Blog Archives

stress test results predict cancer too

Sept 22

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

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

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

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

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

Have a great weekend,

Mike E.

stress buffering: remembering recess

Sept 15

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

ancient medicine, modern results

Sept 8

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

"Let Food Be Thy Medicine"

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

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

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

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

Have a great weekend,

Mike E.

the humble banana: villain or misunderstood?

Sept 1

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

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

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

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

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

Have a great weekend,

Mike E.

have the rhythm of a dancer?

Aug 25

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

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

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

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

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

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

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

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

What is an example of such an activity?

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

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

Have a great weekend,

Mike E.

hold that pose and lower blood pressure

Aug 18

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

the multiplier effect of a regular bedtime

Aug 11

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

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

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

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

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

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

Have a great weekend,

Mike E.

the 4th headline: 5 of 12 cuts 2 by 32!

Aug 4

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

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

connect is the bridge

July 28

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

peak loads - recover well

July 21

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

do you know your pure score?

July 14

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

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

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

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

The scoring is as follows:

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

what i did last summer

July 7

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

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

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

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

Have a great weekend,

Mike E.

magic in the margins - where to invest our 20%

June 30

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

positively "affected"; building buffers

June 23

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

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

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

So how do we build these buffers?

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

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

Have a great weekend,

Mike E.

walking and the brain

June 16

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

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

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

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

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

Have a great weekend,

Mike E.

It Just Works. Even Now: FUEL 2 RECOVER

June 9

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

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

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

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

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

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

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

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

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

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

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

So what should we DO?

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

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

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

Have a great weekend,

Mike E.

Beat the Heat WITHOUT the Sweet

June 2

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

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

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

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

Change. For the Better.

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

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

Have a great weekend,

Mike E.

The SLOW Shift on Back Pain

May 26

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

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

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

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

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

Where to start: The ELEMENTS

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

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

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

The bottom line: It's an active process.

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

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

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

Have a great weekend,

Mike E.

The Least Expensive Brain Protection Around

May 19

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

Build Reserves, It's Worth It

May 12

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

Movement is a window into future health.

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

Better With Age

May 5

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

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

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

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

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

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

 What were the factors that increased the odds? 

There were 4:

Physical activity (17%)

Healthy Joints (42%)

Good Sleep (43%)

Financial Health (73%)


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

Have a great weekend,

Mike E.

The Stack and the spectrum

Apr 28

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

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

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

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

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

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

Have a great weekend,

Mike E.

FUEL Quality and knee pain

Apr 21

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

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

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

The key points are simple enough:

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

2 for toughness: our models matter

Apr 14

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

from "does it?" to "dose it!"

Apr 7

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

The Dashboard Glow and the Co-Pilot

Mar 31

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

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

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

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

Here are the important bits:

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

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

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

What's the punchline?

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

Have a great weekend,

Mike E.

Purple Power!

 Mar 17

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

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

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

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

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

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

Have a great weekend,

Mike E.

It's Not Just for Heart Attacks Anymore

Mar 10

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

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

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

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

Have a great weekend,

Mike E.

Aging Slower

Mar 3

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

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

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

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

What was the intervention? Simple calorie restriction.

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

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

There's certainly more to come.

Have a great weekend,

Mike E.

Part 2 - Less is More

Feb 24

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

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

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

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

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

Have a great weekend,

Mike E.

How Much is Too Much? Part 1

Feb 17

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

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

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

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

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

So what can we do? 

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

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

Have a great weekend,

Mike E.

in the arsenal: work hard and recover well

Feb 10

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

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

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

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

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

Individuals with the shortest sleep duration were:

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

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

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

Have a great weekend,

Mike E.

score one for popeye

Feb 3

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

Let's set the scene:

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

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

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

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

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

Have a great weekend,

Mike E.

need a brain boost? Simple, Not easy

Jan 27

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

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

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

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

Simple and quick, but definitely not easy.

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

Have a great weekend,

Mike E.

For the exercise haters

Jan 20

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

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

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

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

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

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

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

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

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

To the stairwell!

Have a great weekend,

Mike E.

which is better?

Jan 13

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

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

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

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

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

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

Have a great weekend,

Mike E.

Putting a Bow on '22 - A Year in Review and Our Top Picks

Dec 30

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

What we wrote about in 2022

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

MOVE: 14 (27%)

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

FUEL: 10 (19%)

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

RECOVER: 5 (10%)

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

ENDURE: 6 (11%)

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

CONNECT: 7 (14%)

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

Multiple ELEMENTS: 8 (15%)

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

Other: 2 (4%)

Ergonomic Clothing, year-in-review


Our Top 5 Picks

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

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

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

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

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

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


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

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

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

Have a great weekend,

Mike E.

Into the Cold: Win the Winter

Dec 23

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

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

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

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

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

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

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

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

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

Mike E.

Step Change: Dialing in Dosage

Dec 16

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

Nurture Your Nature - MOVE More

Dec 9

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

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

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

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

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

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

Have a great weekend,

Mike E.

Salty and Stressed - New Findings in FUEL

Dec 2

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

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

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

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

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

Have a great weekend,

Mike E.

Start Stopping More Often

Nov 25

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

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

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

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

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

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

We hope your Thanksgiving was a great one.

Have a great weekend,

Mike E.

cause and effect: Food choices and pain

Nov 18

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

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

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

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

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

Have a great weekend,

Mike E.

puzzles & Proteins - a whole new twist on "brain food"

Nov 11

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

*special thanks to Mike W for sending the NEJM article

Social Contagion is Powerful Stuff

Nov 4

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

3 things you've already heard (that still matter)

Oct 28

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

no shame for snoozers

Oct 21

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

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

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

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

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

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

Interestingly, they found that:

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

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

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

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

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

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

Have a great weekend,

Mike E.

what's wrong with eating late?

Oct 14

We've all heard it before - "If you want to stay healthy and lean, don't eat after 8 PM"  Or is it 9 PM? Or does it really matter at all? 

 The short answer is - Yes it matters - there are many studies that have shown this observation over the course of time - but until very recently we didn't know exactly why. Some evidence says eating late relates to changes in our core body temperature while other research says it relates to metabolic disorders. However new research out this week from a team based in both Boston and Spain has brought a deeper level of understanding than we've ever had before.

According to the research - eating late at night has three important and strikingly negative effects on our systems:

(1) Late eating increases waketime hunger and decreases levels of the fullness-hormone "leptin", which acts as the signal that tells our brain when we are no longer hungry, but that's not all. 

 (2) Late eating decreases the rate that our bodies burn calories while we are awake (waketime energy expenditure) as well as lowers our body temperature over the next 24 hours, but that's still not all.

(3) Late eating tells the genes that regulate our fat cells to store fat (rather than burning it).

Any one of these effects could be problematic, yet combined, the impact of all three could be very detrimental. 

This one is relatively short. There's simply no need to belabor the point - going to bed "empty" is not just for better sleep - it will protect our metabolic health as well. 

Have a great weekend,

Mike E.

to shiver or sprint: training to endure

Oct 7

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

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

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

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

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

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

Have a great weekend,

Mike E.

generational health

Sept 30

We can learn a lot from worms; well, a Nematode (roundworm) to be exact. C. Elegans, a particular type of roundworm, is a model organism used to research a variety of biological functions in animals; its involvement leading to a variety of discoveries that have helped us better understand how the nervous system, metabolism, and even the way genes work (or don't). Not a bad contribution for a little animal most people have never heard of.

Earlier this week, the well-studied little critter made science headlines again as the subject of research at the University of California Santa Cruz which showed, with more clarity than ever, that our life experiences can imprint, encode, and can ultimately prove responsible for turning genes on and off, generations in the future. Formally known as "transgenerational epigenetic inheritance", which, admittedly sounds a little complex, the concept is not as hard to understand as it sounds.

In essence, our life's experience (environment, behaviors, etc) has an impact on which of our genes turn on, which turn off, and to what degree. This is called "epigenetics" and it has established a very clear link between our day-to-day health behaviors and the way our bodies adapt to those behaviors - all the way down to our genes. For example, epigenetics helps explain the genetic harm done by smoking or by routinely poor dietary choices and it has been a hotbed of study for the last 10 years or more.

This new research however adds a significant wrinkle - that those changes are NOT something that gets reset in the next generation, but that they are passed down to our children and grandchildren (at least) and possibly even further than that. Said more simply, the expression of OUR genes, at least in part, has been influenced by our grandparents' health choices and the same will be true for those of us who have children and grandchildren of our own. 

Not unlike the savvy saver who builds a financial nest-egg that can be handed down to children or grandchildren, the healthy mover (or fueler, recoverer, endurer, and connector - since all of these areas of health are known to influence epigenetics and some generationally) is building a critical asset with value well into the future.

There are very few investments that can give both instant and distant returns. Healthy actions are one.

Have a great weekend,

Mike E.

right system, wrong environment - cravings part 2

Sept 23

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

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

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

where cravings come from

Sept 16

My refrigerator has ratted me out. OK, that's probably a little sensational. In truth, it has "raised my awareness" of a nasty little habit I've developed. No, it's not some type of smart tech that is designed to keep me least I don't think it is...but it seems to work that way for me. See, this 2-door refrigerator (a recent replacement), has a feature where it cannot dispense water when the opposite door is open. Now, this probably doesn't seem like that big of a deal; in truth, it's not. But it was a VERY effective way to point out that I had developed a mindless fridge-trolling habit every time I got up to fill a glass of water. And I do mean EVERY time. 

It used to be a simple loop of: start filling the glass (left hand), open the fridge (right hand), and mindlessly scan for a snack - whether hungry or not - at least until the glass was full. I didn't always find something, but I always looked. That is until the loop became: start filling a glass (left hand), open the fridge (right hand), notice the water had frustratingly shut off, close the fridge and get back to work, feeling like something was missing. It was literally a wake-up call. 

I wasn't really hungry nor was I craving anything in particular and yet my behavior (once it was made so glaringly obvious), suggested I was always open to the idea of eating. So where does this mindless snacking habit come from? If we could solve this riddle, we might better understand some of why most of us are at risk of steady weight gain by middle age, despite the ever-increasing certainty that over-consumption of particular foods, especially those that are sugar-sweetened or fatty, seem to add both pounds and risk for injury/illness/disease and even dying prematurely. Well, thanks to a team of researchers at Columbia University we have more clues and, as it turns out, it's NOT just as simple as "because they taste so good" (aka hyper-palatability).

This time they found, much like their 2020 work on sugar, fat consumption is driven not only by lighting up the brain by way of taste (i.e. receptors on the tongue) but ALSO by circuits that monitor nutrient absorption in the intestine. Said more simply, even when the subjects (mice) were unable to taste the food (bred without the ability to taste), they learned to prefer foods that were able to provide usable fuel (sugar and now fat) over tasty but unusable fuel (artificial sweetener) within 48 hours. The connection between their gut and their brain (aka the gut-brain axis), although much slower than taste receptors, which helped prove it wasn't the tongue driving the behavior, was still driving them to go back to the source of the sugar and fat....not that unlike my fridge habit.

It may even help us understand why individuals who habitually ingest artificial sweeteners (i.e. tasty but not usable nutrients) may actually have an increased risk of metabolic diseases like diabetes and decreasing consumption of diet sodas (even those with no calories) can improve weight and associated risks ...because we don't only forage for flavor...we forage for FUEL; and since one without the other won't satisfy our needs, we are left craving more.

This time next week it will officially be Fall. Here's to finding some recipes that are both flavorful AND satisfying; perhaps a little less pumpkin spice and a bit more pumpkin! Definitely let us know if you've got a good one.

Have a great weekend,

Mike E.

bumper sticker wisdom (Learning to "Duck")

Sept 9

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

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

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

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

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

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

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

Have a great weekend,

Mike E.

it's like a lift-gate, in your shirt

Sept 2

Although we don't write about it nearly as often as tactics to stay healthy or ways to improve physiological variables like cardiorespiratory fitness, strength, recovery rates, etc, a big part of our team's work is looking at human movement during particular tasks and finding ways to improve efficiency; broadly, the use of ergonomic principles. Whenever possible, reducing wasted energy, such as finding, based on a person's movement patterns, the easiest way to get a task done, is a worthy pursuit.

In some cases, when the task is highly intense or commonly performed, we might research the tools, mechanisms or materials that contribute to fatigue (for example, glove materials that have less stiffness and reduce the risk of forearm fatigue in our utility clients). In other cases, we might explore mechanisms that make a task more "doable" or enjoyable by a larger population (such as the use of an E-bike to lower barriers to physical activity). In still other cases, such as with traditional athletes, we might be looking for ways to give a competitive edge, such as exploring research related to shoe choice, energy return and running economy in sports like running. 

In situations like these, even a "a little help" can go a long way: 

- A slightly less stiff glove may keep the wearer below the fatigue threshold and therefore out of harm's way. 

- A little bit of assistance from a lightweight motor might make cycling for transportation more enjoyable (and less sweaty) and encourage more people to do it. 

- Improved running economy of +/- 3% over the course of a marathon can make a real difference in performance.

So what if these assists were available all the time? Would there be less injuries? Would there be a greater likelihood that more people would engage in physically demanding efforts? Would performance improve overall? It looks like a team at Rice University is betting the answer to at least 1 (and maybe all three) is a strong "Yes". In a recent paper (with accompanying videos) they describe a method for embedding mini-assists into the clothing we wear. Can you imagine a shirt that interprets your movement as "intending to lift your arm" and then helps you do so? They did....and built it. 

Of course, it's very early on, and I'm not sure robot-clothes are higher on my list of cool gadgets than a Jetson Car just yet, but there are many possibilities that can make heavy tasks safer and more efficient here, so we'll definitely keep watching for ergo-clothes to hit the market.

Have a great weekend,

Mike E.

plugging the leaks with tea time