Blog Archives

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.

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.

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.

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.

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.

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.

Oct 27

I've mentioned the Methuselah Foundation in the past.  They fund longevity research, of which calorie restriction is a well-known go-to strategy. For some reason, when otherwise healthy mice and non-human primates are fed 25% (or so) less than they might typically take in, they live stronger, longer. Until the early 2000s this effect was not well studied in humans. Few debated that designing a study like this would be complex and wildly costly. But at the same time, if such a simple tactic, to simply cut down on personal energy consumption, actually worked, the implications would be massive. In 2007 with the help of the National Institute of Health and the National Institute on Aging the "Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy", aka the CALERIE study (clever!) was launched. The design turned out to be simple indeed - they would recruit a few hundred folks, randomly assign a group who would attempt to reduce calorie intake by 25% without reducing key nutrients, and track everything they possibly could for years. The findings were impressive.

About a decade after the start, results started to pour in. 4 major themes emerged:
 

(1) Cardiometabolic profile improved
(2) Markers of inflammation improved
(3) Biological Aging slowed
(4) Physical function improved or maintained

But there was a twist - the actual calorie reduction achieved was about 1/2 of that attempted. On average, participants reduced calories by only 12%, which on a standard 2000-calorie-per-day diet equates to 240 calories. To put that in more real-world terms, eliminating a 20 oz soda daily or subbing something healthy for a couple of processed snacks throughout the day could drastically alter even a generally healthy person's trajectory.

Now for some that might be good enough - "no need to know more - it works, let's do it".

However, as science does, the dive into "why" became the next unknown...until now.

Using muscle biopsies taken at baseline, year 1 and year 2 from a subsample of the CALERIE population researchers at NIH were able to determine that the real impact of calorie restriction was at the genetic level. By eating slightly less on a consistent basis, the body "turned up" (upregulation) genes that preserve muscle function, strength, fuel efficiency (both sugar and fat) and also "turned down" (downregulated) those associated with the processes linked to both disease and aging, sometimes referred to as "inflammaging".

While this does not specifically relate to fasting or time-restricted eating, both of which have become far more commonplace since the beginning of the study, it may be hitting similar targets. More remains to be discovered.

Until then, if you're the type of person who sees giving up a few snacks as a worthy tradeoff for better health and stronger aging, the proof is quite literally in the pudding...and anywhere else a few hundred empty calories might be found.

Have a great weekend,

Mike E.

Oct 13

While I have a strong belief there are things in this world that are "unseeable" but no less "real", I am admittedly a bit skeptical about the unlucky nature of the number 13 or the fear of that number falling on a Friday. The History Channel tells us there's an actual name for this fear - paraskevidekatriaphobia - and that it is real enough to cause massive economic losses. Meanwhile, NPR has tried to help us actually pronounce the term (a practice they say helps rid us of it). Yet, I find myself wondering if this year, by falling in October, the most unlucky part of Friday the 13th might be that it's easier for the Halloween priming messages to buy and load up on sugar to break through. We know for example that ultra-processed foods tend to poke at our emotions to a greater extent than low-processed foods, which likely drives us toward purchase, consumption, and ultimately poorer health. Now don't get me wrong, I'm SURE I will find myself sifting through the leftover candy bowl to see if there are any Heath Bars left in the mix in a few weeks (I love those things), but, minimizing the impact of the unofficial overeating season (October 31st to January 1st) or avoiding altogether the potentially addictive gravity of the ultra-processed foods it tends to feature, would certainly not be a bad thing. 

For those of us trying to stay on the right side of risk, the question becomes - in our modern environment, where these foods are easy to get and relatively inexpensive, can this risk actually be avoided? Well, according to some new evidence from a research team in Germany, there's good news, if we get started soon.

Building on discoveries that clearly show the connection between the gut microbiome and our day-to-day decisions, the team decided to test the suggestibility of certain foods before and after influencing the bacterial makeup of the biome. In more simple terms they fed a random 1/2 of the study participants a plant-based fiber which is known to "feed" healthy bacteria (PREbiotic, which is different than PRObiotic) for 2 weeks, and the other 1/2 a placebo. They then studied a variety of markers from brain imaging on Functional MRI to blood and even stool samples to understand what was driving an association (if one existed). Then, after a washout period to get participants back to baseline, they switched the fiber and placebo groups and reran the experiment. What they found was interesting, if not stunning.

When individuals were "primed" with a healthier biome they experienced reduced activity in the reward centers of their brain when they were tempted with ultra-processed food. That is, if their brain was re-wired in just 2 weeks, it didn't "light up" the same way when high-sugar and high-fat foods were presented.

While this study does not claim that if we feed the healthy bacteria in our gut we will definitely be able to resist the powerful pull that the junk food industry has on our emotions, for those of us who see wisdom in the age-old maxim "know thyself" (originally interpreted as "know your limits"), it may provide a tool that helps us extend those limits and avoid the traps of the season.

If you start now, Friday the 13th might just be the luckiest day your future self has had in a while.

Have a great weekend,

Mike E.

Sept 29

By 2016 nearly 20 years had passed since we incorporated and our model and approach were starting to get noticed by professional colleagues and peers. While it seemed outlandish (and even misguided) in 1998 to make prevention, and health promotion the central goals of a healthcare practice, the results were adding up and at every turn, the research was backing up our claim that it could be done. Around that time we began teaching a continuing education course for professional peers (mostly physical therapists) that covered key concepts. With as many as 1 of every 3 healthcare professionals feeling burned out at any given time, many were looking to redirect their skills and experience the often inspiring "give AND get" that our team enjoys while helping people achieve this way. Acknowledging that it isn't always an easy journey, we called one of the key assignments the "pathway project". It was designed to challenge the professional to use research and evidence to map the course from our influences and daily behaviors to common diseases. As they scoured the evidence, they developed a better understanding of "how we got here" and more importantly, as they compared notes, the root causes that needed to be dealt with to turn things around. 

Although a growing and important problem, the map on mental health concerns like depression had wide gaps. The evidence of a clear connection with our day-to-day behaviors and the influences that drive them was only beginning to emerge and many people were still assuming much of it was not within our personal control. Although clearly incomplete, having a family history or genetic risk was often used as the likely explanation. In the last few years, however, the path has become far more visible.

For example and as we've previously mentioned, in February of this year we learned that regular physical activity can actually outperform "usual care" (medications) for common mental health concerns and that higher intensities are particularly powerful. One cool study in August even validated the dynamic warm-up that we use with so many of our clients. How we time our physical activity can make a difference it seems. It turns out that priming our systems with movement and physical activity BEFORE the workday can increase resilience and well-being as compared to waiting until afterward. Then, a few weeks ago another massive study that tracked more than 1/4 Million people over 9 years made the pathway even more clear. Researchers from The University of Cambridge were able to compare the preventative impact of genetics and lifestyle, drill down the risk-lowering contribution each of 7 specific lifestyle habits made, and even show a few physical health markers that connect the dots. 

Here's the breakdown:

First - our genetics do matter, but not as much as our lifestyle. According to the study, those with a high-risk gene profile had up to a 25% increased risk compared to those with a low-risk profile. However, this was less than 1/2 the impact that lifestyle had. Those with unhealthy lifestyles had a 57% increased risk compared with those with the healthiest lifestyles and 41% increased risk compared with individuals with even moderately healthy lifestyles. This effect suggests that most of the benefit comes with even doing a little bit, an effect that was maintained even after genetic risk was accounted for.
Next - there were as many as 7 different habits that had a risk-lowering impact. Healthy Sleep (7-9 hours) had the strongest effect, lowering risk by 22%. The others lowered personal risk as follows:

Never Smoking: 20%

Regular Social Connections: 18%

Physical Activity: 14%

Low to Moderate Sedentary Time: 13%

Moderate (or less) Alcohol Consumption: 11%

Healthy Diet: 6% 

Last - they were able to fill in key gaps on the map that link behaviors to the eventual disease. In addition to notable changes on MRI of the brain structure in people who led healthy lifestyles, simple blood markers of inflammation (C-reactive protein) and metabolism dysfunction (high triglycerides) were far more likely in those who had a high risk of future depression. Depression may "end up" in the brain but it appears to run through metabolism and immune system health.

Mental Health concerns are impacting as many as 50 Million Americans each year - it's a big problem. The risks we face are real and likely impact every one of us at some level. HOWEVER with a map in hand, the support of those around us, and the willingness to work hard at risk-lowering, "Stronger, Happier People through Better Health" is not just a mission statement...it is a reasonable expectation. 25 years later we are excited to be walking the journey to health with you.

Thank you for allowing us to play a role in your journey. Let us know if you need a map.

Have a great weekend,

Mike E.

Sept 15

It might have been my favorite "subject" during my educational journey. Movement + Freedom to decide how, what could be better? At some point, it was replaced with gym class (Phys. ed) which checked off most of the same boxes but added structure. Then, eventually, it was gone. Although it's fair to assume not everyone remembers recess with such nostalgia, for me it was a chance to burn some pent-up energy, let my mind decompress, and was usually positive; something that might even help to lay down the framework for future habits and well-being. I sometimes wonder how much more productive I'd be as an adult if there was still an unstructured break to go out and run around in the middle of the day. Apparently, I'm not the only one. If you search the term "adult recess" on just about any web browser, you'll discover a fairly long list of articles that relate "play" back to wellness, leadership, productivity, and more. 

But how does it work? And does it work for everyone?

In short, we don't fully know, however this week we got closer to an answer.

First - whether we point to studies of modern-day hunter-gatherers as proof that we humans are built to move A LOT or, maybe as articulated here we (as dynamic systems) actually ARE movement, most of us have experienced the challenge of "being fully still" (no screen, no movement, just be) for longer than a few minutes during waking hours. It's no surprise then that when we "contain" ourselves for extended periods, whether in a desk chair tucked behind a monitor, standing behind a machine, in a vehicle or perhaps off to the side somewhere watching our kids, we are functioning outside of our default and it's tiring. As we tap into our reserves, cognitive and emotional especially, we feel depleted, which often equates to the sensation of stress.

Although it gets a bad rap, stress isn't inherently bad. It's almost like a Goldilocks phenomenon where there is a "just right" sweet spot ("eustress") between too little ("sustress") and too much ("distress") as discussed here. One way it can get confusing is that we can have too much in one domain (such as psychosocial overload) even while having too little in another (physical under-load). This may be why the outlet of movement-based play is so effective, not only does it help us to avoid the trap of slumping into a chair after a long day of doing too much of the same, but it also stimulates the under-loaded areas while resting the often over-loaded. With that in mind, we have been advocating for a 5-10 minute "movement test" as a way to help know the difference between physical and psychosocial fatigue for years. Feel more energized and less stressed after movement? Keep going - you need the movement to free up the energy log jam and ultimately clear your brain!  

By 2018, the research community began adding to the idea. As it turns out, because we are all one system (i.e. no such thing as "body and mind"), a carryover effect is not only available, it seems automatic; when we move we soak up existing social or emotional over-stress while getting the bonus of creating a buffer against future stress. In a review of 14 different studies on the subject, those who got adequate physical stress via physical activity and eventually fitness tended to absorb psychosocial stress more effectively. Those who did so with a group in nature may even get an extra resilience boost.  

By 2021 evidence of a dose-response relationship was emerging. Higher movement intensities created stronger buffers against future stress. The link was clear - finding the sweet spot of daily physical stress helps us to reset the way our system manages other stress, especially psychosocial stress which impacts our mental health and wellbeing. With that in mind, the results of this 2022 review of more than 2 million person-years of data shouldn't surprise us. The authors concluded that if less active adults met physical activity guidelines (+/- 20 minutes per day) more than 1 of every 10 cases of depression would have been prevented, powerful stuff.

For the parents and caregivers out there, especially those who remember recess fondly, the most recent proof might be the one for you to know. As a team in Switzerland reported last week, the same effect holds true for kids. Those who met physical activity guidelines (1 hour per day for kids) were able to deal with future psychosocial stress better than those who didn't.

Simple enough - if you need a stress reliever, go play, preferably outside.

Have a great weekend,

Mike E.

Sept 1

If you're old enough to remember watching the nightly news to get information you're probably old enough to remember all the hooks used to keep you there..."Your _____ (pillow?) might be killing you! Film at 11". As information has become even more accessible and condensed, the tweet-able headline (X-able?) has become even more critical if whatever a source has to say is to cut through the noise. Andrew Warner gets it - in May of 2021, the blogger wrote an outrageous headline...about outrageous headlines. It's a little like stepping into the matrix of clickbait. Nutritional information is notorious for this. Since everyone is a consumer of food (of one type or another) but very very few care to consume the details of what food is doing with, for, and to us, the headlines often win the day. So when I saw a press-release headline that read "The Right Combo: Getting the Most Health Benefits from Fruit Smoothies" earlier this week, I knew I had to dive in; let's pick it apart a bit.

In general, it's fair to say that at Pro-Activity we are pretty big fans of the smoothie so any article that highlights the smoothie as the nutritional delivery mechanism of choice tends to get my attention.  Not only do we have a handful of our own recipes, we often recommend smoothies in general as an easy-to-prepare, tasty, and nutrient-dense starting point for those looking to FUEL better as they journey toward better health. Whether it's the "Jersey Slime", heavy on spinach giving a strikingly green color and similar to the one described here which demonstrated an inflammation-lowering effect in 1 week in people who consumed it daily, or the "Berry Bomb", as the name implies, is loaded with berries and similar to this one proven to lower muscle soreness after intense effort and this one proven to improve blood vessel function or any other number of recipes we've seen, for most medically-uncomplicated folks, a smoothie can be a great option. When I started to read the release, however, I found myself wondering how fast we would start to see the misinterpretations pop up.

The basic gist of the article is that foods that contain high amounts of a particular enzyme (a protein that makes biochemical reactions happen faster) known to be involved in the process that makes them turn brown when bruised or left on the countertop, such as bananas, apples and avocados called Polyphenol Oxidase (PPO) have a, now confirmed, ability to block another important nutrient, limiting the available concentration of it when the two food-types are consumed together. In headline form - a banana in a smoothie blocked the flavanol (recommended for its cardiometabolic protective effect) provided by berries in the same smoothie by up to 84%.

Here's where it's bound to get muddy "out there". The ability of one food to block the healthy properties of another does not make it unhealthy or even something that should be avoided...however, when "bioavailability of flavanol" is important to us (and it probably should be), either keeping the foods apart in preparation or eating them at different times of day could make a difference. This was found in the study as well; when the two food types were actively mixed before consumption (that is, blended together) the reaction was stronger than when they were not mixed but consumed in the same sitting. From the UC press release: "He also said bananas remain a great fruit to be eaten or consumed in smoothies. For those who want to consume smoothies with bananas, or other high PPO activity fruits and vegetables such as beet greens, the suggestion is to not combine them with flavanol-rich fruits such as berries, grapes, and cocoa." With that in mind, substituting a low PPO food in your berry (or other high flavanols) smoothie, such as mango which will bring a bit of sweetness the banana is known for, may make sense. 

The bottom line is - bananas aren't "bad", so when the hype arrives, resist! They check a LOT of boxes: naturally occurring, minimally processed, nutrient-dense, inexpensive, biodegradable carrying case and have even made for a shockingly fun minor league baseball mascot to name a few...I mean, seriously a bases-loaded backflip catch?... but I digress. They're also not the perfect food for every situation or goal. If you find what is, please DO let me know.

Have a great weekend,

Mike E.

Aug 18

“Dripping water hollows out stone, not through force but through persistence.”
- Ovid (Roman Poet, 43 BC - 18 AD)

120 Million. That's a big number and the approximate number of Americans who are living with hypertension which is, heartbeat by heartbeat, overburdening and eventually wearing to the point of harm, the inside lining of the arterial pipes. It is a patient little health gremlin, lulling us into believing it's not really that big of a deal. After all, many people can't feel it and can still "do" everything without any obvious symptoms. Yet there it is, heartbeat by heartbeat hammering away until irreparable harm is done. If we consider that there are around 35 million heartbeats per year for the average adult, we understand why it doesn't take that long to take its toll.

It's not all bad news though. Hypertension is preventable by most, treatable for many and even little things can add up to big results. If blood pressure (combined with heart rate) acts as a "body tachometer" telling us how "revved up" we are, it stands to reason that it has been associated with stress and pain. It also makes sense then that anything which helps us to slow or otherwise calm down can help. 

We've known for a while for example that some of our greatest levers include exercise which pushes our stress-threshold higher over time, nutritional approaches that lower the inflammatory load and balance the intake of foods that naturally constrict the arterial pipes like highly processed foods with those that relax them (nitric oxide and potassium-containing fruits and veggies especially) and sleep which gives us a chance to relax and repair. These are not the only approaches though. Stress management, breathing exercises, and even social connectedness may have a role in protecting us.

More recently, however, research teams have tried to take the conversation deeper - attempting to find the signal through the noise. Comparing various dietary approaches for example has helped us to contrast what might work (there are many) with what actually does for most.  The DASH which promotes low-process, high-fiber, and naturally occurring foods usually scores at or near the top. Under the header of the exercise, the story has been less clear until recently. This year, 2 cool new studies have made the case for holding still...right where we are...for minutes on end. In exercise-jargon: Isometric exercises.

The first study which was published in March showed that office workers who spent 16 minutes per day (4 rounds of 2-minute "holds" with 2 minutes break in between), 3 times per week, either performing a wall-squat or a sustained gripping exercise at 30% of their maximum could lower their blood pressure in a meaningful way in as little as 3 months. They went on to show that after the initial 3 months, they could maintain the changes by dropping it down to only 1 day per week. While the wall squat out-performed the gripping task, both were effective.

The second, out last month, reviewed 270 different studies on the blood pressure lowering impacts of exercise and found that, on average, the isometric exercise outperformed the other modes which included: aerobic, resistance, high-intensity interval, and even combined aerobic & strength. The effect was strongest for systolic blood pressure ("the top number"). Aerobic exercise, specifically running, took the top spot for diastolic ("the bottom number").

It takes effort to control risk factors and ultimately prevent disease but sometimes not as much as we might think. Pretty good terms, not only for those required to meet certain work standards but also for those who look forward to a long healthy life after that phase is over.

Maybe this week try sitting for a few minutes without the chair :)

Have a great weekend,

Mike E.

Aug 4

It's the second leading cause of death worldwide (and sadly number one in America for children and middle-aged adults). Like most risks we face the ones that lead to cancer are probably not 100% avoidable. We inherit certain risks (genes) and might face stressful enough life circumstances to experience a significant risk bump. But still, the more we learn, the more we can confidently say that we humans, with even a very little bit of effort focused on "strengthening the host", are pretty hearty and cancer is just the latest in a long list of unwelcome guests that we can close the door on.

It starts with a very cool experiment in 2017 where researchers had healthy folks ride a bike to exhaustion. They then collected a blood sample, centrifuged off a few factors, and dripped the remaining "serum" onto a dish of human lung cancer cells. Compared to a control group the post-exercise serum killed off more than 50% of the lung cancer cells and sharply slowed a human aging factor. Other similar studies showed similar results with other forms of cancer. Various scientific reviews such as this one in late 2017 and this one in 2020 of how it all works followed, but the oversimplified headlines are:  

1 - Exercise appears to "supercharge" our blood and therefore make the internal environment very inhospitable to unruly & rogue cells.

2 - Exercise should be a part of the conversation throughout the cancer journey, from prevention to treatment and beyond.

Of course, the work never stops and researchers have been working hard to refine exact dosages, whether it combines well with other treatments, etc. but the take-home message has generally been a good one - for those that can tolerate it, exercise is a powerful lever when cancer risk is high.

Then, in April of this year, another cool study popped up. As it turned out, even short bouts of low to moderate-intensity exercise, in this case lightly pedaling a bike (enough to get the heart rate up to 100 beats per minute for 10 minutes) in newly diagnosed breast cancer patients was enough to get a significant immune system boost. As if the first two headlines weren't promising enough, this seemed to both reinforce them and add an important third to the conversation:

3 - It takes a lot less "load" (duration x intensity x frequency) than you might imagine.

But then last week, maybe the most persuasive of them all, especially for those in the "prevention stage" of the journey, was published in the Journal of the American Medical Association. After analyzing the health data collected via wearable sensor from nearly 23,000 people for a 7-year period (on average), it turned out there was a sharp risk reduction for those individuals who had a few minutes of "exercise-like" activity during their normal day, or "Vigorous Intermittent Lifestyle Physical Activity" (VILPA) as the research team called it. Specifically, those who got huffing and puffing through normal activities (carrying groceries, climbing stairs, lifting a child, etc) in 1-2 minute bursts for at least 3 minutes total per day saw an 18% risk reduction over the next 7 years. Those who spent a total of 4.5 minutes (in 1-2 minute bursts) combatting the country's 12th leading risk factor did even better yet, experiencing a 32% risk reduction. That is:

4 - 5 minutes of MOVE (the US' 12th risk factor) cuts Cancer (killer #2) risk by nearly 1/3rd (32%).

Park further away, get off the subway 1 stop earlier, take the stairs or dust off that bike helmet - if it leads to enough MOVE to break a sweat, it can work.

Have a great weekend,

Mike E.

July 21

You don't have to go very far to find the heat this year. Whether it's scrolling through the headlines pointing to various record-breaking temperatures or just being outside for more than a few minutes in most places, the Summer of 2023 has brought the haze, heat, humidity, and, of course "all of the above". And while officially we're only 1/3rd of the way through Summer (June 21-Sept 22), we are more than halfway through the "unofficial Summer" (Memorial Day to Labor Day, aka 100 days of Summer) and we are near the historical peak for the energy-sapping, body-inflaming temperatures. So while we hope everyone gets through the summer without any issues, our experience (historically and this year) pretty clearly shows that heat brings our bodies right to the edge of their capacity and a few extra tactics to keep the odds in our favor is a good idea in Mid-July to Mid-August.

If you've missed it in previous blogs or our recent training sessions or materials, there are a few key points worth knowing:

1. The effects of heat are "double-edged". While small loads with adequate rest (equivalent to sauna use for example) can improve fitness as our cardiovascular system adapts, large total loads and/or inadequate rest can negatively impact our physical abilities, especially fatigue-resistance (endurance).

2. While maintaining hydration is critical to maintaining our body temperature, it is not our only cooling strategy. Whether in the form of "pre-cooling" (before activity) or "per-cooling" (during activity) employing strategies specifically targeted at lowering the body temperature such as ingesting ice slurry, can improve performance. Using cold air or immersion after strenuous work can also speed recovery.

3. While heat can deplete us faster, it can also make it harder to get adequate sleep since our body temperature has to fall before we nod off. Cooling strategies might help here too. While the research is far from conclusive, there is some evidence that suggests a cold shower after a hard physical effort can help. Either way, our sleep continues to be our best chance to recover, so in addition to getting in an extra hour whenever possible, cutting off calories and bright lights a few hours before bedtime and keeping the room dark and cool when we get there can help.

And now, a counterintuitive twist. While starting an intense outdoor exercise program this time of year is typically NOT on our list of recommendations, movement, and exercise can still pay dividends if done thoughtfully. Foam rolling or other forms of self-massage for example can reduce soreness after a taxing effort, and according to some very new analysis, when individuals face very heavy recovery loads (in this case planned major surgery) even slight fitness improvements enhance recovery. This doesn't have to mean long hours of effort or even effort for a long time. Even three, 20-second bursts on a stationary bike (whether done all in a row or with hours of rest in between) and powering up 60 stairs a few times per day (also with hours in between bouts) have been shown to stimulate meaningful improvements. In other studies, 6 sessions of effort over a two-week period provided enough stimulus to get a bump.

The take-home message here is the heat can get us down...but it probably doesn't have to. We are about to climb the peak of the season and there's always risk as we get to the edges of our capacity. Now is the time to reassess, make a few small adjustments, and RECOVER well so we can enjoy the remaining weeks of Summer and stride into Fall.

Have a great weekend,

Mike E.

July 7

To the dismay of my children, we're not really known for our vibrant Summer vacations. An occasional beach week perhaps but not a lot like friends and family who "always go to the shore" or have some other great downtime tradition. Thinking back, many (maybe even most) of our family vacations have been functional; a planned trip to "chase" a member of the family who is doing something. Many trips are associated with two serious soccer-playing daughters who grew up to be serious rugby-playing daughters, one or both of the parents competing in endurance events for a while there or even the not-so-little-anymore brother who is carving his path on the water with an oar in hand, the adventure of the day has often dictated the downtime.

This time it was a trip to Ottawa, Canada, and the surrounding region to watch one of the rugger-daughters do her thing. It was only my second time in the city and the last was during a Winter cold enough to freeze "the World's longest ice rink" (not so in 2023 apparently), so it was an entirely different experience this time. Walking the city (no ice skates required), seeing a team help a boater navigate the canal, watching the changing of the guard at the National War Memorial, and enjoying the very walkable paths that flank the river was time well spent. Besides the occasional reminder that my heart was in-fact pounding while watching my kid on the field (Garmin really should include a parent-spectating mode), it was relaxing and enjoyable.

However, perhaps one of my favorite moments was an exchange with one of the locals who, as legend (and stereotype) sometimes has it, lived up to the billing of friendly and cordial at least in my experience. It only took a moment. I walked into a pizza shop where we had previously placed an order. The person at the register asked if I was there for a pickup. Almost reflexively I said "Yes, two large pies" and then there was a pause. She tilted her head a little and looked at me blankly. Not really knowing what to do, I just looked back. It was only a second of course, but then she smiled and said "Oooh, pies...right...I was thinking like 'coconut creme' or something". It dawned on me that "New Jers-eese" doesn't always translate and I got a good laugh.

I don't know how much current research exists on the impact of vacations on health. Mostly because I decided not to look too far and instead just enjoy some downtime. Whether you've got something great planned or, like me, are mostly just chasing kids this time, I hope you find some moments to be going slow enough to appreciate the little things...in my n=1 study, it feels like a good thing.

Have a great weekend,

Mike E.

June 23

I remember the feeling well. I've probably talked about it in this blog at one point or another. It was around mile 8 of my first marathon, an unseasonably cold day in Philadelphia. There I was, running with (quite literally) thousands of others, packed tightly enough that I could easily reach out and physically contact the person next to me because it was still early enough in the race that the course hadn't thinned itself out yet. Despite the number of people, it was eerily quiet, with most people focused on executing their race strategy like I was supposed to be. It was past the high-energy stage of the race and not yet to the harder stages, a strange limbo portion, and I was amazed at how alone I could feel in a sea of people doing the exact same thing at the exact same time. Thankfully a fun distraction presented itself and I was able to put my energy into it; a story for another day.

We live in the most connected time in the history of the world. With today's tech, we are a few clicks from connecting with the majority of the world's population, a virtual version of those packed marathon streets, and as ironic as it may seem, we are also living in a time when more people feel more disconnected than ever. According to a health advisory issued by the US Surgeon General's office last month, which described loneliness and isolation as an epidemic in the United States, it is taking a huge toll on our health.

Somewhere around page 30 of the full 81-page report, the authors get into the prevailing theory of how it all works. Although wildly oversimplified, as creatures that run in packs, feelings of isolation go against our nature and can lead to harmful levels of stress in those who don't have adequate buffers. Without those buffers we inch closer and closer to our injury/illness/disease threshold, increasing our odds for a variety of diseases and possibly even accidents.

So how do we build these buffers?

Well, the easy answer is to invest time and energy into the communities where we live/work/learn/play/pray. To engage, get involved, and ultimately CONNECT. However, as outlined in a very interesting article this month, we can also cultivate positive affect - said more simply, do things that bring us excitement and find the joy (hidden as it might sometimes be) in the things we already do. As it turns out, across a population of more than 4,000 people studied for a decade or more, those individuals who regularly felt "enthusiastic", "excited", "strong", "interested", "proud", "alert", "inspired" (or other similar terms taking from the positive affect scale) were not only less likely to experience harm but were almost fully protected against the negative health effects of loneliness.  

May we all find a little time to do what energizes us and invest in our health along the way.

Have a great weekend,

Mike E.

June 9

As Tuesday came to a close I found myself sitting in the cell phone lot at the Newark (NJ) airport waiting to pick up a family member. Out of seemingly nowhere, the sky got grey and a warm dry wind blew. It was strange like it wanted to be a summer afternoon thunderstorm, but without the temperature drop and dark clouds...it was just grey. Then, the smell said it all. The smoke from the wildfires hundreds of miles North was here...and there...and almost everywhere apparently. It was a new twist, something we hear about but usually don't experience much in the Eastern US and so, a new risk to consider.

Not surprisingly, others were asking similar questions, and the "experts", some qualified and some not, were emerging to answer the question that was on everyone's mind - should we be worried?

The short answer is, we don't conclusively know. Risk is always relative to our personal circumstances and since we could never know all of the factors that play into the calculus, our best bet is to consult the evidence, make an informed guess, and ultimately adapt accordingly. With that in mind, we unleashed the geekdom on the questions we've been asked this week, and here's what we came up with, without any fluff:
 

1. High levels of fine particulate matter (PM2.5) in the atmosphere is a known health risk and shouldn't be ignored. 

2. Duration of the exposure matters (a lot) but even short-term exposure adds some risk. 

3. Wildfire-related smoke does bring risk and possibly even more risk than other sources of particulate, but a person's baseline health is critical to any risk assessment.

4. The more vulnerable a person is, the more they are impacted by the particulate from wildfires. One study showed for example that older asthma sufferers struggled more on "smoke days" but the risk for others, including those who were older but didn't have a respiratory illness, was fairly minimal.

5. Since inflammation is a known component of the body's response, "right-sizing" the immune/inflammatory response should factor in. Things that raise our baseline inflammation (like eating inflammation-promoting foods) directly impact how we personally respond. For example, there are known and significant connections between the dietary inflammatory index of our food and respiratory illness, including how a person with asthma reacts after exertion. Eating low inflammatory now and for the days after things resolve may be particularly important.

6. It doesn't end there. Since minimizing our risk is really about maximizing our recovery, especially during sleep, our sleep quality is critical during periods of increased risk...and since both sleep quality and duration are connected to the air we breathe (although "oxidative stress" is a likely culprit, the mechanisms are not fully known), we should work hard now more than ever to protect our sleep.

7. It gets even more important because sleep quality has a major role in our immune function, a system we lean more heavily on with increased exposure to new stressors.

8. Brand new research makes an even stronger case for "FUEL 2 RECOVER". Higher inflammatory eating (especially high sugar, high fat, high process) literally alters our brain activity while we rest, making full recovery from the day-to-day almost impossible.

So what should we DO?

There are many possible approaches. "In" the moment, it's always smart to minimize exposure to whatever extent possible. This is of course, especially true for those who are among the more vulnerable to respiratory or inflammatory conditions. The CDC has more than 20 resources on a page for health professionals HERE, including one really cool tool that tracks air quality and can produce an interactive map. While limiting exposure (staying indoors and considering filtering the air in extreme cases) is often the "go-to" strategy, giving our body the tools to adequately respond without overshooting is key. 

If we boil it all the way down, dialing in immune & inflammatory responses should be among our top priorities - which means FUEL well, especially with foods known to reverse oxidative stress like fruits/veggies.

It's likely we'll have more than a few "smoke days" this summer. The stressor may be new, but the strategies to minimize risk are tried and true. Start there.

Have a great weekend,

Mike E.

May 26

Admittedly, it's a pretty geeky thing to be excited about. Admittedly, I'm pretty geeky about this stuff. And so, like a kid looking at a wrapped birthday present, my eyes widened and I eagerly unwrapped the first study of the season using data from the "Global Burden of Disease" effort, a Gates Foundation-funded mega study that works to get a better vantage of the diseases and disorders keeping the world from thriving...and back pain is near the top of the list.

Although staggering in scale, the most recent study, published in the Lancet Rheumatology puts the count at 619 Million people worldwide, a number expected to grow to 843 Million by 2050, those who follow the topic closely aren't too surprised given that statistically, almost everyone will suffer an episode of back pain in their lifetime. The good news is, in the vast majority of cases it behaves like the common cold, with most cases resolving in a few days or weeks. The trouble is, low back pain can also be a bit mysterious. 

• The pain can be very severe even without significant harm. 

• The fear of something being wrong can overwhelm us because most people know someone who believes their back is somehow "bad" and they don't want that for themselves.

• The same medical management that works for some areas of the body, such as advanced imaging (MRI, etc), strong pain control, and surgeries can actually make the situation worse. In fact, one well-done study showed that individuals who got medical care that was outside of current guidelines in the first 3 weeks (which recommend exercise, therapy, anti-inflammatories, etc) did worse; more than double the risk of going from acute back pain to chronic back pain in some cases.

• The causes can be unclear because there are many things that change our personal risk picture, even day to day, which means even routine tasks can be a trigger on some days. "I wasn't even really 'doing' anything". The same study in the link above for example also showed that smoking (+56% risk), obesity (+52% risk), having a lower baseline function (+82% risk), and depression/anxiety (+66% risk) also impacted the likelihood a person would go from acute to chronic.

So, when we zoom in past the big numbers, what do we know?

First and most importantly, like almost all soft tissue irritations and injuries, many (if not most) cases of back pain are, in fact, preventable since risk factors are something we can impact, and if the total risk is lower than exposure to "load" we will fly under the "pain radar". It's a sliding scale of course, which means those who interface with very high loads during the day/week, have to do more than those who do not, but the principle doesn't change much.

Second and much like preventing other leading disorders/diseases (heart disease, diabetes, etc), there is no single lever that takes away all the risk. The more comprehensive our approach, the better our results.

Where to start: The ELEMENTS

1. MOVE: Exercise - this shouldn't shock anyone. After all, strong and flexible "working tissues" are far more resilient to load than weak and stiff ones. Exercise alone cuts the risk of back pain by 35% and when added with education (especially back pain myth-busting), climbs to nearly 1/2.

2. FUEL: Yep, here too. Not surprisingly, when we take the internal combustibles down (i.e. baseline inflammation levels) things are less likely to catch on fire. Specifically, The Dietary Inflammatory Index (DII), which we covered several weeks ago related to other conditions, has also been linked to pain sensitivity (especially in women), and in a small study, switching to a more plant-based diet (known to lower inflammation) also helped improve pain and function.

3. RECOVER: Giving our bodies a proper chance to rest from the daily grind is a big deal for all of our working parts. But our "postural" (i.e. anti-gravity) systems get a particular boost. It turns out to not only be important, but bidirectional, meaning people who have back pain often don't sleep well AND people who don't sleep well often develop pain.

The bottom line: It's an active process.

The key takeaway (again) on back pain is that although most of us will experience it, if we know what to do when we feel it (and what to avoid), protect ourselves with a healthy lifestyle, and manage our risks, we can prevent it. We couldn't agree more with Manuela Ferreira, the lead author of the latest study who said in a press release: 

"Currently, how we have been responding to back pain has been reactive....we can be proactive and lead by example on back pain prevention."

The best time to start was 25 years ago. The next best time is now.

Have a great weekend,

Mike E.

May 12

I recently listened to a podcaster with a neurology background who helped make perfect sense out of a very complex, but no less consistent and reliable idea. He said (paraphrasing) "So much of our brain's structure is dedicated to our ability to move that it shouldn't surprise us that our movement in turn tells us a lot about the health of our brain and nervous system." It was a great idea that efficiently explained a lot of the "why" behind a phrase we've been using for years:

Movement is a window into future health.

So simple, so true, and thanks to a team in Australia who published their findings on movement and (dementia-related) cognitive decline with age, showing that the inability to get up out of a chair, walk 10 feet, turn around/walk back and sit down quickly, along with grip strength, more than doubled the risk of future cognitive decline, ever-growing in its evidence base.

We've known for a while that complex, whole-body movements (like getting to and from the floor), as well as measures of aerobic power (e.g. climbing stairs), have predictive value in regard to our health. They join things like "gait speed" (how fast you can walk a specified distance) which was shown to have a very clear association with cardiovascular disease and premature death and strength tests to give us an idea of how much "functional reserve" we have...that is, how close to our body's threshold we are living day to day and whether we have a little extra if needed.

Maybe not surprisingly, having more reserve predicts our ability to recover from an injury or other setback, especially as we age, something we will all go through at one point or another. The trouble is, we often don't start paying attention to these factors UNTIL we age - which, like starting a retirement plan in old age, is likely a big mistake since (1) it gets harder and harder to build reserves as the years go by (2) even in childhood the trajectory is visible and may lead to a less than ideal future if not altered.

So the question becomes - how can we know where we stand and whether we are living too close to our threshold? Is there a way to know if we'll have enough "assets in our health retirement plan" when we need them?

The answer is yes and the list of tests is almost endless. If you haven't had a movement & fitness assessment in a while (or ever) with our team - this is probably the easiest place to start. If you're more of a "DIY" type - make a point to test a few of the critical movements mentioned above annually - think of it as a birthday gift to yourself. Or, if you want something you can track more regularly, something that can possibly act as a motivation to get out there and improve, consider daily fatigue, globally your energy levels at the beginning and end of the day, and your sleep quality which predicts performance even in elite military environments or by taking this survey, which creates a reliable fatigue score.

If you feel tired when you wake up and/or totally wiped out on most days, you are likely living very close to your threshold, something which can (and probably should) be improved.

It's not easy to build reserves. By definition, it requires an "extra" investment of time and energy and therefore a motivation to do more that isn't always easy to muster. To do it without risking injury or illness it has to be ramped up appropriately.

It is however worth it, and we can help. We're ready when you are.

Have a great weekend,

Mike E.

Apr 28

We've spent a fair amount of time discussing the connection between how our bodies make and use energy from our food (metabolism) and its relationship to the risks we face because it is one of the major roots that will determine whether we flounder or flourish. Just last week we talked about the connection between diet quality and movement-related pain, in this case knee arthritis, and many times in many different ways we've touched on the benefits of efficiently utilizing the energy we put in. One of the most common and challenging examples of the accumulated harm associated with inefficient or ineffective metabolic systems is Diabetes type 2, something an estimated 130+ million Americans are currently struggling with in its diagnosable or pre-clinical (prediabetes) form. While avoiding the condition outright is ideal, the complications associated with poorly controlled metabolic disease, which include problems with sensation, vision, balance, heart function, brain function, tissue stiffness, pain, sexual dysfunction, and even occupational injury can be so extreme that controlling or reversing the disease is a major priority.

So, whether we are a person who has some of the early signs of an inefficient system but no discernable disease (e.g. belly fat), one end of the spectrum, or are actively exploring the best strategy to reverse the disease and its complications, the other end of the spectrum, how should we go about it?

New research out this year from teams in Canada and China suggests that the answer is simple (but not easy): Stack a few power habits; 2 in the early stages, and 5 further down the spectrum.

The first study looked at 265 people who were either prediabetic (81) or had been diagnosed (184) who agreed to participate in a 2 pronged, 2-year lifestyle intervention (Nutritional counseling that focused on a moderate carbohydrate Mediterranean diet and physical activity that included both fitness and strength). They found that around 1 in every 4 participants (24%) who started in the prediabetic range fully reversed their risk. Stunningly a few in the diabetic range were also able to entirely reverse the condition, about 5%, however, it was more common (as expected) for those who started with the disease to partially reverse it, about 40%.

Around the same time, a dive into the UK Biobank data showed that when individuals diagnosed with the disease adopted healthy habits, they too were able to prevent future problems, in this case, the small vessel disease that seems to drive the heavy-hitting complications mentioned above. Those who turned even 1 of 5 studied healthy habits into a consistent part of their life had an effect, however, and perhaps not surprisingly, those who figured out how to consistently stack 4 or all 5 (in order of impact: moderated alcohol, minimized belly fat, regular physical activity, avoiding tobacco products and maintaining a healthy diet), did the best.

One of the greatest things about being human is that we are so adaptable. There are times when our health fails us, but most of the time, if we change the actions we can change the outcomes; a worthy investment.

Have a great weekend,

Mike E.

Apr 14

If you were building a championship-caliber team (in almost any endeavor) you'd probably want them to be tough in the face of challenges; that is, to be resilient to the stress they face and somehow still perform at their best. This may sound like something from the movies led by a macho, cigar-chomping, and fearless type who just seems born for the moment, but it turns out that's not the case as the growing body of research on the topic has once again shown.

First, let's start with a new brain development that sets the stage - a group of researchers has found that there may be an actual structure responsible for whether we are resilient to stress or sends us down the path of distress and despair. They found that similar to humans, within the brain of their mouse subjects there is a bundle of nerves called the arcuate nucleus (ARC) which has two smaller "sub bundles" with differing functions. Bundle 1 acts as the depression/despair circuit; when it is turned on, the mice lost interest in many of the things that demonstrate thriving (eating, moving, etc). Bundle 2 had the opposite effect, when it was "on" the mice demonstrated thriving. Here's where it got interesting - as the researchers expected and due in part to the plasticity of the nervous system...sometimes encapsulated by the phrase "practice makes permanent", repeated exposure (10 days of unpredictable stress), made it far easier for the mice to get "stuck" in a circuit 1 (toxic) loop. It was only when the researchers activated circuit 2 that they were able to override and, in a sense, "reset" the nervous system of the mice. This begs the question - if our brains function anything like this and, whether at work or home, it's likely we will all experience potentially harmful levels of stress at some point, how do we activate circuit 2 and guard ourselves against it? How do we build the capacity to ENDURE? Which brings us back to toughness.

Although we don't have definitive proof (yet) that individuals with high mental toughness are skilled at activating circuit 2, we do know that by definition, possessing "the psychological attribute that allows one to remain confident and determined and maximize one's performance even in challenging situations (Jones et al., 2002)", aligns well. As it turns out, this too can be learned, it is particularly important in our early working years (18-25 years old) and is far more likely when we have the right models and social environment to do so. Building on the social contagion theory, which is one way of explaining how behaviors and norms spread through groups, new research showed that mental toughness was both passed down in families, mentally tough parents had mentally tough kids, and bolstered when "cohesion", a strong devotion to the group and members' success, was high and predicted future mental health and well-being.

Of course, since we also know that social contagion is not limited to families and has been seen in peers, friends, teachers & students, coaches & athletes, and more, this finding could be important in any learning environment where we spend significant amounts of time. Said another way: 

1 - Leaders who model and demonstrate resilience in the face of stress are likely to pass this on to those who come behind them and 

2 - The few who do so with a strong "team before self" commitment, will enjoy accelerated achievement. 

Who are we watching? And who's watching us?

Whether leading a family, coaching in the community, or mentoring in the field - our models matter - at times more than we realize.

Have a great weekend,

Mike E.

Mar 31

I've never flown a plane. Despite hearing that it's really not so complicated, even from my then 12-year-old son who went up with an instructor, I have a hard time seeing past the momentary glimpse into the cockpit when boarding. It takes no longer than that split second for me to register a mental "yikes" when considering all those colors and lights and screens and switches. Seems pretty complicated to me, something that deserves more than the brief "thank-you" to the pilot and crew when I get off safely. In some ways, I imagine this is what some people must feel like when health or safety professionals throw out numbers, stats, and measures of risk...lots of indicators, but maybe hard to make sense of.

For those who want to fly on their own, we try to make it simple - the odds of any daily event, let's call it an output, happening ("a good day") or not happening (an incident, injury, illness or disease onset) is directly impacted by the inputs, such as the actions we take on that day or in the time leading up to it. An obvious example is seatbelt use. The odds of serious harm in a motor vehicle accident are cut roughly in 1/2 by the simple act of buckling up; simple and direct, cause & effect. Like a 12-year-old handling a plane...that is already in flight, with an instructor, under perfect conditions. Yet, we are human, and we live in a world filled with other humans, which means it's never quite so simple.

We've written about complexity here many times before. We've talked about non-linear effects, where some of a particular thing could be good, but too much of that same thing could be not so good ("goldilocks phenomenon"). We've talked about contextual factors, those things, often in the periphery of our lives and possibly out of our direct control, that impact the conditions and therefore likelihood for an event; in a sense, the "environment", which can dramatically change the total risk. If we are zoomed into our own lives we might miss them and make really poor judgments. It's probably reasonable to assume for example that, under different conditions, a "smoke bomb gender reveal", personal opinions aside, wouldn't have resulted in the loss of life - but in Southern California, at the end of the summer, it seems like some important context was missing. 

This week, we have more evidence that can both help us understand our complex internal conditions and assess whether they too if we lose sight of them, are ripe for a catastrophic event, as well as reassurance on what simple strategies work to keep us on the right side of the risks we face.

Here are the important bits:

First - after tracking more than 2,000 for nearly three decades, the main takeaway is once again clear - dying prematurely of heart disease is something men can sharply reduce the odds of. Although we suspect the same result would be true for women, this study was a limited sample and unfortunately only included men.

Next - the risks we face are complex, interdependent, and sometimes compound with each other making the whole greater than the sum of its parts. This means that although elevated blood pressure (a 39% average increased risk) and poor fitness (a 74% average increased risk) each negatively impact our odds, combined they have an even larger impact. In this case, 1 risk + 1 risk doesn't equal 2 risks, but rather 39% increase + 74% increase actually = 235% increase, despite the math.

Last - if the causes are complex, it shouldn't surprise us that the effects are too. Even though poor fitness as a stand-alone had, statistically speaking, almost twice the impact of elevated blood pressure, it did NOT fully eliminate the risk when fitness was good. The group that was both fit AND had normal blood pressure did the best, followed by the group that had high fitness but also high blood pressure, followed by the group that had normal blood pressure but poor fitness, followed last by the group that had both risks, who was more than twice as likely to die of heart disease during the study period.

What's the punchline?

Well, if you're the type that wants to get in there, grab your flight by the controls, fitness works...really, really well, but it won't fix everything. With that in mind, even if you're a dedicated mover, check your blood pressure now and again, more often if it's elevated, and consider the compounding effects of all those other inputs (like sleep, consuming high-fiber foods, time away from screens or in nature, close friendships, etc) can have. On the other hand, if this all feels a bit like me glimpsing into the cockpit, no worries, we're happy to help you safely navigate from point A to point B and keep an eye on the dash if life feels a bit too turbulent to take your eyes off the horizon right now. Reach out anytime.

Have a great weekend,

Mike E.

 Mar 17

I'm not shy about the professional crush I have on Finland for their epic disease reversal story which started in the 1970s, an 80+% reduction in cardiovascular disease risk. I figure if you can take a nation from "worst to first", from incredibly high likelihood to having life cut short due to preventable disease in the 70s to, according to the World Happiness Report, the happiest nation on earth in 2022 (and many of the years since the report was first published in 2012), you're doing many things right. Although we won't know until next week if they retain the title again in 2023, as the report is scheduled for release on Monday, it's fair to say that when I see a study on injury/illness/disease prevention coming from the labs and universities there, I pay attention; this time, it was related to Diabetes.

Thankfully, the US doesn't need a worst-to-first type performance in this case and by global standards. According to rankings built on data from the International Diabetes Foundation and the World Bank, we're somewhere around 50 on the list of countries and territories by prevalence (percentage of the population with the condition). Of course, given the size of our population, that still translates to 130+ million Americans who either manage the disease (38 M) or are in the pre-diabetes progression (96 M), the highest risk category of developing the disease, which negatively impacts every tissue in the body, very much including the moving parts like muscles, joints, and connective tissue where nearly 3 of every 5 also have musculoskeletal disorders. 

So what have they learned in Finland? In short, and when it comes to Diabetes, it may be that purple is the new blue...or at the very least "Purple for Prevention."

 One of the really cool details in the Finland health-turnaround story of the 70s was that they had the right conditions to grow berries - lots and lots of berries, with special emphasis on strawberries, raspberries, blackberries, and blueberries. For those that follow this blog, you know we hold those blueberries in high regard. They are packed with anthocyanin (a plant phenol that gives the berry its blue color) which has been shown to have positive impacts on inflammation and therefore, not surprisingly, conditions with a significant inflammation component including heart disease, arthritis, and, yes, even Diabetes.  

Early this year, and thanks to a research team about 2 hours West of the capital of Finland, our understanding has gotten even more nuanced. In a very detailed review, they showed that acylated anthocyanin (a slightly more stable kind that gets through the stomach and deep into the intestines/colon before its relative magic is unlocked by the gut bacteria there) which is found abundantly in purple grapes (concord) and purple sweet potatoes may have an even more impressive impact. The review cites countless studies that have shown this impact for a variety of reasons from blood sugar lowering to inflammation impact. Pretty impressive stuff and more evidence of how much we can do to lower the risks we face.

It's almost gardening season. If you've got a green thumb, save some space for purple.

Have a great weekend,

Mike E.

Mar 3

If history is correct, as far back as the 5th Century BC, ancient Greek historian Herodutus wrote of a mysterious pool of water in Africa that was responsible for the extended lifespan of a nearby tribe. Since then and across many centuries, whether a river, pool, or fountain, similar legends about life-giving springs that restore youth have persisted. On the surface it seems like it'd be a worthy pursuit if nothing else, a means to provide more time to learn and benefit from the inevitable mistakes made in actual youth. Such a thing might even make the famous Shaw quote, "youth is wasted on the young," a lot less relevant than it often seems.

But is it even possible to delay aging? Could 90 become the new 50? Or is this more smoke and mirrors than science?

Not surprisingly, this is the source of both debates and some very serious science. The Methuselah Foundation for example (originally the Performance Prize Society and rebranded to share a name with the most well-known super-ager of all time) whose mission actually is "to make 90 the new 50 by 2030," gives a substantial monetary prize to research teams who break the record for longevity in lab-mice in hopes to learn from the work. Although no actual fountain of youth has been found, researchers have recently started to more convincingly show that biological aging, which considers how our cells function and markings on our DNA (rather than solely our chronological age in years) might actually be malleable - something that can be accelerated or decelerated.

Perhaps not surprisingly, the same habits that are known to prevent, delay, or reverse many diseases associated with age (MOVE, FUEL, RECOVER) also seem to slow biological aging. However, as these habits are hard to regulate and study in a lab, the results are often "promising but not definitive." This month, however, a team led by researchers at Columbia University made a major step. Published in Nature Aging, the results of a two-year randomized controlled trial (often regarded as the "gold standard" of interventional science) showed that markers of biological aging (DNA Methylation) could, in fact, be slowed.

What was the intervention? Simple calorie restriction.

The team recruited 130 participants who were placed on 25% fewer calories per day for two years as well as a control group who ate normally. Not surprisingly the restricted group lost some weight and had some other cardiometabolic health markers improve. However, the really impressive stuff was in their DNA, where the rate of aging slowed considerably...not unlike some of the earliest winners in the mouse-longevity contest years before or many other studies on worms, insects, and non-human primates which have shown similar results.

The idea is simple - burning FUEL (metabolism) is one of many stresses on our system and results in the signs of aging in our cells. Improving the quality or reducing the quantity can both lessen this burden.

There's certainly more to come.

Have a great weekend,

Mike E.

Feb 17

Hormesis. Such a cool idea - something that is toxic, in small enough doses, can be beneficial; a challenge to come back better, a stimulus for growth. In a sense, this is the proper term for the well-known phrase "that which doesn't kill us makes us stronger" - which although not universally applicable, is something we can find evidence of all around us. The most obvious example might be handling heavy objects. If we choose something way too heavy we could be crushed. Yet, if we choose something heavy "enough" to represent a near maximum but still successful effort, we call it resistance training, something almost everyone should be doing multiple times per week. There are of course other, less obvious, examples as well. We don't typically think of the Oxygen we breathe as a "bad" thing, but ask any scuba diver if the concentration of O2 matters, and you might get a lecture on central nervous system toxicity, the result of violating that "sweet spot" for too high a concentration of this otherwise life-sustaining gas.

For a while we thought that alcohol consumption followed a similar pattern - a little (such as 1-2 drinks per day) seemed to provide benefit, something of a challenge to our system, even though a lot was well-known to be harmful. In 1997 for example, a study in the prestigious New England Journal of Medicine showed a 30-40% benefit related to cardiovascular disease in men and women who consumed 1 drink per day. A similar study replicated in Japan in 2005 showed similar patterns of benefit, between 12-20% in those who consumed 1-2 drinks per day, which for a long time was synonymous with "moderation" and generally considered to be an otherwise "safe" limit.

In the last 10 years, though, the messaging has begun to change as evidence continues to mount. The Centers for Disease Control and Prevention now takes a more cautious tone noting that a growing body of research points to risk worthy of pause, especially as it relates to cancer, at far lower doses, including "less than one drink". For someone like me, who enjoys a good beer, a glass of red wine, or something mixed now and then, this has all come as mostly unwelcomed news; something I didn't want to believe, a stage of change labeled "pre-contemplation", that is, the very very early stage when we're not-yet-even thinking about making a change...or more commonly referred to as denial.

As a person who lives, eats, sleeps, and breathes "health research" and also strives to live a high quality of life, this month it got even harder to deny. New research from one of the worlds best in the field of gut-microbiome studies (the trillions of bacteria in our gut that have roles in everything from digestive health to social and emotional health) showed that the World Health Organization, in January put out a statement that "alcohol is toxic", is probably right.

The study followed college-aged individuals (18-25 years old) who had no significant health or dependency history but drank to a level of binge drinking (more than 60g of pure alcohol, the equivalent of 4+ drinks) at least once in the last 30 days. They then tested a variety of bodily fluids to determine the impact. The findings were stark. Even after one bout of heavy drinking, the gut microbiome was significantly harmed. Although this probably shouldn't surprise us, we often use other forms of alcohol for the sole purpose of killing bacteria, it does provide a strong clue to the likely link to gastric distress suffered more frequently in binge drinkers as reported here. It might even be a root cause of inflammation levels spiking and the significant deficits in emotional processing reported both historically and in this new study.  

So what can we do? 

Well, the simplest answer is "we can change" - although like any change, simple shouldn't be mistaken for easy. But, like in any change process, we might start by weighing the pros and cons and begin to explore whether the benefits of changing outweigh the consequences of not changing. We might also consider working very hard to protect our gut health and minimize the harm in the meantime. Eating more fiber (prebiotic) or possibly fermented foods as well as foods that are high in antioxidants before or after ingesting alcohol could help. Some animal studies have shown that concentrated "superfoods" like pomegranate can help the gut wall from "leaking", one of the early cellular level changes that start the gastric-distress ball rolling.

Change is hard. Maybe it's time. Reach out if we can help to make it easier.

Have a great weekend,

Mike E.

Feb 3

If you're old enough to remember Popeye the Sailor you're also old enough to remember his magical source of strength. You might even feel old enough to need such a thing...well, fresh out of the lab at the University of Exeter, we bring you good news. If you're not old enough, not to worry, you can benefit too.

Let's set the scene:

Popeye was a generally good, but not-particularly-special, character that first appeared in the comics in 1929. A few years later, as his character evolved, he drew great power, mostly in the form of physical strength, by eating spinach. Of course, with great strength comes great responsibility and so, in addition to performing amazing feats for his less physically endowed friends (one of which went by the name "wimpy"), he also had brief stints fighting crime or solving mysteries. The key to his great strength of the course was the spinach...which up until last month, seemed more fiction than the truth.

That's not to say that spinach (and other powerful leafy greens like arugula or other plants like beetroot) didn't seem to confer special physical benefits. For example, we've known for more than a decade that beet-root juice and even whole beetroot can increase running performance in recreational runners and that consuming foods that naturally contain high concentrations of dietary nitrate & nitrite, the source of the benefit, can be beneficial for our cardiovascular, immune and even inflammatory systems. However we should be aware (or maybe beware!), that the source matters.

 While natural sources (veggies, leafy greens, etc) give us the positive effects mentioned above, these same compounds, when used as food additives (often in highly processed foods, especially processed meats) appear to be linked with increased health risk. In a 2022 French population study of more than 100,000 people over 7 years for example, the risk of cancer, in particular breast cancer and prostate cancer, was significantly higher in those individuals who consumed significant amounts of dietary nitrates from food additives; an important wrinkle that effectively makes dietary nitrates/nitrites a double-edged, nutritional sword.

Fast forward to this year and the story gets even more compelling - fresh research produced (see what I did there? Fresh? Produce? anyway...) from The University of Exeter in England showed that these same compounds, when taken from healthy sources, can quickly get to the muscles AND can improve strength production, an average increase of 7%, especially in the early repetitions (the effect was most pronounced in the first 18 reps of 60), 1 hour after they were ingested.

So, while I'm not sure we can expect the kind of instant surge of grip strength needed to pop open a can of spinach in one squeeze, that big leafy salad at lunch might just be enough to keep us on the right side of injury risk. Score one for Popeye.

Have a great weekend,

Mike E.

Jan 20

Not everyone likes to or is able to exercise. Although I hate to admit this fact, since there are many benefits across many areas (physical, mental, social, emotional, and more), it's no less true. For some, it's just too much. Maybe it takes too much time, too much planning, or maybe it feels boring and like a chore, or maybe the intensities in the gym or sports don't align well with their current abilities. Yet, as more and more of the world's population moves less and less, we also lose more of our resilience against the injury, illness, and disease risks we face - making the need to MOVE more both widespread and of critical importance.

But what if we could decouple "MOVE" or even "MOVE intensely" from "exercise"? After all, they're not really the same. Could it still give us what we're after? Could it possibly give us the reduction in risk (disease and even dying) that exercise does?  Well, according to new research, the answer seems to be "yes" and to understand it a bit better you have to rewind to 2020.

Without getting too deep into the weeds, in 2020 while the World Health Organization was busy trying to deal with a new widespread threat (pandemic), another wing of the organization was revising its physical activity guidelines to strike references to the idea that health benefits were only substantially gained by bouts of physical activity lasting at least 10 minutes. There are many reasons why they made this change, one of the most important was that as wearable devices that measure both physical activities (e.g. steps) and intensity (e.g. heart rate) were more commonly used and accurate, researchers could rely less on surveys and more on objective data...which was increasingly pointing to benefits of ALL physical activity, even incidental movement, especially if it was achieving exercise-like intensity - heart pumping and people huffing a puffing - something we and others started referring to as "fitness snacks".

As it turns out when they crunched the numbers over seven years of tracking, the risk of dying for those who got enough "VIPA" (vigorous-intensity physical activity) minutes, which was at least 2-3 bouts lasting 1-2 minutes, were significantly less likely to die during the study period, ranging from 25% to a staggering 50% less likely compared to those who did not get at least this "dose". The effect was seen across all causes, and when carved out, for cardiovascular disease and for cancer, the leading causes of death worldwide.

What does this mean for all of us? Well...

(1) if you love exercise, KEEP GOING - the benefits of doing so continue to be clear.

(2) If you don't share that love and find it hard to get going on a consistent exercise routine, you can still get a substantial portion of the benefit by working a few hard bouts of MOVE into your day.

(3) Dose matters - remember F.I.T.T.; The risk reduction came in around 2-3 bouts (frequency), hard enough to get the heart pumping at least 77% of max (estimate here) and/or becoming "breathy" when trying to talk during the activity, using short 1 or 2 word answers (intensity) for at least 1-2 minutes (time) doing any number of typical daily activities, like climbing stairs, carrying bags, walking fast, etc (type).

Generally speaking, this confirms that being sedentary comes with risk, but it also tells us there are ways to manage that risk at a lower investment of time and money than previously thought. 

To the stairwell!

Have a great weekend,

Mike E.

Jan 6

I do love the smell of a freshly brewed cup of coffee. Always have. For those of us who start our day with one, it can represent a range of experiences - both an energy jolt when we aren't quite ready to hit the ground running and a satisfying way to ease into the day when the schedule allows. Not only is it the delivery mechanism of choice for the most commonly used drug on the planet (caffeine), a good cup of coffee prepared in any number of ways, can represent the backdrop of a business meeting or an excuse to catch up with a friend. To say coffee has an important role in modern culture is a big understatement. 

And it's healthy for us right? Right? 

This of course is not nearly as simple a question as it sounds. Although no one likes "it depends", yes...and no...and maybe, under certain circumstances, is about as accurate an answer as we have.

Here's what a snapshot of the science says:

Observational studies, the kind which monitors groups of people and then applies statistical tests to see if consistent associations exist (such as "coffee consumption" and "health outcomes") have generally leaned toward the positive. This large umbrella review from a team based in the UK in 2017 for example showed that by and large, the health benefits appeared to outweigh the drawbacks except in specific groups and the greatest benefit came in around 3-4 cups per day. Certain groups (e.g. women at greater risk of fracture) however appeared to land on the opposite side of the risk-reward curve with the team concluding "Women at increased risk of fracture should possibly be excluded". 

Studies with a randomized design, including those which consider genetic predispositions help us to get closer to understanding cause and effect (rather than only association) seem to produce mixed results. For example, this 2016 study which looked more closely at the seeming benefit of coffee consumption on Type 2 diabetes, Alzheimer's disease, and depression found that the effect, if any, was very small, while this 2020 randomized controlled trial suggested higher consumption may actually make risk factors like blood lipids (cholesterol, etc) worse.

Some randomized trials like this one which showed beneficial effects in adults after consumption of either caffeinated or decaffeinated coffee suggest some benefit at least in the short term, while prospective studies which instead of looking backward into the past to find observations, look from a point in time forward have found that a few caffeinated cups per day (3-4) can yield positive benefits somewhere in the 10% risk reduction range but the effect requires something of a "Goldilocks", not too little, not too much (nonlinear) dose.

And still yet, new research out last month and published in the Journal of the American Heart Association found that when blood pressure was already high (greater than 160 systolic over greater than 100 diastolic), consuming more than 2 cups of coffee per day was linked with about twice the risk of dying due to cardiovascular disease as those consuming one cup or less per day; a risk that was NOT present with the consumption of green tea. 

Last, but certainly not least, there's enough caffeine in coffee to have a significant impact on our sleep which DEFINITELY DOES impact our health and ability to fight pain, injury, and disease (such as in this new study)...which showed that when individuals reached for more coffee they had both poorer sleep and more reports of pain.

Confused Yet? If so, you're not alone. The best we can say right now seems to be "it depends" which can be maddening, but is no less accurate. 

In plain English - although it may be a cure for "a case of the Mondays", and may indeed have some minor risk-lowering benefit, coffee is probably not a cure for actual disease. Then again, with the exception of burns, it's probably not the cause of disease either. For those who might fall into a special population (high risk of fracture, uncontrolled hypertension) caution is probably warranted, and learning as much as possible about the condition is likely a good thing. 

Wintertime can have us reaching for coffee more frequently. If we respect it for what it is and isn't, what it can and cannot do, we can stay within the healthy dose. For those looking to maximize current health or minimize the risk of decline, after a cup or two, switching to green tea (or similar) when we're feeling the desire for something warm probably makes good sense.

Have a great weekend,

Mike E.

Dec 23

I was talking to a colleague who lives in the Midwest about his holiday plans. He was excited to be only a few days away from boarding a plane East. Not only was he going to see his daughter, son-in-law, and the first grandchild which was enough to foster the courage to brave holiday travel all by itself, but he was also pretty excited to be leaving plummeting temperatures and wind chills deep into the negative double-digits for highs in the comparatively balmy mid-Atlantic. Fully warranted excitement if you ask me.

And so here we are - the time of year when "Jack Frost starts nipping at our nose", our bodies stiffen (literally) in the face of colder temps and, as we age, our susceptibility to more serious injury/illness/disease goes up. Yes, as we march toward the end of the calendar year 2022, we also march toward the first risk peak in 2023 (winter), which officially started on Wednesday of this week and marks the beginning of a 13-week period when our bodies work a little harder to adapt to the seasonal-stress that cold brings.

If you work in an environment where surfaces freeze, slips/trips/falls may seem the obvious threat and for good reason, however, that's not the only risk we face. We are more likely to suffer from movement-related disorders during the winter and, due in part to rises in blood pressure that naturally occur in the cold, cardiovascular complications are more common in the early winter(December/January) and especially in the week between Christmas Day and New Year's Day as our bodies both adapt to the colder temps and manage the bustle of the season.

So what can we do about it? How can we stay on the healthy side of the risks we face now and all winter long?

Respect the Cold and consider a face covering when appropriate: When body temperature drops things can go wrong in a hurry...and when there's moving air or water involved "cool" is plenty cold enough to cause problems. This is especially true at areas of the body where specialized blood vessels move a lot of blood from arteries to veins (anastomoses). For example, this new research showed that moderate cold exposure to the face caused a blood pressure increase similar to whole-body cold exposure.  

Take time to warm up: When done deliberately, "getting moving" prior to full activity is both simple and effective. By gradually bringing the heart rate up and stimulating blood flow to the working tissues, we can bring the body temperature up and at the same time prime the soft tissues for greater elasticity, all of which can enhance physical performance. A few minutes of MOVE can go a long way.

Warm Up before Bed: When we consider that a slightly cooler body temperature appears to induce sleep, this one may be a bit counterintuitive. Yet the results are fairly consistent - people who get warm before bedtime seem to do better from a health perspective. Take for example this sample of individuals who resoundingly reported better sleep after sauna exposure or this new study from Japan which showed better blood pressure in those who routinely bathed in hot springs later than 7 PM. No sauna or hot springs nearby? Not to worry, this study-of-studies showed that even a 10 min warm shower 1-2 hours before bed improved sleep markers.

The Winter is not coming, it's here. Plan accordingly and stay on the right side of risk.

Have a great weekend, great holidays, and for those who celebrate, a Merry Christmas.

Mike E.

Dec 9

At the time we thought we were on the dawning of a new era in medicine. Now that the human genome project had wrapped up (2003) and gotten us more than 90% of the way to full sequencing, the promise of personalized and precision medicine seemed right in our grasp. It would undoubtedly be a time when understanding, isolating and repairing or replacing high risk genes, was right around the corner. 

Then, less than a decade later, which was about twice the speed that things were getting from the lab to medical practice back then and so, quite fast, a 2010 review in the New England Journal of Medicine pointed to data which showed, outside of very specific single-gene diseases, the direct conclusive evidence for whole system diseases like diabetes simply wasn't there. 

Around that same time, the concept of epigenetics, which is the study of how our behaviors and environment can cause changes that affect the way our genes work, was gaining importance. Simply put, and something we've covered as recently as September in the blog titled "Generational Health", our day-to-day actions and exposures have the ability to turn the "dimmer switch" of our genes up and down (up and down regulate) and maybe even on and off. Said another way, we may have been given the underlying nature for a disease (potential via genes), but how we nurture that nature (our actions/exposures) is critical to what actually happens; a fact that is particularly important in complex situations where it's not a single gene that matters but dozens like metabolic health and disease (diabetes, obesity, and related).

To test this theory even further, researchers from the medical school at Washington State University studied the impact of physical activity in identical twins (same genes), who were raised in the same household but had differing health behaviors and/or lived in significantly different environments from a "walkability" perspective as adults. Their findings, published this month provided further support for exactly how powerful our healthy actions are, in this case recommended physical activity minutes per week (150 moderate minutes). 

The bottom line was that at least 50 different gene-sites known to impact metabolic health were positively impacted from a habit of physical activity. 

Our actions and experiences impact our future health...all the way down to our genes. Make them count.

Have a great weekend,

Mike E.

Nov 25

By now you MUST have heard the news. Gratitude is a powerful emotion for individuals, teams, families, and even corporations. While I'm certain the Thanksgiving story misses the historical mark on more than a few details - it seems the theme, that is, giving thanks, is bigger than most realize - and probably deserves moving from "a" day to every day.

For starters, let's touch on some of the physical health benefits - in a systematic review of the available research published in 2020, a team in New Zealand determined that those who practice gratitude are more likely to enjoy the following:

• Better Sleep Quality

• Better Blood Pressure

• Better Blood Sugar control

In addition, some (although inconclusive) effects on inflammation and physical symptoms appear. But that's not all. 

 Last year, a team looked at a dataset from a University of California at San Francisco study related to stress and blood pressure across nearly 5,000 participants and found that gratitude (and optimism) predicted lower heart rate and blood pressure, better sleep quality, more exercise, less stress, more positive expectations and reflections, and greater feelings of appreciation toward others. But that's still not all...and here's where it gets cool.

This year, another team investigated whether over a few weeks, either "taking a moment", that is, intentionally stepping back from one's day (decoupling) and practicing mindfulness (via a guided meditation) or journaling twice weekly could improve gratitude markers (measured by survey) and helpful behavior (measured by a survey of a coworker). Interestingly, both sub-studies pointed to a similar finding: Achieving a state of mindfulness, prompted greater levels of gratitude, motivation to help others, and, eventually signs of better teamwork. 

Thanksgiving may be a one-day endeavor that features big meals or sometimes entertaining football games. If we let it, it can also be the kickstart we may need to step back, "just be" for a few minutes every day, and, if the research is right, ultimately enjoy better health and more positive relationships with those around us.

We hope your Thanksgiving was a great one.

Have a great weekend,

Mike E.

Nov 11

Boil us humans all the way down and it's really pretty simple, like any system, we are a series of inputs and outputs. On the input side of the equation are things we eat, things we do, things that we are exposed to (even without "doing"), and, at risk of getting too deep, even things we miss/lack or avoid. On the output side of the equation are thoughts, actions, emotions, sensations, and more. Pretty simple. 

Of course, in between the inputs and outputs lies an interwoven, hard to understand, and even mysterious at times "system of systems" - the very definition of complex. The upside is, this gives us plenty to write about each week and with any luck, each wrinkle we can smooth out gives us all a bit closer understanding of how best to care for and maintain it. This week, after an email tip from a reader* and the emergence of a cool new discovery about motivation, we decided to highlight a few cool input/output stories which impact the brain.

First, let's start with another healthy investment of time/effort (input) which has proven to improve our cognitive performance (output) as we age. It's not exercising, nor maintaining a low inflammatory diet, nor getting good sleep this time - although each of those is well proven - this is closer to "brain games", and specifically which have the greatest impact on future brain health. As it turns out (and published here in the prestigious journal NEJM), one and 1/2 years after starting either computerized games designed to challenge the brain or crossword puzzles, the crossword puzzle group outperformed the "games" group on a variety of measures and even saw less decline in the size of the brain in two areas measured (hippocampus volume and cortical thickness). Conclusion? Crossword puzzles were the superior "input" if maintaining healthy cognition is the "output" we're looking for. Open question? Where does wordle fit? Stay tuned, I'm sure someone is studying it.

But what if it's not a knowledge thing - we know what we "should" do - but a motivation thing; we just can't seem to get into gear and do it!? 

Well, according to new research from a team in Switzerland, it seems we are closer to a place to start. In a fascinating twist, the team found that a particular area deep in the brain which is known to play a major role in motivation including rewards/aversions/etc (called the nucleus accumbens), is sensitive to oxidative stress, which, way oversimplified, is the higher-than-ideal presence of toxic cellular waste molecules ("oxidative species"). This discovery led to a simple theory: if substances known to combat oxidative stress ("antioxidants") were more abundant, motivation might increase. 

The research team focused on a potent brain antioxidant, a protein known as glutathione (GSH) which the body outputs from a variety of inputs (spoiler alert, MOVE and FUEL and RECOVER among others). When GSH levels were low in that area of the brain, so was motivation. When they were high, so was motivation. Then, to tease out cause and effect (and this time in rats not humans) they either input a GSH blocker or booster and found that, right on cue, the output of motivation went down and up respectively.

If the outputs matter, so do the inputs. Now is as good a time as any to pick a good one.

Have a great weekend,

Mike E.

*special thanks to Mike W for sending the NEJM article

Oct 21

On average, how many hours of sleep do you get in a 24-hour period? 

Over the last 2 weeks, how many days did you unintentionally fall asleep during the day? 

During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?

These are just 3 of the questions researchers from The Centers for Disease Control and Prevention ask when they poll Americans to learn about sleep habits and health. Unfortunately, despite our growing understanding of how important it is to RECOVER well each day (with adequate sleep as the primary means), their data shows more than 1 of every 3 American Adults are under-rested, which is sadly enough, an improvement when compared to our high school-aged children. If you listen to the experts, like Matthew Walker of UCal Berkeley as he makes abundantly clear across 16 video shorts, getting enough high-quality sleep is absolutely critical to every system in our body and therefore our future health and performance...helping the conversation evolve from one that emphasizes the importance of getting "enough" sleep (7+ hours per night being the 2015 consensus for working adults), to one that dives deeper into the accurate measurement of it and when needed, its improvement.

Like most areas of life, there are both low-tech (waking up feeling refreshed and energetic) and high-tech (measuring brain waves and hormone levels) ways of knowing where we stand. One "real world" method that often gets discussed is the use of an alarm clock and the ever-demonized snooze button; suggesting that when we are fully rested and in the lighter stages of sleep, i.e. closer to the surface, we will wake up without prompting (no bells, songs or other jolts needed) and minimize the risk of feeling extra tired, aka "sleep inertia" if we force ourselves awake during deeper sleep. Some enterprising researchers have even suggested that a "smart alarm" which adjusts wake time to match sleep stage could help. Few however, have taken on the more widely accepted narrative that "snooze buttons are bad"...until now.

Researchers at Notre Dame University followed several hundred subjects for a full year asking them to use a wrist-based wearable that measured their heart rate, tracked their sleep cycles, and measured their steps. They also surveyed them about their use of the snooze button and a variety of other items. 

Interestingly, they found that:

- a slight majority of those surveyed (57%) used the snooze button

- those with a later chronotype aka "night owls" were more likely to use the snooze than "morning larks"

- although those who didn't use/need an alarm at all tended to do a bit better than those who felt they need an alarm to wake, there were no major differences in markers of fatigue (including caffeine usage) between those who snoozed and those who got up on the alarm's first ring

- one possible, although not yet proven, the silver lining for snoozers is that the average total snoozing time (minutes spent in bed after the first alarm) of nearly 27 minutes was within the 15 to 30-minute range most studies estimate that it takes for "sleep inertia" (grogginess and mental fog after waking) to wear off. This raises the question - "are snoozers more alert when they finally get out of bed than non-snoozers?" - more to come, I'm sure.

Here's the bottom line - if we need an alarm to make sure we get out of bed on time, whether we use the snooze or not, we may be under-rested (not ideal) but we are definitely not alone. 

With the sun setting earlier and the temperatures cooling as we creep toward winter, now may be the perfect time of year to get some additional rest. Search for "elements guides" on your client website or click here for more sleep tips from the team. 

Have a great weekend,

Mike E.

Oct 7

It's no secret that I strongly dislike the cold. "Hate" is probably a strong word, but it gets close at times. So when I was invited to headway North into Canada last winter to try my hand at ice-fishing, I made an immediate trip to Cabella's (like the Costco of outfitters for wilderness sports for those who've never been) to find the warmest possible gear they had. I wasn't afraid to look like Randy from The Christmas Story (Ralphie's little brother who could barely move in his snow suit) if it meant I'd be comfortably warm...or at the very least mostly avoid the discomfort of being cold for hours on end.

But what if that cold was good for me? What if the stress of controlled cold exposure actually turned out to be "good stress" that could start a cascade of healthy reactions that modern life in mostly temperature-controlled environments and warm gear has severely limited? What if enduring other stressors that were far more common to the human experience not all that long ago and less likely today could also unlock health benefits? Would we find a way to fit them into our lives?

As it turns out, there are more than a few things that we might consider stressful (and therefore "preferable if avoided") that can have positive impacts on our health; controlled cold exposure is one. In a research review published a few weeks ago, the authors summarized more than 100 studies that looked at the possible health benefits of cold exposure, specifically cold-water immersion, often in the form of winter swimming. Although many of the studies were small, leading them to conclude the effects were, well, inconclusive, there was enough of an effect to consider it promising. In summary, actively-enduring cold as a mechanism to improve health, especially by helping the body convert less healthy (white) fat to more healthy (brown) fat as well as improve cardiometabolic responses, appears to be gaining support. The authors phrased it this way: "Cold Water Immersion (CWI) seems to reduce and/or transform body adipose tissue, as well as reduce insulin resistance and improve insulin sensitivity. This may have a protective effect against cardiovascular, obesity and other metabolic diseases and could have prophylactic health effects.", while also acknowledging "it is clear that there is increasing scientific support that voluntary exposure to cold water may have some beneficial health effects."

Putting ourselves through the challenge of cold is not the only way to ENDURE our way to better health. In other news this week, it appears that combining 2 tactics which, on their own, each appear to improve health increases the benefit.

Time-restricted eating (TRE), which attempts to compress the "feeding window" for the user rather than the energy consumed (calories), specifically to eat all food in a 10-hour window, appears to have several positive impacts on metabolic health. High-Intensity Interval Training, which similarly compresses the time window, in this case of exercise by pairing high-intensity bursts (traditionally 4 minutes of work with a heart rate at or above 90% of maximum) with relative rest periods (2-3 minutes to recover), has also proven to be effective at improving cardiac and metabolic profiles in those who perform it regularly. This week, a study from Norway showed that the combination of the two approaches helped the women who participated to make significant gains in key measures of cardiometabolic health including diabetes risk (HbA1c) and 2 different types of body fat (total and visceral) after 7 weeks.

We humans are amazingly resilient. The ability to adapt to and grow from challenges is quite literally, programmed into our wiring. We call it the ability to ENDURE and believe it is fundamental to flourishing. It appears that environmental and time/intensity stressors, although not easy to handle or particularly comfortable in the moment, when applied under controlled conditions, can be added to the list of ways we get stronger outside of our comfort zone.

Have a great weekend,

Mike E.

Sept 23

Last week we discussed a newly confirmed wrinkle in how food cravings work - that we have 2 unique tracks. The first is driven by the flavors we experience, generally toward the "green light" flavors (sweet, salty, savory/umami) and, at least initially, with caution when "yellow-light" flavors (sour and bitter) are present. The second channel, which has only recently been confirmed applies to our 2 types of energy-producing FUEL (sugar and fat) and appears to be wired to the brain from the intestinal wall where nutrients are absorbed. Even when the "taste" portion of the sensory system is shut off (bred out), mice found their way to the nutrients needed (track 2) in 48 hours and kept going back to get what they needed - a biological workaround in the unfortunate case of a faulty "taste" system.

Simply put, our nervous system is wired to make the hard work of hunting and gathering more efficient, especially in times of scarcity so we are not wasting energy to find energy. However, when we consider this 2 track craving system in the light of our modern food system, with its wide availability of highly flavorful (ultra-processed & hyper-palatable, track 1) foods that are often sugar/fat soaked (energy-dense, track 2), it's not hard to see where things can go wrong. For example, new research out this week showed that if we are anything like the mice being studied and followed our "track-2 craving" for high-energy and infinitely storable fat, within 3 weeks we would begin overproducing inflammatory cells in our bone marrow, which may explain why weight gain is so closely related to low-grade inflammation and the ripple effects which can include heart disease, joint pain, cancer and age-related disease of the brain like Alzheimer's disease.

Of course, a similar "too much of a good thing" path exists for sugar, which also has track 2 wiring. We can pack a fair amount of sugar into our liver and muscles but they eventually get full which, in an oversimplified way, causes a back-up into the bloodstream (one key feature of Diabetes Type 2) which tells the body to begin conversion and storage (high triglycerides, excess weight, etc) which can eventually get us to the same unfortunate place - disease.

So what can we do about this right system/wrong environment problem?

Well, like many challenges we face - we can start by recognizing them and then build strategies that make them easier to control. Here are 3 of my favorites:

1. Go easier on ourselves by being relentless on our environments: This might mean cleaning out that pantry of easy-energy snacks and replacing them with healthier choices so we have to work harder than simply walking across the room to get those track-2 cravings met.

2. Eat nutrient-dense foods FIRST and often: meaning put in the low inflammatory good stuff like fruits and veggies (especially if it is flavorful) to keep track-2 busy working on absorbing all the nutrients present.

3. Train Track 2 with consistency: Like any other nervous system pathway, the "gut-brain axis" is closely related to our wake/sleep cycle (circadian rhythm). Some research has shown that when our eating schedule is disrupted (or lacks sufficient structure and regularity), the gut bacteria that heavily impact the gut-brain axis are also disrupted. Scheduled eating or even time-restricted eating schedules seem to help.

Of course, there's a lot more to it, but if keeping track-2 on track is the goal, it's a solid place to start.

Have a great weekend,