Blog Archives
fascinating findings for future use
Jan 3
With my youngest child now old enough to be out celebrating with friends, it would be the first "quiet" New Year's Eve in a very long time. Although, to be fair, since 2024 was just the usual chaos and nothing really to complain about, it had been busy enough that getting in bed at a reasonable hour (well before Auld Lang Syne) felt like a win. After a couple of hours which felt like minutes, I woke to the sound of Charlie the Yellow Dog loudly protesting a neighbor's use of fireworks to commemorate the moment. Then, after a few minutes that felt like hours (oh, the barking!), I knew 2024 was a thing of the past and I could go back to sleep.
It's one of the reasons I love New Year's Day. At a time when we often hear about the benefits of quieting thoughts about the past and/or future to "stay in the moment" (aka mindfulness), it is one of few scheduled pauses, brief as it may be when the mental time travel of reflecting on the past 12 months to help plan the next twelve (future) is a good thing.
So what if we apply this approach to the goal of staying safe, living healthy now, and improving our odds of thriving longer? What fascinating findings from 2024 should help inform our plan for 2025?
Here are few of the most important to know about in my opinion:
(1) Build Reserves: Whether it's this massive study of studies published in September which showed that for every 1 unit increase in cardiorespiratory fitness, adults had a double-digit drop in the risk of dying or this March 2024 review of 130 different studies which showed that "inadequate physiologic reserve" as we age (aka frailty) was definitively linked with important social drivers of health such as loneliness and isolation, the big message is clear: Improving or maintaining fitness, strength and power now can be one of the best investments we can make.
(2) Fiber First: If a headline read "Eat enough of this every day and lower your risk of dying by more than 20%" many of us might take a look. If the fine print said it was a study of more than 3 million people, even those who like to dive into the details might be satisfied. Well, that is exactly the observation made in this January 2024 review of 64 different studies on the subject. As a bonus, this study which does a deep dive into interventions shown to improve blood sugar control showed that not only does consuming more fiber (>=10g/day) help lower the risk of metabolic disease (sections 6.4 and 7.2 in the article) but points to emerging evidence that suggests if we eat it first, that is, order our eating patterns so we eat the veggies first and the carbs last, we might get an even better effect.
(3) Energy Vampires are REAL: This review from a team in Italy early in 2024 points to an important theme when it comes to the well-being and performance of groups and teams - attitudes really are contagious. While most of the work in this area has been done on leaders as the "sender" and followers as the "receiver", the authors point out that this relationship has also been established in those who tend to command attention (i.e. the loudest or most expressive person in the group). If you are on a team or work in a group, assessing and creatively addressing the emotional energy in that group might be a powerful risk-lowering strategy in 2025.
Of course, these are only 3 themes...and fascinating is most definitely subjective, but there's enough here to build on. Keep an eye out for more as we journey through 2025.
Have a great weekend and Happy New Year,
Mike E.
all of the above
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.
Beyond the Buffers
Dec 20
Around this time last year, we used "Holiday Heart Syndrome", the seasonal uptick of heart-related problems this time of year, to illustrate one of the most critical themes in thriving - sudden & heavy loads, no matter the type, leave us exposed to risk.
The idea is pretty simple - our biology (like all living creatures) is built for efficiency. Below the surface of our thoughts and like a seasoned holiday traveler who meticulously packs to avoid the pitfalls of "checking a bag", our body is constantly working to interpret our past experiences in order to anticipate our future needs and ultimately to "bring only what we need to survive". As unique individuals, we each interpret the statement differently, as this scene in a 1987 classic makes clear, but any way you slice it, wasted energy is biologically expensive, so we try to avoid it.
Since our predictions, with a little buffer built in, are usually right, we get home about the same way we left...but not always. The trouble comes in when a sudden or heavier-than-expected load pushes us beyond the buffer. We scramble to deal with it, but the extra energy required puts us in a risky spot until we can recover. The type of load doesn't really matter. Whether it is a sudden temperature spike in the early summer before we've acclimated, a sudden sleep disruption from "springing ahead" or a sudden increase in the alcohol we consume because it's part of our holiday tradition this time of year, the risk is real. Thanks to a team in Germany whose dive into the cardiac physiology of Oktoberfest was published this month, we are now closer to understanding why.
Here are the basics: When we consume alcohol our system works harder to process it. Counterintuitively, and despite it being a depressant, our heart actually beats faster and our nervous system revs up toward fight/flight/freeze, an effect which took as long as 48 hours to resolve. In about 5% of the people studied the heartbeat became irregular enough to cause more serious problems (called atrial fibrillation). While, it may be easy to dismiss "only" 5 of every 100...when we consider this is about 10X typical, it's a risk worth managing. Here are 3 simple strategies:
1. Know thyself - if you are at heart risk or have been particularly stressed, overtired, or are fighting something else recently (e.g. a cold or other infection), the risk is higher, cut the consumption way back (or out entirely).
2. Counter the Salt - it's not just the alcohol this time of year, it's also the food, which is often packed with salt. While sodium is not inherently "bad", it plays a major role in our muscles' ability to contract, including the heart muscle. Getting too far out of the sweet spot can lead to heart conduction disorders like a-fib, as shown in this 2021 study. If you are surrounded by highly processed food this time of year, make sure to counterbalance with some fresh fruit and veggies (as well as nuts and seeds) which naturally have higher concentrations of potassium and magnesium, which can get depleted.
3. Monitor hydration - we may not be sweating like the summer, but it always matters. Even in young, well-trained athletes, dehydration alters the heart's ability to perform. The further we are from young or well-trained, the greater the risk. This can also compound the salt imbalance and can be accelerated by the diuretic effects of alcohol.
It's the beginning of the peak and it's easy to get beyond the buffers when traveling light. Have fun...but not too much. :)
Have a great weekend,
Mike E.
The Little Things
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.
making time
Dec 6
It's hard to believe it's December. Even with the sharpness of this morning's air temps, which well below freezing, had a bite and emails about the end-of-year planning deadlines starting to occupy my inbox, it feels like only yesterday when we were talking about the benefits of acclimatizing to the heat in a strategic and measured way...but here we are...entering the homestretch of 2024. If you are anything like most this time of year, it feels like a sprint to the finish, and you know every minute counts. We might even wish we could make more of it in order to get a few more items checked off the list. Here's the good news - for those who invest a few minutes wisely, the evidence says we can. It's a two-part story, and it starts with a little myth-busting.
Let's call part one the "don't judge a book by its cover" myth of health. This popular myth says that to be healthy the most important thing we can do is lose weight. Since we know excess weight DOES add risk, this myth is plausible, but not ironclad. There are more effective ways to lower risk - if you want more time, as measured in years of life, spend more time with the stairs than the scale. Or, in the words of the lead author of a recent "study of studies" from the University of Virginia: "Fitness, it turns out, is far more important than fatness when it comes to mortality risk.". Across 20 different studies and a combined population of nearly 400,000 people those who were fit but overweight (or obese) had a much better health trajectory than those who were normal weight but not fit...and it wasn't by a little bit. Specifically, the low-fitness group was 2-3 times more likely to die during the study period as compared to the fit group. Yet, where things get really interesting, especially for women, is in how shockingly small an investment required to kickstart the time making effect was...which gets us to part 2.
A team from Australia studied activity tracker data from more than 20,000 adults in hopes of determining the minimum "dose" of physical activity required, if done in short bursts throughout the day, to have a meaningful impact on preventing major cardiovascular events in the future. Since these bursts are more like activity "snacks" than formal or structured exercise, the theory is that they may be doable for more people. The results were impressive, once again reiterating that the difference between "something" that gets us up, moving and preferably out of breath (enough to call it vigorous), and "nothing" can be, well, "everything" if we are trying to add years to our clock.
Compared to sedentary individuals, and after ruling out a long list of other risk factors and health behaviors, it took only 5.6 minutes per day of vigorous activity (VILPA) to have a meaningful risk reduction of about 15% for men. The effect was even better in women who only 3.4 minutes per day to lower risk by a massive 45%. In plain English, for those of us who spend larger and larger portions of our lives sitting or driving or looking at screens (essentially everyone), finding a way to get a little out of breath by taking the stairs, sneaking in some air-squats or wall-push ups during that stretch break or just about any other way, can cut our risk substantially.
The final sprint is on and every minute does indeed count. If whatever you're working on today is as important as it feels, we'll all need you doing it again tomorrow - the best way to make sure you'll have enough time then is to invest some now.
Have a great weekend,
Mike E.
there's power in thanks
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.
don't forget the flavanols
Nov 22
We're pretty much there. The sugary primer of Halloween has given way to the richness of Thanksgiving and the start of the holiday season. In less than a week many hometowns and communities will be celebrating with traditions that range from "big games" between rivals to moments of reflection and gratitude for many good things (even if never quite perfect)...and in many places, there will be food; in some cases lots of it, including some which may not love us as much as we love it.
While not intended as rain on the parade, which at least as of now seems unlikely for NYC and Macy's 98th, today we offer some food-for-thought based on what we know about how our bodies respond to rich foods, larger than usual portions and possibly some stress that comes with the holidays. The physiology of it is pretty simple - fatty and sugary meals have an immediate impact on our blood flow. The vessels become a little less responsive and oxygen has a slightly harder time traveling through the system. This is especially true following a stressful event making the combination of stress and rich foods a more risky one.
For example, a research team from the UK showed in 2023 that a high-fat meal following a stressful event resulted in significantly altered blood flow patterns in even young and healthy subjects. In plain English, after a stressful event, the subject's vessels presented in a constricted state (as measured by FMD) during the first 30 minutes, as we might expect in "fight, flight, freeze" reactions. However, those given the high-fat meal after the event remained in this state for another 60 minutes, which isn't ideal. The good news is, it doesn't have to be this way. There are simple strategies we can use to minimize this negative impact.
The first, and perhaps most well-studied, is the strategic use of MOVE. A small study at Penn State University in 2006 showed that a 45-minute walk at approximately 60% effort taken 2 hours after a high-fat meal counteracted the change. Then, in 2020, another team showed that mixing in some stair-climbing (5 min per hour for 4 hours) also helped restore vessel responsiveness. However, new research out earlier this week suggests there might be another way.
The same team from the UK mentioned above which showed the detrimental combination of stress and rich foods has now shown that the high concentration of healthy compounds (called flavanols) in foods like cocoa, green tea, certain fruits and spices, can also help reset things. They tested low-processed cocoa powder (12 g added to milk) and found better vessel responsiveness at 30 and 90 minutes after the fatty meal. According to the study's author, "This research shows that drinking or eating a food high in flavanols can be used as a strategy to mitigate some of the impact of poorer food choices on the vascular system. This can help us make more informed decisions about what we eat and drink during stressful periods."
If you haven't already, maybe this is a good year to take a walk, find some stairs, put the kettle on, and add a new healthy wrinkle to your tradition.
On behalf of the team and with our sincere gratitude as we roll into Thanksgiving, have a great weekend,
Mike E.
the convenience trap
Nov 15
"If you find yourself in a hole, stop digging".
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.
small investments pay off
Nov 8
As Ryan tells it, Mary was interested in making a health improvement. She was engaged in the education sessions he provided at her workplace and she always had good questions, truly an inquisitive mind. Mary wanted to lose some weight and was organizing and strategizing how best to do so. In the world of health change, she was "contemplating", commonly referred to as the step before taking action. She felt there were more pros than cons, but it still had to fit within the many other priorities in her life. Understanding how easily we get off course in this stage, Ryan was careful to give something proven effective but not drastic. He suggested having a "calorie cutoff time", which effectively shifts the last meal of the day to a slightly earlier hour and consistently "closes the kitchen" to allow a slightly longer burn-only period, which is known to improve how well we can process FUEL (especially sugar and fat) and may even lead to weight loss since eating late can be detrimental to health. A few months later Mary was down 10 lbs and feeling good about making a positive health change...and rightfully so, since most studies show even a small weight loss can improve several health markers.
Of course, weight loss isn't the only outcome that matters, and shutting off calorie intake isn't the only viable strategy. Perhaps strength and fitness are on your mind - according to the Mayo Clinic if you can't do 10 perfect push-ups (all ages and more if you're younger) it probably should be.
Could even 1 minute of daily exercise between now and New Year's Day make a difference? This study from 2021 says, for some folks, the answer is yes.
Could small dietary changes known to increase our body's Omega 3 and 6 availability (such as eating fish twice weekly and adding walnuts and almonds daily) lower cancer risk? This study out last month says, that for 19 different cancer types, the answer is yes.
Could adding in 5 minutes of exercise-like activity into our day lower blood pressure to a healthy range? This study, out last Wednesday says, especially in cases when we trade sedentary time for exercise, the answer is yes.
Many people feel the urge to take their foot off the gas and maybe even coast into the end of the year when it comes to health. Given the known risks of the season, this is not a great strategy for most. On the other hand, since small investments add up to meaningful outcomes, we believe now is a fantastic time of year to start building a habit. You might be surprised with how quickly that investment compounds into real results.
Have a great weekend,
Mike E.
together we bounce back
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.
training the brain to endure
Oct 25
Fatigue is a complex phenomenon. It is both physical and mental (body and mind) and can be impacted by the places we are in and people we are with - some that energize us and others that, well, don't. Most importantly, however, fatigue has significant power over our performance. When we are ready and fresh we are capable of amazing things but when we are tired or drained, we tend to be clumsy and struggle. It might show up as fumbling over our words or having difficulty staying relaxed in stressful situations, or as we've seen in every type of athlete we serve (traditional, industrial, lifestyle, etc), it might show itself in the momentary lapse in coordination or reaction time that so often precedes an injury. With that in mind, fatigue is a big target when it comes to prevention efforts. Understanding it better opens the door for approaches that can improve our resistance to it and put the odds more firmly in our favor.
One of the most important insights over the last 10+ years has been that in addition to training our body and its tissues to handle greater loads in order to become more fatigue-resistant, training our brain to handle greater loads during times of fatigue can also improve our ability to ENDURE. Brain Endurance Training (BET) as it is sometimes called, is an approach that not only challenges an athlete physically, such as cycling, but cognitively as well using tasks that load working memory for example, in order to improve physical performance. Some studies have shown it works well.
For example, in 2015 a team from Denmark reported significant improvements in endurance using a "time to exhaustion" test in healthy subjects who were randomly assigned to either perform endurance exercise only or endurance exercise accompanied with cognitively loaded tasks like a "2 backtest" where a person is shown a sequence of items and asked to quickly recall which appeared 2 ago (try it here). Another study in 2021 had similar findings showing a 32% increase in muscular endurance in a group that had both types of training concurrently and a 2023 study showed significant improvements for those who performed the mentally fatiguing tasks prior to the physical exercise.
But what about average/everyday folks - could there be benefits for individuals who aren't super concerned about their cycling endurance and really just want to think more clearly and minimize health risks? The answer seems to be yes. Last week, findings from a team from the University of Birmingham showed that along with physical performance, both attention and cognition (executive function) could be improved to a greater extent when physical exercise was combined with cognitive loading tasks even when the subjects were fatigued. Although the best protocols are still likely a way off, finding ways to challenge body and mind seems to promote a better ability to ENDURE in each.
Not sure if we will see puzzles in the gym anytime soon, but for those who might benefit from being a bit more fatigue-resistant, throwing in some MOVE in the midst of a mentally tiring day might go a long way.
Have a great weekend,
Mike E.
tricked by treats
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.
untangling back pain risk
Oct 11
Lower back pain is a complex beast. Decades of trying to make it simple have mostly failed and, even after nearly 80 years (since World War Two when it burst onto the scene) and hundreds of billions of dollars spent annually since, making "spinal pain" (lower back and neck) the most costly condition of 154 when ranked in 2020, we haven't fully decoded it yet. What we can say with some level of confidence is that if your back is hurting it is almost definitely a whole picture thing and not just a single or even a few simple factors.
Here's what we know: Occupational exposures like heavy physical work are often pointed to as the culprit. While they certainly add risk, they have not proven to be the sole "cause". In one recent review, and beyond the usual number 1 predictor (a history of lower back pain), the strongest predictors included both work-related risks (carrying heavy loads, heavy work, and awkward postures) as well as personal health risks (higher body weight, anxiety/depression) as well as unhealthy behaviors (smoking and maladaptive behaviors). Said another way, the movement risk (biomechanical) is real...but so is the psychological and psychosocial risk. Other studies have shown that metabolic disease (small vessel disease like diabetes) may add risk, while others have focused on dietary risk (especially high inflammation), poor sleep, and the benefits of social support.
Finally, sedentary time alone is a strong possible driver. If this all sounds like a tangled mess, well, we agree.
With that in mind, a team in Finland set out with the hope of unraveling some of it. They decided to take on the metabolic component by looking at energy utilization (glucose uptake and percentage of fat) in the muscles of the lower back by reducing sedentary time by 1 hour per day in a sample of overweight but otherwise healthy individuals with back pain. They recruited +/- 60 subjects and randomly assigned them to either the control group or the movement group. The headline findings were interesting but certainly not earth-shattering: those who reduced sedentary time slowed (or stopped) the progression of pain but didn't reverse it and standing alone wasn't enough to improve the metabolic efficiency of the back muscles. The fine print however was far more intriguing.
As it turned out, step count, that is, actual movement and not "just" posture change WAS associated with metabolic improvements in muscle and, when compared to previous studies, standing, like many interventions might have a minimally effective dose. An average 42-minute per day increase for six months in this study wasn't enough, but double that and throw in some professional support on managing discomfort as was the case in this study, and things improved. Of course, this is not the end of the line, there is still more to unravel. Until then, we continue to suggest a strategy that stands on the evidence:
MOVE enough - even if the best you can do right now is get out of your chair more frequently, posture change is good. FUEL clean - lower your dietary inflammatory load by increasing the healthy stuff and decreasing the metabolic stressors like low-quality, sugary/fatty & processed foods. RECOVER fully - keep your system relaxed with enough sleep. Build ENDURE - managing stress plays a bigger role in pain than most realize and last but certainly not least CONNECT - find a few people who have similar goals and band together; social support can help with all of the above.
Lower back pain continues to be common and frustratingly complex for too many Americans. Until we've got the whole mess untangled, go with what you know - a healthier body is a stronger, happier, and more resilient one.
Have a great weekend,
Mike E.
Win the Weekend
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.
2024 coffee update - still generally healthy?
Sept 27
With the Summer season officially in the rearview as of Sunday, it shouldn't have come as a surprise that Tuesday morning "already" felt a bit like Fall, but it still did. The air was brisk, the sky had some grey and, as it tends to when the air is cooler (at least for me), the first sip of coffee was especially satisfying. Now, while I try to be conscious of the line between actual coffee (with nothing, often considered a healthy habit) and coffee-flavored drinks with enough sugar to have a nutritional profile closer to a dessert (not quite as wonderful), I admit to having mixed feelings when I answered "yes" last Spring to a highschooler doing a science project that asked me if I thought I drink coffee regularly enough for it to be considered a caffeine addiction. And so, like I often do, I've tried to keep an eye on the related research to make an informed decision as to whether this is a habit I should work to change. For those who might also wonder, today's blog is for you.
Let's start with the last time we covered the topic (January 6, 2023). Then, the general consensus was that consumption of up to 4 cups per day in healthy, well-rested individuals, did not appear to have a negative impact and might even have a small positive benefit on health. However, in groups who were up against either a health condition, such as a higher risk of fracture (osteopenia or osteoporosis), high blood pressure (160/100 mmHg or higher), or musculoskeletal pain or were chronically under-rested (less than 6 hours of sleep per night) there was a higher risk, the effect was negative. More than 1.5 years later, we have more information, but the punchline is similar.
Broadly, for otherwise healthy people, the news on coffee consumption (and by proxy caffeine) is mostly, but not all, good. In moderate doses (generally considered 2-4 cups per day) and when taken early enough to not interrupt sleep, there are positives including lower markers of inflammation (CRP), lower risk of Parkinson's Disease, a lower risk of a cardiometabolic disease cluster (called "multimorbidity") and a neutral effect on blood pressure. On the other side of the spectrum, one review this year reported an increased risk of lung cancer in habitual coffee drinkers, a risk that has been hard to pin down in previous years, something the authors acknowledged in the last line of their conclusion when they stated: "Further studies, especially with a prospective design, are required to expand our knowledge on the association between coffee consumption and risk of lung cancer.".
For individuals already struggling with a disease, condition, or at high risk of one, the take-away is a bit more nuanced. The news for those with a history of colorectal cancer appears positive - the likelihood of recurrence in habitual coffee drinkers was significantly lower (-32%) than in non-drinkers, while the news for those with chronic pain was more complex; coffee consumption was associated with the known relationship between chronic pain and mental health concerns like depression and anxiety.
And so, like so much in health and human physiology - it seems the answer is "it depends". If you are otherwise taking care of yourself, generally healthy, are a non-smoker, and consume up to a few cups of coffee and/or tea per day (200-300 mg of estimated caffeine) preferably without added sugar, should you look to trim back your consumption? Probably not, you're likely not harmed and may even be lowering your health risk. On the flip side, if you have one or more health conditions (especially those that may be impacted by stimulants such as high blood pressure and/or anxiety), aren't getting enough sleep, or are already at the high end of consumption (more than 4 cups per day), a more thorough dive into your risk picture is probably a good idea.
We wish it were as simple as "hold the cream and sugar", but until then, we'll keep an eye on it and report back.
Have a great weekend,
Mike E.
mind your fuel score
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.
a lasting imprint
Sept 13
I was standing on the sideline chatting with a friend recently and he was telling me about his most recent physical. Now, this wasn't any ordinary physical where the doctor might review some blood work and vital signs, this was a comprehensive physical mandated by his employer because his is a key strategic role there. He described a battery of tests and a long review with the specialist which took somewhere in the realm of 6 hours (and a lot of dollars) to complete. The bad news was, at/near "middle age" he wasn't perfect and sadly there was no fountain of youth, but the good news was he was doing pretty well all things considered, and on the right track. After a pause in the conversation, I asked "So, what did he tell you to do from here?", having a sneaking suspicion I might not be surprised. "Eat well and exercise mostly," he said...and I smiled thinking how clear things can be at the 30,000-foot view.
Way down here in the weeds where most of us spend our days, it doesn't always seem so simple. Super easy access to cheap and tasty (but harmful) food on every shelf combined with fewer and fewer requirements to MOVE during the day has resulted for many, in poorer metabolism earlier in life, less muscle and bone mass ("working tissues") during our peak years, a shorter distance to the risk threshold and ultimately a dwindling number of fully healthy years. And while there is a strong argument for "earlier is better" when it comes to building preventative habits and the reserves they create, "now" with a goal of "consistently" is almost always next best if there's been a gap. In fact, new research out this week showed that our working tissues aren't the only ones that build reserves from healthy habits.
As described in a press release from the University of Michigan, even our fat cells get stronger and more efficient. Habitual movers, which were generally defined as individuals who performed physical activity at least 4 times weekly for 2 years, had differences in both structure and function when researchers compared their fat cells to counterparts who were not exercisers but were otherwise similar. Just like exercisers tend to retain "cellular muscle memory" which allows their muscles to respond faster and better to training, especially if they've been away from resistance exercise for a while, it turns out that the fat cells of those who performed endurance exercise regularly had better blood flow, more cellular powerplants (mitochondria) and were better able to store fat in a healthy way; under the skin and away from higher risk areas like organs in times of weight gain. This kind of adaptation may even cross generations, which, if this animal study holds true in humans, is especially important for future fathers and daughters.
When we do the right things consistently and give our bodies time to adapt, they do, even if the changes in the mirror aren't obvious or fast. Before there are results, there are actions, and the faster we turn them into habits, the better off we'll be.
If you didn't get started 2 years ago, now is a great time.
Have a great weekend,
Mike E.
the pause pill
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.
engage the brain
Aug 30
Around the country, school is back in session, or close to it. First-day school pictures are starting to pop up on social media feeds - some with smiling faces and some with that "ugh!" look. And then there are those like my son (old enough to drive and much to the chagrin of my wife), who have been in "the game" long enough to "forget" about this time-honored tradition. Now, while it's entirely possible that he's become something of a grand master at this game of awkward photo chess played in households around the globe, it is equally possible that, like so many of us every day, his brain wasn't fully engaged and he was just trying to get out the door on time. This may be a bigger deal than it seems and one that might set us up for something less than our best, risky on a variety of fronts. For those of us who are driving first thing in the morning or in safety-sensitive roles at work, not feeling fully awake could be disastrous. For those who are working hard to focus and learn (like our kids), the same physiology could be keeping them from achieving their best...and if so, perhaps a few minutes of priming and "activation" using one of the most effective tactics known, would be worth the investment.
At its very root, this was the theory a team from Japan set out to test with a group of middle-school children. They provided a protocol of 7 light movements (stretching and low-intensity dynamic body-weight movements) each lasting between 10-20 seconds and then measured oxygen levels in the part of the brain known to handle higher-order tasks (prefrontal cortex) which sits directly behind our forehead. In essence, they were testing the idea that movement, even at very light intensities for less than 3 minutes total, could prime the brain for better performance. The answer, as published early this week, was "yes"; however some movements were better than others.
Dynamic movements that involved multiple muscle groups and a postural challenge (such as movement from a stretched position or one requiring stabilization) showed a more significant effect than static stretching alone. Or said another way, although it doesn't have to be strenuous to get the effect if you feel a movement is so easy or ingrained that you could "do it in your sleep" it is unlikely to do much to activate the brain...so maybe you could.
We are entering the transition zone - that period where the lazy days of Summer give way to the routine (and maybe racing) of the Fall. On the one hand, and with any luck, cooler temps will be here soon. On the other hand, there are more people on the roads, more demands for our attention, and therefore quite possibly more tired bodies and brains. If you haven't done the inventory in a while it's an easy way to prime the physiological pump...and the pulleys, levers, vessels, and synapses too.
Whether you join us the next time we cross paths or you take the idea home with you and share it with your family, it's never a bad thing to start the day well.
Happy Labor Day, have a great weekend,
Mike E.
the pause pill
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.
more (and less) of the same
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.
Headlines - so far, it's more than movement
Aug 16
Understanding a problem is at the heart of solving it. Whether we prefer the way Charles Kettering (American Inventor and Businessman) said it "A problem well-defined is half solved" or we lean toward Einstein's approach "If I had an hour to solve a problem, I'd spend 55 minutes thinking about the problem and 5 about solutions", the first step in being a problem solver is almost definitely being a problem understand-er.
When it comes to the declining musculoskeletal health (the body's moving tissues) in the US over the last 30 years, sometimes it feels like a poorly understood problem. Just like there are 88 unique risk factors for heart disease and therefore thousands of potential risk combinations per person (as mentioned here), movement disorders are simply not simple. We may want them to be about some singular biomechanical "fault" or completely encapsulated in the cause and effect of a moment when we first felt pain but that just isn't so. This is one of the main reasons we put such an emphasis on communicating the evidence in every opportunity AND why we try to approach the problem from all 5 known vantage points (MOVE, FUEL, RECOVER, ENDURE, CONNECT). With any luck, it helps to broaden the understanding of those who have their sights set on living as healthy as possible for as long as possible.
This year has already produced some important insights from military populations, members of the trucking industry, and recreationally active US adults. Here are the headlines worth knowing, sorted by release date and which population the theory was tested with:
Jan 2024 - Mental Workload & Static Postures are correlated with musculoskeletal disorders in truckers (Industry)
Feb 2024 - Strength & Fitness measures predicted 2 of every 3 injuries (CAN Military)
Mar 2024 - Health & Fitness measures (BMI & Aerobic Fitness) were superior to movement assessment at predicting injury in young/healthy individuals (US Military)
Apr 2024 - Inflammatory Markers, Lack of Health Behaviors, and History of Pain predict musculoskeletal injury (Recreationally Active US Adults)
Jun 2024 - Muscular Power and Unhealthy Behaviors (smoking) predicted injuries and dropout in Marine Recruits (US Military)
Jul 2024 - Painful movement today predicts future injury tomorrow (US Military)
And now, the 5 minutes on solutions. Pick "any", work toward "all":
Move often throughout the day, preferably enough to be a little winded.
Do something for your strength & fitness every day. Evolve toward power movements.
Lower inflammatory load with healthy fuel and work on sleep hygiene.
Avoid known system-wide stressors like smoking.
Check-in with your movement daily and prime it for success (body inventory). Let us know if you need help (schedule a consult).
And last, but certainly not least....
Have a great weekend,
Mike E.
dietary "base" building
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.
planes, trains, and sciatica
Aug 2
I mentioned a few weeks back that I had taken a trip out of the US. It was a fun-tiring kind of thing like vacations so often are. Yet, on my way back home, as the hours of trains, planes, and automobiles slowly passed, I noticed an annoying little ache in my right leg. It didn't have the features of anything serious (blood clots, etc.) - but it was there, steadily making itself known. With a pretty clear line from my hip region to the front of my shin, all signs pointed to sciatic nerve irritation. Of course, having seen this kind of thing so many times, I knew not to worry, but I also knew ignoring it would only prolong it.
After thinking through the possible causes for the irritation it was pretty clear to me that between 5 time zones, lots of time sitting during transit and 10 days of vacation food, my system was pretty revved up. Data from my Garmin confirmed it - my resting heart rate was up significantly from my norm, my heart rate variability (a measure of system stress) had gone in the wrong direction and my "training status", Garmin's way of telling us when we are (or aren't) in the training-load sweet spot, was reading "strained". Essentially my sciatic nerve was a window into what my entire system was dealing with - I was exhausted and my body was shooting up a flare.
The good news is, I knew what I had to do. It would be a rebuild of the same 3 legged stool we so often share with clients and talk about here:
1. Get moving. Exercise is one of the most potent ways we have to "soak up" inflammation and lower the overall load. Just enough to stimulate me without further exhausting myself. A few minutes of stretching after breaking a sweat and doing a little resistance felt amazing. The fact that the sciatic pain was mostly gone after the exercise told me all I needed to know - irritation, not injury.
2. Get rest. Not only full night's sleep but perhaps even more importantly, monitor how rested we feel upon waking. Almost a week later, I woke up today feeling refreshed.
3. Eat well. Being back at home can definitely help here. Not eating out every meal is a fast way to add nutrients and minimize sugar by incorporating more fresh fruits & veggies. Shifting to water as the default beverage of choice didn't hurt either.
This is of course perfectly in line with the latest research on the subject. One study out this week showed that unhealthy diets (in this case either too much sugar or not enough nutrients) were linked with accelerated biological aging (years of living near the threshold) and another from early in July showed a link between similarly unhealthy diets (this time sugar-sweetened beverages like soda) and lower back pain which combined with another study from earlier in the year which connected pro-inflammatory diets to back pain makes the connection even stronger.
We throw a lot at our bodies this time of year. It's easy to go from revved up to broken down. There's no need to get that far. Reach out if we can help.
Have a great weekend,
Mike E.
move to recover Part 2
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.
move to recover
July 19
As ironic as it may seem for someone who spent his first 20 working years logging the kinds of miles that would easily classify as "super commuter", I don't consider myself particularly well-traveled. Having only been outside the US a couple of times before this past week, I was both looking forward to and dreading the idea of a trip to Europe to watch my middle daughter take on a few of the other up-and-comers in her age group on the rugby pitch. Maybe it's just my age group, but the idea of a "European Vacation" conjures up something sort of hilarious to watch (a classic movie in one humble opinion) but maybe not to experience.
I'm happy to report that, generally speaking, all went smoothly in Chapter 1: Getting There. Security was shockingly easy, the airport was busy but simple to navigate, the trains to my local destination were slam-packed but ran on time and people were friendly and helpful. The only real issue was - WOW the timezone shift got me. For the first 3 days, I went to bed early, woke up in the middle of the night for a few hours and by the time I finally fell back asleep I was so exhausted I could've easily slept the next day away. It felt a little bit like what "light sleepers" describe, especially as we age; something I've never really struggled with. No surprise, when a new randomized study that claimed to show a significant improvement in sleep popped up in the headlines this week, I dove in.
The mechanism? Simple enough really - it was a dosing study on MOVE, and it once again showed there's a sweet spot.
While high intensity or heavy loads of movement (work, exercise, etc) right before sleep tend to impair the quality and duration, it turned out lighter loads done during the post-work, pre-sleep time period had the opposite effect. More specifically, when researchers had people shift some of their physical activity to the "ramp down" period and had them do light to moderate intensity, bodyweight exercises for a few minutes, twice per hour starting 4 hours before bedtime, sleep duration improved with no negative impact on sleep quality...a very simple add on to make sleep hygiene tactics even more effective.
It doesn't take a major timezone shift to have sleep be a little "off" this time of year. The heat and the workloads tend to be up (or way up) and oddly enough this can leave us both tired AND unable to settle into the depths we need to RECOVER. If "3 minutes chair squats, calf raises and standing knee raises with straight leg hip extensions for 20s each over three rounds" can give us 30 minutes of rest, it's probably worth the effort. I know I'll be trying it on the way back!
Have a great weekend,
Mike E.
how to (and not to) live to 100
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.
we love a challenge: nudging the nervous system
July 5
In our weekly scour of the health literature, we often find information that we hope to never need. While many studies have no relevance to our efforts, others carry important messages even when their primary message is not immediately applicable. This week, tucked away in the Journal of the American Medical Association's Internal Medicine pages was such a study.
At face value, a study about minimizing the negative side-effects of chemotherapy might not seem directly in line with Pro-Activity's health-facing (upstream, preventative, etc) efforts. However, when we consider what this study is telling us, it is perfectly in line as it is evidence, in a highly concentrated way, of one of the core messages we often deliver - future quality of life (happier people) is more easily achieved when we push ourselves to stay strong now.
The harsh reality of chemotherapy is that, while powerful and at times nearly miraculous in its ability to kill cancerous cells, it often has spillover effects causing a negative impact on nearby healthy tissues. Since the nervous system supplies all cells and tissues of the body (even those that have gone rogue), it is especially susceptible. Like having a "pinched nerve" that never quite goes away, patients undergoing chemotherapy often experience nerve-related symptoms such as burning, pain, weakness, and balance problems called chemotherapy-induced peripheral neuropathy (CIPN); a recipe for lower quality of life that no one wants. Interestingly however, when patients demanded more from their nervous system, in this case by stimulation with specific exercises, they were able to cut their risk by 50-70%.
In a randomized trial that involved 3 groups: the first was a control group which had the usual care, the second was a group that received nervous system stimulation through whole-body vibration and a third which was given a sensorimotor exercise protocol (designed to stimulate the nervous system through balance, stability, sensory challenges, etc) twice per week, the results were clear and impressive: stimulating the nervous system, even in the presence of toxic chemical agents, added resilience. Or said more plainly, when we challenge our systems to MOVE deliberately and appropriately, they work hard to respond and adapt.
Although in this case it was tested with chemical stress, the response is very similar to that which is reported with exercises that challenge our balance as we age (e.g. Tai Chi) or dynamic warm-up protocols which are known to significantly lower injury rates in athletes - when we tell our body we need something and give it a little time to respond, it almost always does.
It doesn't take much to keep our nervous system strong and resilient but it does take something - give it a nudge with a few minutes of balance work today.
Have a great weekend,
Mike E.
lower back pain? walk it off
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.
trading away health: all part of the process
June 21
There's really no need to make it complicated - the more industrialized the diet we choose, the harder it is on our bodies. This is the general theme that rang through 3 new studies all published in the last 2 weeks. While each evaluated a different problem - the first, the connection between salt and a common skin condition, the second, the connection between junk food and anxiety and the third, the link between a common artificial sweetener and major heart events - the takeaway was the same: the trade-off for a highly processed diet (which are often loaded with salt, fat, and sweeteners to achieve shelf-life and brain-teasing flavor) is future health.
The first study looked at the results of more than 200,000 urine samples and found that as sodium content increased, so did the likelihood a person was diagnosed with eczema, one of the most common (+/- 30 million Americans) skin conditions. For every 1 gram of sodium excreted in the urine, the likelihood of eczema went up 11%. Although they're not exactly sure why, the general consensus is that as the body tries to rid itself of excess salt (not only through urine but sweat) it gets stored or even trapped in the skin creating a chronic irritant. This adds plausibility to some studies which have shown flares tend to be more common in the winter months - less sweating means more trapped salt.
The next study looked at fat consumption and its connection to behavior. While it's important to point out that this was an animal study (lab rats), the results paint a very clear picture that is worth at least considering: A diet that was engineered to achieve +/-10% greater fat than the "Standard American Diet" resulted in behaviors that suggest greater anxiety, negative changes in the gut biome and even genetic changes associated with unhealthy changes in brain chemistry.
The last study looked at a commonly used artificial sweetener and sugar substitute (xylitol) and whether it increased the risk of major cardiac events. The short answer, from a research team that looked at more than 3,000 subjects, was yes, as much as 57% in the highest consumption group compared to the lowest, which showed signs of an increased likelihood of developing blood clots. Of course, as always, there is nuance and this risk, especially in those who don't over-do it, may not entirely outweigh the benefits of this low-glycemic sweetener, but it should give pause to those who are consuming lots of highly processed sweets.
Of course, sometimes the hardest thing to do is to find the "what to do" which fills the void left when so many studies tell us "what not to do". This time of year we are in luck - fresh fruit and veggies are easier than ever to come by and we know that consuming more of them can counteract and fill the gap. Not only do they increase water and potassium (which helps to counterbalance the effects of high sodium) but the fiber on board helps us to rebalance the gut and even tamp down cravings for the kinds of treats that are loaded with fats and sweeteners.
Step away from the dietary machine...and find a farm stand...chances are they are selling the FUEL that your future self wants more of now.
Have a great weekend,
Mike E.
beliefs drive behavior? safety in movement
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.
No Matter the Blueprint, 8 Factors Guide the Build-Out
June 7
I remember feeling excited and maybe even a bit vindicated in 2022 when the American Heart Association announced their latest update to the list of "most important things known to lower heart risk"...which was being called Life's Essential 8. The excitement had to do with them finally and definitively including sleep to their known risk factors; something that seemed so obvious given the research on the subject. I quickly created a free account and performed their "My Life Check" online risk calculator (found here) to see where I stood. It was relatively quick and easy, a solid tool for those of us who try to stay ahead of heart disease...and of course, all the outcomes that these same root risks are connected to, including aches, pains, and more.
Their 8, which although not perfect for everyone but solid for most, includes four behaviors and four clinical values all graded on a 0-100 point scale (and then averaged), considered within the context of life stress and healthy connections. While we use terms like MOVE, FUEL, RECOVER, ENDURE, CONNECT they say:
1. Eat Better - which they define as close to a DASH Diet
2. Be More Active - which they define as 150 moderate minutes of exercise per week or more
3. Quit Tobacco - which they grade from never smoking to being a current smoker (or other)
4. Get Healthy Sleep - which they define as 7-9 hours per night (not more, not less)
5. Manage Weight - which uses a sliding scale based on BMI
6. Control Cholesterol - which they define as less than 130 mg/dL of "non-HDL" cholesterol
7. Control Blood Sugar - which they define as having no history of diabetes AND fasting glucose < 100 mg/dL
8. Control Blood Pressure - which they define as < 120 systolic and < 80 diastolic mmHg.
All while considering known health risks like isolation, inadequate social connection/contact, and inadequate stress management via unhealthy coping skills.
Perhaps not surprisingly, when I saw a new study, that compared the relatively simple my life check score to the odds of future heart events and with more complex signs of biological aging encoded on our DNA (methylation profiles), I was eager to dive in. The initial findings were also not particularly surprising: As healthy lifestyle scores increased, future heart event risk decreased. For every 13 points a person's health score went up, the likelihood of a future heart event or dying was cut by around 1/3rd. Interestingly however, there was also a strong link with biological aging which meant that for those who were genetically susceptible to accelerated biological aging, having a healthy lifestyle had an even greater impact, lowering their risk by closer to 40% for heart-related events and more than 75% for dying during the study period. Ultimately this meant that while the 8 health factors accounted for as much as 20% of an average person's total heart risk, they accounted for twice as much (40%) for those with the risk of accelerated biological aging.
We may not control our cellular blueprint, but the build-out is largely up to us.
Have a great weekend,
Mike E.
Enjoy the Warmth to Endure the Heat
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.
The Bat Phone
May 24
Most people know the basic story of Batman. Secret crime-fighter, lots of cool gadgets and only 1 phone call away when the police commissioner (Gordon) needs help. Way back, when Batman was a TV show, the commissioner would pick up a direct-line red phone to relay information about a high risk situation and within seconds, the problem was being dealt with.
Although far more entertaining than a typical risk monitoring and reporting system, the bat phone "system" is not all that different than other systems we rely on to stay safe. Smoke detectors monitor our homes and prompt us to call for help when it's needed. We teach even our youngest citizens how to make that call and what to expect when they do. The sooner we call, the faster help can arrive and assess the threat.
In the late 1990's we started seeing a similar pattern when people were at high risk of aches and pains. When those whose bodies were giving warning signs got to us quickly they usually did better, faster than others who waited and let things get even more tangled. It was easier for us and better for them so we started sharing our direct phone numbers. Within a year the clinical research started suggesting the approach had merit. Studies like this one were reporting better outcomes in less time for those who got the help they needed quickly. As the model got more refined, it became clear that it not only mattered "when" the call was placed, but also "who" picked up on the other end. It didn't have to be a superhero, but they needed the right plan, and it was easier to remember 1 number...and so the triage hotline idea was born.
15 years later, it was data from the US Military on low back pain which backed up the approach; they showed significant time and cost savings when guidelines designed to get people moving quickly were followed... but only when those guidelines were followed. Fast forward another decade to the present and the research has gotten even more refined.
In a review of 3,000 studies, of which 31 met the criteria, this study (published earlier this year) showed that early response or "MSK Triage" as we sometimes call it, works well when it accomplishes 2 critical goals:
(1) it helps the person experiencing pain understand what they are feeling, why and the likely progression so they can worry less and
(2) gets them appropriately active - not too little, not too much, just right.
Anything that worked against those two goals, for example by either slowing down the first call, causing the person to become a more passive participant in their recovery or adding significant medical complexity to their path (strong pain meds and advanced images like MRI), tended to do worse; very similar to what we see on the ground in workplaces everyday.
With Summer coming, this is often a time of year when bodies get a little overdrawn and tend to grumble and groan. While it's definitely better to build capacity and resilience to the risks we will face, and there's still time to do it, please know that we are standing by should you need to pick up the phone...capes not included.
Have a great weekend,
Mike E.
less hack, more lifestyle
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.
Sleep, It Does The Body Good
May 10
If the CDC estimates are correct, roughly 2 million US men and 12 million US women, that is, 4% and 19% of the population over 50 respectively, have lost enough bone strength to be diagnosed with osteoporosis. It's a way bigger problem than most people consider because when we overlay the millions of falls our parents and grandparents experience every year, things get pretty grim.
To me, one of the more interesting things about this risk is that for a long time those of us in our working years could feel OK about putting off thinking about it. After all, it's a problem mostly faced in our retirement years and we're not there yet. However, more recently, like several other injuries & diseases where age appears to be a major risk factor, what we do today tells us more about how we will live tomorrow, than ever before.
For example, 20 years ago suggesting that common age-related brain disease (e.g. dementia) was similar enough to other common lifestyle related diseases (e.g. diabetes type 2) to call it "the same problem at a different site" would've been a fringe idea. The idea that Alzheimer's disease was actually "Type 3 Diabetes", originally attributed to a researcher from Brown University in 2005, being reported on in an alternative medicine journal in 2009 probably shouldn't surprise us.
Yet, while we've learned a lot since then, and the understanding of age-related diseases has been refined, one take-away seems clear: what we do early in life (pay now), strongly predicts what we will be able to do later (or pay later); and as it turns out, it's not only our brain but in our moving parts too. One study that makes my list of "super interesting" (although too old to really call it current), showed that muscular strength (grip) and lifestyle choices (nonsmoker, physically active) predicted a long and healthy life. This is probably why this research, led by a physician in Colorado really grabbed my attention.
Ultimately beginning with initial studies several years ago, she found that RECOVER now matters for bone strength tomorrow in a very big way. Specifically, in both men and women, when sleep was disrupted or fragmented, bone mineral loss was more pronounced. In younger women, it was even more significant because their bodies more actively used the minerals being released, representing a "decoupling" which likely leads to the disease in the future. Although the study is ongoing (want to join?) the big message seems clear enough - like so many other health risks we face, all 3 legs of the stool matter:
Weight bearing MOVE is well known to stimulate bone growth - this position statement adds more.
FUEL, especially low inflammatory and high in particular nutrients (such as the Mediterranean Diet), gives our body the right inputs to build.
And now, even without the cool milk-mustache, a debate on value for another day, we can say that getting enough high quality sleep helps us RECOVER....all the way to our bones.
Have a great weekend,
Mike E.
has risk met its match?
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.
caution: early warning signs and future risk
Apr 26
One of the most important but often unsung heroes of health & longevity is "the precursor" aka "the early warning sign". Like that small yellow plastic a-frame that says "slippery" after someone just mopped the floor, they can be easy to pass by without much thought, but for those who are both paying attention and understand the message, can be highly valuable indicators that the time for change, in this case shortening our stride length to keep from falling, is now. Although equally easy to miss if not paying attention, changes in our day to day can be important indicators of our future health. For example, and as shown earlier this month, moving slower or less may not only be a well-known risk of developing disease (risk drops at/above 8K steps per day) but may also tell us our heart is struggling to keep up with the demands of life. It's not just physical health. A 2018 study showed that physical activity patterns predicted depression in adolescents and last year, similar patterns predicted accelerated aging at the genetic level. Although wearables make this much easier to see, it's not the only way.
It turns out it's not just movement data and it doesn't necessarily require tech to capture it. Earlier this week a study of more than 15,000 individuals from a team in China showed that sleep patterns also had predictive value. Using a very simple method to create a "sleep score" which ranged from 0 healthy sleep factors to 4 healthy factors, and then comparing those with healthy patterns (those who scored at least "3") over time, created a very simple matrix of persistently unfavorable (unhealthy), favorable to unfavorable (declining), unfavorable to favorable (improving) and persistently favorable (healthy). Perhaps not surprisingly, compared to individuals with regularly unhealthy sleep patterns, those with regularly healthy sleep had the best risk profile (20% lower risk of cardiovascular disease), which was even more pronounced in those who had a high genetic risk for heart disease (35% lower risk).
Want to know what your sleep score is? Try it out using the four factors below - each is worth 1 point and scoring at least 3 points total would indicate "favorable sleep".
(1) Bedtime between 10P and 12A daily
(2) Sleep duration of at least 7 but not more than 8 hours regularly
(3) Daytime sleep (napping) of 60 minutes per day or less
(4) Rating of "sleep quality" as at least "fair" on a four-point scale of "very poor, poor, fair, or good"
Sometimes life isn't subtle - our risk jumps in front of us like a flashing sign. Other times, we won't notice it unless we slow down enough to pay attention. Daily actions and the routines they become often act like early signs cautioning us that something is a little off and it's time to get back on track. Movement and sleep can be great places to start. If you've got a smartphone with a health app or wear a smartwatch you may have all the information you need. Let us know if you need help interpreting it.
Have a great weekend,
Mike E.
the reset button: move more, hurt less
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.
predicting future production
Apr 12
One of the coolest things about the often long-standing relationships we have with clients is witnessing their families grow up. Although always a reminder of how fast time flies, it's super cool to be hearing about tales of rec-sports or dance recitals one minute and then, in what feels like a snap of the fingers, hearing that the kids are heading off to college or applying for a job "at the company". While most people don't think of the large employer clients we connect with as "family businesses", so often, in fact, they are, with generations of men and women learning the literal "tricks of the trade" from their parents and grand-parents; good jobs with an ever-evolving skill set. New tools and process improvements are tested all the time - and scanning for a better way is all part of gaining a performance edge in the marketplace. Now, while sometimes this means producing more, often it's about producing better - a higher quality product or a better outcome, preferably via a process that is less risky for those "doing" it.
With that in mind, anytime I see research that points in that general direction, I'm excited to share it. This time, it is about improving health risks today to maximize the next generation's ability to work a full career tomorrow. Taken from a VERY LONG observation of 1200+ individuals, if we want our kids to not have the aches, pains, and illnesses that we are dealing with today, 45 years later the punchline is - "Invest in Fitness", specifically cardiorespiratory (aerobic) fitness.
In the mid-1970's when Finland was starting their "global worst to first" countrywide health turnaround, an amazing accomplishment we've discussed in the past, they began tracking several measures of fitness in school-aged children (12-19 years old). In addition to standard height and weight measurements, and similar to the US Presidential Fitness test from way back when (now the "FitnessGram"), they also included measurements of muscular endurance, strength, and power, using tests like the flexed arm hang, situps, pull-ups and standing broad jump, along with running tests to measure aerobic fitness.
Where it gets interesting is that researchers were able to track down many of those Finnish adolescents when they were in their prime earning years (37-44 years old) and again in their late earning years (57-64). More than 1200 agreed to complete a questionnaire known as the "Work Ability Index" which has been shown to accurately capture a person's ability to be productive at work and also the amount of illness absence they experienced at those times of life.
After statistical scrubbing to account for known accelerators (like low levels of education and occupations that include heavy physical work) and decelerators (like volume and intensity of leisure time physical activity), they found that only cardiorespiratory fitness was associated with higher future productivity at work and lower odds of illness absence. The researchers concluded, "Enhancing CRF in the first decades of life might contribute to better work capacity and productivity in the labor force, which would have implications for health, quality of life, society, and the economy.".
We don't know what the future holds, but even in a world where computers might do most of the heavy thinking and robots the heavy lifting, it's probably reasonable to assume most of our kids WILL have to work for a living. Nudging their fitness now is likely to be one of the best investments we can make for when that time comes.
Have a great weekend...maybe get out and play,
Mike E.
the "big 3" of brain health
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.
Take a leap of fitness with cranberries
Mar 29
In an effort to keep it brief - here is a 1 paragraph summary of years of data collection and dozens of research articles...and also something you probably already know if you've read this blog for a while:
Healthy foods, naturally loaded with antioxidants and polyphenols (aka "plants"), when consumed regularly, have consistently proven to enhance human performance -- disease resistance and athletic performance alike. Those with very high concentrations (esp. berries, leafy greens, and beets) have been especially well-studied, and have proven benefits and few (if any) negative side effects. Generally speaking except in rare cases, we should all probably eat more of them.
In truth, there's not that much more to say - lots of good, not much (if any) bad, fairly easy to access and consume so outside of special cases (allergy, etc) we recommend - but for those who are a bit more geeky with this stuff, exactly what these foods unlock is always fascinating. This time, a research team from Canada found that after 28 days of cranberry supplementation (**note** the study team used an extract to more easily control the dose, not the whole fruit), well-trained runners improved their times by nearly 2% in an event that stressed the aerobic system (a 1500m time trial) and had better recovery markers in an event that stressed the anaerobic energy system (a 400m time trial). In plain English, this means that loading up on cranberries, which rank at/near the top in their concentration of polyphenols and antioxidants, allowed runners to go faster for longer during submaximal efforts and bounce back faster after maximal efforts with around the same benefit as several other evidence-based performance enhancing supplements.
Of course, since most people are not "well-trained athletes" and therefore might not even notice a 2% improvement because they rarely (if ever) stress their systems this way, it wouldn't surprise us if this one slides into the "meh, who cares" pile and not the "interesting enough to use" pile of daily information...which, at least in my opinion, would be a mistake.
We know that the cardiovascularly-taxing heat ramp-up is right around the corner, a drain that most of us will experience as we try to power through greater levels of fatigue during the first few weeks. And since acclimation is slow, but workloads go up fast, we are walking a fine line with our health while doing so. The unprepared among us will be more vulnerable to fully preventable injury (or worse), something we see every year as the temperatures climb. If adding in some fresh and healthy foods now is enough to keep us below the risk threshold during the next 60 days, it's well worth the effort. For those not into the "earthy" flavor of well-studied beetroot juice (sadly, it tastes a bit like dirt), a handful of cranberries (and preferably walnuts + 1-2 cups of spinach, which together makes an easy-to-prep & tasty salad which can be leveled-up even further with added blueberries) can go a long way. So, while the official leap day was last month, it'd be (April) foolish to push off thinking about heat readiness until tomorrow (get it? ).
We're "there" again, it's time to prepare because with climbing temps comes added heart stress associated with ramping up to meet the demands, something we can not only deal with but benefit from if we respect it. Now is the time for a leap of fitness - healthy FUEL can help.
Have a great weekend,
Mike E.
slowing down time
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.
Use It or Lose It - Toning Happiness
Mar 15
If you're anything like me, you approached this week with mixed emotions. We lost an hour of sleep but gained more light - which meant dragging into Monday a little more than usual but noticing (and loving) the fact that the sky wasn't dark by dinner time. Light can have a powerful effect on us - uplifting, stimulating and positive when we have the right "dose", preferably from a natural source, and disruptive when we have either too little or too much. For example at least 8 different studies were mentioned here when reviewing light as a factor within the architecture we interface with, and how it impacts our wellbeing. Said more simply, having the "right dose" of light at the "right time", can help us feel AND function better, something we may be reminded of after we adapt to the (rather abrupt) change.
Of course, as we've touched on many times, most of the energy sources that power our physiology work in a similar fashion. The "goldilocks phenomenon" of "not too little, not too much, just right" - applies to all 5 ELEMENTS at some level and shines a metaphorical light one of the principles that governs so much of our experience and achievement - we (do in fact) adapt to the stress we're under, growing stronger when we push ourselves "enough" to stimulate growth, weaker when we don't and injured when we overload or otherwise ignore our safe limits.
As it turns out, new research on the subject says our happiness works this way too. When college students were taught techniques known to improve well-being in a course called "The Science of Happiness", it worked. 6 weeks after they got started, there were notable improvements in a variety of scores. However, 2 years later when a subsample of the same group was retested, the effect had mostly worn off....with one important exception; those who continued USING what they learned continued to have the benefit, with well-being scores exceeding their peers who had fallen out of the practice. This led the senior researcher to suggest that our mental health functions just like our physical health - much better when we stimulate it:
"It's like going to the gym -- we can't expect to do one class and be fit forever. Just as with physical health, we have to continuously work on our mental health, otherwise the improvements are temporary."
Spring is officially only 5 days away - it's a great time of year to step into the light and "tone up" those parts that might have gotten a little soft this winter - all of them.
Have a great weekend,
Mike E.
if it was easy...
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.
what your ring finger says about you (or doesn't)
Mar 1
When you get a minute to stop what you're doing, take a look at your hands. Seriously, this seemed equally strange to me, but give it a shot. Rest them on a flat surface with all fingers loosely together. Now, counting from thumb to little finger where your thumb is "1" and pinky is "5", take a look at your 4th finger (the "ring" finger) and specifically, how long it appears in comparison to your 2nd (the index finger). Does it appear significantly longer? If so, new research says you might have the makings of a professional soccer player (or at the very least an endurance athlete).
The theory, admittedly oversimplified, is that exposure to high concentrations of particular hormones while developing pre-birth, most notably testosterone, will be reflected in structural differences in our skeletal system which can be measured in the ratio between our ring finger and our index finger. What the research team found was that as the ringer fingers of 133 professional soccer players got shorter (by comparison to index fingers and therefore the ratio got closer to 1 to 1), VO2 Max, the gold standard of endurance capacity, was lower. Said another way, long ring fingers were associated with better aerobic capacity.
Of course, before we go checking our kids and finding a sports agent, we might want a few more answers...to questions like:
Is this real science? Yes, there have been more than 300 studies on this phenomenon since 2020.
Should I believe it? Well....while there are times when truth is stranger than fiction and so open-mindedness, even to the very strange, is probably the best policy, this one seems "unequivocal" at best; which is a nice way of saying it's hardly conclusive and although wildly interesting, not reliable. For example, this 2022 study is one of several that have found that the intriguing conclusions of small studies have not reliably been replicated in larger ones, making it hard to consider this more than an interesting coincidence.
So while we are very likely to see this research pop up in social media outlets (if it's not there already) like so many others that make the rounds there, for at least the foreseeable future we will continue to suggest exercise to maximize aerobic capacity (and therefore health) and not rely on ring finger length for much more than a fun icebreaker should you need one.
On the other hand, if you use this information to kickstart a global search for the next soccer phenom by examining ring fingers everywhere - remember me when you're famous!
Have a great weekend,
Mike E.
can't outrun a bad diet? maybe reset instead
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.
pump up your endure
Feb 16
If you're old enough to remember them, you probably didn't think of them as innovators or trendsetters at the time. Yet, these two legends were not only among the first to get comedic mileage out of Arnold Schwarzenegger's signature accent (more than 30 years before the recent Superbowl ad), and likely among the first "stars" to go full groutfit many years before it was cool to do so they were also on the cutting edge of the science of happiness apparently, ready to pump up not only muscles but mood. If Hans and Franz as renaissance men seem outlandish, it did to us too but the coincidences don't lie. As exaggerated and blatantly sarcastic as their version might have been, the idea that pushing our bodies physically can have an incredible impact far beyond fitness and strength gains has a growing research base.
We've previously mentioned this massive review of research which included more than 120,000 subjects. The take-home message, that physical activity performed as well or better than usual care was impressive. To quote the authors "the effect size reductions in symptoms of depression (−0.43) and anxiety (−0.42) are comparable to or slightly greater than the effects observed for psychotherapy and pharmacotherapy (SMD range=−0.22 to −0.37)". In particular higher intensities seemed to hold great promise and, as shown in August of last year, resistance training may play an important role. This study showed a clinically significant mental health boost almost immediately and again between 4 and 8 weeks for individuals doing resistance exercise a few times per week for 25 minutes per session. The exact mechanism driving the benefit hasn't yet been determined, but the authors concluded that the effect wasn't due to strength gains alone. Then, earlier this month another review of the available research made it clear that muscle-loading activities like resistance training hold great promise for lowering anxiety and depression, and improving wellbeing.
Life throws curves. There are ups and downs around every corner. It's hard work to ENDURE. While we certainly don't have to have a terminator's physique, an all-grey sweatsuit or even log hours in the gym to pull it off, pushing some heavy things around can have an impressive role in pumping us up - in body, mind, and mood. If you haven't in a while, it's a great time to start. Let us know if we can help.
Have a great weekend,
Mike E.
language - the fine line on stress
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.
changing fast and slow
Feb 2
In an effort to get the most from my professional knowledge/skills and give back when possible, I coach youth sports, primarily competitive high schoolers. It is one of those perfect challenges - frustrating enough of the time to hold teachers who do it 8 hours per day in very high regard (as I question if it's worth the effort) and yet amazingly rewarding when the kind of breakthrough which radically changes the trajectory of someone's life occurs. Sometimes the breakthrough is in the sport but most of the time it's due to lessons where sport mimics life. "Consistency beats Intensity" and "work smarter, not harder" have been two particularly grueling lessons over the years. The idea that the climb from a current level to a desired future level (i.e. "change") is something that is most often achieved with patience and a process similar to painstakingly adding coats of varnish to wood or clear coat to a custom paint job like that which was said to be used by Da Vinci when creating The Mona Lisa is not a particular favorite at a time of life (or a time of the world) when just about everything is available instantly, on-demand. You can imagine how much of a boost it can be therefore when we find situations that don't necessarily behave that way, when change happens quickly.
Last week we talked about one such scenario - the "warm-up" effect - and how powerful it can be for those willing to invest a few minutes in readying their physiology for action. Of course, this isn't just for adult bodies - we know that a similar pattern of priming for young athletes can reduce the incidence of serious injuries like ACL tears (example 1, example 2) in those who complete it, something I've seen first-hand both positively with low injury rates in those who take it seriously and negatively with serious, yet preventable injuries in those who do not. However, changing the MOVE inputs to get better or safer outputs is not the only domain that responds quickly. How our bodies respond to changes in FUEL inputs does too. Some great new preliminary research out this week showed that from an immune system perspective, significant change can happen in as little as 2 weeks with different outputs resulting from changes to inputs.
Specifically, the research team showed that across an age range of 18 years to 50 years in a tightly controlled setting, there was a consistent change in how the immune system responded to differing diets. When participants were given a low-fat vegan diet for 2 weeks, their "first line of defense" (innate immunity) ramped up, while when they ate a high-fat/low-carb ketogenic diet for 2 weeks their "next line of defense" (adaptive immunity) ramped up; this is both impressive and fast. On the other hand, many studies have shown that those who apply the "layered", slow, and steady approach can also have great benefits. One of the most recent showed across a sample of more than 100,000 individuals, a healthy diet tracked closely with better metabolic health which was not super surprising, especially in light of this one which reviewed a bunch of the "how" and "why".
When we boil it all down one of the big takeaways is something we all inherently know and use every day to survive and (hopefully) thrive: change is fast...slow...and always. We constantly react to subtle changes in our environment (homeostatic) and, since certain things have to be very fast to keep us alive we even "predict" and anticipate when it benefits us (allostasis). Those systems can definitely get off track if we don't provide them the right support. Still, perhaps one of the reasons we have examples of humans thriving in nearly every imaginable environment (and some that seem unimaginable) is because, not unlike the way our "dual process brain" was described by a Nobel prize winner in 2011, our entire system is uniquely purposed for the demands of a "both and' world. If we take care of it, it works well.
This is the time of year when an immune system "boost" could be very valuable. Start today and you'll be hitting the winter homestretch STRONG.
Have a great weekend,
Mike E.
move skillfully - to prime is to retain
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.
breaking the stress cycle
Jan 19
Stress generally gets a bad rap. We've mentioned this before and while it seems the overall perception may be changing, I suspect if asked "Is stress bad for our health?", most people would instinctively answer "yes" and not "it depends", which is far more accurate.
On the one hand, we know that intense stress (such as traumatic experiences) or early life stress, or the unfortunate circumstance of both together ("ACEs") can create lasting harm. Two recent studies out late last year made the link even more clear. One study showed that excessive stresses experienced by an expectant mother were passed on to the developing child and linked to a greater likelihood of future behavior challenges. Around the same time, a second study showed that the impact of excessive early life stress on the brain might actually be greater than the harm done by a physical injury like a concussion. This of course all seems bad. On the other hand, however, we know that small doses of physiological stress (e.g. exercise), in most situations, are one of our best ways to improve health. We also know that at some level stress is different from person to person. Certain factors can be protective against the risk of harm and particular traits, like grit (the passion and perseverance for long-term goals) can actually turn stressful events from negative to positive, from potential harm into periods of growth. So it's nuanced and it depends...
To make it even a little more complex, some new evidence suggests that our perception of our stress can actually shape our reality; and possibly set us up for future cardiometabolic risk by influencing an accumulation of cholesterol and triglycerides, pushing blood pressure higher, influencing weight and fat accumulation and the many health risks that come with some or all of those factors. The trouble is, the details are still fuzzy; but thanks to brand new research which seems to have taken us another step closer to the root causes, things are getting more clear.
We've known for a while and have previously mentioned the significant link between chronic inflammation and the progression of disease. When inflammatory markers are high, disease risk is also high. One of the best reasons to make lifestyle modifications like improving fitness and eating better is that they are both known to lower inflammation and in so doing lower the risk of heart disease, brain disease, metabolic disease, and even pain. But physical health is not the only thing that drives inflammation, how we perceive and cope with stress plays an important role too. By using a simple survey, not ironically called the "perceived stress scale", researchers were able to show that high perceived stress was closely linked to both inflammation and future metabolic health risk. With that in mind, focusing on actions known to positively impact perceived stress (like sleep quality) could be a very valuable way to get on the right side of risk. Unfortunately, the jury is still out on interventions like mindfulness.
So is stress bad for our health?
Well, it depends...but it doesn't HAVE to be. Try the survey and if you score higher than a 27, consider taking action to break a sweat, eat a healthy meal, and get a good night's sleep in order to break the stress cycle and chip away at risk...or of course, reach out; we'd be happy to help you get started.
Have a great weekend,
Mike E.
preventative maintenance of the brain
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.
"change weeK": an open door
Jan 5
The calendar has flipped, 2024 is here, and (if history is any indicator) most Americans, whether "considering" or actually "doing", are a few days into some version of change that so often comes with the New Year. Although not the only target, health improvement is usually near the top of the traditional resolution list, so it's a safe bet that you don't have to look very far to find stories about people trying to use resolution season as a lever to get healthier.
Netflix for example, has released a new 4 part documentary called "You Are What You Eat", which takes a well-timed and entertaining look at the Stanford University Identical Twin Study which compared a healthy omnivore diet and a plant-based (healthy vegan) diet in genetic identicals; the same study we blogged about on 12/8. Although the documentary has been far more entertaining than the medical journal, the punchline remains - while both groups improved, the plant-based group outperformed the healthy-omnivore group on several measures. Along similar lines and out last week, in a study of more than 120,000 people who attempted to "cut carbs" for longer-term weight loss, "how" appeared to matter. Cutting carbs (in general) may work in the very short term, but in the longer term, it's more nuanced. The researchers concluded that "only low-carb diets that emphasized high-quality protein, fat, and carbohydrates from whole grains and other plant-based foods were associated with less weight gain".
Of course, changes in food intake are not the only way to move the wheels of health change. A focus on just about any modifiable health factor can work. For example, along with challenging oneself to eat well or exercise, abstaining from alcohol during January has become increasingly popular. There isn't a ton of strong clinical evidence relating to the effectiveness of month-long health challenges, but what is available is promising. One small study that looked at a 28-day food and fitness challenge showed signs that things were moving in the right direction for those who took it on and this review of month-long "dry" efforts (e.g. Dry-uary, Feb-Fast, Dry July & other public health campaigns) showed that those who gave up alcohol enjoyed both physical and mental health benefits (including a positive impact on sleep), even if they didn't complete 30 full days. As a bonus, one of the most common indirect health indicators (financial stress) was reduced, with users most often citing "saving more" as a benefit of drinking less. Couple this with some interesting findings from military medicine that showed a relationship between alcohol consumption and chronic pain and the case for giving ourselves a reset in this way gets stronger.
The possibilities are nearly endless. Resolving to keep a consistent bedtime or to stop taking in calories within a few hours of that bedtime could both be impactful. Resolving to be more altruistic or "prosocial" by performing a small and new daily act of kindness could have an almost immeasurable ripple effect. Or, for those who prefer a more well-worn path, simply finding a way to tax our muscles every day (increasing step counts, 30-second 1/2 squat holds for blood pressure improvement, a few flights of stairs for fitness or a few push-ups for strength and mobility) can have a surprisingly powerful impact.
For those who receive our monthly health promotion content, we will be diving in a bit deeper. For those that don't - here are some key takeaways: we humans don't always like to change, and we may even avoid it...but we most definitely can, sometimes know we should, and occasionally have a window of time that makes it easier. Now is one of those times; the door is open. Whether you do it for the future you or because you need it now to be there for those around you - your health is worth taking a step. We are here and ready to help.
Have a great weekend,
Mike E.
2023 - bursts, bundles, and the biome
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.
peak week - managing thresholds
Dec 22
I had never heard the term "holiday heart" before yesterday. Scanning the health-headlines as I often do, I saw an editorial in the Journal of Thoracic and Cardiovascular Surgery written by a team from the Medical College of Wisconsin that caught my eye. In less than 1000 words the authors put some important data behind a few themes I've been writing about this month and at some level all year:
(a) we each have a threshold
(b) the consequences of crossing it can be powerfully negative and long-lasting
(c) if we pay attention, the body provides warning signs
(d) and while it's probably better to operate far away from those thresholds (build capacity, etc), life is hard, so knowing how to navigate choppy waters is critical
The next 7 days are one of those classically choppy times. For those who celebrate any of the many holidays, religious and not, which fall during this time of year, last minute shopping, gift giving, travel, festive meals and more might be peaking. For those who don't, even the sprint-to-the-finish of another calendar year can ratchet up the physiological loads. If we don't pay attention, our heart may pay the price.
As it turns out, "holiday heart syndrome" a term coined in the 1970's, is the common name used for a phenomenon which includes a spike in heart-rhythm disorders, most commonly atrial fibrillation, which seems to be tied to the excess of the holidays. While binge-drinking, which is known to have a strong impact on the heart, is the top suspect (as many of 1/3 of individuals with a-fib link it to alcohol), it is not the only one. Electrolyte imbalance from a common dietary shift toward salty foods and away from fruits & veggies can be enough to push us into risky territory and adding in some stress, fatigue and even possible dehydration (either seasonal or alcohol induced or both) and we've got a recipe for conduction disorders. According to the editorial "Holiday Heart Syndrome often presents with symptoms of palpitations, shortness of breath (dyspnea), anxiety, weakness and chest pain among others."
So what can we do to prevent crossing the threshold? Simply put, we can respect the fact that we have one and manage it like we would during any other period of peak-load.
(1) First monitor (and likely add) hydration, especially if salt intake is up this time of year. All the same rules from the summer apply. Clear urine once per day and/or using the top-off-test (if no urge to urinate within 30 minutes of drinking 16 oz of water, likely some dehydration) are good rules of thumb.
(2) Get fruits and veggies "in" early and often. Not only will this also add water, it will help counterbalance the holiday foods by adding in potassium (to balance sodium) and fiber (to balance sugar). As always, there is no shortcut here. Potassium supplements should NOT be taken without medical guidance.
(3) De-stress with exercise. Even a few bouts of stair-climbing can go a long way.
(4) Protect your bed and wake times to ensure your sleep is maximally restorative.
(5) Send a “thank you” or “well done” to someone who you think deserves it this year - not only will it light up their day, it’ll have surprisingly positive effects on yours!
Enjoy peak week...but not too much.
Have a great weekend,
Mike E.
standing with the "Late-majority"
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.
plan ahead for gremlins everywhere
Dec 8
There's really no reason to belabor it. Most of us know the risk exists, can see it coming, and still get caught up in it year after year. Almost a quarter century ago a group of researchers studied the "holidaze" phenomenon and concluded that the evidence of its existence could be measured on the scale to the tune of +/- 1 lb of net body weight gained per year during adulthood. While they found a post-holiday "loss" was common, maybe in the form of New Year's resolutions, it wasn't enough to offset the total amount gained during the pre-holiday and holiday season. The obvious conclusion was "avoiding the risk is better than reacting to it".
The gremlins tend to be everywhere this time of year. Maybe you've got a Christmas cookie coworker who is like willpower kryptonite this time of year. Maybe it's the holiday parties with rich food and alcohol. It might have nothing to do with the holiday season and is more the shift in the stress/rest balance of trying to get those annual goals checked off in the homestretch that does us in. Maybe it's all of the above. If it's any, having a few tactics on hand can be valuable.
This was the conclusion from a team based in The Ohio State University's Medical Center which recently published findings of a survey they conducted related to health habits during the holiday season. Not shockingly exercise habits were sharply down, 45% of people said they stopped, and almost 67% said their nutrition suffers. Add in the 50% who feel more tired and stressed and the 33% who consume more alcohol this time of year and it's no wonder health takes a hit. The good news is, it probably doesn't have to.
If we boil their recommendations down we get a well-known logic - anything that throws off our routine (upstream/inputs) increases the odds of more problems later (downstream/outputs) - so protect our routines. This might most easily be done by going even further upstream anticipating risks and planning ahead to prevent them from becoming problems.
Specifically, they recommended:
Doing a little dietary downfield blocking by making the early meals of the day higher quality and more likely to last by adding a bit more protein and lowering the carb count at breakfast.
Working hard to work hard by making sure some energy exertion, exercise when able, and active events when not, is part of the day
Respecting Rest by keeping a normal bed/wake time whenever possible
Limiting the number of drinks to a healthy dose and making sure you're consuming water too can minimize the impact
Of course, on the other end of the spectrum, we know that some people turn this time of year into a challenge - a chance to improve rather than simply slow the decline. For those folks we add one simple (not at all new) tactic based on a very cool study from Stanford U - Eat More Plants.
In a cool randomized clinical trial of identical twins (that is, genetic identicals), a team showed that a "healthy vegan" diet (that is, whole plants, not vegan junk food) outperformed a "healthy omnivore" diet (eat anything in moderation, avoid the high process, minimize added sugar) over an 8 week period. Specifically, LDL Cholesterol fell, insulin levels improved and body weight dropped more in the healthy-vegan group than the healthy-omnivore group. 8 weeks from now is the beginning of February. Improving through the holidays may be uncommon, but isn't impossible.
Have a great weekend,
Mike E.
quieting our holiday zombie
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.
gratitude works
Nov 24
When I first learned about Positive Psychology, the (far oversimplified) less-traditional practice of diving into mental health with an eye toward the "upside" like resilience, happiness and growth, instead of the more traditional focus on rehabilitating the negative (disease, disorder and trauma) it felt like a game changer. It was clear that within their profession, at least some psychologists were trying to reorient back toward attaining "health" (flourishing, thriving, etc) rather than "avoiding disease"...something that can seem nuanced at first but is clearly spelled out by authorities like the World Health Organization in their constitution. As funding led to research, we began to understand the difference more fully and where our efforts should be.
As it turned out, gratitude, whether it be a momentary appreciation for something good in life or a cultivated practice of recognizing such things, became one of the most widely studied components. The "what went well" exercise described by one of the profession's giants in the early 2000's, which in the most basic form is writing down 3-5 unique experiences that "went well" each day for a few weeks, showed promise across several of life's domains and across a large portion of the lifespan. Gratitude also shows up near the top in a framework Dr. Paul Conti recently discussed with Andrew Huberman on his podcast - part of a 4 part series and a great listen on mental health. In a review of 19 different studies it even showed a clear benefit on cardiovascular risk, adding more evidence that there is no "physical" or "mental" health...just health with all systems playing a role. However, as is the case with many health practices, knowing the "best" way to do it has not been as clear.
Not surprisingly then, when this study from the University of California came across my feed I was intrigued. The researchers tested a variety of gratitude practices to find out which had the most impact. The punchline? Taking the time to sit down, think through the details and write a letter was most powerful.
And so, in the spirit of the season here's a quick one to you:
To our clients, friends and the employer teams who have invited us into your spaces, stories and lives, I know I speak on behalf of the entire Pro-Activity Family when I say, it is both an honor and a privilege to play a small role in your big thing. We have had the unique fortune to witness up close what it takes to make the components and assemble the structures that become homes and buildings. We've seen the magic that goes into bringing power and water and heat to those structures and to keep them well lit and warm when nature intends otherwise, 24/7, 365. In some places we have seen the effort, nothing short of an act of daily love that goes into making those products that mop up messes while in others those that help fuel the bodies doing the mopping. And we have had the great honor to walk with many of you as you journey through life and in health. When we give thanks this week and into the holiday season please know that YOU are among those we are most thankful for.
Now it's your turn - write one for someone you're thankful for and enjoy a health bump.
Have a great weekend,
Mike E.
exercise and infection risk: prepping for winter's peak
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.
sleeping slow and low
Nov 10
If I'm being honest, I am fascinated by the powerful pull of the click-bait quiz. You know, those pop-ups and posts in social media that start with something like "people who _____ do these five things..." where the blank is always something shockingly specific to some conversation you had recently, an image you paused over for a split second or something you dared to search for as if Siri and Alexa were trading your interests in some backroom deal over at the Zuckerberg house. It's one of the reasons we've shared "Fun Fact Friday" on our LinkedIn page this year - to help provide at least one feed of information that has actual science at its base. It's been an interesting experiment.
Sleep health is one of those topics. Not surprisingly, as we've learned more about the powerful impact of sleep on health and performance, people are seeking out information about it more often. It has far outpaced the other 2 basic lifestyle pillars (exercise and nutrition) in the last 20 years according to internet traffic trends, pulling away from "exercise" about 20 years ago and "nutrition" 10 years ago. Add in the technology to track sleep reasonably accurately and funding that follows public interest and we've got a recipe that makes "sleep health", which is critical to overall health, more accessible than ever.
If however, you've missed the trend - here are the basics:
Sleep is broken into stages that until recently have not been uniformly labeled. This makes it more confusing than it has to be. Those in the "simple is better" camp (like us) prefer the 2 category system, Rapid-Eye-Movement (REM) and Non-Rapid-Eye-Movement (NREM) where NREM is further broken into 3 stages, very light (N1), light (N2) and deep (N3) with each stage having important functions and features (a good overview of the basics can be found here). While historically much of the focus in sleep research has been on REM sleep which typically happens in the second half of a normal 7-8 hour bout, more recently it has been Deep Non-REM (N3) which has been gaining attention. One of the reasons is its role in future brain health.
While we've known for a while that sleep overall and deep non-REM in particular tends to decline as we age, a study published in the Journal of the American Medical Association late last month showed that the decline isn't standard across all people and therefore probably shouldn't be considered inevitable or normal. The authors observed that those who had a more significant decline in this type of sleep also had a more significant decline in brain health, and therefore a significantly higher risk of dementia and Alzheimer's disease in the future. Specifically, for every 1% loss in deep non-REM (or "slow wave sleep" as it is referred to in the research community), individuals experienced +/- 30% increased risk of developing one of these diseases.
If we follow the logic that (1) it's a problem but (2) it's not uniform and inevitable then it might be reasonable to think (3) we can probably influence it in some way or another...which does seem to be the case.
As it turns out, when we are in this stage of sleep (as measured by "brain wave" activity on EEG) we are susceptible to certain sounds. Some research has shown that particular frequencies when played during this stage can keep us there longer and wildly, even relaxing words played at the right time seem to have some potential. Of course, if the idea of wearing a brain monitor and being whispered to all night long seems strange, vigorous exercise later in the day (oversimplified) may prompt the body to need more deep restorative sleep and diets low in saturated fat and high in fiber which may allow the nervous system to get into a state of "rest and relax" (parasympathetic state), also seem to have a positive impact.
The key takeaway seems to be more of the same - if we eat and move well we are more likely to sleep well, with plenty of slow waves at low frequencies...which, not surprisingly makes it easier to eat and move well the next day.
The most important first step therefore is the one we seek...even for those rockin' 8 days per week. Whether you're heading to Brooklyn or home countin' sheep - keep working those ELEMENTS and get some sleep. OK, OK, this is better left to Aaron. :)
Have a great weekend,
Mike E.
optimal dose: turkey trot as easy as 1-2-3
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,