Blog Archives

Apr 12

One of the coolest things about the often long-standing relationships we have with clients is witnessing their families grow up. Although always a reminder of how fast time flies, it's super cool to be hearing about tales of rec-sports or dance recitals one minute and then, in what feels like a snap of the fingers, hearing that the kids are heading off to college or applying for a job "at the company". While most people don't think of the large employer clients we connect with as "family businesses", so often, in fact, they are, with generations of men and women learning the literal "tricks of the trade" from their parents and grand-parents; good jobs with an ever-evolving skill set. New tools and process improvements are tested all the time - and scanning for a better way is all part of gaining a performance edge in the marketplace. Now, while sometimes this means producing more, often it's about producing better - a higher quality product or a better outcome, preferably via a process that is less risky for those "doing" it.  

With that in mind, anytime I see research that points in that general direction, I'm excited to share it. This time, it is about improving health risks today to maximize the next generation's ability to work a full career tomorrow. Taken from a VERY LONG observation of 1200+ individuals, if we want our kids to not have the aches, pains, and illnesses that we are dealing with today, 45 years later the punchline is - "Invest in Fitness", specifically cardiorespiratory (aerobic) fitness.

In the mid-1970's when Finland was starting their "global worst to first" countrywide health turnaround, an amazing accomplishment we've discussed in the past, they began tracking several measures of fitness in school-aged children (12-19 years old). In addition to standard height and weight measurements, and similar to the US Presidential Fitness test from way back when (now the "FitnessGram"), they also included measurements of muscular endurance, strength, and power, using tests like the flexed arm hang, situps, pull-ups and standing broad jump, along with running tests to measure aerobic fitness.

Where it gets interesting is that researchers were able to track down many of those Finnish adolescents when they were in their prime earning years (37-44 years old) and again in their late earning years (57-64). More than 1200 agreed to complete a questionnaire known as the "Work Ability Index" which has been shown to accurately capture a person's ability to be productive at work and also the amount of illness absence they experienced at those times of life.  

After statistical scrubbing to account for known accelerators (like low levels of education and occupations that include heavy physical work) and decelerators (like volume and intensity of leisure time physical activity), they found that only cardiorespiratory fitness was associated with higher future productivity at work and lower odds of illness absence. The researchers concluded, "Enhancing CRF in the first decades of life might contribute to better work capacity and productivity in the labor force, which would have implications for health, quality of life, society, and the economy.".

We don't know what the future holds, but even in a world where computers might do most of the heavy thinking and robots the heavy lifting, it's probably reasonable to assume most of our kids WILL have to work for a living. Nudging their fitness now is likely to be one of the best investments we can make for when that time comes.

Have a great weekend...maybe get out and play,

Mike E.

Mar 29

In an effort to keep it brief - here is a 1 paragraph summary of years of data collection and dozens of research articles...and also something you probably already know if you've read this blog for a while:

Healthy foods, naturally loaded with antioxidants and polyphenols (aka "plants"), when consumed regularly, have consistently proven to enhance human performance -- disease resistance and athletic performance alike. Those with very high concentrations (esp. berries, leafy greens, and beets) have been especially well-studied, and have proven benefits and few (if any) negative side effects. Generally speaking except in rare cases, we should all probably eat more of them.

In truth, there's not that much more to say - lots of good, not much (if any) bad, fairly easy to access and consume so outside of special cases (allergy, etc) we recommend - but for those who are a bit more geeky with this stuff, exactly what these foods unlock is always fascinating. This time, a research team from Canada found that after 28 days of cranberry supplementation (**note** the study team used an extract to more easily control the dose, not the whole fruit), well-trained runners improved their times by nearly 2% in an event that stressed the aerobic system (a 1500m time trial) and had better recovery markers in an event that stressed the anaerobic energy system (a 400m time trial). In plain English, this means that loading up on cranberries, which rank at/near the top in their concentration of polyphenols and antioxidants, allowed runners to go faster for longer during submaximal efforts and bounce back faster after maximal efforts with around the same benefit as several other evidence-based performance enhancing supplements.

Of course, since most people are not "well-trained athletes" and therefore might not even notice a 2% improvement because they rarely (if ever) stress their systems this way, it wouldn't surprise us if this one slides into the "meh, who cares" pile and not the "interesting enough to use" pile of daily information...which, at least in my opinion, would be a mistake. 

We know that the cardiovascularly-taxing heat ramp-up is right around the corner, a drain that most of us will experience as we try to power through greater levels of fatigue during the first few weeks. And since acclimation is slow, but workloads go up fast, we are walking a fine line with our health while doing so. The unprepared among us will be more vulnerable to fully preventable injury (or worse), something we see every year as the temperatures climb. If adding in some fresh and healthy foods now is enough to keep us below the risk threshold during the next 60 days, it's well worth the effort. For those not into the "earthy" flavor of well-studied beetroot juice (sadly, it tastes a bit like dirt), a handful of cranberries (and preferably walnuts + 1-2 cups of spinach, which together makes an easy-to-prep & tasty salad which can be leveled-up even further with added blueberries) can go a long way. So, while the official leap day was last month, it'd be (April) foolish to push off thinking about heat readiness until tomorrow (get it? ). 

We're "there" again, it's time to prepare because with climbing temps comes added heart stress associated with ramping up to meet the demands, something we can not only deal with but benefit from if we respect it. Now is the time for a leap of fitness - healthy FUEL can help.

Have a great weekend,

Mike E.

Mar 15

If you're anything like me, you approached this week with mixed emotions. We lost an hour of sleep but gained more light - which meant dragging into Monday a little more than usual but noticing (and loving) the fact that the sky wasn't dark by dinner time. Light can have a powerful effect on us - uplifting, stimulating and positive when we have the right "dose", preferably from a natural source, and disruptive when we have either too little or too much. For example at least 8 different studies were mentioned here when reviewing light as a factor within the architecture we interface with, and how it impacts our wellbeing. Said more simply, having the "right dose" of light at the "right time", can help us feel AND function better, something we may be reminded of after we adapt to the (rather abrupt) change.

Of course, as we've touched on many times, most of the energy sources that power our physiology work in a similar fashion. The "goldilocks phenomenon" of "not too little, not too much, just right" - applies to all 5 ELEMENTS at some level and shines a metaphorical light one of the principles that governs so much of our experience and achievement - we (do in fact) adapt to the stress we're under, growing stronger when we push ourselves "enough" to stimulate growth, weaker when we don't and injured when we overload or otherwise ignore our safe limits. 

As it turns out, new research on the subject says our happiness works this way too. When college students were taught techniques known to improve well-being in a course called "The Science of Happiness", it worked. 6 weeks after they got started, there were notable improvements in a variety of scores. However, 2 years later when a subsample of the same group was retested, the effect had mostly worn off....with one important exception; those who continued USING what they learned continued to have the benefit, with well-being scores exceeding their peers who had fallen out of the practice. This led the senior researcher to suggest that our mental health functions just like our physical health - much better when we stimulate it:

"It's like going to the gym -- we can't expect to do one class and be fit forever. Just as with physical health, we have to continuously work on our mental health, otherwise the improvements are temporary."

Spring is officially only 5 days away - it's a great time of year to step into the light and "tone up" those parts that might have gotten a little soft this winter - all of them.

Have a great weekend,

Mike E.

Mar 1

When you get a minute to stop what you're doing, take a look at your hands. Seriously, this seemed equally strange to me, but give it a shot. Rest them on a flat surface with all fingers loosely together. Now, counting from thumb to little finger where your thumb is "1" and pinky is "5", take a look at your 4th finger (the "ring" finger) and specifically, how long it appears in comparison to your 2nd (the index finger). Does it appear significantly longer? If so, new research says you might have the makings of a professional soccer player (or at the very least an endurance athlete).

The theory, admittedly oversimplified, is that exposure to high concentrations of particular hormones while developing pre-birth, most notably testosterone, will be reflected in structural differences in our skeletal system which can be measured in the ratio between our ring finger and our index finger. What the research team found was that as the ringer fingers of 133 professional soccer players got shorter (by comparison to index fingers and therefore the ratio got closer to 1 to 1), VO2 Max, the gold standard of endurance capacity, was lower. Said another way, long ring fingers were associated with better aerobic capacity.

Of course, before we go checking our kids and finding a sports agent, we might want a few more answers...to questions like:

Is this real science? Yes, there have been more than 300 studies on this phenomenon since 2020.

Should I believe it? Well....while there are times when truth is stranger than fiction and so open-mindedness, even to the very strange, is probably the best policy, this one seems "unequivocal" at best; which is a nice way of saying it's hardly conclusive and although wildly interesting, not reliable. For example, this 2022 study is one of several that have found that the intriguing conclusions of small studies have not reliably been replicated in larger ones, making it hard to consider this more than an interesting coincidence. 

So while we are very likely to see this research pop up in social media outlets (if it's not there already) like so many others that make the rounds there, for at least the foreseeable future we will continue to suggest exercise to maximize aerobic capacity (and therefore health) and not rely on ring finger length for much more than a fun icebreaker should you need one.

On the other hand, if you use this information to kickstart a global search for the next soccer phenom by examining ring fingers everywhere - remember me when you're famous!

Have a great weekend,

Mike E.

Feb 16

If you're old enough to remember them, you probably didn't think of them as innovators or trendsetters at the time. Yet, these two legends were not only among the first to get comedic mileage out of Arnold Schwarzenegger's signature accent (more than 30 years before the recent Superbowl ad), and likely among the first "stars" to go full groutfit many years before it was cool to do so they were also on the cutting edge of the science of happiness apparently, ready to pump up not only muscles but mood. If Hans and Franz as renaissance men seem outlandish, it did to us too but the coincidences don't lie. As exaggerated and blatantly sarcastic as their version might have been, the idea that pushing our bodies physically can have an incredible impact far beyond fitness and strength gains has a growing research base.

We've previously mentioned this massive review of research which included more than 120,000 subjects. The take-home message, that physical activity performed as well or better than usual care was impressive. To quote the authors "the effect size reductions in symptoms of depression (−0.43) and anxiety (−0.42) are comparable to or slightly greater than the effects observed for psychotherapy and pharmacotherapy (SMD range=−0.22 to −0.37)". In particular higher intensities seemed to hold great promise and, as shown in August of last year, resistance training may play an important role. This study showed a clinically significant mental health boost almost immediately and again between 4 and 8 weeks for individuals doing resistance exercise a few times per week for 25 minutes per session. The exact mechanism driving the benefit hasn't yet been determined, but the authors concluded that the effect wasn't due to strength gains alone. Then, earlier this month another review of the available research made it clear that muscle-loading activities like resistance training hold great promise for lowering anxiety and depression, and improving wellbeing. 

Life throws curves. There are ups and downs around every corner. It's hard work to ENDURE. While we certainly don't have to have a terminator's physique, an all-grey sweatsuit or even log hours in the gym to pull it off, pushing some heavy things around can have an impressive role in pumping us up - in body, mind, and mood. If you haven't in a while, it's a great time to start. Let us know if we can help.

Have a great weekend,

Mike E.

Feb 2

In an effort to get the most from my professional knowledge/skills and give back when possible, I coach youth sports, primarily competitive high schoolers. It is one of those perfect challenges - frustrating enough of the time to hold teachers who do it 8 hours per day in very high regard (as I question if it's worth the effort) and yet amazingly rewarding when the kind of breakthrough which radically changes the trajectory of someone's life occurs. Sometimes the breakthrough is in the sport but most of the time it's due to lessons where sport mimics life. "Consistency beats Intensity" and "work smarter, not harder" have been two particularly grueling lessons over the years. The idea that the climb from a current level to a desired future level (i.e. "change") is something that is most often achieved with patience and a process similar to painstakingly adding coats of varnish to wood or clear coat to a custom paint job like that which was said to be used by Da Vinci when creating The Mona Lisa is not a particular favorite at a time of life (or a time of the world) when just about everything is available instantly, on-demand. You can imagine how much of a boost it can be therefore when we find situations that don't necessarily behave that way, when change happens quickly.

Last week we talked about one such scenario - the "warm-up" effect - and how powerful it can be for those willing to invest a few minutes in readying their physiology for action. Of course, this isn't just for adult bodies - we know that a similar pattern of priming for young athletes can reduce the incidence of serious injuries like ACL tears (example 1, example 2) in those who complete it, something I've seen first-hand both positively with low injury rates in those who take it seriously and negatively with serious, yet preventable injuries in those who do not. However, changing the MOVE inputs to get better or safer outputs is not the only domain that responds quickly. How our bodies respond to changes in FUEL inputs does too. Some great new preliminary research out this week showed that from an immune system perspective, significant change can happen in as little as 2 weeks with different outputs resulting from changes to inputs.

Specifically, the research team showed that across an age range of 18 years to 50 years in a tightly controlled setting, there was a consistent change in how the immune system responded to differing diets. When participants were given a low-fat vegan diet for 2 weeks, their "first line of defense" (innate immunity) ramped up, while when they ate a high-fat/low-carb ketogenic diet for 2 weeks their "next line of defense" (adaptive immunity) ramped up; this is both impressive and fast. On the other hand, many studies have shown that those who apply the "layered", slow, and steady approach can also have great benefits. One of the most recent showed across a sample of more than 100,000 individuals, a healthy diet tracked closely with better metabolic health which was not super surprising, especially in light of this one which reviewed a bunch of the "how" and "why".

When we boil it all down one of the big takeaways is something we all inherently know and use every day to survive and (hopefully) thrive: change is fast...slow...and always. We constantly react to subtle changes in our environment (homeostatic) and, since certain things have to be very fast to keep us alive we even "predict" and anticipate when it benefits us (allostasis). Those systems can definitely get off track if we don't provide them the right support. Still, perhaps one of the reasons we have examples of humans thriving in nearly every imaginable environment (and some that seem unimaginable) is because, not unlike the way our "dual process brain" was described by a Nobel prize winner in 2011, our entire system is uniquely purposed for the demands of a "both and' world. If we take care of it, it works well.

This is the time of year when an immune system "boost" could be very valuable. Start today and you'll be hitting the winter homestretch STRONG.

Have a great weekend,

Mike E.

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 10

We call them the ELEMENTS; those fundamental health-related power habits that lie at the roots of human thriving. We've been talking about them for years, decades even, but it still never ceases to amaze me how interrelated they prove to be. They don't come with complex rules per se, and there aren't many of those when it comes to the human experience, but for those who balance them well, the odds of living a long and high-quality life are both consistently and significantly better. 

This time of year makes it particularly obvious. This weekend many of us will once again subject ourselves to a long-running "natural experiment" where we abruptly cut one of these power habits and face the possibility of rather grim results of doing so, a nearly 25% increase in cardiac events the following day. Yes, "Spring Ahead" and the associated sleep loss brings some risk if we don't respect it, but it also presents a great time to talk about the other side of the coin, how much we can gain if we do. 

Good sleep not only boosts our immune system and reduces our risk of emotional burnout, but it also improves our capacity to learn and perform cognitive tasks. But that's not all. New research presented at the American Heart Association Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023 showed that it also increases the likelihood that we will stick with other healthy habits. A team from the University of Pittsburgh built on previous research which showed that individuals with healthier sleep patterns were more likely to lose weight and body fat than those with irregular or lower quality sleep to show that good sleep was also associated with a higher likelihood of sticking to diet and exercise programs.

Although it may still seem a bit of a chicken and egg - should we eat better and exercise to improve sleep or focus on better sleep to help ourselves eat better and exercise? The answer seems to be "YES". RECOVER matters and our principal way of ensuring it is good to sleep. Protect it.

Have a great weekend,

Mike E.

Feb 24

In case you missed it, last week we poked at the idea of a "threshold dose" - the amount of exposure to any one thing that is beyond our capacity to safely absorb and therefore begins the transition to "harmful". We used alcohol as an example because it is both a common exposure (about half of American adults consume it regularly) and an evolving topic, with authorities like the World Health Organization leading the charge to move away from a "moderation" message, which may have seemed appropriate if the primary goal was avoiding liver-disease (like cirrhosis) or possibly addiction, and toward one that considers a broader range of risks (such as cancer, gut-health, sleep-health, etc) and ultimately concludes "there is no safe amount".  

But is alcohol the only common risk factor that is getting a threshold update? 

Although few are getting quite as significant a messaging makeover as alcohol, there are always new findings emerging that help to dial in our understanding of where the risk threshold exists. For example, by 2004 when the unscientific (and sometimes criticized) documentary Super Size Me was released, it was probably fair to assume most people already knew that eating fast-food 3 times per day wouldn't do good things to our health. It's probably equally reasonable to assume that by the time this 2011 study was published, most people weren't surprised that the more frequently a person consumed fast food the more likely they were to be overweight. On the other hand, the link between fast-food consumption and other, less obvious conditions like asthma (as linked in this 2018 study) or even self-harm (as linked in this 2020 study) beg us to dive deeper and ask what types of reactions these foods are triggering. It's possible that like alcohol, as found in this 2021 study, consuming fast foods can foster a higher-inflammatory environment in the gut which sets off a series of reactions throughout the body. The odds of having back pain, for example, are higher in those with poorer diet quality.

Although we are not nearly as clear in our understanding of the risk threshold, new research from a team at the University of Southern California may help point the way. As it turns out, non-alcoholic fatty liver disease, an increasingly common (1 in 4 adults globally) and even life-threatening condition which is marked by having fatty deposits around the liver was far more likely when individuals consumed more than 20% of their daily calories in the form of fast-food. The risk was particularly significant in those individuals managing diabetes or obesity, but still present in otherwise healthy individuals of normal weight. In plain English, this means that if even one meal per day is fast-food, we are likely beyond the risk threshold.

It's not a closed case. We will almost certainly learn more over the next months or years and the message will continue to evolve. Until then it seems safe to conclude that when it comes to the relationship between our health and the drive-thru or kiosk, "less is more".

Have a great weekend,

Mike E.

Feb 10

"On average over the last 6 months, how many hours of sleep did you get in a 24-h period?" 

This seems like a simple enough question, the results of which might create something close to a bell-shaped curve (aka "normal distribution") where most individuals fall into the middle, aka "healthy" range of 7-9 hours per night and relatively few sit at the higher or lower extremes. Thankfully, when researchers look across large samples of working Americans, they mostly find this to be the case.  For example in this 2016 study, 65% of those surveyed reported healthy sleep duration, which is very close to the 68% expected in a normal distribution. However, not all sub-populations fall into this pattern.

For example, shortened sleep is more common in certain industries such as those with around-the-clock operations or the need to respond to emergencies. Given that shortened sleep is known to predict occupational injury, this can be a particularly important risk factor. Since the US military has a large contingent of personnel who both experience high occupational demand risk and high ergonomic risk (physical work, fast paced, etc), they are at particularly high risk. However, given their extensive recordkeeping, their experience also provides an amazing learning opportunity for the rest of us.

To that end and over the last several years, the US military has become a great source of information that relates to the role sleep plays in resilience/readiness and even soft-tissue (musculoskeletal) injuries, something that has helped our team as we continually work to unlock even more risk-reduction and/or performance boosting tactics that can be leveraged for our clients. This month a research team who analyzed information from more than 20,000 service members across all four branches (Army, Navy, Airforce, Marines) found yet another important link to sleep. Not only was a link between shortened sleep and injury/illness/disease present even after statistically ruling out other contributing factors, but it was surprisingly large.

When they compared those who reported the shortest sleep duration (4 hours per night or less) to those who reported the longest (at least 7 hours per night), the odds of more than 75% (25 of 33) major medical risk categories were higher in those with short sleep, with 5 in particular seeming to jump off the page.

Individuals with the shortest sleep duration were:

• Nearly 3x as likely to have a nervous system disorder

• 2.7x as likely to have a mental health or behavioral condition

• Nearly twice as likely to have a musculoskeletal/soft-tissue injury

• 1.7x as likely to have a circulatory disorder and

• 1.6x as likely to have a digestive system disorder

If that leaves you saying "wow", us too.

There is of course more to learn, but the take home message seems clear. Our bodies are incredibly strong and can do amazing things...HOWEVER, even in those who regularly perform heroic acts, not without rest.

Work hard. RECOVER well. Your body will thank you.

Have a great weekend,

Mike E.

Jan 27

Last week we discussed new and fascinating research that holds great promise for the "non-exercise intense movers" - those folks who may not formally use their leisure time to play a sport or go to the gym, but still can get many of the associated health benefits (as measured by risk reduction of dying of any cause, cardiovascular disease, and cancer) because, in their normal day to day, they get "enough" - which turned out to be at least 2-3 bursts of intense physical activity (+/- 75% of their max), lasting 1-2 minutes each. Sure there are many benefits of leisure-time physical activity (aka exercise) and this couldn't account for all of them - for example, the "stress melting" benefit of a planned hike or the positive mental health benefits that accompany the achievement of some new feat  - but, the big win, significantly less risk associated with 2 of the top health risks we face, in a few minutes per day, is certainly powerful.

For many, however, it's not an either/or but a both/and. These are people who both love to compete, feel great when deliberate exercise is part of the day, and want to make it a priority but often feel strapped for time when they have the energy and sapped of energy when they have the time. For people like this, whether it's a few hard efforts in a stairwell or push-ups by the side of the bed, there is something powerful in knowing that a few minutes can go a very long way, since many of the great health-promoting benefits from exercise come front-loaded in the first few minutes.

But what if it's not a cardiovascular or anti-cancer benefit we are looking for? What if it's brain health we are after? Can we fend off diseases of the brain similarly to how we appear to be able to fend off diseases of the heart? According to a new small study from a team in New Zealand, the idea has merit.

Building on research which showed that under the right conditions, even a single bout of moderate-intensity exercise (30 minutes of brisk walking for example) could stimulate the brain to produce greater amounts of BDNF (a protein that is critical for its role in brain health and repair after injury), the team compared a variety of exercise protocols. While low-intensity physical activity (light pedaling a stationary bike) showed some small gains, max-intensity interval bursts (pedaling as hard as possible) lasting 40 seconds and repeated 6 times, almost the exact same "dose" as the incidental bursts we reported on last week (3-6 minutes of high-intensity work per day), more than quadrupled the effect.

Simple and quick, but definitely not easy.

Here's the good news: even the busiest among us can likely invest 6 minutes in our health...which is enough to cut our heart, cancer, mortality, and now brain-health risk. Not too shabby.

Have a great weekend,

Mike E.

Jan 13

Imagine tracking the habits of thousands of people over the course of decades. What they ate, what they drank, if they smoked, if they exercised, and more. Although never perfect (as nothing in the real world is), it could tell you quite a bit about which combinations and patterns seemed to have helpful and harmful effects. In essence, this is what large studies like the "US National Health Interview Survey" and the "Nurses' Health Study" attempt to do. They track thousands of people across decades resulting in millions of "person-years" and an important set of links between behaviors and long, healthy lives lived.

In October of last year, such a study was published. It looked at the health impact of smoking, specifically the risk of dying during the study period, which has been studied and published many times. The twist in their research was that they attempted to determine whether there was a benefit in quitting and if so, how much. Of course, the answer was generally what most people expected - yes, there was a benefit in quitting. However, the surprise came when the numbers showed exactly how much benefit existed. While compared to non-smokers, those who smoked throughout their life were MUCH worse off than non-smokers (3X more likely to die), those who quit before midlife, age 45 in the study, did FAR better, having only a 15% risk increase over non-smokers. All hope is not lost for those over 45, there was a benefit in quitting at any age, but quitting earlier than midlife was especially powerful as the effect was less as study participants aged.

In a similar way, a study published earlier this week compared healthy eaters (defined as being in the top 1/5th on one of 4 healthy eating indexes) to those whose eating habits were considered unhealthy (bottom 1/5th of the same indexes). After crunching the numbers of 70,000 women and another 40,000 men who were followed for decades, the research team concluded that on average, the healthy eaters enjoyed an 18% risk reduction compared to those who ate poorly.

Although these kinds of studies are never quite apples to apples, it is fascinating to think about these risk factors side by side as it should give both hope to smokers who are trying to quit AND provide a stern warning to those who think they can wait to start eating healthy. 

If we had to dream up headlines for these studies they'd be pretty powerful - the data of one would suggest that "quitting smoking before midlife can remove almost all the mortality risk" (all but 15%), while the other could tell us "eating poorly can be as risky as smoking for 1/2 your life".

Which is better? Well, both of course. But the best news is, either can make a difference, and now is a great time to start.

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 28

It's a bit like the financial planner who tells the story of the person who chose to "set it and forget it" - that is, automatically withdraw pretax money from their paycheck each week and let it use the power of compound interest over time. The conclusion is almost always an impressive nest egg by retirement. 

Or maybe it's the story the seasoned coach tells of the (rare) athlete who simply "trusted the process" and logged the training hours even when "base" training seemed too easy to do anything or "breakthrough" sessions seemed like punishment.

The moral of these stories are shockingly similar - slow and steady wins the race, the tortoise often beats the hare, consistency beats intensity, and the "tried and true" got that way for a reason.

With that in mind and in light of 3 new studies that came out this week which reinforced a few of those tried and true concepts, here's what you need to know:

(1) When it comes to MOVE - something is infinitely better than nothing. As shown in research from a group in Canada, "activity snacks", that is, short bursts of movement to break up an otherwise sedentary day, especially when timed after a meal, are surprisingly powerful. The team tracked a blood marker that signifies whether food is being used by the muscles in a healthy way under 3 conditions: sedentary (no activity snacks), air squats (do a sit-to-stand using only bodyweight 15 times every 30 minutes), and walking (brisk 2 min walks every 30 minutes). When it came to the results - squats were better than sitting and walking was the best. Headline? Less than 5 minutes of movement every hour significantly changes how our bodies use fuel.

(2) In the FUEL category - another tried and true message bubbled up to the top of the pile this week. Maybe you've heard us say (over and over and over) to "eat more plants". Of course, we are quick to point out that this is a general statement for "every person" and maybe too general for some. However, the concept is simple and holds true for the vast majority - when we put a little bit more of the inflammation-lowering, gut-health-promoting fiber, which comes from plants, and many diets lack, we get health benefits. As it turns out, for those who don't eat much fiber, "more" could be as small as 2 servings of almonds per day. Researchers from London asked study participants to try it using 56 grams of almonds, either whole or ground, and compared a key indicator of their gut health (butyrate) against a control group. The almond eaters fared significantly better. Of course, it's unlikely that almonds are the only food giving this result but there's certainly more to come. Headline this time? If you're not getting enough fiber, even a little effort can go a long way.

(3) In regards to RECOVER - duration matters. Once again research has confirmed that short sleep at midlife is linked with chronic disease as we age. A team in London confirmed that individuals who routinely slept 5 hours or less per night at 50 years old were 20% more likely to develop a single chronic disease in their retirement years AND up to 40% more likely to develop two or more (termed "multimorbidity") than those who routinely got at least 7 hours of sleep per night. Sleep is one of the most important health tactics we have - we should probably treat it like our (quality of) life depends on it; it does.

If you're already doing these things CONGRATS....keep going. If not, maybe it's a great time for an experiment to see if the tried and true can work for you. Good luck and let us know if we can help.

Have a great weekend,

Mike E.