Blog Archives

Apr 11

When it comes to health, some bits of information have proven so reliable that they have attained the lofty standard of being a generally accepted truth. "Eat Right, exercise and get good sleep" certainly fall within this category, and "don't smoke, learn to manage stress and practice good hygiene to minimize the spread of disease" are also on most people's lists. However, and as we hope is made clear each week here, the details contained within those truths are always being examined. Occasionally, new information is so impressive it shifts the narrative toward something simpler than we previously thought, making the benefits of a healthy lifestyle more accessible to an even larger number of people. Exercise has experienced such a shift. The last few years have seen significant refinements in what we thought we knew, showing clearly that benefits can be gained earlier, easier, and in a way that fits into more people's lives. 

 For example, while knowledge that there are major benefits in accruing 150 minutes per week at a moderate intensity, we also (now) know that to some extent we can trade time for intensity and either cut the total time required if we are willing to push a little harder or still get impressive gains when we need to go a little easier. We also know that so much of the benefit comes so early in the process that even "movement microdosing" (stairs, squat breaks, etc) inserted into an otherwise sedentary day can be especially powerful; and in March of 2023 we learned that the beneficial threshold for incidental movement (as measured by steps per day) might be lower than we previously thought - 8,000 steps is enough to make a major difference in risk - even when only achieved twice per week.

Over the last six months, we learned that the frequency of exercise sessions can also be compressed without losing much benefit. This study, which we blogged about in October of last year, was great news for those who feel too busy during the workweek to fit in a consistent movement practice. Contrary to conventional wisdom, it showed that even "weekend warriors" who do all of their exercises in a compressed two-day window, can get most of the benefits that those who have a more consistent pattern get. New research that tested the weekend warrior method against a different dataset found that for some risks, we might even do BETTER this way.

When a research team looked at data from nearly 100,000 accelerometers (such as those in our phones or watches that measure movement) worn by individuals who they tracked for nearly a decade, they found that those who got a full week's worth of exercise (e.g. 150 minutes) over a two-day window, such as the weekend, actually did marginally better than those who had a more consistent pattern of exertion. "Weekend Warriors", who accounted for about 42% of the total group (nearly double the 24% classified as "regularly active"), had more than a 30% lower risk of dying from any cause or from heart disease when compared to the sedentary group as well as more than a 20% lower risk of dying from cancer. While the active group also had a significant risk-lowering effect for all causes, cardiovascular disease, and cancer, the benefit was 6-8% less in each area. The only caveat, as mentioned in the American Heart Association's press release, is that "ramp rates" matter - that is, muscles, joints, bones, and connective tissue (the moving parts) need to be ready for heavier loads so while "winning the weekend" is clearly a win for future health, building up a load-tolerance before (literally) jumping in with both feet, would be a wise choice. 

It's a great time of year to get out there. There's wisdom in working up to it but there's health in making this weekend one that moves.

Have a great weekend,
Mike E.

Mar 28

Imagine watching someone getting ready to do a "push-up" for the first time, maybe your child. They assume the position with hands on the floor, body straight, core tight, and knees off the ground and then suddenly they let go of all muscle tension, flop to their belly with a loud thud, slowly push up, return to the starting position and proudly exclaim "one"...only to repeat it a few more times and then look to you for approval. You might think of a creative way to suggest that something seems a little off...can you spot it?

It may not be obvious to everyone, but, despite the name of the exercise, most people who've done it know that "pushing-up" is only part of the movement...and that "controlled lower" and "brief stop"(or sometimes "hands off" even) broadly represent the other parts. As humans, we are constantly changing directions...which means we are also accelerating, decelerating, stopping, and then accelerating again. When it comes to injuries, it's during the deceleration and stopping where things often go wrong and yet few people actually focus on improving or maintaining the ability to do so.

Recently, however, eccentric training (the technical term for focusing on the controlled deceleration of the load more than the acceleration of it) has gained more attention. Studies from the last few years have shown that focusing on getting stronger by resisting while the muscle lengthens can improve strength and also promote gains in joint flexibility, muscle performance, and injury risk over time (especially in the lower body), and may even have more holistic health benefits like lowering blood pressure. This week, from a team in Australia, the news got even better after they found improvements in strength, flexibility, fitness, and well-being scores after 4 weeks of a low-dose home-based plan that emphasized eccentric exercise.

The protocol, a 5-minute bodyweight circuit that included 10 repetitions of chair squats, chair reclines, wall push-ups, and heel drops was performed daily. While there were no appreciable changes in global health measures or muscular power movements (such as body composition, resting heart rate, blood pressure, or various jump tests), there were notable gains in strength, flexibility, fitness, and mental health (such as isometric leg strength, push-ups, sit-ups, sit and reach, 3 min step test and the SF-36 as wellbeing survey).

While in the study's press release, the author acknowledges that 5 minutes doesn't achieve physical activity guidelines, he makes a point of saying it's a great starting point for those who need one. I couldn't agree more...don't be surprised if your local Pro-Activity professional incorporates a few eccentrics into your next visit.

Have a great weekend,
Mike E.

Mar 14

Life moves pretty fast these days. At times, it seems like what was new yesterday is commonplace today and outdated by tomorrow. Of course, the speed of innovation wasn't always so fast. By some accounts, it took at least 1800 years from the first proposal of the sun as the center of our planetary system (heliocentrism) to become conventional wisdom. However, as communication improves and ideas are less degraded by "the telephone game" of person-to-person verbal transfer (stories), they can spread much faster. In a very simplified way, this may explain why the "meme" has become so powerful as an agent of change. It is fast to transfer and arrives mostly intact, passing on from person to person quickly and often aided when it is funny, strange, or too emotionally gripping to not pass along to those you care about most.

Health information is often at the mercy of the meme. What actually works (eat right, exercise, get good sleep, manage stress, and connect with others) is not particularly exciting or funny or emotionally gripping. Unless used as a lever for an adventurous life, ironically it is the lack of health and the chaos it tends to bring, which is more emotionally gripping than the relative ease and low-stress nature of many generally healthy days. It's just not that exciting to tell friends over and over and over that no matter how many times they are studied, those same 5 actions pile up to success.

On the other hand, since the funny and weird ARE super entertaining, every once in a while, I like to bring you a few of those. It's entirely possible that these ideas will grow up to be major changes in our thinking - that we here on earth are not, in fact, the center of the universe, for example - or, they may just be entertaining health memes for around the dinner table...only time will tell. So in that spirit, here are three bits of strange science that caught my eye:

1 - Fish is CONNECT Food: Changing the inflammatory load in our diet can have an almost immediate impact on our brain. This animal study from The Ohio State University for example, showed that older rats eating a diet more heavily loaded in saturated fats had rapid changes in memory and learning functions. However, where it gets a little strange is on the other end of the age spectrum. This study observed that children who ate fish more frequently, a known source of "good fat" among other nutrients, were more prosocial. That is, by the time they were 8 years old, they showed a better ability to work in teams and with peers. The researchers recommend 2 servings of fish per week. It's probably a stretch, but if yours is the child who is not playing nice in the sandbox, or you find yourself with the same tendency in the work "sandbox", check your FUEL.

2 - Long Ring Fingers Return: In March of 2024, I wrote about this study, which showed a connection between long ring fingers (4th finger) as compared to index fingers (2nd) called a 2D:4D ratio. That study concluded that soccer players with longer ring fingers, which the authors suggest arise from more testosterone exposure when a developing fetus, tended to have better maximum exercise capacity than those who didn't. It was an idea that was super intriguing but just too strange for me to buy into. Well, they're back again in this study, where they show in a small group that long ring fingers also correlate to lower levels of lactate accumulation during exercise, which means an ability to exercise harder, longer. I'm still not convinced, but I am a bit less self-conscious of my weirdly long ring fingers, if I'm being honest. More to come.

3 - Finding the Flow Signal through the Noise: Creative and extreme sports (BMX, Skateboarding, Aerial Skiing, etc) are amazing to watch. The boldness required to hurl yourself through space and the concentration required to defy the laws of physics in order to land draws the spectator in. Clearly, it requires a finely tuned nervous system. New research on skateboarders suggests it's not just the "skater's eye" that drives things... but also their ear. While blocking sound is a smart choice when the world is loud enough to create harm (such as an industrial workplace), it's possible that skaters are proof positive that working with the sounds around us might help us get better at finding enjoyment and flow in a noisy world. While there is definite peace found in blocking out the noise with earbuds and headphones at times, it's possible that in order to achieve creative flow, those who practice finding the signal through the noise may have better odds. Protected hearing is good for our brains; sheltered hearing may not be. This may especially be true for nature-based sounds, which are shown to calm the nervous system. You may not need to be on a skateboard, but the science says to get "out there" and listen.

Hope you found these as interesting as I did.

Have a great weekend,

Mike E.

Feb 28

I had the great fortune of meeting a new-to-me client group this week: people we have worked with for a long time, but I have never personally had the opportunity to meet. It required some travel to a city I've never been to. It was, as always, an honor to be given the stage to share Pro-Activity's essential message - that investing time and effort into health is a worthy pursuit; that consistency (even a little bit) will outperform attempting to catch up (even with extra intensity) later and that, although there is great personal benefit from being stronger and happier, the real "why" which gives it such great power, is the far-reaching ripple-effect that pass on to those we care about the most, even for generations.

Since rule number one in these situations is "know thyself", I did what I always do - I set my watch so I wouldn't run over - and then dove into the information containing some of the latest health headlines. In what felt like a few minutes and after a little Q&A, the hour was up. We exchanged thanks, and I got off the stage...and then something really cool happened: a small group used the well-timed break to ask individual questions. This attracted more friends, who eventually became a group of folks who were genuinely curious about using their health to thrive in an otherwise complex world. They asked great questions and allowed me to poke at the barriers that stood between today and an even better tomorrow. I felt lucky to be there working on behalf of one of a growing number of employers who understand that good health is good business...who make easier access to good information a priority for their teams. 

Here are 3 great questions that I wish they would've asked in front of the full group as I am sure many people would benefit from the discussion:

(1) Sleep Health: I currently get 5-6 hours of sleep per night. Why is short sleep such a problem if I feel fine in the morning? 

This is, of course, a great question with a really long answer... but the short-short version is that our sleep cycle generally follows a pattern with deep non-REM sleep cycling in the earlier part of the sleep window and REM cycling in the later part. If we are constantly chopping off an hour or more at the end, we are chopping off a critical portion of our recovery, one that has been implicated in worsening cognitive health as we age. Although there is a minuscule portion of society that can go well on short sleep, it's more likely that you are waking when you are in a higher arousal state, that is "closer to the surface", and have been doing it so long your body is trained to wake up. It would be worth diving a little more deeply into, but one question that's easy to ask yourself is - are you sleepy during the day? If so, that's a pretty good sign your body is under-rested.

(2) Keeping Arthritis "at bay": I'm active and enjoy soccer. I had a knee injury that I rehabbed, and everything is going well, but colleagues have told me I'm more susceptible to arthritis in the future - should I worry about this, and is there anything I can do to keep it under control?

This is a great question that impacts a lot of people. The most important thing to poke at, in my opinion, is - is arthritis (i.e., roughening of the joint surface) always "bad"? What if it's there but not limiting you? Almost everyone who lives an active life will have some roughing of the surfaces of the joints - we work them hard - but if what you see on an x-ray isn't impacting your function, maybe it's not super worrisome. By staying strong and mobile, joints keep working for a very long time. By eating a healthier diet which may decrease dietary acid load, the roughening exists, but it's not as painful or limiting. Google "blueberries and knee arthritis" and dive into the findings a little - it's fascinating stuff (here is 1). Punchline: it's a risk, but maybe it shouldn't be as much of a worry if you have a plan and follow it.

(3) What's the Future: Do you think there will ever be a blood test or marker that tells us enough information early enough to do something about?

Well, yes and no. With studies clearly showing that our health is impacted before we are born and maybe even influenced by the actions and environment of our family tree generations before us, I'm not sure I really believe there is such thing as "early enough". Health is a generational asset - investing in it now will help your grandkids! Now, if I get off my soapbox, I'd say it's promising. This study out just this week showed that proteins from our organs and how they are "aging" can tell us about our health risk DECADES before disease. Most of them were direct lines - if your heart was showing signs of aging, heart disease was the future problem, for example, BUT not all. Kidney aging was tied to a variety of diseases, and, counterintuitively, immune system aging was the strongest predictor for brain risk. There's a lot more to learn there, but that definitely makes me want to keep my fitness up, eat in a way that doesn't over-inflame my system, and get plenty of rest - all of which are tied to immune health.

There were so many more great ones...I sort of wish we recorded the conversation because it's always SUPER fun for me to see the lightbulb go on for people and them realize how much power over their future health they really do have.

Thriving is complex, but we don't have to over-complicate it. If we invest some time, every day, even if only a few minutes when life is especially busy, we and everyone around us will be rewarded for the effort. 

Have a great weekend,
Mike E

Feb 14

So here we are, our final chapter in the blood glucose monitoring experiment. 30 days of experimentation went by pretty fast. We've learned a ton about our habits, how surprisingly easy they can be to change under the right conditions, how counterintuitive that feels to write, and a bunch about why metabolic health is truly a priority along the way.  Honestly, it's too much to capture in a blog that is designed to be a few minutes read each week, so if you're looking for the "TLDR" version of this journey, I'd say the following 4 sentences contain most of what you should know:

If you are a US-based consumer, sugar is everywhere, and you are probably ingesting more than is healthy. Unless you are training for something, even if you do hard physical work every day, it is unlikely you are moving enough to use it all for FUEL. This creates an energy log-jam that our bodies & brains are valiantly fighting to keep up with, but, sad as it may be, are losing over the longer term if we consider the millions who are progressing to diseases now tied to this root cause. For those who desire to more deeply explore their day-to-day AND are evidence-oriented enough to actually follow the path it lays out, a continuous blood glucose monitor can make it easier to change course when needed. In short, this is a story of hope...but not necessarily ease.

Let's start with 3 observations from this week:

1. Doubling down on deferring, getting the most from the important meal of the day: Building on last week, changing the AM routine was hard at first, but it's been good enough to work to make it a keeper. By replacing the order of our eating from one that is carb-dominant in the AM to one that shifts more toward protein and fat in the morning, we saw cool changes. Sugar spikes were blunted, and we felt fuller longer, but that's not all. Early indicators say our bodies are getting more efficient at using the "other" physiological fuel, the energy stored as fat during the day, which is also known as "fat adaptation," a phenomenon studied as early as 1985. It feels important to point out, however that while this approach DOES likely turn the dial toward burning more fat throughout the day, it is not a "keto diet" or an attempt to enter ketosis per se. This website does a nice job of illustrating the differences, but it's not all about fat burning. This review, for example, showed that a higher protein breakfast was linked to better muscle mass in adults and a cardiometabolic effect was also seen in groups as young as adolescents. HOWEVER, there are ripple effects. I noticed a clear need to increase my water consumption after making this switch, a factor associated with increased protein consumption that has been known for a while.

2. Context Matters a LOT - as the 30 days have gone on, we have seen a wide variety of spikes and drops of blood glucose under a variety of conditions. At times, it took some effort to remind myself that spikes are not necessarily good or bad in the absolute sense, but rather a normal response from the body...which can become problematic if too extreme or left unchecked for too long. For example, after moderate-intensity exercise, glucose values dropped as expected, one of the main reasons why post-meal exertion is so powerful and, in my opinion, why a movement break after eating should become a routine for almost everyone. But after intense or "fasted" exercise (i.e., before eating in the AM) things were very different. My glucose values actually climbed. While this makes total sense physiologically - when it is not readily available in the bloodstream, the body taps the liver's reserves to solve the immediate need (intense muscle work or an adrenaline spike), it could EASILY be confusing to the point of being alarming.

3. Better RECOVER means better everything - one of the most impressive findings has been in the "energy" category. Waking up refreshed is not only a nice way to start the day, it also provides greater ease in every action taken and decision made. For Lindsay in particular this change has been hard to put into words but very positive overall; as blood glucose has become more tightly controlled, her energy levels have become not only more abundant (more energetic overall) but also better, including outlook, stress, etc (more energized about making the change). In an otherwise busy world, everything gets a little easier when energy levels rise. Again, this is less surprising when diving into the evidence. The link between metabolic health and brain health seems to be getting more and clearer all the time. For example this review published in January, showed a strong link between metabolic risk (insulin resistance) and brain risk (future dementia) and this new research from Rutgers University showed that the same things that improve one (brief exercise) made a difference in the other (brain markers) in as little as 2 weeks.

So, where does this all leave us? To try to wrap it all up succinctly, we posed 4 questions: "which changes could become permanent?", "Are there any learnings you'll use more as a tactic or tool?", "How will you prevent slipping into old habits when it comes to shopping, snacking or other zombie sugars?" and last, "If a friend asked to summarize the 30 days in one sentence, what would you say?".

So what would we keep? For me, the shift to more protein and less carbs at breakfast, timing movement breaks before or after meals, and being more cognizant of the order in which I eat (goal = fiber first) are all impactful enough and still doable enough to strive to make them permanent.  For Lindsay, it was similar. She said, "The savory breakfast, the order in which you eat and working to consume more veggies overall are worth the effort".

In regards to tactics or "good to know for use when needed," Lindsay said "being aware of what a high-carb meal can do makes 'prioritizing priming' (e.g. with a salad) and 'blunting the spike' (e.g. with a walk) good tactics for future use". For me, switching to oil & vinegar instead of something more creamy could be an easy one to use when the opportunity presented.

When it comes to shopping, snacking, and other ways to keep the gremlins at bay, Lindsay said shopping smarter became the clear strategy - there has been a notable and deliberate drop-off in foods that are designed to sit on a shelf in the pantry these last few weeks. For me, trying to continue to get myself to recognize the difference between "sweet" and "treat", now that I have seen the impact, will be important. For example, the contrast between unsweetened Greek yogurt (a high protein) snack and the sweetened version of the same brand was striking. The first showed almost no sugar jump (and therefore no need for an insulin response from my body), and the second behaved like I had eaten a cookie. It was powerful and obvious. While this is not to demonize foods or even sweet treats...it seems to me that we should at least know when we are eating one.

Lastly, to wrap it all up in one sentence to a friend, Lindsay said "the real-time feedback has made it easier to make changes and those changes have produced positive benefits - I can't quite put my finger on it because it's as much a feeling as it is a metric, but I just feel better, more energetic and maybe even more comfortable in my body which I know is a struggle for many; I think the experiment helped me kickstart something good". For me the sentence to a friend would be less interesting and about what any friend might expect. It would go something like this "you know I love this stuff...the more we know about how things are working BEFORE they are breaking or broken the easier it is to stay that way. If you can approach it less like a dieter and more like a scientist, picking apart what you see and learning as much as possible along the way, it might be worth the effort.".

All said, this was fun and enlightening. We hope you enjoyed tagging along and are considering ways you can benefit, too. Reach out with questions.

Have a great weekend,

Mike E.

Jan 31

When we left our heroes last week things were mostly novel & new. They were uncovering a few buried truths about their daily habits, finding a few ways to make them a little better, and maybe even nudging their health in the right direction in the process. The undeniable data in front of their faces made it easier to confront the brutal facts, which like a trailer for some sort of terrible movie was a realization that they sort of LOVE simple carbs but the feeling wasn't mutual - they mostly just felt tired and empty inside. And, since this is usually when the hero starts their slog through the dark cave which inevitably includes a fight with some beast that was previously too big to defeat without newfound inner strength, we pick up our story with our heroes in a similar environment - the pantry. Filled with snacks, some that were previously thought to be "mostly OK", it turned out the shelves were actually packed with sneaky little gremlins just waiting for the clock to strike the witching hour. Now back to our story...

Onto Hack 3

If hack 1 (the vinegar preload) was interesting but not super tasty, then hack 2 (the veggie preload) was far more likable. Not a huge surprise from a preference perspective, we both generally like the freshness of a good salad, but having one consistently every evening makes the benefit much more obvious. 

For Lindsay, the changes have been most clearly related to energy levels. In her words, "It's hard to quantify 'feeling better' but you definitely know it when you do - more energetic and less lethargic at the end of the day for sure". In regards to measurable changes - "I haven't really lost any weight per se, but I do notice my clothes fitting a little better and I feel like my workouts are better" - which of course are all early signs of progress for those working to make health changes.

For me, as someone who is typically trolling for snacks by 4 PM, hungry enough for two servings by dinner, and still easily swayed by the snack gremlins a few hours before bed, the effect of consistently putting in a fiber "fill" before the main dish was real and obvious. Timing it before dinner made it easy to push off the late afternoon snack and, in line with one of the major health benefits of consuming foods that are both high in fiber and low in process (slower digestion makes you feel fuller), I have found myself far less hungry when starting on the main dish. I now eat a little slower and 1 serving at dinner feels filling enough. It's a small change but a lower calorie-load later in the day is generally a good thing, as this review of the research shows. The pantry gremlins still called in the hours before bed in the first few days, but since progress is motivating it was easier to say "no". The result? I was down more than 5 lbs in the first 14 days, and my sleep, which was pretty good to begin with, has continued to get better as going to bed "fully empty" has become the standard. 

It probably shouldn't surprise me since shifting eating to match wake-sleep cycles tends to improve metabolic health as reviewed here, but in addition to my Garmin sleep and HRV data continuing to improve, I have definitely been feeling more refreshed in the morning which makes everything easier, including starting hack 3 (5 minutes of exercise immediately before or after eating). We've tested stairs, various forms of push-ups (wall, stairs, floor, etc), air squats, walking fast enough to be huffing and puffing, and even a rowing machine - all seem to work pretty well. To be clear, it doesn't outright stop the rise in blood sugar, as expected there is a normal rise and it's sharper after high-carb foods but logically the blip resolves far more quickly when the muscles are primed and ready to soak it up for use.

Crowd-sourcing

One of the coolest things that's happened during our little experiment of ours, is YOU. I've had several people reach out, curious to learn more, ask good questions and even offer some ideas. One person suggested kombucha over vinegar as a tastier & gut-biome-boosting option. As it turns out, there is a small study from a team in New Zealand that supports it. I could definitely see this becoming part of the final ("extra") 5 days. Another wondered (paraphrasing) "Are you trying to eliminate the rise and fall totally?" - the answer here is no, this is a normal and healthy metabolic reaction, however like most things seeing extreme reactions by the body only in extreme circumstances is probably closer to "right"...so that's the goal.

Device Hiccups 

Several people have also inquired about the devices we are using and whether we like it so far. For those considering a similar experiment I would say, up until day 15 it would've gotten a strong thumbs up. On day 15 however, when it was time to change out the sensor (each lasts 15 days), things got a little off track. Lindsay's new sensor didn't pair with her phone and so she had to pause her portion of the test while a replacement was being sent and my values were very different from my first sensor. To be fair - Dexcom's (the parent company) customer support bot was great and Lindsay's replacement was in the mail within 24 hours of the issue being reported and I am getting my brain wrapped around the sudden jump in my baseline, something that, given our sensors' inability to calibrate against a fingerstick blood test to give the truest value, like a prescription-only model does, is probably reasonable. So while building in 5 extra days in our experiment for glitches now seems smart, it also reinforces the fact that these devices are on the health side of the spectrum and more educational than medical or diagnostic.

Last up (hack 4) is starting the day with a "savory breakfast". Tune in next week to learn how it went.

Have a great weekend,
Mike E.

Jan 17

Just last week I got an increasingly common question - "What is that little pod I'm seeing people stick to the back of their arms...and is it a good thing?". As a data geek and someone who loves the idea of wearables and biosensors to help me be more precise in my day-to-day actions, the Continuous Glucose Monitor (CGM) has been an intriguing idea for a few years. Like a heart-rate monitor for how we process food into energy (metabolism), this little plastic pod, smaller than a silver dollar, sticks onto the skin and sends data on blood sugar (glucose) to an app on the phone, creating a digital trace of the ups and downs, both normal fluctuations and responses to activity and diet. Over the last few years, they've become more common but as a prescription-only device and harder to get without boxing out someone who needed it more than me during the post-pandemic supply chain woes, up until recently the idea was frivolous at best.

Fast forward to late last year when one of the leading manufacturers received FDA approval for an over-the-counter version along with our recognition that metabolic health was a big area to watch in 2025 and now seemed like a perfect time to see what we could learn and share.

How it works - an overview: At the risk of wildly oversimplifying an incredibly complex process that impacts almost everything we experience daily, metabolism is the biochemical act of converting our FUEL to energy. When we are healthy, we do it predictably and efficiently, changing carbohydrates into "fast energy", which tends to be better for higher-intensity efforts, and fats more slowly which is ideal for lower-intensity sustained efforts. Whatever we don't use gets stored. Too much all at once, low-quality foods, or simply not using what is available through physical activity increases the risk that the system will lose efficiency and eventually become diseased, the most common of which is diabetes type 2, which impacts 40 to 130 million Americans depending on whether we include those with prediabetes in the tally. At least 1 expert's research into what drives cancer says it's a common root in that category of diseases too.

Most of us know that with low-quality, sugary, and cheap foods everywhere and daily routines that make it easy to NOT be physically active, we are definitely all at some level of risk. Things get even more urgent when we consider data like this which shows a clear connection between metabolic disease and injuries. This is not a "someday" problem, it's a now problem that seems to only get worse if left alone. Since it also only gets harder to reverse as time passes, if we can take the mystery out of it and know where we stand - which is what the CGM + app is built to do - it can be a good thing...and so, we experiment.

The Experiment: 

For the 30 days from Jan 12th to Feb 12th I (and my wife b/c she's a good sport and there are definite differences between men and women) will be wearing a CGM and trying to closely track and document the experience. The first 5 days (ending today) will be a baseline week, where no significant changes will be made. Then, every 5 days after that, we will implement 1 strategy known to help smooth out blood sugar spikes and keep people in a healthier range. We will be putting 4 of the "hacks" discussed by a popular expert & influencer on the subject (@glucosegoddess) to the test, "stacking" them each time we add one so that by the end, we are doing all 4 things simultaneously. We've built in 1 extra 5-day block as a buffer for any difficulties we run into but may also use it as a bonus block if everything goes smoothly. Our first will be to consume vinegar before the "biggest meal of the day" - about 1 tablespoon mixed in a glass of water, something that has been shown (for example here and here) to blunt the rise in blood glucose and "flatten the curve" - before dinner. 

Disclaimer

Now, while I generally LOVE the idea of people making small "experimental" changes to learn more about what works for them, such as "don't eat a slice of cake as the first course of lunch", a micro-test I ran (and failed miserably) on Tuesday, I can't in good conscience, recommend it this time.  Without knowing someone's health or relevant history, possible interactions with medications, or any number of other factors that might make "playing along" unsafe or unadvisable, doing so would be irresponsible. With that, we will not be making recommendations in any way - these are observations only.

For those who read along, I hope it's fun and you learn something you can talk about around the dinner table or with a friend. As always - feel free to send questions or ask you local member of the Pro-Activity team.

Have a great weekend,
Mike E.

Jan 3

With my youngest child now old enough to be out celebrating with friends, it would be the first "quiet" New Year's Eve in a very long time. Although, to be fair, since 2024 was just the usual chaos and nothing really to complain about, it had been busy enough that getting in bed at a reasonable hour (well before Auld Lang Syne) felt like a win. After a couple of hours which felt like minutes, I woke to the sound of Charlie the Yellow Dog loudly protesting a neighbor's use of fireworks to commemorate the moment. Then, after a few minutes that felt like hours (oh, the barking!), I knew 2024 was a thing of the past and I could go back to sleep. 

It's one of the reasons I love New Year's Day. At a time when we often hear about the benefits of quieting thoughts about the past and/or future to "stay in the moment" (aka mindfulness), it is one of few scheduled pauses, brief as it may be when the mental time travel of reflecting on the past 12 months to help plan the next twelve (future) is a good thing.

So what if we apply this approach to the goal of staying safe, living healthy now, and improving our odds of thriving longer? What fascinating findings from 2024 should help inform our plan for 2025? 

Here are few of the most important to know about in my opinion:

(1) Build Reserves: Whether it's this massive study of studies published in September which showed that for every 1 unit increase in cardiorespiratory fitness, adults had a double-digit drop in the risk of dying or this March 2024 review of 130 different studies which showed that "inadequate physiologic reserve" as we age (aka frailty) was definitively linked with important social drivers of health such as loneliness and isolation, the big message is clear: Improving or maintaining fitness, strength and power now can be one of the best investments we can make.

(2) Fiber First: If a headline read "Eat enough of this every day and lower your risk of dying by more than 20%" many of us might take a look. If the fine print said it was a study of more than 3 million people, even those who like to dive into the details might be satisfied. Well, that is exactly the observation made in this January 2024 review of 64 different studies on the subject. As a bonus, this study which does a deep dive into interventions shown to improve blood sugar control showed that not only does consuming more fiber (>=10g/day) help lower the risk of metabolic disease (sections 6.4 and 7.2 in the article) but points to emerging evidence that suggests if we eat it first, that is, order our eating patterns so we eat the veggies first and the carbs last, we might get an even better effect.

(3) Energy Vampires are REAL: This review from a team in Italy early in 2024 points to an important theme when it comes to the well-being and performance of groups and teams - attitudes really are contagious. While most of the work in this area has been done on leaders as the "sender" and followers as the "receiver", the authors point out that this relationship has also been established in those who tend to command attention (i.e. the loudest or most expressive person in the group). If you are on a team or work in a group, assessing and creatively addressing the emotional energy in that group might be a powerful risk-lowering strategy in 2025.

Of course, these are only 3 themes...and fascinating is most definitely subjective, but there's enough here to build on. Keep an eye out for more as we journey through 2025.

Have a great weekend and Happy New Year,
Mike E.

Dec 20

Around this time last year, we used "Holiday Heart Syndrome", the seasonal uptick of heart-related problems this time of year, to illustrate one of the most critical themes in thriving - sudden & heavy loads, no matter the type, leave us exposed to risk.

The idea is pretty simple - our biology (like all living creatures) is built for efficiency. Below the surface of our thoughts and like a seasoned holiday traveler who meticulously packs to avoid the pitfalls of "checking a bag", our body is constantly working to interpret our past experiences in order to anticipate our future needs and ultimately to "bring only what we need to survive". As unique individuals, we each interpret the statement differently, as this scene in a 1987 classic makes clear, but any way you slice it, wasted energy is biologically expensive, so we try to avoid it. 

Since our predictions, with a little buffer built in, are usually right, we get home about the same way we left...but not always. The trouble comes in when a sudden or heavier-than-expected load pushes us beyond the buffer. We scramble to deal with it, but the extra energy required puts us in a risky spot until we can recover. The type of load doesn't really matter. Whether it is a sudden temperature spike in the early summer before we've acclimated, a sudden sleep disruption from "springing ahead" or a sudden increase in the alcohol we consume because it's part of our holiday tradition this time of year, the risk is real. Thanks to a team in Germany whose dive into the cardiac physiology of Oktoberfest was published this month, we are now closer to understanding why.

Here are the basics: When we consume alcohol our system works harder to process it. Counterintuitively, and despite it being a depressant, our heart actually beats faster and our nervous system revs up toward fight/flight/freeze, an effect which took as long as 48 hours to resolve. In about 5% of the people studied the heartbeat became irregular enough to cause more serious problems (called atrial fibrillation). While, it may be easy to dismiss "only" 5 of every 100...when we consider this is about 10X typical, it's a risk worth managing. Here are 3 simple strategies:

1. Know thyself - if you are at heart risk or have been particularly stressed, overtired, or are fighting something else recently (e.g. a cold or other infection), the risk is higher, cut the consumption way back (or out entirely).

2. Counter the Salt - it's not just the alcohol this time of year, it's also the food, which is often packed with salt. While sodium is not inherently "bad", it plays a major role in our muscles' ability to contract, including the heart muscle. Getting too far out of the sweet spot can lead to heart conduction disorders like a-fib, as shown in this 2021 study. If you are surrounded by highly processed food this time of year, make sure to counterbalance with some fresh fruit and veggies (as well as nuts and seeds) which naturally have higher concentrations of potassium and magnesium, which can get depleted.

3. Monitor hydration - we may not be sweating like the summer, but it always matters. Even in young, well-trained athletes, dehydration alters the heart's ability to perform. The further we are from young or well-trained, the greater the risk. This can also compound the salt imbalance and can be accelerated by the diuretic effects of alcohol.

It's the beginning of the peak and it's easy to get beyond the buffers when traveling light. Have fun...but not too much. :)

Have a great weekend,
Mike E.

Dec 6

It's hard to believe it's December. Even with the sharpness of this morning's air temps, which well below freezing, had a bite and emails about the end-of-year planning deadlines starting to occupy my inbox, it feels like only yesterday when we were talking about the benefits of acclimatizing to the heat in a strategic and measured way...but here we are...entering the homestretch of 2024. If you are anything like most this time of year, it feels like a sprint to the finish, and you know every minute counts. We might even wish we could make more of it in order to get a few more items checked off the list. Here's the good news - for those who invest a few minutes wisely, the evidence says we can. It's a two-part story, and it starts with a little myth-busting.

Let's call part one the "don't judge a book by its cover" myth of health. This popular myth says that to be healthy the most important thing we can do is lose weight. Since we know excess weight DOES add risk, this myth is plausible, but not ironclad. There are more effective ways to lower risk - if you want more time, as measured in years of life, spend more time with the stairs than the scale. Or, in the words of the lead author of a recent "study of studies" from the University of Virginia: "Fitness, it turns out, is far more important than fatness when it comes to mortality risk.". Across 20 different studies and a combined population of nearly 400,000 people those who were fit but overweight (or obese) had a much better health trajectory than those who were normal weight but not fit...and it wasn't by a little bit. Specifically, the low-fitness group was 2-3 times more likely to die during the study period as compared to the fit group. Yet, where things get really interesting, especially for women, is in how shockingly small an investment required to kickstart the time making effect was...which gets us to part 2. 

A team from Australia studied activity tracker data from more than 20,000 adults in hopes of determining the minimum "dose" of physical activity required, if done in short bursts throughout the day, to have a meaningful impact on preventing major cardiovascular events in the future. Since these bursts are more like activity "snacks" than formal or structured exercise, the theory is that they may be doable for more people. The results were impressive, once again reiterating that the difference between "something" that gets us up, moving and preferably out of breath (enough to call it vigorous), and "nothing" can be, well, "everything" if we are trying to add years to our clock. 

Compared to sedentary individuals, and after ruling out a long list of other risk factors and health behaviors, it took only 5.6 minutes per day of vigorous activity (VILPA) to have a meaningful risk reduction of about 15% for men. The effect was even better in women who only 3.4 minutes per day to lower risk by a massive 45%. In plain English, for those of us who spend larger and larger portions of our lives sitting or driving or looking at screens (essentially everyone), finding a way to get a little out of breath by taking the stairs, sneaking in some air-squats or wall-push ups during that stretch break or just about any other way, can cut our risk substantially. 

The final sprint is on and every minute does indeed count. If whatever you're working on today is as important as it feels, we'll all need you doing it again tomorrow - the best way to make sure you'll have enough time then is to invest some now.

Have a great weekend,
Mike E.

Nov 22

We're pretty much there. The sugary primer of Halloween has given way to the richness of Thanksgiving and the start of the holiday season. In less than a week many hometowns and communities will be celebrating with traditions that range from "big games" between rivals to moments of reflection and gratitude for many good things (even if never quite perfect)...and in many places, there will be food; in some cases lots of it, including some which may not love us as much as we love it.

While not intended as rain on the parade, which at least as of now seems unlikely for NYC and Macy's 98th, today we offer some food-for-thought based on what we know about how our bodies respond to rich foods, larger than usual portions and possibly some stress that comes with the holidays. The physiology of it is pretty simple - fatty and sugary meals have an immediate impact on our blood flow. The vessels become a little less responsive and oxygen has a slightly harder time traveling through the system. This is especially true following a stressful event making the combination of stress and rich foods a more risky one. 

For example, a research team from the UK showed in 2023 that a high-fat meal following a stressful event resulted in significantly altered blood flow patterns in even young and healthy subjects. In plain English, after a stressful event, the subject's vessels presented in a constricted state (as measured by FMD) during the first 30 minutes, as we might expect in "fight, flight, freeze" reactions. However, those given the high-fat meal after the event remained in this state for another 60 minutes, which isn't ideal. The good news is, it doesn't have to be this way. There are simple strategies we can use to minimize this negative impact.

The first, and perhaps most well-studied, is the strategic use of MOVE. A small study at Penn State University in 2006 showed that a 45-minute walk at approximately 60% effort taken 2 hours after a high-fat meal counteracted the change. Then, in 2020, another team showed that mixing in some stair-climbing (5 min per hour for 4 hours) also helped restore vessel responsiveness. However, new research out earlier this week suggests there might be another way.

The same team from the UK mentioned above which showed the detrimental combination of stress and rich foods has now shown that the high concentration of healthy compounds (called flavanols) in foods like cocoa, green tea, certain fruits and spices, can also help reset things. They tested low-processed cocoa powder (12 g added to milk) and found better vessel responsiveness at 30 and 90 minutes after the fatty meal. According to the study's author, "This research shows that drinking or eating a food high in flavanols can be used as a strategy to mitigate some of the impact of poorer food choices on the vascular system. This can help us make more informed decisions about what we eat and drink during stressful periods."

If you haven't already, maybe this is a good year to take a walk, find some stairs, put the kettle on, and add a new healthy wrinkle to your tradition.

On behalf of the team and with our sincere gratitude as we roll into Thanksgiving, have a great weekend,

Mike E.

Nov 8

As Ryan tells it, Mary was interested in making a health improvement. She was engaged in the education sessions he provided at her workplace and she always had good questions, truly an inquisitive mind. Mary wanted to lose some weight and was organizing and strategizing how best to do so. In the world of health change, she was "contemplating", commonly referred to as the step before taking action. She felt there were more pros than cons, but it still had to fit within the many other priorities in her life. Understanding how easily we get off course in this stage, Ryan was careful to give something proven effective but not drastic. He suggested having a "calorie cutoff time", which effectively shifts the last meal of the day to a slightly earlier hour and consistently "closes the kitchen" to allow a slightly longer burn-only period, which is known to improve how well we can process FUEL (especially sugar and fat) and may even lead to weight loss since eating late can be detrimental to health. A few months later Mary was down 10 lbs and feeling good about making a positive health change...and rightfully so, since most studies show even a small weight loss can improve several health markers.

Of course, weight loss isn't the only outcome that matters, and shutting off calorie intake isn't the only viable strategy. Perhaps strength and fitness are on your mind - according to the Mayo Clinic if you can't do 10 perfect push-ups (all ages and more if you're younger) it probably should be. 

Could even 1 minute of daily exercise between now and New Year's Day make a difference? This study from 2021 says, for some folks, the answer is yes. 

Could small dietary changes known to increase our body's Omega 3 and 6 availability (such as eating fish twice weekly and adding walnuts and almonds daily) lower cancer risk? This study out last month says, that for 19 different cancer types, the answer is yes. 

Could adding in 5 minutes of exercise-like activity into our day lower blood pressure to a healthy range? This study, out last Wednesday says, especially in cases when we trade sedentary time for exercise, the answer is yes.

Many people feel the urge to take their foot off the gas and maybe even coast into the end of the year when it comes to health. Given the known risks of the season, this is not a great strategy for most. On the other hand, since small investments add up to meaningful outcomes, we believe now is a fantastic time of year to start building a habit. You might be surprised with how quickly that investment compounds into real results.

Have a great weekend,
Mike E.

Oct 25

Fatigue is a complex phenomenon. It is both physical and mental (body and mind) and can be impacted by the places we are in and people we are with - some that energize us and others that, well, don't. Most importantly, however, fatigue has significant power over our performance. When we are ready and fresh we are capable of amazing things but when we are tired or drained, we tend to be clumsy and struggle. It might show up as fumbling over our words or having difficulty staying relaxed in stressful situations, or as we've seen in every type of athlete we serve (traditional, industrial, lifestyle, etc), it might show itself in the momentary lapse in coordination or reaction time that so often precedes an injury. With that in mind, fatigue is a big target when it comes to prevention efforts. Understanding it better opens the door for approaches that can improve our resistance to it and put the odds more firmly in our favor.

One of the most important insights over the last 10+ years has been that in addition to training our body and its tissues to handle greater loads in order to become more fatigue-resistant, training our brain to handle greater loads during times of fatigue can also improve our ability to ENDURE. Brain Endurance Training (BET) as it is sometimes called, is an approach that not only challenges an athlete physically, such as cycling, but cognitively as well using tasks that load working memory for example, in order to improve physical performance. Some studies have shown it works well.

 For example, in 2015 a team from Denmark reported significant improvements in endurance using a "time to exhaustion" test in healthy subjects who were randomly assigned to either perform endurance exercise only or endurance exercise accompanied with cognitively loaded tasks like a "2 backtest" where a person is shown a sequence of items and asked to quickly recall which appeared 2 ago (try it here). Another study in 2021 had similar findings showing a 32% increase in muscular endurance in a group that had both types of training concurrently and a 2023 study showed significant improvements for those who performed the mentally fatiguing tasks prior to the physical exercise.

But what about average/everyday folks - could there be benefits for individuals who aren't super concerned about their cycling endurance and really just want to think more clearly and minimize health risks?  The answer seems to be yes. Last week, findings from a team from the University of Birmingham showed that along with physical performance, both attention and cognition (executive function) could be improved to a greater extent when physical exercise was combined with cognitive loading tasks even when the subjects were fatigued. Although the best protocols are still likely a way off, finding ways to challenge body and mind seems to promote a better ability to ENDURE in each. 

Not sure if we will see puzzles in the gym anytime soon, but for those who might benefit from being a bit more fatigue-resistant, throwing in some MOVE in the midst of a mentally tiring day might go a long way.

Have a great weekend,
Mike E.

Oct 11

Lower back pain is a complex beast. Decades of trying to make it simple have mostly failed and, even after nearly 80 years (since World War Two when it burst onto the scene) and hundreds of billions of dollars spent annually since, making "spinal pain" (lower back and neck) the most costly condition of 154 when ranked in 2020, we haven't fully decoded it yet. What we can say with some level of confidence is that if your back is hurting it is almost definitely a whole picture thing and not just a single or even a few simple factors.

Here's what we know: Occupational exposures like heavy physical work are often pointed to as the culprit. While they certainly add risk, they have not proven to be the sole "cause". In one recent review, and beyond the usual number 1 predictor (a history of lower back pain), the strongest predictors included both work-related risks (carrying heavy loads, heavy work, and awkward postures) as well as personal health risks (higher body weight, anxiety/depression) as well as unhealthy behaviors (smoking and maladaptive behaviors). Said another way, the movement risk (biomechanical) is real...but so is the psychological and psychosocial risk. Other studies have shown that metabolic disease (small vessel disease like diabetes) may add risk, while others have focused on dietary risk (especially high inflammation), poor sleep, and the benefits of social support.

Finally, sedentary time alone is a strong possible driver.  If this all sounds like a tangled mess, well, we agree.

With that in mind, a team in Finland set out with the hope of unraveling some of it. They decided to take on the metabolic component by looking at energy utilization (glucose uptake and percentage of fat) in the muscles of the lower back by reducing sedentary time by 1 hour per day in a sample of overweight but otherwise healthy individuals with back pain. They recruited +/- 60 subjects and randomly assigned them to either the control group or the movement group. The headline findings were interesting but certainly not earth-shattering: those who reduced sedentary time slowed (or stopped) the progression of pain but didn't reverse it and standing alone wasn't enough to improve the metabolic efficiency of the back muscles. The fine print however was far more intriguing.

As it turned out, step count, that is, actual movement and not "just" posture change WAS associated with metabolic improvements in muscle and, when compared to previous studies, standing, like many interventions might have a minimally effective dose. An average 42-minute per day increase for six months in this study wasn't enough, but double that and throw in some professional support on managing discomfort as was the case in this study, and things improved. Of course, this is not the end of the line, there is still more to unravel. Until then, we continue to suggest a strategy that stands on the evidence:

MOVE enough - even if the best you can do right now is get out of your chair more frequently, posture change is good. FUEL clean - lower your dietary inflammatory load by increasing the healthy stuff and decreasing the metabolic stressors like low-quality, sugary/fatty & processed foods. RECOVER fully - keep your system relaxed with enough sleep. Build ENDURE - managing stress plays a bigger role in pain than most realize and last but certainly not least CONNECT - find a few people who have similar goals and band together; social support can help with all of the above.

Lower back pain continues to be common and frustratingly complex for too many Americans. Until we've got the whole mess untangled, go with what you know - a healthier body is a stronger, happier, and more resilient one.

Have a great weekend,
Mike E.

Sept 27

With the Summer season officially in the rearview as of Sunday, it shouldn't have come as a surprise that Tuesday morning "already" felt a bit like Fall, but it still did. The air was brisk, the sky had some grey and, as it tends to when the air is cooler (at least for me), the first sip of coffee was especially satisfying. Now, while I try to be conscious of the line between actual coffee (with nothing, often considered a healthy habit) and coffee-flavored drinks with enough sugar to have a nutritional profile closer to a dessert (not quite as wonderful), I admit to having mixed feelings when I answered "yes" last Spring to a highschooler doing a science project that asked me if I thought I drink coffee regularly enough for it to be considered a caffeine addiction. And so, like I often do, I've tried to keep an eye on the related research to make an informed decision as to whether this is a habit I should work to change. For those who might also wonder, today's blog is for you.

Let's start with the last time we covered the topic (January 6, 2023). Then, the general consensus was that consumption of up to 4 cups per day in healthy, well-rested individuals, did not appear to have a negative impact and might even have a small positive benefit on health. However, in groups who were up against either a health condition, such as a higher risk of fracture (osteopenia or osteoporosis), high blood pressure (160/100 mmHg or higher), or musculoskeletal pain or were chronically under-rested (less than 6 hours of sleep per night) there was a higher risk, the effect was negative. More than 1.5 years later, we have more information, but the punchline is similar.

Broadly, for otherwise healthy people, the news on coffee consumption (and by proxy caffeine) is mostly, but not all, good. In moderate doses (generally considered 2-4 cups per day) and when taken early enough to not interrupt sleep, there are positives including lower markers of inflammation (CRP), lower risk of Parkinson's Disease, a lower risk of a cardiometabolic disease cluster (called "multimorbidity") and a neutral effect on blood pressure. On the other side of the spectrum, one review this year reported an increased risk of lung cancer in habitual coffee drinkers, a risk that has been hard to pin down in previous years, something the authors acknowledged in the last line of their conclusion when they stated: "Further studies, especially with a prospective design, are required to expand our knowledge on the association between coffee consumption and risk of lung cancer.".  

For individuals already struggling with a disease, condition, or at high risk of one, the take-away is a bit more nuanced. The news for those with a history of colorectal cancer appears positive - the likelihood of recurrence in habitual coffee drinkers was significantly lower (-32%) than in non-drinkers, while the news for those with chronic pain was more complex; coffee consumption was associated with the known relationship between chronic pain and mental health concerns like depression and anxiety.

And so, like so much in health and human physiology - it seems the answer is "it depends". If you are otherwise taking care of yourself, generally healthy, are a non-smoker, and consume up to a few cups of coffee and/or tea per day (200-300 mg of estimated caffeine) preferably without added sugar, should you look to trim back your consumption? Probably not, you're likely not harmed and may even be lowering your health risk. On the flip side, if you have one or more health conditions (especially those that may be impacted by stimulants such as high blood pressure and/or anxiety), aren't getting enough sleep, or are already at the high end of consumption (more than 4 cups per day), a more thorough dive into your risk picture is probably a good idea.

We wish it were as simple as "hold the cream and sugar", but until then, we'll keep an eye on it and report back.

Have a great weekend,

Mike E.

Sept 13

I was standing on the sideline chatting with a friend recently and he was telling me about his most recent physical. Now, this wasn't any ordinary physical where the doctor might review some blood work and vital signs, this was a comprehensive physical mandated by his employer because his is a key strategic role there. He described a battery of tests and a long review with the specialist which took somewhere in the realm of 6 hours (and a lot of dollars) to complete. The bad news was, at/near "middle age" he wasn't perfect and sadly there was no fountain of youth, but the good news was he was doing pretty well all things considered, and on the right track. After a pause in the conversation, I asked "So, what did he tell you to do from here?", having a sneaking suspicion I might not be surprised. "Eat well and exercise mostly," he said...and I smiled thinking how clear things can be at the 30,000-foot view.

Way down here in the weeds where most of us spend our days, it doesn't always seem so simple. Super easy access to cheap and tasty (but harmful) food on every shelf combined with fewer and fewer requirements to MOVE during the day has resulted for many, in poorer metabolism earlier in life, less muscle and bone mass ("working tissues") during our peak years, a shorter distance to the risk threshold and ultimately a dwindling number of fully healthy years. And while there is a strong argument for "earlier is better" when it comes to building preventative habits and the reserves they create, "now" with a goal of "consistently" is almost always next best if there's been a gap. In fact, new research out this week showed that our working tissues aren't the only ones that build reserves from healthy habits. 

As described in a press release from the University of Michigan, even our fat cells get stronger and more efficient. Habitual movers, which were generally defined as individuals who performed physical activity at least 4 times weekly for 2 years, had differences in both structure and function when researchers compared their fat cells to counterparts who were not exercisers but were otherwise similar. Just like exercisers tend to retain "cellular muscle memory" which allows their muscles to respond faster and better to training, especially if they've been away from resistance exercise for a while, it turns out that the fat cells of those who performed endurance exercise regularly had better blood flow, more cellular powerplants (mitochondria) and were better able to store fat in a healthy way; under the skin and away from higher risk areas like organs in times of weight gain. This kind of adaptation may even cross generations, which, if this animal study holds true in humans, is especially important for future fathers and daughters.

When we do the right things consistently and give our bodies time to adapt, they do, even if the changes in the mirror aren't obvious or fast.  Before there are results, there are actions, and the faster we turn them into habits, the better off we'll be. 

If you didn't get started 2 years ago, now is a great time.

Have a great weekend,

Mike E.

Aug 30

Around the country, school is back in session, or close to it. First-day school pictures are starting to pop up on social media feeds - some with smiling faces and some with that "ugh!" look. And then there are those like my son (old enough to drive and much to the chagrin of my wife), who have been in "the game" long enough to "forget" about this time-honored tradition. Now, while it's entirely possible that he's become something of a grand master at this game of awkward photo chess played in households around the globe, it is equally possible that, like so many of us every day, his brain wasn't fully engaged and he was just trying to get out the door on time. This may be a bigger deal than it seems and one that might set us up for something less than our best, risky on a variety of fronts. For those of us who are driving first thing in the morning or in safety-sensitive roles at work, not feeling fully awake could be disastrous. For those who are working hard to focus and learn (like our kids), the same physiology could be keeping them from achieving their best...and if so, perhaps a few minutes of priming and "activation" using one of the most effective tactics known, would be worth the investment.

At its very root, this was the theory a team from Japan set out to test with a group of middle-school children. They provided a protocol of 7 light movements (stretching and low-intensity dynamic body-weight movements) each lasting between 10-20 seconds and then measured oxygen levels in the part of the brain known to handle higher-order tasks (prefrontal cortex) which sits directly behind our forehead. In essence, they were testing the idea that movement, even at very light intensities for less than 3 minutes total, could prime the brain for better performance. The answer, as published early this week, was "yes"; however some movements were better than others.

Dynamic movements that involved multiple muscle groups and a postural challenge (such as movement from a stretched position or one requiring stabilization) showed a more significant effect than static stretching alone. Or said another way, although it doesn't have to be strenuous to get the effect if you feel a movement is so easy or ingrained that you could "do it in your sleep" it is unlikely to do much to activate the brain...so maybe you could.

We are entering the transition zone - that period where the lazy days of Summer give way to the routine (and maybe racing) of the Fall. On the one hand, and with any luck, cooler temps will be here soon. On the other hand, there are more people on the roads, more demands for our attention, and therefore quite possibly more tired bodies and brains. If you haven't done the inventory in a while it's an easy way to prime the physiological pump...and the pulleys, levers, vessels, and synapses too.

Whether you join us the next time we cross paths or you take the idea home with you and share it with your family, it's never a bad thing to start the day well.

Happy Labor Day, have a great weekend,
Mike E.

Aug 16

Understanding a problem is at the heart of solving it. Whether we prefer the way Charles Kettering (American Inventor and Businessman) said it "A problem well-defined is half solved" or we lean toward Einstein's approach "If I had an hour to solve a problem, I'd spend 55 minutes thinking about the problem and 5 about solutions", the first step in being a problem solver is almost definitely being a problem understand-er.

When it comes to the declining musculoskeletal health (the body's moving tissues) in the US over the last 30 years, sometimes it feels like a poorly understood problem. Just like there are 88 unique risk factors for heart disease and therefore thousands of potential risk combinations per person (as mentioned here), movement disorders are simply not simple. We may want them to be about some singular biomechanical "fault" or completely encapsulated in the cause and effect of a moment when we first felt pain but that just isn't so. This is one of the main reasons we put such an emphasis on communicating the evidence in every opportunity AND why we try to approach the problem from all 5 known vantage points (MOVE, FUEL, RECOVER, ENDURE, CONNECT). With any luck, it helps to broaden the understanding of those who have their sights set on living as healthy as possible for as long as possible. 

This year has already produced some important insights from military populations, members of the trucking industry, and recreationally active US adults. Here are the headlines worth knowing, sorted by release date and which population the theory was tested with:

Jan 2024 - Mental Workload & Static Postures are correlated with musculoskeletal disorders in truckers (Industry)

Feb 2024 - Strength & Fitness measures predicted 2 of every 3 injuries (CAN Military)
Mar 2024 - Health & Fitness measures (BMI & Aerobic Fitness) were superior to movement assessment at predicting injury in young/healthy individuals (US Military)

Apr 2024 - Inflammatory Markers, Lack of Health Behaviors, and History of Pain predict musculoskeletal injury (Recreationally Active US Adults)

Jun 2024 - Muscular Power and Unhealthy Behaviors (smoking) predicted injuries and dropout in Marine Recruits (US Military)

Jul 2024 - Painful movement today predicts future injury tomorrow (US Military)

And now, the 5 minutes on solutions. Pick "any", work toward "all": 

Move often throughout the day, preferably enough to be a little winded. 

Do something for your strength & fitness every day. Evolve toward power movements.

Lower inflammatory load with healthy fuel and work on sleep hygiene.

Avoid known system-wide stressors like smoking.

Check-in with your movement daily and prime it for success (body inventory). Let us know if you need help (schedule a consult).

And last, but certainly not least....

Have a great weekend,

Mike E.

Aug 2

I mentioned a few weeks back that I had taken a trip out of the US. It was a fun-tiring kind of thing like vacations so often are. Yet, on my way back home, as the hours of trains, planes, and automobiles slowly passed, I noticed an annoying little ache in my right leg. It didn't have the features of anything serious (blood clots, etc.) - but it was there, steadily making itself known. With a pretty clear line from my hip region to the front of my shin, all signs pointed to sciatic nerve irritation. Of course, having seen this kind of thing so many times, I knew not to worry, but I also knew ignoring it would only prolong it. 

After thinking through the possible causes for the irritation it was pretty clear to me that between 5 time zones, lots of time sitting during transit and 10 days of vacation food, my system was pretty revved up. Data from my Garmin confirmed it - my resting heart rate was up significantly from my norm, my heart rate variability (a measure of system stress) had gone in the wrong direction and my "training status", Garmin's way of telling us when we are (or aren't) in the training-load sweet spot, was reading "strained". Essentially my sciatic nerve was a window into what my entire system was dealing with - I was exhausted and my body was shooting up a flare.

The good news is, I knew what I had to do. It would be a rebuild of the same 3 legged stool we so often share with clients and talk about here: 

1. Get moving. Exercise is one of the most potent ways we have to "soak up" inflammation and lower the overall load. Just enough to stimulate me without further exhausting myself. A few minutes of stretching after breaking a sweat and doing a little resistance felt amazing. The fact that the sciatic pain was mostly gone after the exercise told me all I needed to know - irritation, not injury.

2. Get rest. Not only full night's sleep but perhaps even more importantly, monitor how rested we feel upon waking. Almost a week later, I woke up today feeling refreshed. 

3. Eat well. Being back at home can definitely help here. Not eating out every meal is a fast way to add nutrients and minimize sugar by incorporating more fresh fruits & veggies. Shifting to water as the default beverage of choice didn't hurt either.

This is of course perfectly in line with the latest research on the subject. One study out this week showed that unhealthy diets (in this case either too much sugar or not enough nutrients) were linked with accelerated biological aging (years of living near the threshold) and another from early in July showed a link between similarly unhealthy diets (this time sugar-sweetened beverages like soda) and lower back pain which combined with another study from earlier in the year which connected pro-inflammatory diets to back pain makes the connection even stronger.

We throw a lot at our bodies this time of year. It's easy to go from revved up to broken down. There's no need to get that far. Reach out if we can help.

Have a great weekend,

Mike E.

July 19

As ironic as it may seem for someone who spent his first 20 working years logging the kinds of miles that would easily classify as "super commuter", I don't consider myself particularly well-traveled. Having only been outside the US a couple of times before this past week, I was both looking forward to and dreading the idea of a trip to Europe to watch my middle daughter take on a few of the other up-and-comers in her age group on the rugby pitch. Maybe it's just my age group, but the idea of a "European Vacation" conjures up something sort of hilarious to watch (a classic movie in one humble opinion) but maybe not to experience.

I'm happy to report that, generally speaking, all went smoothly in Chapter 1: Getting There. Security was shockingly easy, the airport was busy but simple to navigate, the trains to my local destination were slam-packed but ran on time and people were friendly and helpful. The only real issue was - WOW the timezone shift got me. For the first 3 days, I went to bed early, woke up in the middle of the night for a few hours and by the time I finally fell back asleep I was so exhausted I could've easily slept the next day away. It felt a little bit like what "light sleepers" describe, especially as we age; something I've never really struggled with. No surprise, when a new randomized study that claimed to show a significant improvement in sleep popped up in the headlines this week, I dove in.

The mechanism? Simple enough really - it was a dosing study on MOVE, and it once again showed there's a sweet spot. 

While high intensity or heavy loads of movement (work, exercise, etc) right before sleep tend to impair the quality and duration, it turned out lighter loads done during the post-work, pre-sleep time period had the opposite effect. More specifically, when researchers had people shift some of their physical activity to the "ramp down" period and had them do light to moderate intensity, bodyweight exercises for a few minutes, twice per hour starting 4 hours before bedtime, sleep duration improved with no negative impact on sleep quality...a very simple add on to make sleep hygiene tactics even more effective.

It doesn't take a major timezone shift to have sleep be a little "off" this time of year. The heat and the workloads tend to be up (or way up) and oddly enough this can leave us both tired AND unable to settle into the depths we need to RECOVER. If "3 minutes chair squats, calf raises and standing knee raises with straight leg hip extensions for 20s each over three rounds" can give us 30 minutes of rest, it's probably worth the effort. I know I'll be trying it on the way back!

Have a great weekend,

Mike E.

July 5

In our weekly scour of the health literature, we often find information that we hope to never need. While many studies have no relevance to our efforts, others carry important messages even when their primary message is not immediately applicable. This week, tucked away in the Journal of the American Medical Association's Internal Medicine pages was such a study. 

At face value, a study about minimizing the negative side-effects of chemotherapy might not seem directly in line with Pro-Activity's health-facing (upstream, preventative, etc) efforts. However, when we consider what this study is telling us, it is perfectly in line as it is evidence, in a highly concentrated way, of one of the core messages we often deliver - future quality of life (happier people) is more easily achieved when we push ourselves to stay strong now.

The harsh reality of chemotherapy is that, while powerful and at times nearly miraculous in its ability to kill cancerous cells, it often has spillover effects causing a negative impact on nearby healthy tissues. Since the nervous system supplies all cells and tissues of the body (even those that have gone rogue), it is especially susceptible. Like having a "pinched nerve" that never quite goes away, patients undergoing chemotherapy often experience nerve-related symptoms such as burning, pain, weakness, and balance problems called chemotherapy-induced peripheral neuropathy (CIPN); a recipe for lower quality of life that no one wants. Interestingly however, when patients demanded more from their nervous system, in this case by stimulation with specific exercises, they were able to cut their risk by 50-70%.

In a randomized trial that involved 3 groups: the first was a control group which had the usual care, the second was a group that received nervous system stimulation through whole-body vibration and a third which was given a sensorimotor exercise protocol (designed to stimulate the nervous system through balance, stability, sensory challenges, etc) twice per week, the results were clear and impressive: stimulating the nervous system, even in the presence of toxic chemical agents, added resilience. Or said more plainly, when we challenge our systems to MOVE deliberately and appropriately, they work hard to respond and adapt.

Although in this case it was tested with chemical stress, the response is very similar to that which is reported with exercises that challenge our balance as we age (e.g. Tai Chi) or dynamic warm-up protocols which are known to significantly lower injury rates in athletes - when we tell our body we need something and give it a little time to respond, it almost always does.

It doesn't take much to keep our nervous system strong and resilient but it does take something - give it a nudge with a few minutes of balance work today.

Have a great weekend,

Mike E.

June 21

There's really no need to make it complicated - the more industrialized the diet we choose, the harder it is on our bodies. This is the general theme that rang through 3 new studies all published in the last 2 weeks. While each evaluated a different problem - the first, the connection between salt and a common skin condition, the second, the connection between junk food and anxiety and the third, the link between a common artificial sweetener and major heart events - the takeaway was the same: the trade-off for a highly processed diet (which are often loaded with salt, fat, and sweeteners to achieve shelf-life and brain-teasing flavor) is future health. 

The first study looked at the results of more than 200,000 urine samples and found that as sodium content increased, so did the likelihood a person was diagnosed with eczema, one of the most common (+/- 30 million Americans) skin conditions. For every 1 gram of sodium excreted in the urine, the likelihood of eczema went up 11%. Although they're not exactly sure why, the general consensus is that as the body tries to rid itself of excess salt (not only through urine but sweat) it gets stored or even trapped in the skin creating a chronic irritant. This adds plausibility to some studies which have shown flares tend to be more common in the winter months - less sweating means more trapped salt.

The next study looked at fat consumption and its connection to behavior. While it's important to point out that this was an animal study (lab rats), the results paint a very clear picture that is worth at least considering: A diet that was engineered to achieve +/-10% greater fat than the "Standard American Diet" resulted in behaviors that suggest greater anxiety, negative changes in the gut biome and even genetic changes associated with unhealthy changes in brain chemistry.

The last study looked at a commonly used artificial sweetener and sugar substitute (xylitol) and whether it increased the risk of major cardiac events. The short answer, from a research team that looked at more than 3,000 subjects, was yes, as much as 57% in the highest consumption group compared to the lowest, which showed signs of an increased likelihood of developing blood clots. Of course, as always, there is nuance and this risk, especially in those who don't over-do it, may not entirely outweigh the benefits of this low-glycemic sweetener, but it should give pause to those who are consuming lots of highly processed sweets.

 Of course, sometimes the hardest thing to do is to find the "what to do" which fills the void left when so many studies tell us "what not to do".  This time of year we are in luck - fresh fruit and veggies are easier than ever to come by and we know that consuming more of them can counteract and fill the gap. Not only do they increase water and potassium (which helps to counterbalance the effects of high sodium) but the fiber on board helps us to rebalance the gut and even tamp down cravings for the kinds of treats that are loaded with fats and sweeteners. 

Step away from the dietary machine...and find a farm stand...chances are they are selling the FUEL that your future self wants more of now.

Have a great weekend,

Mike E.

June 7

I remember feeling excited and maybe even a bit vindicated in 2022 when the American Heart Association announced their latest update to the list of "most important things known to lower heart risk"...which was being called Life's Essential 8. The excitement had to do with them finally and definitively including sleep to their known risk factors; something that seemed so obvious given the research on the subject. I quickly created a free account and performed their "My Life Check" online risk calculator (found here) to see where I stood. It was relatively quick and easy, a solid tool for those of us who try to stay ahead of heart disease...and of course, all the outcomes that these same root risks are connected to, including aches, pains, and more. 

Their 8, which although not perfect for everyone but solid for most, includes four behaviors and four clinical values all graded on a 0-100 point scale (and then averaged), considered within the context of life stress and healthy connections. While we use terms like MOVE, FUEL, RECOVER, ENDURE, CONNECT they say:

1. Eat Better - which they define as close to a DASH Diet

2. Be More Active - which they define as 150 moderate minutes of exercise per week or more

3. Quit Tobacco - which they grade from never smoking to being a current smoker (or other)
4. Get Healthy Sleep - which they define as 7-9 hours per night (not more, not less)

5. Manage Weight - which uses a sliding scale based on BMI

6. Control Cholesterol - which they define as less than 130 mg/dL of "non-HDL" cholesterol

7. Control Blood Sugar - which they define as having no history of diabetes AND fasting glucose < 100 mg/dL

8. Control Blood Pressure - which they define as < 120 systolic and < 80 diastolic mmHg.

All while considering known health risks like isolation, inadequate social connection/contact, and inadequate stress management via unhealthy coping skills.

Perhaps not surprisingly, when I saw a new study, that compared the relatively simple my life check score to the odds of future heart events and with more complex signs of biological aging encoded on our DNA (methylation profiles), I was eager to dive in. The initial findings were also not particularly surprising: As healthy lifestyle scores increased, future heart event risk decreased. For every 13 points a person's health score went up, the likelihood of a future heart event or dying was cut by around 1/3rd. Interestingly however, there was also a strong link with biological aging which meant that for those who were genetically susceptible to accelerated biological aging, having a healthy lifestyle had an even greater impact, lowering their risk by closer to 40% for heart-related events and more than 75% for dying during the study period. Ultimately this meant that while the 8 health factors accounted for as much as 20% of an average person's total heart risk, they accounted for twice as much (40%) for those with the risk of accelerated biological aging.

We may not control our cellular blueprint, but the build-out is largely up to us.

Have a great weekend,

Mike E.

May 24

Most people know the basic story of Batman. Secret crime-fighter, lots of cool gadgets and only 1 phone call away when the police commissioner (Gordon) needs help. Way back, when Batman was a TV show, the commissioner would pick up a direct-line red phone to relay information about a high risk situation and within seconds, the problem was being dealt with.

Although far more entertaining than a typical risk monitoring and reporting system, the bat phone "system" is not all that different than other systems we rely on to stay safe. Smoke detectors monitor our homes and prompt us to call for help when it's needed. We teach even our youngest citizens how to make that call and what to expect when they do. The sooner we call, the faster help can arrive and assess the threat.

In the late 1990's we started seeing a similar pattern when people were at high risk of aches and pains. When those whose bodies were giving warning signs got to us quickly they usually did better, faster than others who waited and let things get even more tangled. It was easier for us and better for them so we started sharing our direct phone numbers. Within a year the clinical research started suggesting the approach had merit. Studies like this one were reporting better outcomes in less time for those who got the help they needed quickly. As the model got more refined, it became clear that it not only mattered "when" the call was placed, but also "who" picked up on the other end. It didn't have to be a superhero, but they needed the right plan, and it was easier to remember 1 number...and so the triage hotline idea was born.

15 years later, it was data from the US Military on low back pain which backed up the approach; they showed significant time and cost savings when guidelines designed to get people moving quickly were followed... but only when those guidelines were followed. Fast forward another decade to the present and the research has gotten even more refined. 

In a review of 3,000 studies, of which 31 met the criteria, this study (published earlier this year) showed that early response or "MSK Triage" as we sometimes call it, works well when it accomplishes 2 critical goals: 

(1) it helps the person experiencing pain understand what they are feeling, why and the likely progression so they can worry less and 

(2) gets them appropriately active - not too little, not too much, just right.

Anything that worked against those two goals, for example by either slowing down the first call, causing the person to become a more passive participant in their recovery or adding significant medical complexity to their path (strong pain meds and advanced images like MRI), tended to do worse; very similar to what we see on the ground in workplaces everyday. 

With Summer coming, this is often a time of year when bodies get a little overdrawn and tend to grumble and groan. While it's definitely better to build capacity and resilience to the risks we will face, and there's still time to do it, please know that we are standing by should you need to pick up the phone...capes not included.

Have a great weekend,

Mike E.

May 10

If the CDC estimates are correct, roughly 2 million US men and 12 million US women, that is, 4% and 19% of the population over 50 respectively, have lost enough bone strength to be diagnosed with osteoporosis. It's a way bigger problem than most people consider because when we overlay the millions of falls our parents and grandparents experience every year, things get pretty grim.

To me, one of the more interesting things about this risk is that for a long time those of us in our working years could feel OK about putting off thinking about it. After all, it's a problem mostly faced in our retirement years and we're not there yet. However, more recently, like several other injuries & diseases where age appears to be a major risk factor, what we do today tells us more about how we will live tomorrow, than ever before.

For example, 20 years ago suggesting that common age-related brain disease (e.g. dementia) was similar enough to other common lifestyle related diseases (e.g. diabetes type 2) to call it "the same problem at a different site" would've been a fringe idea. The idea that Alzheimer's disease was actually "Type 3 Diabetes", originally attributed to a researcher from Brown University in 2005, being reported on in an alternative medicine journal in 2009 probably shouldn't surprise us. 

Yet, while we've learned a lot since then, and the understanding of age-related diseases has been refined, one take-away seems clear: what we do early in life (pay now), strongly predicts what we will be able to do later (or pay later); and as it turns out, it's not only our brain but in our moving parts too.  One study that makes my list of "super interesting" (although too old to really call it current), showed that muscular strength (grip) and lifestyle choices (nonsmoker, physically active) predicted a long and healthy life. This is probably why this research, led by a physician in Colorado really grabbed my attention.

Ultimately beginning with initial studies several years ago, she found that RECOVER now matters for bone strength tomorrow in a very big way. Specifically, in both men and women, when sleep was disrupted or fragmented, bone mineral loss was more pronounced. In younger women, it was even more significant because their bodies more actively used the minerals being released, representing a "decoupling" which likely leads to the disease in the future. Although the study is ongoing (want to join?) the big message seems clear enough - like so many other health risks we face, all 3 legs of the stool matter:

Weight bearing MOVE is well known to stimulate bone growth - this position statement adds more.

FUEL, especially low inflammatory and high in particular nutrients (such as the Mediterranean Diet), gives our body the right inputs to build.

And now, even without the cool milk-mustache, a debate on value for another day, we can say that getting enough high quality sleep helps us RECOVER....all the way to our bones.

Have a great weekend,

Mike E.

Apr 26

One of the most important but often unsung heroes of health & longevity is "the precursor" aka "the early warning sign". Like that small yellow plastic a-frame that says "slippery" after someone just mopped the floor, they can be easy to pass by without much thought, but for those who are both paying attention and understand the message, can be highly valuable indicators that the time for change, in this case shortening our stride length to keep from falling, is now. Although equally easy to miss if not paying attention, changes in our day to day can be important indicators of our future health. For example, and as shown earlier this month, moving slower or less may not only be a well-known risk of developing disease (risk drops at/above 8K steps per day) but may also tell us our heart is struggling to keep up with the demands of life. It's not just physical health. A 2018 study showed that physical activity patterns predicted depression in adolescents and last year, similar patterns predicted accelerated aging at the genetic level. Although wearables make this much easier to see, it's not the only way.

It turns out it's not just movement data and it doesn't necessarily require tech to capture it. Earlier this week a study of more than 15,000 individuals from a team in China showed that sleep patterns also had predictive value. Using a very simple method to create a "sleep score" which ranged from 0 healthy sleep factors to 4 healthy factors, and then comparing those with healthy patterns (those who scored at least "3") over time, created a very simple matrix of persistently unfavorable (unhealthy), favorable to unfavorable (declining), unfavorable to favorable (improving) and persistently favorable (healthy). Perhaps not surprisingly, compared to individuals with regularly unhealthy sleep patterns, those with regularly healthy sleep had the best risk profile (20% lower risk of cardiovascular disease), which was even more pronounced in those who had a high genetic risk for heart disease (35% lower risk).

 Want to know what your sleep score is? Try it out using the four factors below - each is worth 1 point and scoring at least 3 points total would indicate "favorable sleep".

(1) Bedtime between 10P and 12A daily

(2) Sleep duration of at least 7 but not more than 8 hours regularly

(3) Daytime sleep (napping) of 60 minutes per day or less

(4) Rating of "sleep quality" as at least "fair" on a four-point scale of "very poor, poor, fair, or good"

Sometimes life isn't subtle - our risk jumps in front of us like a flashing sign. Other times, we won't notice it unless we slow down enough to pay attention. Daily actions and the routines they become often act like early signs cautioning us that something is a little off and it's time to get back on track. Movement and sleep can be great places to start. If you've got a smartphone with a health app or wear a smartwatch you may have all the information you need. Let us know if you need help interpreting it.

Have a great weekend,

Mike E.

Apr 12

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

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

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

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

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

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

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

Mike E.

Mar 29

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

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

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

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

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

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

Have a great weekend,

Mike E.

Mar 15

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

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

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

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

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

Have a great weekend,

Mike E.

Mar 1

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

Feb 16

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

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

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

Have a great weekend,

Mike E.

Feb 2

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

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

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

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

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

Have a great weekend,

Mike E.

Jan 19

Stress generally gets a bad rap. We've mentioned this before and while it seems the overall perception may be changing, I suspect if asked "Is stress bad for our health?", most people would instinctively answer "yes" and not "it depends", which is far more accurate. 

On the one hand, we know that intense stress (such as traumatic experiences) or early life stress, or the unfortunate circumstance of both together ("ACEs") can create lasting harm. Two recent studies out late last year made the link even more clear. One study showed that excessive stresses experienced by an expectant mother were passed on to the developing child and linked to a greater likelihood of future behavior challenges. Around the same time, a second study showed that the impact of excessive early life stress on the brain might actually be greater than the harm done by a physical injury like a concussion. This of course all seems bad. On the other hand, however, we know that small doses of physiological stress (e.g. exercise), in most situations, are one of our best ways to improve health. We also know that at some level stress is different from person to person. Certain factors can be protective against the risk of harm and particular traits, like grit (the passion and perseverance for long-term goals) can actually turn stressful events from negative to positive, from potential harm into periods of growth. So it's nuanced and it depends... 

To make it even a little more complex, some new evidence suggests that our perception of our stress can actually shape our reality; and possibly set us up for future cardiometabolic risk by influencing an accumulation of cholesterol and triglycerides, pushing blood pressure higher, influencing weight and fat accumulation and the many health risks that come with some or all of those factors. The trouble is, the details are still fuzzy; but thanks to brand new research which seems to have taken us another step closer to the root causes, things are getting more clear.

We've known for a while and have previously mentioned the significant link between chronic inflammation and the progression of disease. When inflammatory markers are high, disease risk is also high. One of the best reasons to make lifestyle modifications like improving fitness and eating better is that they are both known to lower inflammation and in so doing lower the risk of heart disease, brain disease, metabolic disease, and even pain. But physical health is not the only thing that drives inflammation, how we perceive and cope with stress plays an important role too. By using a simple survey, not ironically called the "perceived stress scale", researchers were able to show that high perceived stress was closely linked to both inflammation and future metabolic health risk. With that in mind, focusing on actions known to positively impact perceived stress (like sleep quality) could be a very valuable way to get on the right side of risk. Unfortunately, the jury is still out on interventions like mindfulness. 

So is stress bad for our health?

Well, it depends...but it doesn't HAVE to be. Try the survey and if you score higher than a 27, consider taking action to break a sweat, eat a healthy meal, and get a good night's sleep in order to break the stress cycle and chip away at risk...or of course, reach out; we'd be happy to help you get started.

Have a great weekend,

Mike E.

Jan 5

The calendar has flipped, 2024 is here, and (if history is any indicator) most Americans, whether "considering" or actually "doing", are a few days into some version of change that so often comes with the New Year. Although not the only target, health improvement is usually near the top of the traditional resolution list, so it's a safe bet that you don't have to look very far to find stories about people trying to use resolution season as a lever to get healthier. 

Netflix for example, has released a new 4 part documentary called "You Are What You Eat", which takes a well-timed and entertaining look at the Stanford University Identical Twin Study which compared a healthy omnivore diet and a plant-based (healthy vegan) diet in genetic identicals; the same study we blogged about on 12/8. Although the documentary has been far more entertaining than the medical journal, the punchline remains - while both groups improved, the plant-based group outperformed the healthy-omnivore group on several measures. Along similar lines and out last week, in a study of more than 120,000 people who attempted to "cut carbs" for longer-term weight loss, "how" appeared to matter. Cutting carbs (in general) may work in the very short term, but in the longer term, it's more nuanced. The researchers concluded that "only low-carb diets that emphasized high-quality protein, fat, and carbohydrates from whole grains and other plant-based foods were associated with less weight gain".

Of course, changes in food intake are not the only way to move the wheels of health change. A focus on just about any modifiable health factor can work. For example, along with challenging oneself to eat well or exercise, abstaining from alcohol during January has become increasingly popular. There isn't a ton of strong clinical evidence relating to the effectiveness of month-long health challenges, but what is available is promising. One small study that looked at a 28-day food and fitness challenge showed signs that things were moving in the right direction for those who took it on and this review of month-long "dry" efforts (e.g. Dry-uary, Feb-Fast, Dry July & other public health campaigns) showed that those who gave up alcohol enjoyed both physical and mental health benefits (including a positive impact on sleep), even if they didn't complete 30 full days. As a bonus, one of the most common indirect health indicators (financial stress) was reduced, with users most often citing "saving more" as a benefit of drinking less. Couple this with some interesting findings from military medicine that showed a relationship between alcohol consumption and chronic pain and the case for giving ourselves a reset in this way gets stronger.

The possibilities are nearly endless. Resolving to keep a consistent bedtime or to stop taking in calories within a few hours of that bedtime could both be impactful. Resolving to be more altruistic or "prosocial" by performing a small and new daily act of kindness could have an almost immeasurable ripple effect. Or, for those who prefer a more well-worn path, simply finding a way to tax our muscles every day (increasing step counts, 30-second 1/2 squat holds for blood pressure improvement, a few flights of stairs for fitness or a few push-ups for strength and mobility) can have a surprisingly powerful impact.

For those who receive our monthly health promotion content, we will be diving in a bit deeper. For those that don't - here are some key takeaways: we humans don't always like to change, and we may even avoid it...but we most definitely can, sometimes know we should, and occasionally have a window of time that makes it easier. Now is one of those times; the door is open. Whether you do it for the future you or because you need it now to be there for those around you - your health is worth taking a step. We are here and ready to help.

Have a great weekend,

Mike E.

Dec 22

I had never heard the term "holiday heart" before yesterday. Scanning the health-headlines as I often do, I saw an editorial in the Journal of Thoracic and Cardiovascular Surgery written by a team from the Medical College of Wisconsin that caught my eye. In less than 1000 words the authors put some important data behind a few themes I've been writing about this month and at some level all year:

(a) we each have a threshold

(b) the consequences of crossing it can be powerfully negative and long-lasting

(c) if we pay attention, the body provides warning signs
(d) and while it's probably better to operate far away from those thresholds (build capacity, etc), life is hard, so knowing how to navigate choppy waters is critical

The next 7 days are one of those classically choppy times. For those who celebrate any of the many holidays, religious and not, which fall during this time of year, last minute shopping, gift giving, travel, festive meals and more might be peaking. For those who don't, even the sprint-to-the-finish of another calendar year can ratchet up the physiological loads. If we don't pay attention, our heart may pay the price.

As it turns out, "holiday heart syndrome" a term coined in the 1970's, is the common name used for a phenomenon which includes a spike in heart-rhythm disorders, most commonly atrial fibrillation, which seems to be tied to the excess of the holidays. While binge-drinking, which is known to have a strong impact on the heart, is the top suspect (as many of 1/3 of individuals with a-fib link it to alcohol), it is not the only one. Electrolyte imbalance from a common dietary shift toward salty foods and away from fruits & veggies can be enough to push us into risky territory and adding in some stress, fatigue and even possible dehydration (either seasonal or alcohol induced or both) and we've got a recipe for conduction disorders. According to the editorial "Holiday Heart Syndrome often presents with symptoms of palpitations, shortness of breath (dyspnea), anxiety, weakness and chest pain among others."

So what can we do to prevent crossing the threshold? Simply put, we can respect the fact that we have one and manage it like we would during any other period of peak-load.

(1) First monitor (and likely add) hydration, especially if salt intake is up this time of year. All the same rules from the summer apply. Clear urine once per day and/or using the top-off-test (if no urge to urinate within 30 minutes of drinking 16 oz of water, likely some dehydration) are good rules of thumb.

(2) Get fruits and veggies "in" early and often. Not only will this also add water, it will help counterbalance the holiday foods by adding in potassium (to balance sodium) and fiber (to balance sugar). As always, there is no shortcut here. Potassium supplements should NOT be taken without medical guidance.

(3) De-stress with exercise. Even a few bouts of stair-climbing can go a long way.

(4) Protect your bed and wake times to ensure your sleep is maximally restorative.

(5) Send a “thank you” or “well done” to someone who you think deserves it this year - not only will it light up their day, it’ll have surprisingly positive effects on yours!

Enjoy peak week...but not too much.

Have a great weekend,

Mike E.

Dec 8

There's really no reason to belabor it. Most of us know the risk exists, can see it coming, and still get caught up in it year after year. Almost a quarter century ago a group of researchers studied the "holidaze" phenomenon and concluded that the evidence of its existence could be measured on the scale to the tune of +/- 1 lb of net body weight gained per year during adulthood. While they found a post-holiday "loss" was common, maybe in the form of New Year's resolutions, it wasn't enough to offset the total amount gained during the pre-holiday and holiday season. The obvious conclusion was "avoiding the risk is better than reacting to it".

The gremlins tend to be everywhere this time of year. Maybe you've got a Christmas cookie coworker who is like willpower kryptonite this time of year. Maybe it's the holiday parties with rich food and alcohol. It might have nothing to do with the holiday season and is more the shift in the stress/rest balance of trying to get those annual goals checked off in the homestretch that does us in. Maybe it's all of the above. If it's any, having a few tactics on hand can be valuable.

This was the conclusion from a team based in The Ohio State University's Medical Center which recently published findings of a survey they conducted related to health habits during the holiday season. Not shockingly exercise habits were sharply down, 45% of people said they stopped, and almost 67% said their nutrition suffers. Add in the 50% who feel more tired and stressed and the 33% who consume more alcohol this time of year and it's no wonder health takes a hit. The good news is, it probably doesn't have to.

If we boil their recommendations down we get a well-known logic - anything that throws off our routine (upstream/inputs) increases the odds of more problems later (downstream/outputs) - so protect our routines. This might most easily be done by going even further upstream anticipating risks and planning ahead to prevent them from becoming problems.

Specifically, they recommended: 

• Doing a little dietary downfield blocking by making the early meals of the day higher quality and more likely to last by adding a bit more protein and lowering the carb count at breakfast.

• Working hard to work hard by making sure some energy exertion, exercise when able, and active events when not, is part of the day

• Respecting Rest by keeping a normal bed/wake time whenever possible

• Limiting the number of drinks to a healthy dose and making sure you're consuming water too can minimize the impact

Of course, on the other end of the spectrum, we know that some people turn this time of year into a challenge - a chance to improve rather than simply slow the decline. For those folks we add one simple (not at all new) tactic based on a very cool study from Stanford U - Eat More Plants.

In a cool randomized clinical trial of identical twins (that is, genetic identicals), a team showed that a "healthy vegan" diet (that is, whole plants, not vegan junk food) outperformed a "healthy omnivore" diet (eat anything in moderation, avoid the high process, minimize added sugar) over an 8 week period. Specifically, LDL Cholesterol fell, insulin levels improved and body weight dropped more in the healthy-vegan group than the healthy-omnivore group. 8 weeks from now is the beginning of February. Improving through the holidays may be uncommon, but isn't impossible.

Have a great weekend,

Mike E.