the history books. 

One of the greatest changes in the broader narrative, which I've mentioned previously because I'm a fan, is the transition from "exercise is (generally) good" to "exercise is so powerful it can be dosed like medicine to prevent and reverse disease", which has its own growing evidence mountain. Just this week some additional research was thrown onto the pile which made the case even clearer and therefore the headlines even more powerful.

First, an interesting finding presented at the European Society of Cardiology's prevention conference made it super simple - take the stairs and live longer. After performing a study of combined studies (meta-analysis) which included nearly 1/2 Million participants across 9 different studies, the conclusion was clear. From the press release: "Compared with not climbing stairs, stair climbing was associated with a 24% reduced risk of dying from any cause and a 39% lower likelihood of dying from cardiovascular disease.".

Next, an even larger bundle of studies published in the British Journal of Sports Medicine, in this case including 20 Million observations, made the "why" far more clear: as fitness improves, risk drops - to the tune of nearly 20% per 1 unit of fitness (aka Metabolic Equivalent of Task or "MET") gained. This is really great news because it strongly supports the notion that we highly value progress, even if our personal potential isn't yet within reach.

Next, and bringing some of the jargon closer to something practical, earlier this year, the world got an update to one of the fitness master documents, a list of common activities and the fitness (in METs) required to complete them known as The Compendium of Physical Activities. This makes it easy to know where we stand from a fitness perspective and what a one-unit jump might require. My favorite in the updated list might be that some of the Monty Python silly walks are listed...but I'm still searching.

Last, I was really excited to see some new research tackle a really important question - what is the best dose of exercise to reduce lower back pain? For this, the authors used MET-minutes, which gives us a good idea of 2 critical parameters of exercise: "How intense?" and "How long?". As it turned out, just like medicine, it was a "sweet spot" - too little didn't help and too much was too much. The minimal dose to get an effect was 520 MET-minutes per week and the maximum effect was achieved at 920 MET-minutes. If we used "brisk walking" (as defined by the CDC and cross-referenced in the Compendium) as our activity of choice, it would take somewhere between 85 and 175 minutes per week to get an effect, with the maximal effect coming in between 150 and 300 minutes. Not ironically, these numbers just happen to be almost exactly what most studies point to as the amount of moderate physical activity needed to maintain or improve health.

Whether you MOVE for enjoyment for prevention or treatment, when we find the right dosage for our goals and needs, it works. It just happens to be a wonderful time of year to get a bit more of it.

Have a great weekend,

Mike E.

Apr 19

Imagine being asked to put your hand into a bucket of ice-cold water and keep it there until it was so uncomfortable you had to take it out. Then imagine 7,000 (or thereabout) other people doing this same thing. It might sound like some sort of cruel and unusual punishment, but in actuality, it is one of the most commonly used methods to assess pain tolerance, a surprisingly adaptable "warning system" that helps us to safely interface with the world around us by allowing us to quickly determine whether or not something is likely to cause us harm. Accidentally touch something "too hot", that is, beyond the threshold of our tolerance such as a pan on the stove, and our brain quickly knows to pull back from the source because it could cause severe harm. Step outside on a cool morning and feel the less intense, sub-threshold warmth of the sunshine and we might find ourselves turning into it because this level of the same kind of stress (thermal) is not a threat. For most of us, pain is a reliable threat-detection system, however in some situations, such as in chronic pain, things can get a bit miscalibrated, and our brain can overreact keeping our default setting so close to the threshold that the feeling of pain and the level of threat or risk become decoupled. Not surprisingly, lots of study goes into understanding how the system works in hopes of guiding how to keep it working well and even to reset it if the need arises.

One of the more interesting findings in the last few years came from a research team in Norway in 2023 which found a link between movement habits and pain tolerance. Specifically, they found that as leisure time physical activity went up, so did pain tolerance on the hand submersion (aka Cold Pressor) test. Even with as much as 8 years between measurements, those who were physically active or became physically active, had a higher tolerance - suggesting that not only do our tissues physically toughen with regular use, but that our threat-detection system which protects those tissues, also adapts to account for this new resilience.

It is probably not, however, an endless potential. It is far more likely another of our many physiological Goldilocks phenomena, in this case where the brain progressively turns the volume up, possibly to the point of over-sensitive when it's not being adequately used and down, possibly to the point of non-functional in the case of excessive stimulation. One study for example showed that both elite athletes ("too hot") and non-athletes ("too cold") were less accurate than non-elite athletes ("just right") when it came to tasks that required "listening to their bodies", called interoception. The question then, especially for those that may have long-standing aches or pains (e.g. > 90 days) or multiple body areas that are always cranky which can be a sign of this decoupling is "How can we start to reset things"?

While the initial answer is almost always "it depends" and therefore quickly followed by "that's why you have us, let's dive into it and find out", the eventual answer might include FUEL changes toward lower-inflammatory eating (such as those described in this study), an emphasis on tactics known to increase how well we RECOVER through better sleep (known to impact our pain sensitivity) and, with even more evidence out last month from the same Norway based team described above normalizing physical activity patterns, which often means MOVE more to reset pain tolerance and lower the likelihood of chronic pain.

Resetting can be challenging, sometimes to the point of daunting when we've got an ache or pain that's been with us for a bit. However, the more we learn the more confident we are when we say it can be done. We're here when you're ready.

Have a great weekend,

Mike E.

Apr 5

Preventing injury/illness/disease is essentially managing the risks we face. If we avoid those with catastrophic potential and minimize exposure to those known to chip away at our defenses over time, we put the odds of a stronger, happier life in our favor. A simple idea requiring a level of effort and endurance few have the fortitude to pull off...one of the fundamental challenges we wrestle with every day.

As we see it, a big part of achieving our mission is to both find the common roots and make them easier to get to at. And while most of the risks we face can be categorized under 5 themes (ELEMENTS), a steady stream of new information demands that we revisit, refocus and refine all the time. This time, and thanks to a multinational team who tested the 12 risks that have been previously shown to account for 40% of the world's dementia risk, it's in our understanding of how we might be able to narrow the list down to 3 and keep the most vulnerable areas of our brain out of harm's way.

The 12 risks include 9 which had been identified prior to 2017 including less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes and, low social contact along with 3 which were added to the list in the 2020 publication: excessive alcohol consumption, traumatic brain injury and air pollution exposure.

Now, using data from nearly 40,000 people in the UK to test against these risks, the research team was able to determine that after accounting for age and sex, the most vulnerable areas of the brain (referred to as the "last in, first out" network because it includes areas of the brain that develop late and tend to deteriorate early) were most strongly impacted by alcohol intake frequency, a diagnosis of diabetes and air pollution exposure, in particular Nitrogen Dioxide (NO2), which can be tracked here.

So what do we do about it? Thankfully, when we follow the evidence - the answer is "start at the beginning", MOVE and FUEL.

MOVE - meeting physical activity guidelines not only significantly lowers the risks associated with alcohol consumption in those who drink, it also makes a major impact on diabetes risk, interestingly, even in those who are exposed to high levels of air pollution.

FUEL - diets heavy in plants, especially veggies, not only help with diabetes risk, they have also been shown to lower the impact of air pollution on our health.

When we get to the roots the advice is clear: Protect your brain with more of the same.

Have a great weekend,

Mike E.

Mar 22

We humans have a strange relationship with "time". While our physiology is programmed around the standard 24 hours of it, meaning we rely on it as an anchor of daily life, we also live in a world that constantly crams more into it, ultimately straining our ability to keep track of it. To add to the complexity, how we perceive time depends on the situation we are in. Most of us have experienced time "flying" when we're having fun, an often touted positive feature of the "flow state", and still we try to slow it down or even press pause to savor moments we might never have again. We want to believe it is a constant, one of the few hard rules we can count on, but the truth is, it's not.

Now, while intentionally changing time much beyond setting it forward or back to "save" some daylight as the seasons change seems like a recipe for chaos, giving it a little less prominence in how we measure our life might be warranted. For example, while we usually mark our "lifetime" exclusively in years, using our biological clock might make more sense since, variable as it might be, it more accurately predicts how much life we will squeeze into our years; something we are getting far more skilled at measuring. For example, unhealthy sleep patterns accelerate our biological clock (and therefore our rate of aging) as do a combination of unhealthy lifestyle factors like smoking, drinking, being physically inactive, carrying excess weight, and eating poorly. The good news is that it appears that reversing those behaviors has a positive impact, effectively slowing time.

One study out this month confirmed that eating a healthy diet (the brain-protective MIND diet, a version of the Mediterranean diet) slowed aging and those who did so significantly reduced their likelihood of developing dementia along the way. Another study, out in January of this year showed that not only IF we are physically active but WHEN and HOW during a typical day impacts our rate of aging. Individuals who got plenty of vigorous physical activity and those who got two peaks (i.e. a ramp-up relatively early in the day and then another ramp-up later in the day) had the best future health, with the most sedentary of 5 groups doing worst during the follow-up period.

So while the saying "Time and Tide wait for no one" (circa 1225) seems as true now as it probably did then, how fast our biological "time flies" is more within our control than we realize. 

Spring is officially here - the nice weather will follow soon if it's not in your location yet. It's a great time to slow things down and savor the time we have.

Have a great weekend,

Mike E.

Mar 8

My oldest daughter (now a senior in college) has become a very strong writer. Knowing my wife and I hold the skill in high regard, she occasionally sends us a copy of a recently submitted paper to read. The latest was about an epic moment involving a "crossbar challenge" issued to a youth soccer team by an over-confident (among other things) coach and the not-so-tasty crunch of the Cicada-snack he dined on after he lost the bet. It was a legendary moment of justice for the pre-teen version of herself and one that the paper brought back in living color. Now, while I'd like to believe that we put her on a solid foundation by valuing the skill from an early age, there is not a doubt in my mind that over the last four years (savings-draining as they may have been) the environment she has been in has challenged her, creating the kind of push and pull that nudges us forward and refines us along the way.

The environment we find (or put) ourselves in has a funny way of doing this; like a living maze, placing or removing barriers on our path, making certain choices harder or easier, and ultimately shaping the road we travel and therefore the experiences we have. Not surprisingly, as some recent research published by the American Heart Association points out, these environmental barriers (or lack of) have a powerful role in shaping our future health experience too. When our maze makes it easy (or cheap) to regularly eat highly processed and prepared foods because they exist in high density, we tend not only to FUEL this way but pay the price with a double-digit increased risk of heart failure. After examining the records of hundreds of thousands of individuals over the course of time, there was, on average, a 16% increased risk for those who lived in places with the easiest access compared to those who had "the barrier" of a lower number and/or density of fast food, bars and pubs. Of course, when we consider another recent study that showed regular consumption of sugar-sweetened or artificially sweetened beverages (staples in the same establishments) increases the risk of heart rhythm disorders, also by double digits, the case for "making it harder" to ultimately "make it better", gets clearer. For example, some data suggests that making soda more expensive improves health outcomes lending even more credence to the adage often used by people who see value in challenging themselves to do hard things - "if it were easy, everyone would do it". 

Life doesn't come with an operator's manual, but there are rules of thumb that seem to stand the test of time: "Easy isn't always best" often seems to fit, maybe because when it comes to injury/illness/disease risk "pay now (personal effort) or pay later (quality of life)" does too.

And for the youth coaches out there who are at risk of being a little overstuffed the lesser-known "never underestimate a competitive kid" might be worthy of your attention....unless you prefer the taste of Cicada over that of victory. :)

Have a great weekend,

Mike E.

Feb 23

The funny thing about "news" is that it's not always new. Eating too much sugar is bad for us. Not new and probably not surprising since just about everyone knows excessive sugar is not good. We've heard it hijacks our brain, puts our metabolism on a roller-coaster, and quickly elevates our risk of SEVERAL of the major health risks we face. Generally speaking, new as this isn't, it's still true. Sweetened beverages (whether natural sugar or artificial in most cases) add double-digit cancer risk, significantly increase our risk of cardiometabolic disease (as much as 30%), and have even been related to both pain threshold (we hurt faster) and intensity (we hurts worse).

The latest study, a REALLY big one out this month from a team at Harvard, looked at both the connection between drinking sugary beverages regularly and cardiac events like heart attack, etc. but also whether physical activity could counteract the effect. When they examined 13,000 cardiac events over more than 3 MILLION person-years there was a big bump in risk; on average about 20% - not a surprise and maybe not even news. However, interestingly, they also added proof that exercise alone is not enough to fully "right" the risk. They found that while non-exercisers experienced a risk jump of around 18% per daily sugary beverage consumed, individuals who met the physical activity guidelines STILL experienced a 12% risk jump per serving. The old adage said by sages in running clubs everywhere is true - we can't outrun a bad diet. However, all hope is not lost, we may have a reset option.

As it turns out, in another study this week by a researcher who has spent years learning what fasting can do for our health, 5 days per month on a diet that limits enough intake to get the benefits of fasting without actually fasting showed significant promise. Compared to controls who ate a generally healthy Mediterranean diet, those who ate a "fast-mimicking diet" for 5 days out of the month over a 3-4 month period had:

1. Lower risk for diabetes as measured by blood markers

2. Reduced abdominal fat and fat deposited in the liver

3. Improvements in their risk for metabolic syndrome

4. Improvements in immune system functioning

5. 2.5-year reduction in "biological age" (a marker of cell/tissue functioning)

So what is a fast-mimicking diet?

Officially, the team described it as: "comprised of plant-based soups, energy bars, energy drinks, chip snacks, and tea portioned out for 5 days as well as a supplement providing high levels of minerals, vitamins, and essential fatty acids."

However, you can find out more, including some free recipes on the blog of the lead researcher HERE.

Our brains may light up on it enough to crave it, but without plenty of nutrients and fiber to balance its effects on our health, we definitely don't "run on it" very well. If it's time for a reset, consider setting down the sugar and reaping the rewards of risk reduction.

Have a great weekend,

Mike E.

Feb 9

Words are powerful. Language matters. Not only in "what" we say, but "how" we say it. History has demonstrated this over and over again and more recently research has proven it. Powerful speeches whether in front of great crowds or on our phones in the forms of "shorts" or "reels" can stir feelings inside of us and move us toward action. Said more simply, words can shape our thoughts (and therefore beliefs) while simultaneously stirring the emotions that spark our actions - they deserve more attention (and probably intention) than we often give them. This TED Talk from 2017 is a fantastic example of how and why. 

In the realm of prevention and health promotion, where we spend most of our time at Pro-Activity, the idea carries important significance. We have seen many times that how a person "frames" their health, that is the words they use to describe it to themselves or others, can have major implications on how their experience plays out. Studies on the topic are beginning to provide insight as to why. For example, this study from 2022 showed some interesting (but far from conclusive) connections between how a person labels discomfort and how they move, with particular emphasis on lower back pain. It lends some support to what is sometimes called the "fear-avoidance model of pain" which, in an oversimplified way, suggests that when we limit ourselves by avoiding "threats" that have caused pain in the past we can unknowingly make our bodies even more sensitive, getting closer to our natural threshold and more easily "bubble over" the next time we are "challenged" in a similar way.

As it turns out, some new research out last week lends even further support to the idea. In a study that tracked how +/- 370 people appraised stressful situations - that is, whether they tended to label them as "threats" or "challenges" in their internal dialog - those who interpreted stressful events as something to be feared (i.e. threats) had worse future physical and mental health. 

So what's the difference between the two? After all, that's where the proverbial "rubber meets the road"...

The answer most often is - resources. When a person considers a knowingly hard situation but believes they have the resources (skills, tools, people to lean on, tenacity, toughness, creativity, etc) to handle it, they are more likely to see it as a challenge than a threat. When there is a mismatch between what is needed and what is available, the situation is far more likely to feel threatening. The bad news is, we are living through a time with many potentially stressful situations to confront on any given day. Some of them are new, and most of them are hard. The good news is, we are also living through a time when resources, especially the information on "how" to solve many challenges and "who" has already figured it out are easy to access and often free.  The challenge now is often not to find a solution, but to determine which (of potentially many) is the right one.

So although he almost definitely didn't mean it this way in March of 1933 when he said it, FDR was pretty close to the mark when he said, "The only thing we have to fear is fear itself".

And should you find yourself facing some health risks that we can help with - reach out, we love a challenge :)

Have a great weekend,

Mike E.

Jan 26

My Grandfather was an amazing performer. In addition to having an infinite love for his family and the skill to infuse it into a pasta fagioli that felt like a hug from someone who cared, even in his upper 90's he could sit down at a piano and leave onlookers gaping in amazement. It was one of my favorite pastimes - to watch "Pop" absolutely wow whoever was watching that day. Not only could he move his hands where and when they needed to be, but he did it by memory, rarely with sheets of music, and pulled in onlookers with a smile, a head nod, or a wink.

Perhaps not surprisingly I've always thought it would be awesome to be able to play like that someday when I grew up. And since "someday" hasn't quite gotten here yet (even though I've sincerely tried to grow up), it's still on my list of items to do. Couple that with a very real professional interest in movement-related skill, whether playing an instrument or a sport or using the tools of a trading day to day and it's probably no surprise that when new research demonstrates a better way to do so, I pay attention. It is another of the many reasons I am such a big fan of priming the nervous system with an active warm-up before any motor tasks because, in addition to readying the tissues of the body, it stimulates the brain to activate those tissues faster and more accurately. Take for example this 2022 study from Northern Iowa University which showed an active warm-up could improve piano skill acquisition in those pursuing a degree in music by getting their heart rate beating faster (but not too fast); something I'll put to good use whenever I get around to those lessons. Last week, however, thanks to a team in Denmark, our understanding got even more refined.

Their idea was relatively simple - if they tested motor learning in a hand-eye coordination task which required each subject to accurately control the force and timing of a pinching movement in response to what they saw on a screen, and then retested the subjects a week later without any further practice, they could determine who was most-able to retain the new skill. One subgroup had a moderate-intensity warm-up on a stationary bike, and another completed a high-intensity exercise session (also on a stationary bike) following the task, which is also known to help with skill retention. A third had neither the warm-up nor the post-activity exercise and a fourth group had both. As it turned out, all of the "active" groups did better than the control group (who did neither), but the group who did both performed the best overall. 

Of course, this was a relatively small study and so there are still unanswered questions (there always are) but the principle remains - whether it is playing an instrument, operating a machine, dominating a sport, or navigating the uneven and slippery terrain of a winter parking lot, building and maintaining movement skill is a critical factor in our ability to "do"...safely. If we can prime the process with a few minutes of warm-up or solidify the learning with a few minutes of post "practice" exertion or both, we can more skillfully MOVE into the future that we envision for ourselves.

Have a great weekend,

Mike E.

Jan 12

If you stop at the study's headline, it might seem like bad news. In a sample of more than 350,000 people at/near mid-life (approx. 55 years old), more than 1 of every 1,000 were diagnosed with dementia in their next decade of life; a rate that is in line or higher than in previous studies.

After all, even though rare in comparison to leading conditions like heart disease, cancer, diabetes, or joint disorders (where nearly 70% of Americans have 1 and 14% have 3 or more) it still means that hundreds of thousands of people are experiencing significant cognitive declines far before the "golden years" - which is not the quality of life in retirement most of us imagine for ourselves. However, the details provide hope and maybe even a few reasons to be optimistic.

Walking backward (or "upstream") from the disease to the associated risks, it becomes clear that, a lot like those other conditions, this one is further within our control than we originally thought. Of the 15 identified risk factors, at least 13 were at some level modifiable. Interestingly more than 1/3rd of the risk factors were either other chronic diseases (heart/artery/metabolic disease near the top) or known risk factors shared with them (poor strength, high resting levels of inflammation, and habitual alcohol consumption outside of accepted guidelines). More evidence that cognitive decline is in large part, another, in the growing list of lifestyle diseases...and therefore more a consequence of the choices we make than a fate associated with our genetic blueprint (which increased the risk 2-3X depending on the number of known genetic factors).

So what should preventative maintenance for the brain include?

1. Exercise Enough: 7 of the risk areas are known to be improved by a MOVE habit. It gets even better if you do it with others or primarily outdoors.

2. Eat Well: 6 of the factors could be related to dietary choices. Be sure to consider sources of Vitamin D (identified as an independent risk).
3. Protect Your Hearing: This is especially important in the industrial environment and increases risk by more than 50%.

4. Avoid Heavy Alcohol: This was one of the strongest risk factors identified (>=4X risk if a person had a use disorder).

5. Control Inflammation: Although at some level the first 4 can help here, this risk factor was substantial (2.5X risk in some models), so adding in a focus on Sleep which is known to have an impact, is probably worth it.

While it's unlikely that we can avoid the risk entirely, the more we learn about brain health, the less it seems we have to fear. Like heart disease, metabolic disease, several forms of cancer, and many (if not most) musculoskeletal disorders, with a little preventative maintenance this "machine" we're walking around in can stay strong and work well for many many years.

I hope your 2024 is off to a healthy start.

Have a great weekend,

Mike E.

Dec 29

The 52nd week of the year always feels like it should be a lull between the waves. Most of the previous year is in the history books and the next one is forming quickly on the horizon, but if everything goes well, there's a brief pause to reflect on the past and think about the future. Of course, it doesn't always work out that way - the world is as busy as ever and times to reflect can be hard to come by, but this morning I had such a block. An hour or so to flip back through another year of blogs about prevention, health promotion and population health. Another year which tells the story of what the research community has been looking at. Here are the headlines:

Short bursts of physical activity got a fair amount of attention this year. Whether it was a few minutes of stair climbing, incidental bouts of intensity as part of normal daily living or simply standing more frequently, the idea that although "more" is still probably better in most cases, "something" (hard enough to get the heart pumping daily) is infinitely better than "nothing" when it comes to health was clear in 2023. And while MOVE took top billing in the second half of the year, it slipped to second this year overall representing 24% of the featured topics.

The power of bundling also featured prominently in 2023. While this makes total sense given the well-known interplay between the ELEMENTS, it is not unimportant as it suggests the wider conversation is (finally!) embracing the fact that in the complexity of the real world there is really no such thing as a single, isolated health-habit. Everything we do and everyone we interact with has an impact on...well...everything we do and everyone we interact with. It all adds up and with nearly 20% of our blog topics featuring this storyline in 2023, it seems the world is starting to embrace it.

The last big storyline this year was the biome - or microbiome to be specific. While not a new discovery (the term dates back to 2001 and the field that it grew from the 1800's) the deep and powerful connections it has to our health are some of the most important learnings in a generation. It certainly wasn't the only theme in the FUEL category in 2023, but it was one of the more prominent and likely the one that drove ELEMENT 2 to the top spot, accounting for more than 30% of the blogs this year. 

RECOVER (with emphasis on sleep), ENDURE (resilience, robustness, toughness, grit, etc.) and CONNECT (social dynamics and relationships) filled the gaps, each between 7.5% and 10% of the topic list.

There's no telling where 2024 will take us but if there's any truth to Einstein's famous quote "if you want to know the future, look at the past", it'll include stories of people, connected in purpose, standing on the platform of health, achieving great things.

It has been a pleasure to be a part of your story this year. Thank you for being a part of ours.

Have a great weekend, see you in 2024,

Mike E.

Dec 15

Those who subscribe to the Diffusion of Innovation theory believe that a relative few of any group drive change in a predictable way. In essence, the less than 3% known as "innovators" find something that solves a problem and begin tinkering with it. Through their willingness to be first (and often deal with high prices and less-than-perfect designs) when they give something a thumbs up, they inspire a larger group of friends/colleagues who pass it on to others and eventually almost everyone, except the 16% who resist change known as "laggards", is on board with the solution.

When it comes to personal ergonomics, ironic as it might seem for someone who consults in this space often, I don't really consider myself an "innovator". Most of the gadgets out there create nearly as many problems as they solve, so I tend to pass until there is solid evidence backing them up. Unproven solutions, usually at the height of their cost, just seem like a gamble, and "wait and see" usually prevails. Every once in a while, however, a product or solution makes its way through the diffusion gauntlet and in so doing drives the cost way down. The tinkerers and the trendsetters have done their job and even items that maybe aren't "the best thing since sliced bread" get interesting.

The electric standing desk may be one such solution. When they first hit the market (YEARS AGO), the idea was cool but they were clunky and expensive. The evidence said they had some merit as part of a comprehensive plan for specific needs, but for wide use as a preventative tool, the costs still outweighed the benefits. In essence, static standing wasn't that much better than static sitting since the body is built to MOVE. Then, as the lockdown-driven demand for at-home-ergo solutions caught fire, standing desks went from trendy to mainstream. After all, if you're buying a desk anyway...but while it was pretty clear that if used properly a standing desk doesn't "harm" us, the question of "does it help?" still wasn't definitive, so I still waited.

Then something happened. As the pandemic chapter got further and further into the rearview, the price for non-commercial versions continued to drop (still a little too expensive for commercial grade in my opinion), and at the same time some research, such as this study, was beginning to suggest that if used properly it might give a metabolic boost. I'm still not sure I can get into the habit of using it often enough - 4 uses every hour seems like a lot - however, in one "late-majority" person's opinion, it's now worth a test - so I'll let you know.

On the other hand, if you're an innovator at heart and way past this trend you're probably frustrated even reading this far...so it might be better to jump on this new research and just change your phone screen to grayscale so you can use the 35 minutes gained from that visual-boredom to take a walk...it'll be trendy before you know it...it might even already be, clearly, I'm the wrong guy to ask. :)

Have a great weekend,

Mike E.

Dec 1

It took until Tuesday but then the realization hit, I was really, really tired. Objectively it made total sense; the unofficial start of the "bustle season" came with full force and like a moth to the flame, I went all in. The quick trip to pick up a college kid that resulted in a few extra hours of brake lights, the last-minute leaf-management strategy that I finally had time to execute, the eat/drink/be-merry of a day built around that exact formula, and the long days that follow after the holiday-season moves out of pre-season had given me plenty of ways to burn energy. No complaints, we do this to ourselves and I knew that my dragging was self-induced and right on cue. The risk of course, for those of us who join the sprint this time of year, is that attempting to fit "more" into a fixed volume container eventually results in spillover when we overdraw our time and energy resources.

While this spillover brings a significant drop in our situational awareness which can have catastrophic results in environments where a low-margin of error is often required (e.g. driving), it is not limited to high-risk situations and is not only the result of short-term fatigue. Anything that drains our energy and attentional resources faster than we can replenish them can put us into this state. Commonly referred to as "presenteeism", this phenomenon was identified at least 50 years ago and in plain English refers to being physically present, that is not absent, but not being FULLY present - there in body, but maybe not in spirit or full focus - being at least partially "checked out".  It is most commonly studied in the workplace because it can (but does not always) have a significant drag on productivity; however, it does not conveniently stay at work. Whether due to a health burden, which had traditionally been thought to be the cause, or the other known precursors like fatigue, the risk goes everywhere we go and has an impact on everyone around us. 

One study this year showed that when we tip the balance toward fatigue via insufficient sleep, we lose self-efficacy, optimism, hope, and resiliency ("psychological capital") faster, which as if those are not problematic enough, leads to burnout, lower satisfaction and likely more. But there's good news: as we continue to learn more about the root causes we realize we can impact them with the right strategies. In a study of more than 12,000 individuals out this week, three clear connections were found between day-to-day actions and presenteeism - not surprisingly, variations on the same themes we know to maximize our capacity - whether by raising our threshold to spillover or ensuring we recover as full as possible when we rest. Each is important by itself, however, given their impact on each other, they also have the potential to compound. 

(1) Daily Exercise - especially good when we are mentally tired but physically "pent up" (e.g. those that sit for more than 11 hours per day which nearly triples risk)

(2) Going to bed Empty (known to improve sleep quality)

(3) Getting a full human night's sleep, which is more than an elf, even if you play one this time of year. 

If we start investing a little in quieting our holiday zombie now, we can cross the 2023 finish line with enough energy to enter 2024 strong. May the gift-giving of the season start with a daily investment in yourself today. Happy Homestretch.

Have a great weekend,

Mike E.

Nov 17

Prevention and Performance are games of "seasons". While it is not at all uncommon for a traditional athlete (sport) to have an annual training plan that starts at a peak race or game and plots blocks of time dedicated to ramping up readiness at the right rate. It is a lot less common for work-athletes (who use their body to earn a paycheck) or lifestyle athletes (the game of life) to think in these terms. Staying out of the reaction rut, where we just deal with whatever life throws our way and in the plan-ahead mindset can be tricky. "Paying Now" to avoid "Paying Later" makes total sense when we stop to think about it but is no-less hard to pull off.

This time of year the stakes get increasingly higher for those who are committed to tamping down injury/illness/disease risk. Changes in temperature and daylight patterns can add risk and as the CDC shows fairly clearly HERE, our immune function gets put to the test. While the research has shown that sleep efficiency (getting to sleep, staying asleep, and doing so deeply while we are there) remains one of the best ways to keep our defenses strong, nutrition and exercise become increasingly powerful as we age. In fact, exercise can have such powerful effects, under some circumstances, it might be too good...and thanks to some research this week we are closer to understanding why.

It starts with a phenomenon that every serious athlete must consider - pushing hard enough in training or in competitive events seems to add risk for infection. For example, marathon runners are well-known to have an increased risk for upper respiratory symptoms after peak training or in the days after the event. However, there debate rages on as to why as this paper explains. In short, the risk is real but it was hard to pin down a mechanism.

Then a research team from a lab within the US Department of Energy stepped in. They designed and kicked off a study of serious work-athletes: wildland firefighters which required a dozen volunteers to gear up in their typical 40 lbs of helmets, packs, gloves, and more and do a "strenuous training exercise" in the heat and hills of California. Loosely translated, this meant 45 minutes of running around the woods, in heavy gear, with heat. The team then collected and analyzed blood, urine, and saliva samples across nearly 4,700 variables. They found more than 100 that were significantly different from the start.

As it turned out, the researchers were able to show that as the demands on the body transitioned from "moderate" to "intense", that is the physical loads became exhausting, the body shut down the inflammation system in the nose/throat/lungs presumably to make it easier to get more oxygen in, ramped up secondary microbe fighting agents in the mouth (as found in saliva) and opened the pathways required to burn fuel more efficiently (sugar/fat) and transport it to the muscles more effectively. Said another way, in less than 45 minutes the body traded a temporary boost in physical function for a temporary reduction in immune function...which is exactly the kind of request a marathoner is asking for on race day.

What's the take-home on this?

Exercise has a sweet spot when it comes to our immune function. Some is good, more is probably better but too much is too much. While there is no "bad" season to exercise, if you're a high-intensity or long-duration exerciser, now is the season to consider secondary defenses like hand-washing, and distancing after extreme bouts while doubling down on nutrition and sleep. 

Here's to a healthy winter peak - it'll be here before we know it.

Have a great weekend,

Mike E.

Nov 3

Exercise science is always evolving. Google Scholar has more than 43,000 academic titles from this year alone. It's enough to bog down even the most efficient and committed information consumer who tries to keep up. Here's the good news - it's pretty rare to see many big changes; most of the new information confirms what we already know and adds a few refinements.

For example, in general, we know when people MOVE often enough, vigorously enough, and for long enough to challenge their current capacity in some way on most days, they can prevent and reverse many injuries/illnesses/diseases. Doing so in a variety of ways (not just one motion repeated always) keeps us versatile enough for the twists and turns of life and provides layers of resilience to the stressors we face. Of course, "regularly" and "enough" leave a lot to the imagination so professional organizations, government agencies, universities, and other non-profits often attempt to quantify, prove and someday simplify the phenomenon enough that it becomes practical to the average citizen. Eventually, we have guidelines such as those from the CDC which broadly read:
 

Exercise most days of the week, enough to accumulate 75 minutes of vigorous or 150 minutes of moderate-intensity work saving at least 2 days per week for strength/resistance training.

Which is further distilled by professionals who commonly prescribe as follows:

Perform at least 30 minutes of movement per day where the majority of those minutes can be at a low (incidental movement) to moderate intensity (slightly winded) with 5-15 minutes performed closer to maximum intensity (out of breath). On at least 1/2 of the days (per week) complete these minutes using muscle loading / resistance-oriented activities including organized sports. Grow this number to 60 minutes per day for better results or for children.

And for a long time, this is where things have stayed. Sure there have been new ideas and concepts, but in the grand scheme, very few resulted in big shifts or could be considered game-changers. Trading intensity for volume however may be one. The idea that we may need to invest a whole lot LESS time to get the same (or even better) results if we are willing to work a bit harder during that time is a really big deal that just keeps gaining steam. The idea that our muscles can be FAR more than those rubber bands that move our bones and, when asked just the right way, can be a mechanism that clears inflammation and can release large-scale disease-clearing defenses, is big news.

We saw it again this week with one of the most change-resistant subspecies on the planet - the runners.

Yes, this research, which tested a small group of runners on a newer protocol, discovered that changing the volume/intensity balance could produce excellent results and the recipe was as simple as 1-2-3: 1 part max, 2 parts moderate, and 3 parts easy. Specifically, after a warm-up, the runners were asked to run 5 or 6 minutes of 1-minute intervals which were further broken down into 30 seconds easy (about 30% max) which ramped to 20 seconds moderate (40-55% max) which further ramped to max (84%) or near max (75%) effort for 10 seconds. They completed 2 to 3 rounds of this protocol (10-18 minutes total), 3 times per week for six weeks and compared their 5 km (3.1 miles) racing times before and after.

Translated for the non-runners this means that instead of a training plan which often includes sessions of 30+ minutes to achieve new performance, these folks were able to do it in roughly 1/2 the total time and with less than 15 minutes of maximal effort per week when their exercise "dose" was more fully optimized to their goal. Even better, not only did they improve their performance they also had a significant increase in their cardiorespiratory fitness, one of the most important markers of injury/illness/disease resistance we know of.

It's not too late to get ready for your local turkey trot. Invest 45 minutes per week and you might not only cross a finish line you might change the trajectory of your health.

Get out there and get winded for a few seconds today.

Have a great weekend,

Mike E.

Oct 20

I'm not sure when I first heard the term "the mushy middle". It's been used to describe a political view that isn't polarized to one extreme or another (many people on many issues and in at least 1 person's opinion, not a bad thing). It's also been used to describe writing or storytelling that tends to somehow lose its way between the "beginning" and "end" (been there!). For me, however, it perfectly represents the trap of being (mathematically) average from a health perspective, that is, of being in the middle of the bell-shaped population curve when health risk is plotted.

In plain terms, it's a trap because BOTH time (duration) and age (often correlated but not the same) are risk factors for many injuries and diseases - so even if we are OK being average today, the longer we linger there and leave things "up to nature", the worse things inevitably get. Just like it's hard to build a solid foundation on an unstable or deteriorating platform...standing on mushy ground increases the likelihood we'll sink. From a physical activity perspective, the middle accounts for around 6 of every 10 Americans, which is almost exactly what the math would predict (+/- 1 standard deviation = 68%).

Am I in the middle?

It's pretty simple to determine if this is us. If we are not one of the +/- 15% of Americans who have significant disability associated with mobility or independent functioning AND we are also not one of the +/- 24% who currently meet the physical activity guidelines of at least 75 minutes per week of vigorous aerobic activity (or 150 min moderate) AND resistance exercise (strength, muscle loading, etc) at least 2 times per week, we're there.

Here's the good news - even if we have two of the most commonly cited barriers standing between us and the change we need (time and resources), we can buy ourselves some time by minimizing the impact of being there. Three studies in the last 60 days have pointed the way.

1 - From The University of Connecticut, a team showed that adding an extra 3,000 steps per day (about 2 minutes of walking per waking hour) could lower blood pressure risk as we age.

2 - From the Massachusetts General Hospital, a team showed that a hormone (myokine called irisin) which is secreted from our muscles after as little as fifteen minutes of strenuous effort, can "untangle" and clear the plaques associated with Alzheimer's disease in the aging brain.

Or if you're REALLY pressed for time

3 - From Tulane University, a team showed that taking the stairs 5 times per day was enough, even without exercise, to cut cardiovascular risk by 20%, about 2-3 minutes worth of work (turn 1 of the "UConn walks" above into a stair climb). 

Being in the middle for a little while doesn't have to become another mushy story that goes on and on. The antidote to "stuck" is almost always "MOVE". Let us know if you need ideas.

Have a great weekend,

Mike E.

Oct 6

We've blogged about the powerful impact of nitric oxide (NO) from dietary sources in the past. If you've missed those, here's the recap:

• Nitric Oxide (NO) is made after friendly bacteria in our saliva and gut break down dietary nitrate into nitrite and then eventually nitric oxide.

• NO has a relaxation effect on our arteries allowing us to push blood through the system more easily and exert energy in a more efficient way during high demand.

• It is used by athletes, most traditionally endurance athletes, as a performance enhancer but recent research says it can help with strength as well.

• The Nitrate found in plants (potent sources include beetroots and arugula as well as other leafy greens and root veggies) appears to be safe and effective

• The Nitrate added to meats during processing and curing does not give the same benefit and more likely adds risk, so source matters.

• Some studies suggest that it is one of the mechanisms responsible for the blood pressure-lowering effect that diets rich in fruits and veggies (such as the DASH) have.

In summary - dietary nitrates sourced from plants appear to enhance our performance and protect our cardiovascular system, lowering our odds of a major injury to the heart and arteries - a primary prevention (keeping something from going wrong in the first place) effect. The story got even better last month however when a new discovery showed that healthy nitrate consumption might also be critical to deploying a secondary prevention measure (minimizing harm when something does go wrong) by our red blood cells that we're only starting to understand.

Following a line of research that has shown that our red blood cells not only transport Oxygen around our system but also have a role in regulating pressures and lowering them in extreme cases, researchers wanted to know how it all works. Using a mouse model the team from Sweden was able to prove that:

(a) low oxygen states (such as heart attack) can act as a triggering event for secondary measures and

(b) when enough nitric oxide is present, the red blood cells can release the protective signal required to minimize damage.

Of course, knowing that mice aren't humans and mouse models aren't perfect, the team did something especially cool to go one step further in proving its utility. In the last step of their experiment, they re-ran the mouse heart attack model, but this time using human red blood cells from 3 different groups. The first group got a placebo, the second got a nitrate supplement and the third consumed healthy high-nitrate veggies. The two groups with preloaded nitrate (and therefore higher concentrations of NO available) showed the same powerful effect, a 50% improvement in recovery after the simulated heart attack.

A bit like seatbelts and airbags we hope you'll never have a need...but having a secondary prevention measure on board if you do, can be the difference between a scare and catastrophe. This time it's as simple as salad.

Have a great weekend,

Mike E.

Sept 22

The most well-known stat related to heart disease is that it is the leading killer in America, a title it has held for decades. Lesser known, but not insignificant, is the fact that after the 1960s, Heart Disease has claimed a steadily DECREASING percentage of lives lost each year. While primary prevention efforts, including a better understanding of the impact of smoking, poor diet, and lack of exercise have definitely played a leading role, there are other levers, like catching people who are at risk before a major event that have helped keep things moving in the right direction. The electrocardiogram and testing the heart under "load" during a cardiac stress test has been especially important in this role. It's such a simple concept - when we stress the system with a specific load, we can measure whether the heart is behaving in a normal/predictable manner under that load.

This week, from a research team at the Mayo Clinic, we learned that exercise capacity can tell us about other disease risks too, including the number 2 killer, Cancer. While this makes total sense, a body that has less physical capacity or is not able to recover quickly from physical stress is at greater risk in general (for injury, illness, and disease), this study of more than 13,000 individuals tracked over 10+ years gives very strong proof.

Individuals who had poor fitness (less than 8 METS) were at 42% greater risk of dying in the 10 years after the test than those who had good fitness (10+ METS) and those whose heart rate recovered less than 13 beats per minute from the peak in the first minute after stopping the test were at 36% greater risk during the time.

Do-It-Yourself. While this can be determined in a clinical setting with a treadmill, it is not the only way and may not be the most accessible way for most. As was shown in 2020 and we've blogged about previously, if you have 4 flights of stairs and a stopwatch you can get a good idea of where you're at in a few minutes. The process is relatively straightforward. Climb 60 steps as fast as possible w/o running (and preferably with a handrail for safety but not "pulling"). If you can complete the test in 45 seconds or less, you are near or above the standard and at lower risk over the next 10 years. If the test takes more than twice as long (90 sec or more), you are in the "at-risk" category and may want to consider working to improve. Maybe even better yet, as we've mentioned before, visiting those same stairs a few times daily, can improve where we're at between 5% and 12% in as little as 6 weeks.

 There aren't that many long levers when it comes to health improvement. Now more than ever, fitness is one. Get up and get moving!

Have a great weekend,

Mike E.

Sept 8

While most people know of his contribution of "non-maleficence" (aka "do no harm") which has been deeply ingrained in the practice of medicine, Hippocrates' second most famous quote, which it seems isn't actually his, may be closer to the mark than we ever thought before. This time, even in the most literal sense. 

"Let Food Be Thy Medicine"

Confirmed here in 2013, the famous quote that food IS medicine was probably not the first (or ever) uttered by the great ancient physician. Although the connection between diet and health (and other lifestyle habits like exercise) is made clear in much of his work, the direct line, food being the equivalent to medicine, isn't there. That doesn't make it any less true apparently. Maybe it's the new frontier of the gut biome or maybe the medical community is just finding its way back to its roots, but everywhere we look we just keep finding evidence that lifestyle can be used to correct a growing number of ills, and get as good or even better results to pills and procedures. This week, two different studies jumped off the page.

The first was an observational study of food used as medicine in the most literal sense - the physicians actually prescribed it in areas where healthy food options, specifically fresh fruits and veggies are hard to come by or too costly for consumers who need them. In a special program where physicians could prescribe fruits and veggies, families in 12 different US regions were able to take the prescriptions to local markets and get steeply discounted or even free fruits and veggies. The lifestyle result? Consumption went up - about 1/2 to 1 full serving per day on average. The medical result? Blood sugar improved, blood pressure improved, and body weight improved.

The second was a far more rigorously controlled study - a "Randomized Controlled Trial" (close to the gold standard of interventional research). In this case, participants were separated into 2 groups and randomly given resistant starch, which, as the name implies is a starch that is resistant to digestion and instead tends to ferment in the large intestine. Of course, as we've previously written about, there seems to be a link between the fermentation of foods and gut health which held true here too. As it turned out, in 100 individuals with non-alcoholic fatty liver disease (the most common form of liver disease), a daily dose of resistant starch, in this case, taken from corn but found in a variety of other healthy foods like oats, rice, legumes, and even green bananas, was enough to improve the gut biome. Even more impressive it also appeared to improve their inflammatory profile, rebalance liver enzymes, and cut their triglycerides by as much as 40% in 4 weeks, all very meaningful results.

The summer peak may be getting smaller in the rearview, but that doesn't mean the good stuff has to be gone. Maybe this is your year for a fall garden or if nothing else, to refill your prescription of that new ancient medicine the next time you're cruising a produce section.

Have a great weekend,

Mike E.