Blog Archives

Sept 22

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

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

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

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

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

Have a great weekend,

Mike E.

Sept 8

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

"Let Food Be Thy Medicine"

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

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

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

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

Have a great weekend,

Mike E.

Aug 25

It might be one of the simplest and most straightforward health risk screenings. Place a couple of fingers on an area of the body where a pulse can be picked up (wrist and side of neck being the most common) and pay attention to the rhythm of the heart rate after a person has been resting for a few minutes. The expectation is that it is both steady (beating at regular intervals) and if counted, within a normal pace range, such as 15-20 beats in a 15-second period (60-80 beats per minute). 

But what if it's not? What if instead of "beat, beat, beat" we feel "beat, beat, long pause, beat"? Is there cause for concern?

The short answer is, not always, but quite possibly because, as far as simple clinical tests go, a manual pulse check has a surprisingly high "true positive" rate and so when something is "off", it's probably worth running a few more diagnostics to find out why.

According to the CDC, Atrial Fibrillation, the most common type of heart rhythm disorder (arrhythmia) impacts around 12 million Americans and is a major risk factor for stroke and other cardiac events. Interestingly, it also tends to go hand in hand with other health risks, most notably musculoskeletal health concerns, which add the heaviest burden on quality of life in those with the problem one key reason they are often the primary target of our efforts. Interestingly, there also appears to be some evidence that conditions (such as autoimmune disorders) and habits (such as a pro-inflammatory lifestyle) that relate to high levels of inflammation (reference 1, reference 2) may be possible triggers for the disease's onset.

If this is the case, we would expect the same levers that work so well to lower inflammation and musculoskeletal pain risk (like eating a healthy diet and getting proper sleep) to also lower the risk of developing A-fib. Although not conclusive, a study of patients being treated for the condition revealed lifestyle-related health risks in most, and a 2022 study on the often touted Mediterranean Diet appeared to point in a similar direction.

Exercise on the other hand can be a bit more complex. While the evidence strongly supports general fitness to lower the risk of cardiovascular disease (including heart rhythm disorders like a-fib) with almost all studies concluding "more is better", there does seem to be a ceiling where too much can be too much. Elite Endurance athletes and those who train like them may be increasing the risk. On the other extreme, the "minimal dosage" required to maintain health and prevent disease has been a little less clear...until this week.

Deep in the halls of the European Society of Cardiology Conference in Amsterdam, a poster presentation by a team from Taiwan shared a very interesting discovery - individuals who had at least moderate fitness, defined as "achieving 8.57 to 10.72 METS" on a treadmill stress test had a 98.4% likelihood of NOT developing A-fib in the next 5 years. Interestingly, those with high fitness (>10.72 METS) had exactly the same risk...i.e. no substantial risk-lowering benefit above around 11.0 Metabolic Equivalents of Task (MET).

Translated out of exercise-physiology speak and into plain English - having enough fitness to complete activities and tasks that use 11 times the effort required to sit in a chair almost guarantees our heart will stay in rhythm for the next five years. It also adds that having more than that, although great for many things, is not particularly helpful for this thing.

What is an example of such an activity?

Well, according to this extensive list, running a 9-minute mile, cycling between 15 and 17 mph, rowing at somewhere around 175 watts or competitive-level ballroom dancing would all do the trick!

May we all have the rhythm and timing of a dancer, especially at the most important metronome of all - our heartbeat.

Have a great weekend,

Mike E.

Aug 11

Although it wasn't always as widely accepted as it is today, the fact that adequate time to RECOVER each day is critical to our future health doesn't seem super provocative or even controversial these days. Although sleep is not the only way to recover, we can't live very well without it; and both quantity and quality matter. Whether in the context of injuries, illnesses, accidents (motor vehicle and/or work-related), or disease - good sleep predicts good health - an idea that is taking root with more and more folks and supported by extensive research that is uncovering what matters most and why. While "7-8 hours of uninterrupted sleep" continues to be the gold standard for most adults we also know how fast we fall asleep (latency), how rested we feel when we wake, whether we need an alarm to get going, and if we are sleepy enough to "nod off" during the day, can all provide clues as to whether our sleep is of high enough quality to actually RECOVER. A growing understanding of sleep's "stages" (in part from the wider use of wearable sensors that track heart rate and movement) has helped more people understand their personal patterns and risks.

At the same time, and on a track that turns out to be more parallel than we ever knew, other researchers have been working to decode the "the largest endocrine organ" (gut microbiome) - something that was first mentioned as early as 1988 but now more than ever is being recognized as a critical factor in our health. Like sleep, it appears to impact many disease risks that were previously not thought to be related. One of the key learnings so far has been that microbial diversity (having a gut populated with a wide variety) is generally a good thing.

While our food choices likely have the most direct influence on our gut health (as previously mentioned, consuming a variety of plants each week appears correlated with the greatest gut diversity) they are not the only influencer. We know that our exercise habits impact our gut makeup and other system-wide "stressors" such as alcohol (consumption or abstinence) and possibly even early life stress can play a role. Sleep health makes the list here too. The bottom line seems to be that although it is often easier to separate our day-to-day actions, the various environments we spend time in, and the body systems they impact into neat little compartments, they're actually all connected. 

As messy as "it's all connected" might feel, the beauty of interconnectedness is that when we start doing something positive for our health we get a multiplier effect down the road. People who start to eat right often find it easier to exercise. People who quit an unhealthy habit often unlock the energy to replace it with a good alternative. Last week, as published in the European Journal of Nutrition, a consistent bedtime appears to have this power. 

A research team discovered that small alterations in our sleep/wake routine (which they called "social jet lag"), such as "sleeping in on the weekends" results in changes in both our dietary habits and gut diversity. Individuals who had more than a 90-minute change in their sleep pattern, even if they got the same number of total hours, (e.g. sleeping 12A-8A on the weekends instead of a typical 10P-6A weekday routine) tended to BOTH eat differently AND have alterations in their gut biome. It wasn't clear if one "caused" the other, but it adds a new wrinkle - not only are they "all connected" but the crossroads of health may run through the gut.

Respect the routine - bedtimes are not only for the kids these days.

Have a great weekend,

Mike E.

July 28

I can't remember exactly when "engagement" became something of a buzzword. I remember sitting in a meeting with an employer client many years ago (maybe the early 2000s) as someone from human resources reviewed the results of the recent "employee engagement survey". Soon after, it seemed like the term was everywhere, being used as a way of describing whether people felt connected to whatever it was they were doing - in this case their work. 

The Gallup Organization, well known for its analysis and insights from surveys around the world, started diving into the idea and tracking the information needed to connect the dots. The results were stunning. The current global average for example is 23%, meaning more than 3 out of every 4 people do NOT feel energized and excited at work. It's as if somewhere around the turn of the century a societal switch from viewing a career as a "life's work", something that added to the greater good (and gave meaning and purpose along the way) to a "grind", where people traded irrecoverable personal energy for a paycheck, was flipped. 

Since that time many groups, teams, and organizations have begun working to understand and improve the human connection, whether at work or at home. Articles have been written on how to instill engagement, what the best in the world like the Navy Seals do, and how the best-in-class organizations (where the average is 72%) are both more productive and happier. It has played a role in stoking a larger conversation, awareness, and research agenda of how far it all goes and what can be done. 

A few weeks back we discussed a recent surgeon general's report which raised the flag on the health implications - which are substantial - and since then, we've spent some time diving into some of the latest research in hopes to get closer to the roots of the problem. A few recent studies have helped. Here are the critical take-aways:

One size doesn't fit all - taken from some very interesting research on the multi-sensory social and sales experience customers receive at Canadian wineries, a research team showed that different people have different needs based on their comfort level with the situation, in this case, novice, expert or enthusiast. For the novices, i.e. those attempting to engage, the basic requirement for success was human connection. In the press release, the first author was quoted as saying "The answer is quite simply connection. People desire connection to enhance their experience...". Well said.

Well-being is the end result, but trust gets the ball rolling - two new studies, 1 from earlier this year and another from last month helped to make the pathway clearer, in a sense by walking backward. Starting from the end goal, "well-being" (which includes positive mental health, happiness, etc.), the researchers in the first team showed that engagement, in technical terms "social participation", was a critical first step but that participating alone wasn't enough. Like the winery experience, a sense of belonging and connectedness was required to lead to well-being. The second study went 1 step further and showed that before participation, and therefore at the very root of engagement, sits trust. Specifically,  individuals who generally believe that the people around them are reliable and would act in their best interest are more likely to engage, connect, and ultimately enjoy higher levels of well-being.

Whether part of a work team, a family, or a community group the people around us play a major role in our health and safety (as we do in theirs). Those who are energized, focused, and find enjoyment in whatever they are doing are not only more productive, they tend to be healthier and safer too. Not surprisingly it's a two-way street, those who take healthy actions tend to find enjoyment and happiness.

No matter why we're traveling, if point A is trust and point B is well-being, CONNECT is the bridge. The stronger we build it, the more traffic it can take.

Have a great weekend,

Mike E.

July 14

Simplicity is so refreshing. It's clean and easy to apply. Of course, it's also really hard to find in real life, since the world is complex. The more we dig, the more nuance we find which can be tiring; so tiring in fact, our mind tends to avoid it, instead reducing complex information into more simplistic terms, "one OR the other", "yes OR no" saving "both-and" for when we have the time, energy and open-mindedness to really dig in. Psychologists call this tendency of reducing large streams of information into 2 fundamentally opposing camps "The Binary Bias", and it turns out, despite failing to capture the gradient of real life, to be super common across a wide variety of situations.

When it comes to health information, this tendency often surfaces. It is MUCH easier for us to "pick a camp" than it is to sift through the details where we often realize there are always caveats and contextual factors. For example, a recent study once again showed that exercise was a good thing at midlife from a heart health perspective. No surprise. However, it also showed that too much of a good thing could be not-so-good. High amounts, at very high intensities, were actually associated with worsening of the same heart risks that the proper dosage helped. So exercise is good? Yes, but...

Nutrition tends to follow these same lines. Can healthier eating make a difference to our future selves? Of course, but "healthier" is a very wide spectrum and never as simple as we'd like. With that in mind, we tend to gravitate toward tried and true principles, rules of thumb that work for most people in most situations. If you've heard us say "Eat More Plants" for example, this is why. While neither prescriptive nor applicable in every situation, it simplifies A LOT of the available research, including the 2018 conclusion from a massive dataset that showed that individuals who ate 30 different plant varieties per week had the most diverse gut biome, an important marker of health. It boils down a ton of information into an easy-to-understand concept that is applicable to most Americans while avoiding the tendency to simplify things into "good vs. bad". Every once in a while, however, new information emerges that helps us take the concepts even further. In this case, it comes from the PURE study, a very large study that tracked nearly one-quarter of a million participants across 80 different countries for a decade or more. It showed that, in general, "Eat More Plants" holds true and is good advice for the masses. It also showed (however) that to get the most health benefits the variety and dosage of those plants matter and certain animal-based foods can also provide benefits. 

In an effort to simplify what we know about healthy eating, the researchers categorized and scored foods into 6 types & dosages, assigning 1 point for each. Compared to those who scored only 1 point, those who consumed enough of the good stuff to score 5 or more points on average were substantially healthier, cutting their risk by more than 20%. 4 of the categories are plant-based and 2 are animal-based. 

The scoring is as follows:

Fruit - give yourself a point if you consume 2-3 servings per day (juice does not count)

Vegetables - give yourself a point if you consume 2-3 servings per day

Legumes - give yourself a point if you consume 3-4 servings per week

Nuts - give yourself a point if you consume 1 serving per day

Fish - give yourself a point if you consume 2-3 servings per week*

Dairy - give yourself a point if you consume 2 services per day*

*In a press release the author of the study suggested that the same health outcomes gained with moderate amounts of fish and whole-fat dairy can be achieved by moderate consumption of meat and grains, "as long as they are unrefined whole grains and unprocessed meats", each at 1 serving per day,

Eating to prevent disease is not simple. There are many moving parts. However, the more we learn the simpler it gets. Perhaps the very best news is we don't have to be perfect - 5 out of 6 is 83% - and for each point gained, a significant risk reduction is noted; 6% for major cardiovascular events and 8% for dying.

The gardens are popping everywhere, enjoy the bounty and the better health that comes with it.

Have a great weekend,

Mike E.

June 30

"The best part of being a small business owner is the freedom, you get to work 1/2 days...any 12 hours you want...and only on days that end in 'Y'."

 It might have just hit me at the right time of life to make it perfectly relatable, but, delivered with just enough of an eye-roll to make it funny, that phrase became an instant favorite, one I often use to explain a "typical day". Of course, it's not limited to those of us who work in small businesses. From commutes to actual time on-the-job to off-hours communication catch-up and prep, when asked, most people feel they spend most of their waking hours at (or around) work. The statistics seem to support the idea. According to the Bureau of Labor Statistics in 2022 during the work-week, American adults spent on average up to 5 hours per day on "leisure time activities", that is "time not working". 

The good news is, that's about 20% of a day, enough time to be powerful if invested wisely. The not-so-good news is that most of those hours were spent "watching TV", which, although not clear exactly why (likely its sedentary nature), appears more likely to be harmful than helpful to health, especially as the daily dosage increases. What if, like money, we could "invest" some of today's "little bit extra", in this case downtime, in hopes it too would grow for when we really need it in the future. Is it even possible? If so, how much would we need to invest and which "vehicles" would promise the greatest return? Are there any ways to make "automatic investments", like deducting a certain amount before it "hits" the paycheck?

We're closer to the answers than you might think.

First, the more we learn about how the body ages the more we realize how much power over our lifespan we really have. We can't outright slow time and add hours to the day just yet, but as measured by its imprint on our "epigenetic clocks" (in technical terms DNA methylation)  we can slow time's day to day impact and therefore extend both our number of days and how much we can get done in each of them. More simply, it appears we can slow the rate at which we age more than we ever thought and so, yes, our time investments can indeed grow and pay off. 

Next, not unlike financial investments the "return" is heavily impacted by both the amount we invest and how consistently we do so. A small but regular investment definitely can add up if put into the right portfolio. For example, we've mentioned the power in even a few minutes of MOVE each day in an otherwise sedentary life, but that doesn't change the fact that for most people, as outlined in this 2020 paper, more is usually better.

Last, automatic financial investments are held in high regard for a reason, they tend to work; quietly growing our assets in the background, even without a lot of active energy on our part; set it and forget it. Although most investments in health are active processes, there are a few time investments that appear to, like the magic of compounding interest, pay health related dividends automatically, even when that isn't what we set out to do. Near the top of the list? Volunteering. 

According to a study from a team of North American researchers published a few months ago, volunteering appeared to decelerate the epigenetic clock (loosely, slow the rate of aging) in a sample of more than 4,000 American adults. It's too early to tell exactly why, but the effect was real enough for the researchers to call it a "potential resilience factor for aging biology".

Whether it's getting ready for someday or in the moments we hope to savor when someday arrives, we could all probably use a little more time. Invest wisely.

Have a great weekend,

Mike E.

June 16

I had a little time to get out and do something I haven't done in too long. The simple act of putting one foot in front of the other, sometimes fast enough to be running, sometimes not, mostly away from the rest of the world and listening only to the sounds of nature. It was refreshing. My thoughts were clear, my body was "good tired" and I felt more like myself than before I set out; a great reminder that I was missing being "out there" more than I realized.

Whether it's a hike in the woods, an occasional trail run, a jog through town or just a stroll around the block, getting out and moving with no particular agenda is one of the surest ways to reset for me - and according to the research, it's probably the same for you.

We've known for a while that walking (and other forms of aerobic effort) can be a great creativity hack. A 2014 study out of Stanford really just validated what some of history's greatest thinkers, innovators, and artists had known from experience for centuries - movement, especially walking, stokes the brain. We also know that doing it "out there" seems to have additional benefits. Although some research suggests it's the sounds of the natural world which make the biggest contribution, there is still a lot of learning to do. An article published late last month in the American Journal of Lifestyle Medicine even suggests that it is the "7th Pillar of Lifestyle Medicine", an effect that may be particularly powerful on blood pressure and stress levels (as measured by cortisol) for urban residents.

But do you "have to" immerse yourself in the forest to get benefits? Of course not. The list of beneficial effects of moving in almost any way in almost any place is too long to fit into one blog. However, new research out this month adds a cool one that is worthy of mention - movement helps the functional connectivity (loosely defined as "organization of the circuitry") of our brain, even into later life and even in the case of mild impairment. This is not a small thing. We may not be gaining many new neurons as we age (especially if struggling to sleep), but we can stimulate those we have and it's not just puzzles and brain games that help.

If you're not already, it's a great time of year to nudge those moving tissues into action. If you wind up writing an amazing symphony or literary work or taking our understanding of unified field theory to the next level, just tag us in your social media post! :)

Have a great weekend,

Mike E.

June 2

It was hot outside over Memorial Day weekend but the family-project-plan said I pulled landscaping duty. No worries, I enjoy both being outside and the feeling of accomplishment after each evolution of the slowly moving but never-quite-there-yet backyard project. As the days wore on and I guzzled more water than I could count to try to stay hydrated, I was faced with the dilemma many of our clients face - what to drink when you need more than water.

For some, it's an "electrolyte dilemma" - how to replace the key salts we lose in sweat so as not to also lose our physical capacities along the way. For others it's a "flavor dilemma" - how to find something that changes the sensory experience; to keep the refreshing, thirst-quenching, and easy-to-process benefits of water while adding a little something to stimulate the taste circuits. For others, including me at the time, it was a "little bit of everything dilemma" - as I was losing enough fluid to dehydrate, was trying to avoid breaks to eat to ensure everything would get done, and therefore was running a little low on fluids and the sugar and salt required to FUEL a long day in the sun.

With that in mind, I opted for one of my favorite flavored vices, something I've consumed "flat" in the later stages of triathlon, in the ice-slurry form after a beach day, and as the occasional mixer-of-choice in various social settings. It's loaded with sodium and sugar per ounce, "hits the bloodstream" fast, and, unfortunate as it might be since I know it's pretty unhealthy, has a flavor that I like - which of course makes me one of many million Americans (around 60% per week it seems). It's no wonder they protect the secret formula so diligently. The problem, of course, is that cola, whether the brand in the red can or any other, wreaks havoc on our health. But how bad is it really? The short answer is, well, at a regular dose, pretty bad. 

 According to a recent "umbrella study" which reviewed more than 8,000 other scientific papers on the subject, regular consumption of "sugary sweetened beverages" (SSB), a category that includes not only soda but fruit drinks, sugary teas, sports drinks, and others, has been tied to diseases impacting several body systems including some that aren't super obvious. While we might expect a negative connection to dental health or blood sugar control, heart disease, and cancer might be more surprising.

Change. For the Better.

It's not all bad news though even when harm has already been done. Another study, also published this year in the British Medical Journal, showed that even in the face of metabolic disease, cutting consumption lowered the risk sharply. After examining the health records and consumption patterns of more than 15,000 people over nearly 20 years, researchers found that people who switched from SSB to healthier options (like water, unsweetened coffee, unsweetened tea, low-fat milk, etc) experienced a very different health trajectory than those who did not make the change; a 20% difference in the risk of dying (all-cause mortality) during the study period, a level that is within or near the range of other major risk-reducers like regular physical activity (20-30% risk reduction) and smoking-cessation after 3 years (22% risk reduction). 

The unofficial summer is here - a time of year when most of us are a little thirstier and might find ourselves looking for more than water. Do yourself a favor and skip the added sugar - the benefits are substantial.

Have a great weekend,

Mike E.

May 19

It's project season. Work tends to ramp up, lawns grow fast, the sun shines longer, and if we're not paying to eliminate them in hopes of that perfect summer playlist, the ads about where doers go to "get more done" start flooding our airspaces. Some people love it, others not so much, but many of us get out there and do it. But the question becomes, are we "doing it right?"...or at the very least, "safely"? as we work to cram as much as possible into the over-stretched time we have.

For me, always feeling somewhere between "over-committed" and "too busy to get it all done" it's the lawn that tests my resolve. It's just so easy to find myself trying to squeeze it in; to rush out to the mower and get started, hoping to knock it out as fast as possible. I have to remind myself no matter how many times I've completed the task that it is still inherently dangerous, that protecting myself by slipping on some safety glasses is worth the few seconds it takes, and that losing my focus or rushing could easily result in serious harm. The good news is, with some planning, it's usually pretty easy to overcome those obvious risks. But what about the less obvious ones? The ones that don't cause immediate harm. Those tend to be the tricky ones, easy to ignore but not without consequences.

The more we learn about brain health the more we realize that protecting our hearing and minimizing the impact of age-related hearing loss has significant value. With a "direct connection" to the brain, our hearing essentially becomes a pathway for the exposures to the outside world to impact, potentially negatively, our brain. In 2019 for example, an association between hearing loss and brain health was established in a population studied. Although the "why?" (the mechanism) has been harder to pin down, the connection is clearly there.

Some experts suggest that when we lose hearing we strain our system (cognitive overload) while trying to hear. Others suggest that the opposite is the case, that when that connection is less than it should be we are depriving the brain of proper stimulation. Still, others point to hearing loss and cognitive decline as "symptoms" of some bigger, common ailment (common cause), while still, others think it could be just a diagnostic overlap since it's hard to perform well on either test (hearing or cognition) without the capacity of the other available. Although growing, the evidence base is far from conclusive.

New research from Korea out this month appears to have taken us 1 step closer. Researchers assessed a variety of advanced images of the brains of individuals with mild cognitive impairment, some with hearing loss and some without. They found that in those with hearing loss, there was a significant decrease in the connectivity of the "salience network" which, as described in an accompanying editorial, helps us "process and integrate sensory stimuli with cognition to direct behavior"...that is, make sense of what is happening around us and help us to react accordingly. 

Although this extra detail may only serve to solidify the connection between hearing loss and cognitive loss, the take-home message seems pretty clear - we should take our hearing seriously and protect it fully and always.

Whether we decide it's the foam inserts for a few cents that are right for us, or the many other varieties that go up in sophistication and cost from there, protecting our hearing is protecting our future brain and if now is a time of year when exposure goes up, it's a great time to add some extra layers of protection.

Have a great weekend,

Mike E.

May 5

It was many years ago, but I remember it like it was yesterday. I was standing in front of a large group, giving a presentation when one of the most common phrases in occupational health and safety was said by one of the leaders in the group: “We want you to go home like you came in today“, a simple concept that everyone can generally agree on and usually captures the primary goal; that no one should go to work and experience a functional loss because of some kind of injury or incident.

Then, a minute or so after it was said, one courageous hand was raised in the audience. Bryan, a guy I had gotten to know and earn respect for, said something that stuck with me: “I don’t think that’s good enough. I think we should look for ways to go home better than we came in.” 

It was a great sentiment, that work was not something that necessarily had to take something from us in exchange for a paycheck, but when done right, could give us far more. It wasn’t a denial that hard work comes with risks, but rather that every situation we find ourselves in presents us an opportunity to grow and that “work” could be more than a given day’s bundle of tasks, but something that adds to our development, provides us personal purpose and even adds to our fulfillment by challenging us to achieve.

The tricky part with the idea however was that zoomed out, it seems to go against the natural progression, the fact that over the course of time and especially during our working years, we lose function and decline if we “let nature take its course”; a dislikable fact, but a fact nonetheless.

 With that in mind, when I saw an article published in the Journal of the American Medical Association (JAMA) this week that pointed to actual improvements in function after mid-life, I stopped to read more. Rather than slowing the decline or even maintaining, that is, going home as we came in, this article seemed to suggest some of us could actually get better over time and that certain factors and behaviors increase the odds.

Now before the headline sounds too sensational, it was a small percentage of the group, so a relatively rare but no less meaningful occurrence and in the strictest sense may be reserved for women, as the study sample included no men. However, the improvements in physical functioning (a subset of a well-known quality of life measure known as the SF-36) were undeniable.

 What were the factors that increased the odds? 

There were 4:

Physical activity (17%)

Healthy Joints (42%)

Good Sleep (43%)

Financial Health (73%)

——

It can be done. We can get BETTER as we age. It’s a perfect time to start.

Have a great weekend,

Mike E.

Apr 21

Most people over the age of 18 likely know what the word "octane" means. They may not know the exact definition, or that it refers to the fuel's stability, but if they've ever put a petroleum product into a vehicle, it's likely they know that "higher means more expensive" and "most cars run on regular". Wouldn't it be convenient if we had a similar scoring system for the FUEL we use? The public health community thought so too.

After an initial attempt in 2009 was updated in 2014 by a team from South Carolina, the framework was ready. Called the "dietary inflammatory index" (DII), it was an attempt to show that despite our impressive ability to convert just about anything into usable energy, every combination comes with a cost. Not unlike other fuels we use every day, some, as measured by the inflammation spike after consuming them, burn cleaner than others. In particular, foods with high saturated or trans fat content are "pro-inflammatory" (spike inflammation) while those naturally high in fiber, polyphenols, and vitamins (aka plants) are low or even anti-inflammatory. Since that time, hundreds of studies have explored whether the index predicts disease, and for several (heart disease, cancer, and even other inflammatory conditions like asthma and daily pain), the answer is yes.

Of course, at Pro-Activity the relationship with joint pain is particularly important since it can be a risk factor that stops us from work, sport, training, and countless other life functions. So when we saw a recent systematic review of the connection between dietary inflammation and knee osteoarthritis (OA), it caught our eye.

The key points are simple enough:

1 - after screening thousands of studies and finding 6 that met the quality standard, there was a significant connection between diet and knee OA pain. 

2 - the Prudent Diet (low in saturated/trans fat, low in processed items, high in fiber, lean meats) and the Mediterranean Diet both slowed the progression of knee OA while the "Western Diet" (highly refined/processed, low in fruits/veggies/whole grains, etc; comparison here) accelerated it.

3 - the results are promising and, given the many other diseases that dietary inflammation is connected to likely worth acting on, but more research is needed.

In the most practical terms, healthy FUEL for most of us continues to be "more and/or less":

More: Foods that are naturally high in nutrients, low in calories, and high in fiber (aka plants) and as close to their natural state as possible - too many studies to include.

Less: Hyper-palatable (high saturated fat, sugar, and/or salt) foods and "food-like" creations (ultra-processed) - review here.

 There's no need to complicate it: FUEL Good to Feel Good. 

Have a great weekend,

Mike E.

Apr 7

The calendar says it officially happens in late March, but in my zip code, Spring seemed to arrive this week. Bursts of pink, yellow, and white broke through the grey and brown backdrop of leafless trees, the air felt warm, the sun felt strong and the bees were back to work; a great time of year.

For me, Spring always brings a little bump in motivation to MOVE. To get outside, get started on a project, or find a path that I haven't walked in a while and stretch things out a bit. Of course it also forces me to face the reality, usually amidst some unwelcomed huffing and puffing, that my natural tendency to move a little less and eat a little more over the winter has had an impact...an awareness I don't love but makes turning the little bump of motivation into action a reason to challenge myself to get closer to where I want to be.

Over the last couple of years, I've invited others to join this challenge. On the first day of Spring, I invite people to jump in, a few do, and away we go. This year around a dozen folks decided to play along, this time working to progressively "stack" 10 relatively simple healthy habits (like drinking 40 ounces of water per day or moving at least 1 minute every hour) into a powerful bundle over a month. Some have already started to see some benefits, an amazing example of how quickly our systems can adapt - new stimulus, new response.

It begs the question - exactly how little do we need to see a change? How easy could a significant risk reduction be if we did a little bit consistently?

In a sense, this is the question that has been coming to the forefront of the research on preventative health actions ("lifestyle change") in recent years; less about "does this work?" and more about "what dose is required?" - and we've learned a ton.

Although only 1 avenue of many, when it comes to physical activity we are getting closer and closer to dialing in the dose not only for specific conditions but also for general health, vitality, and longevity. If we had to sum it all up in a few words, we might say "more is more, but a little is way more than you might think." Getting over the growing inertia of an increasingly sedentary world pays handsome dividends, most of the benefit comes in the very first few minutes. New research over the last few weeks confirms this.

First, out in late February this year, a great study in the British Journal of Sports Medicine showed that as little as 11 minutes per day of movement which might be classified as "hard enough to break a sweat" was enough to prevent nearly 16% of premature deaths, whether from the two most common killers (heart disease and cancer) or for any cause. Technically speaking, 8-10 marginal MET hours per week, which, on average, means moving at an intensity that is harder than yard work (6 METS) but easier than running (9+ METS) for a little more than an hour per week had major impacts. A little bit goes a long way.

 Then, last week in the Journal of the American Medical Association, another interesting twist on essentially the same theme, emerged. A preventative benefit started at a relatively low level and didn't even require a daily effort. In this case, the metric studied was the number of days per week a person hit the 8,000 steps per day mark, a known risk-lowering threshold. As it turned out, a significant risk reduction (around 15% which is most of the maximum +/- 20% expected) was gained in as little as 1-2 days per week of hitting 8,000 daily steps. Hope for the weekend warriors!

There's always more to learn, but one thing seems increasingly clear - for most people, more is better, but for almost everyone, something on the MOVE is immeasurably more than nothing. 

Have a great weekend,

Mike E.

 Mar 17

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

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

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

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

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

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

Have a great weekend,

Mike E.

Mar 3

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

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

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

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

What was the intervention? Simple calorie restriction.

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

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

There's certainly more to come.

Have a great weekend,

Mike E.

Feb 17

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

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

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

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

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

So what can we do? 

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

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

Have a great weekend,

Mike E.

Feb 3

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

Let's set the scene:

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

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

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

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

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

Have a great weekend,

Mike E.

Jan 20

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

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

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

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

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

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

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

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

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

To the stairwell!

Have a great weekend,

Mike E.

Dec 30

When we started the blog for our clients many many years ago we had no idea how much reading, writing, editing, and revising it would take to put out a product each and every week. It's become a fairly robust library over the years and, even for our most consistent readers, it's a lot to keep up with. With that in mind along with it being the last of the year, we thought now might be a great time to recap 2022 and pass along our "author's picks".

What we wrote about in 2022

Although we don't set out with any specific agenda or goals as far as the number of times we will hit on any given theme, the stats of what we wrote about in 2022 probably shouldn't surprise anyone. They definitely didn't surprise us.

MOVE: 14 (27%)

Fast-Exercise, Exercise timing, speed of movement, lifelong exercisers, the impact of sedentary behavior on blood flow, exercise on cancer, physical activity guidelines, running & happiness, joint pain prevention, balance & falls, physical activity in youth, exercise frequency, physical activity has an epigenetic impact, diabetes prevention, and MOVE

FUEL: 10 (19%)

Anti-aging, gut microbiome, dietary supplements, fiber consumption, green tea for gut health, cravings (2 part), late-night eating shows negative health impact, high-fat diets and pain, high sodium diet and stress reactions, 

RECOVER: 5 (10%)

impact of sleep and sleep+exercise, light exposure, resistance exercise improves sleep, brain-retraining for back pain, pros and cons of the snooze button, 

ENDURE: 6 (11%)

Cold stress, maintaining weight loss, heat stress, staying under the stress threshold, health benefits of experiencing short-term stressors (cold, meal timing, and high-intensity exercise), cold weather risks.

CONNECT: 7 (14%)

Happiness (4 parts), forest bathing & FUEL, behavioral impacts of physically active friends, "decoupling" and mindfulness, 

Multiple ELEMENTS: 8 (15%)

Impact of FUEL+MOVE on Blood Pressure, Essential 8 health habits, cancer prevention, epigenetics across the generations, updates on MOVE/FUEL/RECOVER, brain health, 

Other: 2 (4%)

Ergonomic Clothing, year-in-review

________

Our Top 5 Picks

It's hard to answer the question "which were the best?", mostly because it really depends on what a person might be looking for information on. With that in mind, we've chosen 5 reads that we think are most worth the investment of time and given them an associated title:

Most Relevant to Daily Life: November 18 - Cause and Effect: Food Choices and Pain. So many of the aches and pains we experience could be impacted by the FUEL we put into our tanks. The research is clearer than ever.

Simplest to Implement: July 1 - A Steady Future in Only 10 Seconds. The ability to stand on 1 foot for 10 seconds after the age of 50 predicted an early death. This can be practiced almost anywhere!

Easiest first Step toward Health: August 12 - Something is Way Better Than Nothing...For FUEL Too. For those who don't get much fiber in their diet, even a little bit (of almost any kind) can pay health dividends. 

The Most Important Theme: September 30 - Generational Health. We can pay health forward by investing NOW. Our health experiences today imprint our genetic code for at least the next 2 generations. 

The Happy Surprise, Author's New Favorite Tactic: April 8 - Pump Up Your RECOVER. Resistance training improves subsequent sleep quality - a tactic I now use on the regular when I feel my sleep is not as good as it could be.

___________________

And there you have it, 52 weeks of blogs all in one. 

We hope you find them useful and will recommend a topic or point us toward an interesting topic in 2023.

We look forward to crossing paths again in the New Year.

Have a great weekend,

Mike E.

Dec 16

MOVE. It's the first on the list of 5 Human ELEMENTS that we talk about at Pro-Activity. The good news is that most everyone knows it matters at some level. The even better news is that many know the basic guidance for staying healthy which comes in at around 2.5 hours per week (30 minutes per day x 5 days per week). However, and possibly most important for those who don't consider themselves exercise-enthusiasts, the trickier part is knowing exactly how to "dose" our daily movement to stay below the threshold of the risks we face...that is, to know we are staying ahead of the specific conditions (injuries/illnesses/diseases) we are personally at risk for.

Take for example type 2 diabetes. It is a disease that negatively impacts every tissue in the body. It not only increases the likelihood of pain and injury of the "working tissues" (especially in the upper limb), it also increases heart disease risk, was a major predictor of complications from COVID-19, and even increases the odds of developing dementia (the earlier a person is diagnosed with diabetes the worse the risk gets) - serious stuff most of us would rather push off or avoid altogether. Yet, if caught and addressed early, such as in the form of prediabetes, a cluster of risk factors that impact as many as 1 in every 3 Americans (88 million in all), it is highly reversible.

Although the CDC suggests that as many as 74 million of the 88 million individuals living with this risk don't yet know it (find out HERE if that's you), those who do have likely been told that working on lifestyle risk factors (nutrition, physical activity, tobacco cessation, sleep hygiene, [di]stress management, etc.) is one of the most powerful approaches we know.  This proved itself out again this year in a study on lifestyle intervention which impressively showed that 93% of participants were able to stop the progression from prediabetes to diabetes and nearly 50% did even better, reversing their risk back to within normal levels.

But what exactly should we be doing? What exactly is the lifestyle "dose" required if we want this result? 

In the study referenced above, participants met regularly with a health educator, were encouraged to get 180 minutes per week of moderate physical activity (30 minutes "most" days of the week), were given nutritional advice to control calories and/or track macronutrients like fat and had access to a counselor who could help with habit formation. For some, this may seem either like a lot to take on or a list of unavailable resources or both...but all hope is not lost.

This week, in a study of nearly 6,000 people published by a team from Vanderbilt University, the dosage guidance for many may have gotten even simpler since it is tracked reasonably accurately, whether we realize it or not, everywhere our smartphone goes. As it turns out, in a population of people who volunteered their step-tracking data as participants in the National Institute of Health's "All of Us" research program, those who got at least 10,700 steps per day were 44% less likely to develop type 2 diabetes when compared to those who got 6,000 or less. This study, which builds on an October 2022 study that showed the risk of developing a variety of diseases began to lower at around 8,200 steps per day, tells us that we are getting closer and closer to understanding exactly how much MOVE we need to stay on the right side of risk.

The human body was built to MOVE. We rely on it for health. Although for most of us that means "more is usually better", for all of us it means our knowledge of how to dial in the right dose is getting more refined all the time. If you're not sure exactly how much MOVE is right for you, we're here to help.

Have a great weekend,

Mike E.

Dec 2

It's no secret to those who know me well that I'm a bit of a data geek. Over the years this has led me into an ongoing single subject "quasi-experiment", aka "my day-to-day life". However, my personal belief is that everyone is actually running this same experiment - that is, each and every day we do things, and over time (minutes, hours, days, years, etc), we get a response - I just try to notice and track as many responses as possible and share them with those who might benefit. As the technology has improved, especially wearables (which I've written about previously), the tracking has gotten more refined.

Recently, one of the responses I've been exploring, although admittedly not fully understanding, is the connection between salty food intake and less restful sleep. On days I give into that craving for something salty (popcorn is a go-to) while enjoying something streamed on TV before bedtime, I notice a consistent increase in my "stress score" as I sleep; which is my wearable's way of telling me the volume knob on my nervous system has been turned up a little too high or in technical terms my autonomic nervous system has become sympathetically dominant as measured by suppressed heart rate variability - that's a lot. I assumed it might have something to do with the impact salt has on the blood vessels, a well-known driver of high blood pressure and cardiovascular disease in those that consume too much salt, which was recently confirmed again in a massive study of more than 175,000 adults. Those who sprinkled salt on their food "most days" were at least 20% more likely to have cardiovascular disease than those who did so only occasionally. A different study out this week, however, makes me think there's more to it than that.

As it turns out, researchers who tried to uncover the mechanism behind the observation that sustained high salt intake drove stress hormone changes (such as in long-term spaceflight simulation), found a direct connection between salt intake and the stress response. Not only were the baseline hormonal markers of the stress response increased within a few weeks, the actual response, that is, the rush of chemicals that create the fight/flight/freeze behavior we've all felt when we click from stress to distress, was doubled! Although, as an animal study it's not directly transferrable, it's an important step that reiterates the connection between FUEL and FEEL and possibly even our risk of injury, illness, and disease.

2 weeks ago we wrote about the consumption of fatty foods sensitizing the pain response. This week salty foods appear to drive us toward distress. Neither fat nor salt is inherently "bad" - in truth we can't function without them - however, too much of a good thing can easily nudge us out of balance and further away from thriving. Beware the ultra-processed food.

It can be tricky this time of year, but it's never a bad time to "FUEL Good".

Have a great weekend,

Mike E.

Nov 18

The connection between what we eat and how we feel is not a new discovery. Ask anyone who has had the unfortunate experience of "overdoing" on Thanksgiving and they might be able to shed some light on why lifehacker.com felt the need to publish a "decision support" article on when to go to the emergency room for "post-Thanksgiving stomach". Of course 2011, when that article was written, is nothing compared to this book which connected the notoriously painful condition of Gout with consumption patterns and an "impaired state of the stomach" more than 200 years prior. Yet, as many of us who aren't quite ready to let go of harmful habits are quick to point out - correlation is not causation - and so the pursuit of evidence rumbles on.

Since those early times, many more connections have been made between our dietary habits and bodily discomfort. High-fat diets have a clear connection with spikes in inflammation while diets that include naturally fermented foods have been shown to reduce it. While the specific mechanism is still not perfectly sorted out, the root cause, what we ate or drank, and the ultimate effect, how we felt, are clear. 

One theory gaining traction is the impact of foods and drinks on the bacteria in our gut (microbiome). Since high-fiber foods drive anti-inflammatory bacteria, and pain is a feature of inflammation, it may explain the connection between a high-fiber diet and lower levels of pain, in this case, knee pain. On the other hand, high-fat diets, which appear to feed the other end of the spectrum, have been connected to joint pain increases in animal models. Although some of the substances on board (polyphenols) show promise, alcohol may have a net-negative impact as (not unlike cleaning a wound or taking long courses of antibiotics) it significantly alters bacteria in the gut (called dysbiosis), leaving us depleted and susceptible depending on what we put-in next.

However, in a recent development that aimed at gaining an even more specific understanding of the connection between dietary factors and pain, researchers at the University of Texas in Dallas were able to definitively show that high-fat diets, even without obesity or previous injury, sensitized the system and primed the transition from acute to chronic pain in a lab experiment on mice. In plain English, within 8 weeks, diets that were high in saturated fat caused an exaggerated pain response with no history of injury and no changes in metabolic health (such as obesity and diabetes) known to do the same - the diet alone was the cause.

The holiday meal and party blitz is almost here. Do your body a favor and tell the chef to hold the side of pain.

Have a great weekend,

Mike E.

Nov 4

My kids get a laugh any time my wife talks on the phone with her sister. They only hear one side of the conversation of course, but they always know who's on the other side as the tone, tempo, and even word choices my wife uses begin to morph ever-so-slightly and sound, somehow, more midwestern or western US (tones of her childhood) than western Jersey (tones of most of her life).

Of course, in one way or another we all do this with the people around us. The more time we spend around people, the more we seem to merge our mannerisms - to find a cadence and rhythm that works for the situation. When we get around family or close friends we haven't seen in a while it can be like "we never missed a beat" (as the saying sometimes goes). During the early portion of the COVID-19 quarantine, we talked a bit about this 2011 study which seemed to show that under heightened arousal (in this case fire walking) there could even be a synchronization of more automatic functions, like heart rate, among people who were socially close (in this case family).

Over the longer term, it seems this effect might have an impact on our health outcomes. For example, 15 years ago a landmark study showed that across 30 years of observation, bodyweight changes in 12,000 people tended to run along social ties, eventually forming clusters. Said more simply, there was evidence that in the case of body weight (and presumably the actions that influence it), people tended to become more similar to those they had the closest interactions & ties with.

A few months ago, in an interesting twist on the phenomenon, a team showed that future earning potential (as a proxy of financial health) seemed to follow a similar pattern. Individuals who had exposure and close ties with people in high socioeconomic brackets had a significantly higher likelihood of enjoying a higher income over the course of time. More simply, children with fewer finances tended to be higher-earning adults IF they grew up with friends whose parents were already higher-income earners - a phenomenon the researchers called "economic connectedness", which can be explored on www.socialcapital.org. 

But what about more classic health behaviors, like whether we MOVE enough during the day to hold off preventable disease?

As it turns out, and as published this week, at the very least, the math modeling says yes. When researchers plugged data into a computational model "Social interactions between sedentary and moderately active populations were the most important social parameter that influenced low active populations to become and remain physically active".

Or in plain English - when sedentary folks became friends with moderately active folks, the sedentary folks started to MOVE more.

Of course, this doesn't mean moderately active folks are immune to the effect. It seems the effect can run both ways. Said more eloquently by the researchers, "On the other hand, social interactions encouraging moderately active individuals to become sedentary drove exercise persistence to extinction".

There is most certainly more to come, but the main point seems to continue to become more clear - our actions, from mannerisms to health behaviors and beyond - are not solely our own; the people we interface with regularly and get close to having a clear impact on our future selves, choose wisely.

Have a great weekend,

Mike E.

Oct 21

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

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

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

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

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

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

Interestingly, they found that:

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

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

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

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

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

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

Have a great weekend,

Mike E.

Oct 7

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

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

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

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

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

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

Have a great weekend,

Mike E.

Sept 23

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

Sept 9

My brother-in-law Tony was a great human. Living across the country didn't make visiting easy, but, on the occasions when our paths would cross, he was easy to visit with. His was a BIG laugh and an energetic spirit; the kind of person we should all be lucky enough to know. His passing left an unfillable hole for his wife and sons and so when the unmistakably clear ("four-letter", rhymes with duck) bumper sticker came into view on the highway earlier today, I thought about Tony and, as the now leading cause of death worldwide, how common stories like his are becoming. What used to be considered a disease of old-age is becoming increasingly common before the age of 50.

Yet, the news isn't all bad - as we learn more and more about what levers exist, we can fight more effectively when needed and, even better, take powerful actions that minimize our personal risk factors and lower the odds we will be impacted. This week a few really interesting and promising insights worth knowing about made headlines:

1. Brain tumors hijack surrounding cells, which may open the door to new treatments: As outlined in a new paper in the journal Brain, Glioblastoma, one of the most aggressive and challenging forms of brain cancer, appears to recruit and convert surrounding brain cells, essentially turning them against our own health interests. However, as shown initially in mice, when those surrounding cells are removed, the tumor is cut off from its energy source and cannot survive. If this effect holds in humans, it will be an advance in an area which has been slow (if not largely stalled) for decades. 

2. Ultra-processed food plays a significant role in colorectal cancer, especially in men: The British Medical Journal published findings drawn from hundreds of thousands of records over the course of decades which showed men who ate the most ultra-processed food had a substantially increased risk of developing colorectal cancer. This was especially processed poultry/meat/seafood and ready-to-eat meals (44% increase) and sugar-sweetened beverages (21% increase). Overall the same effect was not seen in women, however a smaller effect (17% increase) was noted in those who consumed significant amounts of ready-to-eat/heat meals.

3. So much more than strength - exercise produces a natural cancer-fighting byproduct: Lactate, which the body produces when burning sugar for fuel (such as during strenuous muscle work) has been found to combine with certain immune cells to effectively fight cancer growth in mouse studies. Of course, it's far too early to know where this will go, however it certainly lends support to the clear line that the World Cancer Research Fund has drawn regarding physical activity and cancer risk. 

Here's the bottom line - many of the same things that we know add-to and subtract-from our risk for injury and delayed healing, like exercise and healthy/low-inflammatory eating, add-to and subtract-from our risk for a major threat to our health, something we can never start too early. 

Let those muscles burn today and generate a little lactate. Leave the food with the infinite shelf life right where it sits and pick something high in fiber and naturally low inflammatory.  It won't take our risk to zero, but it can shift the odds in our favor.

Have a great weekend,

Mike E.