Nov 28
We've all experienced the emotional power of certain words. Whether the negative bite of a sarcastic comment that hits too close to home or the positive boost we feel when someone we care about recognizes a job well done, something is amazing about how certain strings of letters can prime our actions and shape our behaviors.
According to a research team from Virginia Tech, it starts with brain chemistry. In January, they found that certain words had the power to kickstart a wave of chemicals known to influence our mental health, regulate our emotions, and prompt us to act. They were the first to show that neurotransmitters like dopamine, serotonin, and norepinephrine are released in varying parts of the brain and in differing concentrations depending on the words used and whether they were positive, negative, or neutral (aka "valence"). While the list of tested words wasn't readily available, it did make me wonder if expressions of gratitude, something known to impact on the brain as discussed here, made the list. If so, it may further explain why the annual ritual that many of us participated in yesterday can be so much more than turkey and stuffing...
It's easy to think of "thank you" as a simple and often superficial gesture of politeness, something we might teach our kids to do by the age of 2 or 3 years. However, as has become popularized over the last several years, there's more to it than that. Inwardly, feelings of gratitude can impact a wide variety of personal health metrics and precursors. Interestingly, this 2020 review of research found even improved sleep quality made the list of benefits...but it doesn't have to end there.
A new review published in July suggested passing it on, that is, the moments when we allow our inward appreciation to overflow into a genuine outward expression toward someone deserving a "thanks", acting as a critical communication signal, greasing the cogs of trust between humans. Originally referred to as the "find-remind-bind" theory in 2012, expressions of thanks help us to identify the right people to connect with, keep them (and their positive traits) front of mind, and further solidify the strength of those relationships. They go on to say that when used in socially oriented settings like the workplace, outward expressions of gratitude not only benefit the members of the exchange but also those who witness the act, increasing the odds of positive contagion (social cascade) by priming others to join in (collective emergence). However, there is some fine print. The authors of the review point out that while gratitude as a practice can be powerful, gratitude as a "program" could be something closer to a tightrope walk. If it feels forced, fake, or otherwise phony, it's likely to backfire.
In a world where chaos and calamity sell, there's never a bad time to have a moment to reflect, reset, and ready...in this case, for the final push of 2025. We hope you had the chance to do so and were able to both give and receive the brain boost that comes with expressed positivity. But just in case one more wouldn't hurt...on behalf of our entire team - thank you - we could never complete our mission without every single individual who strives to live a stronger and happier life. We hope you'll pass it on.
Have a great weekend,
Mike E.
Nov 21
I am always drawn to stories about people who seem to quietly make words like "unstoppable", "invincible", and "limitless" their personal brand statement. Whether in the smashing of a 20-year-old course record in NYC a few weeks ago or in becoming the first female Army Ranger to compete (and then complete) the Best Ranger Competition, something 70% of the best-of-the-best entrants aren't able to do, 2025 has been a good year for human achievement. However, to me, where things get really amazing is when we try to understand how these "otherwise normal humans" work through the choice to stop and instead keep going; to deal with inevitable setbacks, leverage the years (or even decades of preparation), and ultimately find a way to ENDURE.
It's tempting to believe that the ability to conquer such amazing challenges is heavily, if not solely, psychological. Whether we call it grit, resilience, or extreme discipline, people who ENDURE seem to tap into an almost super-human toughness. Interestingly, however, new findings suggest otherwise. The limits of our performance are located, anatomically speaking, further south and are far more predictable than we might expect. While we've known for a while that over the very short term (minutes) our ability to physically perform work is largely limited by resource delivery (for example, getting oxygen to the muscles), which is measurable and therefore predictable, over the longer term (hours or days) things get a little less clear. We humans, with our advanced ability to "push past" our limits, haven't always seemed to fit the models that explain how other species survive by finding the balance between energy availability and activity intensity in tasks such as migration, hibernation, or others. It's not quite as simple as "calories in and calories out," but as new research out this week has shown, it's closer than we might think.
According to nutrition labels, the average human burns about 2,000 calories per day. Some portion, called the Basal Metabolic Rate or BMR (1500-1700 calories perhaps) is required for basic functions like breathing, digestion, and alertness to danger. Online calculators such as this one can provide a reasonable estimate by taking into account age, sex, height, and weight. The remaining calories burned get added with the activity requirements of our day, whether occupational or recreational, to give us a total daily energy expenditure (TDEE). Ultra-endurance athletes who might train more than 20 hours per week can obviously far exceed the 2,000 per day threshold and, of course, get the performance benefits of doing so. Impressive as they might be, they, too, however, have limits. As we learned this week, the amount of energy they can consume, convert, and utilize before they either can't keep up or things begin to breakdown trying is finite.
To determine this limit, a team of researchers recruited 14 world-class ultra-endurance athletes. It measured their energy expenditure across training and competition of varying intensities and durations over the course of an entire year. As it turns out, a biological limit did, in fact, exist, and it was approximately 2.5 times the BMR for each, a finding that confirmed previous research. While they found that the athletes had far higher peaks in short term capacity, as much as 6-7 times BMR in bouts lasting hours or even a few days, things consistently leveled out by the one month mark ultimately proving that even at the world class level, our ability to push ourselves in activities that last for more than 4 weeks is governed by the gut and its ability to supply energy...which appears to be capped.
There is almost definitely more to learn here, but when it comes to pushing our performance, the real discipline might start with the dinner plate.
Have a great weekend,
Mike E.
Nov 14
When setting out to write this blog each week, I typically try to find a unifying theme worth relaying to clients, customers, staff, and friends. It starts with a headline that is interesting enough to dive into a little deeper and often sends me down the rabbit hole of review in hopes of determining whether the case is as strong as the headline claims. This week, however, things were a bit different. Instead of one generalizable headline, there were 3 that were interesting enough to share but perhaps applicable to a narrower few. Here they are in no particular order:
Coffee for Conduction - because it is a fan favorite (and because I love a good cup of coffee), we are always on the lookout for research that helps us answer whether coffee is "good for us". As we've mentioned plenty of times before, the general consensus leans "yes" when the dosage falls in a reasonable range and at a time of day unlikely to impact sleep. However, for some groups, such as those with heart rhythm disorders like atrial fibrillation (a-fib), things aren't quite as simple. Even though for at least 10 years observational studies have suggested a slight decrease in the risk of developing the condition for coffee drinkers, not everyone is convinced. This week, the case got even stronger as a randomized controlled trial showed that in a study of individuals who were treated for a-fib, those who consumed 1 cup per day had a 39% decreased risk of recurrence.
Rest for Runners - the second headline worth knowing about seemed intuitive, maybe to the point of obvious at first. Simply put, a research team showed that runners who trained on inadequate or low-quality sleep had a significantly higher risk of injury when compared to well-rested peers. OK, no surprise there. However, where things get interesting is the degree to which the risk was increased. Poorer sleepers - which was defined as low quality, low quantity, or trouble falling (and/or staying) asleep - had a whopping 78% increased risk of sustaining an injury in the 12-month assessment period as compared to peers who were steadier sleepers. Now, to be fair, this was not a super rigorous study, so we can't draw firm conclusions - but it lends support to the idea that recovery definitely matters, especially in those who are pushing themselves physically at work or at play.
More on Movement for Knee Pain - in something of an addendum to our October 24th blog on managing knee pain, a new study out this week added Tai Chi to the list. In a randomized controlled trial, individuals who participated in an unsupervised Tai Chi protocol had significantly greater relief of pain and increased function than participants who received education alone and not by a small margin. Compared to those who got an education alone, 55% more individuals in the movement-based intervention achieved clinically significant pain relief, and 38% more achieved clinically significant functional improvement
So there you have it - MOVE more, RECOVER well, and if you like the stuff, enjoy that cup of coffee...it's probably good for you, even your heart.
Have a great weekend,
Mike E.
Nov 7
When was the last time you had a great night's sleep? You know, the kind of sleep where you wake up refreshed, feeling rested, energized, and ready to conquer the day. If it's been a while, you probably shouldn't feel alone. According to recent data reported by Garmin, the wearable tech giant that measures and scores sleep for its millions of users, only 5 of every 100 people are super-sleepers, scoring in the "excellent" range (at least 90 of a possible 100) on average. The rest of us sit closer to 70, which may partly explain why we spend an estimated $64 billion per year trying to improve it. According to this market survey, many are willing to spend even more.
While supplements led all categories in the survey above, new research suggests it might be time to reconsider, especially for those leaning on melatonin. As reported by the American Heart Association earlier this week, results of a 5-year look at the effects of long-term melatonin use (defined as 1 year or more) showed that users had nearly twice the risk of developing heart failure as non-users and 3.5X the risk of being hospitalized for the condition. While research on the effectiveness of many other sleep supplements is limited, and some show more promise than others, those looking for a safer and more effective option might do better in the produce section.
As summarized in this 7-minute companion video we asked AI to create, most research on the subject shows that both "what" we eat and "when" we eat it can have an impact on how well we sleep. Refined carbohydrates, saturated animal fats, and any calories within an hour or two of sleep are generally negative, and fiber is generally positive, but exactly "how" they impact us is still coming to light. A review from February of this year showed that not every measure of sleep dysfunction was related to a high dietary inflammatory index, a reasonable estimate for diet quality, which may be good news for those who struggle to limit or eliminate unhealthy foods. Even better, finding ways to add healthy foods may be a very strong stand-alone strategy.
New research from the University of Chicago and Columbia University last week showed that individuals who ate at least 5 servings (cups) of fresh fruit and vegetables during the day enjoyed 16% better sleep quality that same night as compared to those who did not. It was the first study to show such an immediate and objectively measured effect. While fiber and naturally sourced magnesium (nuts, seeds, and legumes in addition to fruits and veggies) also trended toward a positive impact, red and processed meat consumption trended toward more sleep disruption.
So, whether it's berries with breakfast, grab & go fruit at lunch, or the "good full" of a dinner that starts with a salad, we can rest-easy knowing an investment of 5 servings today was a good one...quite literally.
Have a great weekend,
Mike E.
Oct 31
Movement is a powerful health elixir. This is not new news. In one way or another, it's a song we have been singing for a very long time. Thankfully, it is also a message that many of the people we interface with understand, agree with, and, if our most recent client survey is accurate, are leveraging. We were excited to see that approximately 45% of respondents were in the low risk category for this ELEMENT, which is nearly double the average for American adults, where only 24% meet the full standard. However, we also know there is still work to be done as 35% of our respondents remained at high risk...they just haven't been able to turn the knowledge into action, which, of course, drives the results. Thankfully, we have a growing pile of research that provides strategies to bridge the gap.
One of the most critical bits to understand is that dosing matters. How often we move (Frequency), how hard we go about it (Intensity), how long (Time), and the mode we choose (Type) will all have an impact on our results...and therefore how close to achieving our goals we get. Exercise every day (F) at maximum effort (I) for hours (T) doing the exact same thing (T), like wind sprints, 7 days per week, and the combination is likely to produce such an overload that we could easily become injured. On the other extreme, sitting in a chair barely moving our thumbs enough to scroll, even for hours every day, is probably not enough to stimulate a healthy response. The good news is, just about everything in between, whether it be short bursts at higher intensities (aka "fitness snacks") or long slow walks, can be beneficial. The even better news, as new findings from a global research team showed this week, the greatest benefit, when dosing is dialed in, can be gained by those who are having a hard time getting the ball rolling.
More than "I" Alone
While so many studies have focused on intensity and there is fantastic research showing many great benefits of trading intensity for time (the stairwell is our friend!), this time, researchers wanted to understand if, at the lower end of the intensity spectrum, the tradeoff would still produce a benefit. They started by mapping the physical activity patterns of more than 30,000 generally healthy adults, but either had low levels of daily activity (5000-8000 steps per day) or were considered sedentary (defined as < 5000 steps per day). They then monitored health trajectories for the next several years to understand the connection between each pattern and the likelihood of developing heart disease or, worse yet, dying during follow-up. After nearly 8 years, the results were in, and the trade-off, in this case for slightly longer duration (Time), even at reasonably low effort (Intensity), worked.
Even though all movement patterns produced some benefit, individuals who got most of their steps in longer blocks (at least 10 minutes of continuous movement) were far less likely to die (about 1/5th as likely) as those who got their movement in bouts lasting less than 5 minutes, with the best result noted when activity bouts lasted longer than 15 minutes. The same basic trend was true for the development of heart disease. The group who got their steps in 15-minute blocks (or more) were more than 67% less likely to develop the disease as compared to those who achieved their movement in 5-minute blocks or less.
The takeaway on this one is simple enough: All movement matters and just about any "dose" can provide health benefits. While short bouts at higher intensities can do great things, even for individuals not quite ready for HIIT, carving out 15 minutes might just "FITT".
Let us know if we can help.
Happy Halloween - Have a great weekend,
Mike E.
Oct 24
For some, it started with an injury from way back when. For others, it was a more gradual combination of tissues that got a little bit stiffer with age and a change in the strength-to-bodyweight ratio, which allowed things to get a little irritated. For many, it's easy to notice after not moving for a while, like those first few steps out of bed in the morning or standing up from a kneeling position. However, for most, as discussed here, it's probably time for a reframing of the conversation.
Osteoarthritis (OA) is a massive, worldwide problem. Some recent data shows that more than 600 million people across the globe work through it every day. The knee(s) is the most common site, accounting for 56% of the cases. Not surprisingly, a significant amount of effort is directed at finding out how to prevent, reverse, and better manage the problem. The good news is, over the last few decades, a lot has changed, including how we talk about the disease; instead of "degeneration" with the sound of inevitability, there is renewed hope in the many promising ways to manage it. The less good news, as is the case with many complex problems, there is no single best or definitive strategy. And so, with that in mind, this week we thought it might be helpful to review some of the current narratives around knee pain with an eye toward those that have a strong or growing evidence base.
Dial-in Your Diet: Healthy Eating improves knee pain trajectory - the connection between diet and pain of all types continues to gain strength. There appears to be a particular benefit for knee pain sufferers who get adequate fiber. Whether it's this 2017 study, which showed between 24-44% lower odds of experiencing moderate or severe knee pain for those who consumed the most fiber, or this review from a few months back, which included more than 30,000 people over 20 years and showed a 27% risk reduction for those who got enough fiber, the connection is worth our attention. For those wondering "how much is enough?", the research team found that the benefit started between 14 and 27 grams per day. To provide perspective, this equates to only a few servings of common fruits, veggies, nuts, seeds, or legumes as listed here.
Out with the Old: Exercise (and yes, even running) helps - The old narrative, that running is somehow "bad" for the knees, thankfully, seems to be on the way out. A few years back, one review was inconclusive at best, with some data showing the repeated and rhythmic joint loads of running actually had a protective effect. Then, last year, another review concluded there wasn't a link between common forms of physical activity (including running) and disease progression. Yet another, which surveyed 37,000 marathoners, found the usual suspects (a history of hip/knee injuries, advancing age, family history, and body mass index) added risk, but years running, number of marathons, weekly mileage, and average pace were not predictors. In fact, just last week, an extensive review that compared a variety of exercise types to determine which was best found that aerobic exercise, which includes running, outperformed the rest.
More than "mass" alone - For years, we've known that elevated body weight (usually measured by body mass index, a weight-to-height ratio) is related to knee pain and OA. The compressive forces at the knee during even routine daily activities like climbing steps can near the injury-risk threshold when we are carrying extra weight. However, a more nuanced narrative, that it's not only our weight-to-frame ratio that matters, but the source of the weight that counts, is emerging. This 2024 review showed that both muscle mass index (a ratio of muscle mass to height), as well as sarcopenic obesity (i.e., both low muscle mass AND excess bodyweight), were related to knee OA, but low muscle mass without obesity (sarcopenia) was not. Of course, this was not a perfect review (as pointed out in follow-up commentary here), but it provides an interesting new vantage for those of us trying to ease the knees - lose the weight if able, but stay strong.
There are, of course, many others, including regenerative therapies and approaches to whole body inflammation that should be on the radar, but staying strong, feeding on plenty of fiber, and maximizing movement remain near the top of the list.
Have a great weekend,
Mike E.
Oct 17
Pain is a universal human experience and, at the most basic biological level, a critical warning system that lets us know when it's best to "stop everything" to avoid danger. Yet, as we've learned in greater detail over the last few decades, it isn't just a "local" danger radar, like the temperature sensors activated when we touch a hot stove, but rather, a finely tuned brain-integrated system which uses our past experiences to help predict our current and future risk. Unfortunately, there are times when our memory doesn't quite fade like it should and the system gets stuck in the "on" position, allowing our brain to send continuous full volume pain warnings long after healing has taken place or, as in cases of phantom limb pain (the experience of pain in a limb that has been amputated), the local signal has been turned off.
This can be just as confusing and frustrating as it sounds. While the initial pain might have been turned on locally with the onset of injury, it ultimately "lives" in the activated circuits of our brain. Therefore, what we experience as very real pain, often at the site of an old injury long after healing and even without any active harm present, is more likely to be a stuck brain switch. Referred to as persistent pain and impacting as many as 50 million Americans, this type of overreaction by our warning system can become a major impact on quality of life.
The good news is, as experts have helped us transition from dismissing something that we don't understand ("it's not real") to searching in the right places ("because it lives in the brain, it is both a mind and body phenomenon"), we have learned a ton. For example, while we know it is more likely to occur in individuals who experience chronic stress at a young age (especially those with adverse childhood experiences), we also know that lifestyle and health habits play an important role. For example, there is a known association between metabolic disease and persistent pain (possibly related to inflammation), and the emerging evidence shows that improving health factors can lower the odds of persistent pain.
For example, in one study from earlier this year, individuals with knee pain who maintained a healthy lifestyle were significantly less likely to experience chronic pain than less health-focused counterparts over the two-year study period. Similarly, in a 2025 randomized trial, back pain sufferers who improved their health habits showed a greater recovery than those who performed more traditional (guideline-based) care without an emphasis on lifestyle habits. Now, in a very interesting development last week, we may be closer to understanding why.
As published in the journal Nature, a UPENN neuroscientist who had personally observed that being really hungry dampened chronic pain, found the root of this phenomenon. As it turns out, a bundle of nerves in the brain stem that plays an important role in driving the chronic pain experience also relates to other key survival circuits such as thirst and fear. The team went on to find a specific signaling molecule called Neuropeptide Y (NPY), which helps the brain juggle these competing needs and override pain in the face of more critical needs.
“It’s like the brain has this built-in override switch. If you’re starving or facing a predator, you can’t afford to be overwhelmed by lingering pain. Neurons activated by these other threats release NPY, and NPY quiets the pain signal so that other survival needs take precedence”.
While there's still plenty of work to be done to develop a treatment for this overactive circuit, the team has made it clear that they hope for more than a pill. “We’ve shown that this circuit is flexible; it can be dialed up or down, so the future isn’t just about designing a pill. It’s also about asking how behavior, training, and lifestyle can change the way these neurons encode pain”.
Pain that lasts for more than 90 days can be frustrating and confusing. The good news is, it doesn't always have to be. Reach out if we can help.
Have a great weekend,
Mike E.
Oct 10
Legendary UCLA Basketball Coach John Wooden once said: “Little things make big things happen.”. It's a philosophy many would agree with, whether in sport or in other domains of life, and one that I was happy to see recognized, even if indirectly, earlier this week on Pro-Activity's "Athlete of the Week" post. The accomplishment is clearly a "big thing"; however, the years of steady build-up can't be understated. When we first met Mike, he was a busy professional, a Dad, and an involved member of the local community. He decided it was time to invest in his health, and along with a few of the other ELEMENTS, he got moving, literally, in that direction. What made him different from many, however, is that he never stopped. Running miles became cycling miles, which eventually became hiking miles. Mountains became milestones with selfies from epic (and enviable) locations, and as the post makes clear, steady steps forward became summits with the included bonus of strength, fitness, and health - exactly the kind of adventure many of us hope for in retirement.
But maybe you find yourself asking the question we so often get: "Could it really be that simple"?
Thankfully, the answer is yes...but we should never confuse "simple" with "easy", something a cool new study reinforces this week.
Some history - Before 2010, the American Heart Association promoted "The Simple 7", a group of habits and health measures that they advised to be the most critical in preventing heart disease. The habits included: Avoiding Smoking, Eating Healthy, Getting Active, Maintaining a Healthy Weight, Managing Blood Pressure, Controlling Cholesterol, and Maintaining Healthy Blood Sugar levels. Those who were able to achieve some or all 7 had significantly better health and saved money on healthcare. Then, with growing evidence that showed the connection between sleep habits and health, they added "Get Healthy Sleep" and rebranded the habit cluster as "Life's Essential 8" (4 health behaviors and 4 health factors).
Around that same time, a research team was tracking the health habits of more than 4,000 young adults across 4 major cities in the US in an attempt to understand exactly how protective, over a longer term, these habits could be. With at least 20 years of data, as reported this week in the Journal of the American Medical Association, they found resounding evidence that the effect was massive and that consistency was critical.
Individuals who achieved and maintained a high healthy habit score (80% average score or better across all 8 markers as listed on page 11 here) and remained consistent over the course of time were nearly 10 TIMES less likely to have heart disease or a heart-related incident by the end of the study period when compared to those who averaged 50% or less. However, the effect wasn't only seen at the two ends of the spectrum. Every 10-point difference in average score changed a person's risk by 53%.
It's not always easy, but it isn't super complicated - get started as early as possible and keep going until it's a habit - there are amazing views that await!
Have a great weekend,
Mike E.
Oct 3
Maybe you, too, grew up hearing the term "brain food". In our house, it usually referred to eating fish, which, whether consumed whole (e.g., low rates of depression per average pound consumed) or as a part (e.g., Omega 3 fatty acids and their connection to brain health and recovery), sometimes needed a little nudge at dinner time. There are of course others, many that we've talked about previously, and some outlined here, however, since then, the proof of the essential idea, that there are foods that are uniquely "good" for our brain and others that are not-so-good, has grown exponentially, which is getting us far closer to understanding why and how fast changes can start.
First, in a series of studies, a research team from Purdue University demonstrated that the accumulation of fat in the brain disabled certain immune functions, which appear to be at the root of Alzheimer's disease. This represents a major shift in thinking away from "plaque" (b-Amyloid) as the root problem and toward viewing it as something closer to a contributing factor linked to inflammation that has been shown to drive a variety of brain diseases and disorders.
Lending support to this idea, another study published last week showed a clear connection between ultra processed food (UPF) consumption and whole-body inflammation in a large sample of Americans as measured by C-reactive protein. Individuals with a diet in which half or more of their calories came from UPF had significantly more inflammation, as much as double, when compared to those who consumed less than 40% of their calories this way.
However, perhaps the most show-stopping finding, also released last week, showed exactly how quickly this can all begin — at least in mice. Researchers from the University of North Carolina Medical School found that when they fed mice junk food, a diet that "resembles typical Western-style junk food rich in saturated fat -- like cheeseburgers and fries", there was evidence that critical brain structures, especially those related to memory, were negatively altered in as little as four days. Whoa.
Notably, the team found evidence that this dose of junky fat and the way the brain attempted to deal with it, which included altering the ability to access blood sugar, further connected the dots between metabolic efficiency (how well the body converts food into energy) and brain health. When they rebalanced blood sugar, brain activity showed signs of normalizing. While mouse models don't always translate perfectly to human models, this one, especially in light of growing evidence that suggests a connection between creatine supplementation (an important cellular energy component) and markers of future brain health, is worth keeping an eye on.
There's certainly more to come on this one, but for now, if, like many, you too are keeping future brain health front of mind, a spinach salad with avocado and/or salmon might be a great choice.
Have a great weekend,
Mike E.
Sep 26
The story on hydration can be complicated. While we know that dehydration (too little) negatively impacts performance, both physical and mental, we also know that the other extreme, excessive intake of fluids to the point of impairing electrolyte balances (e.g., hyponatremia), can be equally (if not more) dangerous; a counterintuitive risk being seen in some vulnerable groups during heat waves. While some experts have suggested the narrative on dehydration has gone too far, heavily influenced by marketing designed to make us worry - pointing to many of us who rarely leave home without a water bottle in tow as evidence - others cite many known benefits for mind and body and conclude it's worth the effort to get right...which isn't always easy in a world of distractions. While our body has an elegant method for knowing when we need more fluid (thirst) and a variety of processes to deal with scenarios when we truly can't get it, it's relatively easy to misinterpret the signs or miss them entirely. Naturally, therefore, many look for guidance, which in itself can be complicated.
The old rule of thumb (8 x 8-ounce glasses = 64 fluid ounces) has been debated, with sources like the Mayo Clinic suggesting significantly more fluid overall based on guidance from the National Academy of Sciences. They cite 90 to 125 ounces for women and men, respectively, of which 20% comes from fresh foods. However, they also recognize that the "right" amount can vary significantly depending on personal factors, so "it depends". As someone who isn't always great about sipping on water throughout the day but has found a clear connection between running a little dry and the signs of a more strained system (poorer sleep quality, delayed recovery after exercise and for the wearable crowd, altered measures of heart rate and HRV), any time there's a simpler method being tested I try to pay attention. With that in mind, a new study which focused on something closer to a functional daily intake - an amount that is far enough above dehydration to minimize system strain without being overly concerned with perfection - caught my eye this week.
The study team compared the stress responses in a small, 32 person, group which was made up of roughly half that were in a low hydration state, habitually consuming less than 50 ounces (1.5L) of water per day and half that were adequately hydrated, consuming between 68 oz (2L) to 85 oz (2.5L) per day for women and men respectively. They confirmed hydration status both in the lab (urine osmolality) and by real-world observation (darker urine color first thing in the AM). They then put both groups through a battery of tests known to induce stress, one of which is the gold-standard "Trier Social Stress Test," and monitored 3 markers of stress at various time intervals afterward, including anxiety (as measured by a validated survey), heart rate, and changes in cortisol (a hormone we release in stressful situations). While the sensation of anxiety and the heart rate changes were similar, they found that in the low-hydration group, there was an exaggerated stress response, as measured by cortisol, 50% greater than in the hydrated group. Given the known connection between exaggerated stress responses and poorer long-term health, hitting the minimum in otherwise healthy individuals is a solid first step for those who regularly do not.
What's the catch?
It is worth noting that in the press release made by the UK University where the study was performed, the team made it clear that funding for this study was provided by the research division of a consumer products company, which owns at least one famous water brand. Not enough to dismiss the findings in my opinion, but perhaps enough to suggest the findings should be replicated and verified to make them stronger, which is almost always the case.
Bottom line on this one is that, in addition to keeping an eye on urine color as a reasonable hydration indicator for most of us, if you've got a deadline looming or some other known stressor on the horizon, topping off the tank might be a simple stress-reducing strategy.
Have a great weekend,
Mike E.
Sep 19
I can't even remember the first time I heard the phrase. As a regular in physical therapy and orthopedic clinics - a quip often used by clinicians to describe the risk of crossing the line into "sedentary" - it is so commonplace that I just assumed the credit belonged to some legendary doctor somewhere. As I dove further in, I found that "if you rest, you rust" was actually attributed to a famous actress who, in addition to a massively productive career, also played an important role in the movement for healthy movement. I learned that Helen Hayes was not only the first female actress to win the "grand slam of American show business" (the Emmy, Grammy, Oscar, and Tony) as part of an 82-year career which started in childhood, she also became a major philanthropic force in the domain of rehabilitation. The hospital in West Haverstraw, NY, where she focused her energies, eventually became her namesake. Research this year has backed her up - we humans are built to MOVE and should do so often if we want to stay vibrant. Here are a few that I thought were particularly cool:
Pain & Injury
First, in February, a group compared the impact of traditional exercise and "exergaming", that is, video games which incorporate whole body movements, on chronic low back pain. Both approaches made a positive impact, and neither was definitively superior to the other, suggesting just about any movement can work to help those suffering longer-term back pain (typically defined as >90 days) feel better. Whether you prefer movement for its own sake or movement that feels more like fun and games, it all counts. Then, in the same journal (a study we mentioned a few months back), another team showed that when it came to pain severity, this time in older adults across 28 different countries, movement was the most important lifestyle factor for predicting severe pain. It showed a much stronger association than even well-known drivers like smoking, poor sleep, and poor diet. Those who reported low and very low rates of physical activity had more than 4X the odds of developing severe pain than those who were highly active. A few months later, in June, as reported in the Journal of the American Medical Association, the work of a team in Norway helped to quantify how much movement, in this case, total walking minutes, is required to prevent low back pain from becoming chronic in the first place. The answer was 100 total minutes per day with higher intensities, such as a faster pace, only slightly better than slow-paced walking. While some benefits began around 80 minutes, the greatest benefit appeared at 100 or more, where an additional 23% risk reduction was achieved.
Illness & Disease
The story got even better last month when, in a huge new review of 57 studies that aimed to determine the "dosage" (in steps) of movement required to get meaningful risk reduction across a variety of diseases, the number 7,000 kept coming up. When researchers pooled the data and reanalyzed, they found that compared to a low-activity group (2,000 steps or less per day), individuals who got at least 7,000 steps daily had a significantly lower risk of getting (and/or dying from) a host of the most common diseases during the study period. In addition to a 47% decreased risk of dying from any cause (which ranged from 37% to 47% for cancer and cardiovascular disease respectively), those who averaged 7,000 steps per day also had a 38% lower risk of developing dementia, a 28% lower risk of falls, a 25% lower risk of developing cardiovascular disease, a 22% lower risk of experiencing depressive symptoms, a 14% lower risk of being diagnosed with diabetes type 2 and a 6% lower risk of being diagnosed with cancer. A powerful benefit from 1 simple habit.
Very few people work for 82 years or live to be 93, but if we can find a way to incorporate her first quote into our lives and minimize the rust with movement, we might be able to prove that she was also right when she said, "age is not important...unless you're a cheese." :)
Have a great weekend,
Mike E.
Sep 12
Sometimes the health headlines are pretty sparse. The team has to really dive deep to find something that is both interesting and applicable to serve as the focal point of the weekly blog. This week wasn't one of those times. While the FUEL-related headlines over the last few months have been dominated by the pros and cons of appetite-lowering drugs, this week, it was like something let loose, and a backlog of healthy eating studies poured onto the scene. The theme doesn't change much, but the details are getting more and more dialed in.
First, and maybe most importantly, a great new study helped to reinforce an important concept - the compounding effect of stacking good habits by combining FUEL with other ELEMENTS. Whether yours is a "SPAN" (combined emphasis on Sleep + Physical Activity + Nutrition) approach or some other combination, this new study out late last month showed that 2 out of 3 could also have a strong effect. A team compared the effects of a healthy Mediterranean diet (with no other restrictions or parameters) to a combined protocol of calorie-restricted Mediterranean (approximately 600 calories per day less) and regular physical activity, such as a brisk walk and/or balance and strength exercise over a six-year period. In 5,000 adults 55 and older, who were at risk for diabetes, the combined group outperformed the diet-only group (which we know to be powerful by itself) by an impressive 31%. Yet it doesn't end there, especially for those who are ready to zoom further in.
One really cool study in the British Journal of Ophthalmology, which caught our eye (pun intended) reported on the impact of dietary fat intake on vision in children. They found a clear link between saturated fat intake and nearsightedness, which was significantly less in those who consumed more Omega-3 PolyUnsaturated Fatty Acids (PUFA). While studies like this are only the start of the discussion and not universally applicable, it's probably fair to assume that it's not only carrots which help maintain or improve vision health...if the fats in your diet lean heavily toward saturated fats, it may be time to consider foods rich in Omega 3s like certain types of fish, nuts/seeds and perhaps soybeans. There's definitely more to learn here, but it's possible (and maybe likely) that given the pro-inflammatory profile of saturated fats and the small "pipes & wires" (vessels & nerves) that supply the eye, fats with a better profile are, quite literally, easier on the eyes.
A little lower down the anatomy ladder, another great FUEL study out recently showed that older adults could "rebuild" their oral biome by supplementing a popular endurance-enhancing root vegetable. Yes, it's beetroot juice for the win again, but this time as a way to lower blood pressure by restoring the bacterial makeup of the mouth. Participants, who were broken into groups by age in this double-blind placebo placebo-controlled study, drank a few ounces of nitrate-rich beetroot juice twice daily for 2 weeks. While the older participants saw a notable blood pressure benefit, their younger counterparts, who had a healthier biome in this regard (and therefore maybe didn't need as much of a reset), did not. The takeaway on this one is that our bacterial profiles likely change with age, and although we're not sure if this is "cause" or "effect", there does appear to be a link to this change with heart health. The good news is, these changes are, in part, reversible by eating a diet rich in plant-based nitrates. Beets and arugula are near the top of the list; however, another family of plants may do this and more, according to a couple of studies we had previously missed.
Putting a little more power in the cruciferous column, this randomized controlled trial last year compared the effects of the powerhouse veggie family, which includes broccoli, cauliflower, brussels sprouts, cabbage, and others, with root vegetables and squash. As it turned out, the cruciferous veggies outperformed when it came to blood pressure-lowering effects, but that's not all...another study out this past May showed an intake of +/- 1 serving per day had a significant impact on as many as SEVEN different types of cancer. Specifically, the minimum effective "dose" ranged from 3 to 7.4 servings per week, depending on the type of cancer studied. Those who ate the minimum weekly dose had lower odds of developing cancer (on average) by 23%. Impressive.
Once again, it seems that when we focus on quality foods, mostly plants and not too much, we can put prevention on the menu. Fold in some physical activity and consistently restful sleep, and we've got a very strong platform to build on. Now is as good a time as any.
Have a great weekend,
Mike E.
Sep 5
If you're an athlete, engaged sports fan, or have followed any of our communications, you've likely heard the term "load management" in one way or another. It's a simple concept - when we overload the body, it's more likely to bark back (or break down) - but until relatively recently, there wasn't really a common language around the idea or a reliable way of measuring it, and therefore it was more intuitive theory than hard science. Then, in the 20-teens, a researcher named Tim Gabbett planted his flag on the concept with some very interesting data, which helped spur a consensus statement and, in the process, something close to a revolution in the training and competition space. The talk of measuring physiological loads, primarily in athletics, became far more commonplace and started to ripple into conversations where injury and illness prevention in other athlete types (e.g., industrial, tactical, etc) was the goal. Fast forward 10 or more years since the idea first entered the conversation, and, like many trends, it has experienced backlash, revisitation, and refinement.
So how does it work?
The basic premise is reasonably simple. Whether high tech, through the use of wearables or monitors which might capture data like continuous heart rate to predict intensity, or low tech, such as a 0-10 "rating" of perceived exertion after a training session multiplied by the total time spent training, a training load can be calculated. For example, if yesterday's exercise session was rated a 7 out of 10 effort level for 30 minutes, it would score 210 "load points" (7 x 30). If we then compared that total to the rolling 1-week and 4-week averages for the same athlete, we would know, relative to both a short-term and long-term baseline, how hard that athlete had pushed. We could do the same thing for the intensity of a workday or training operation.
Gabbett's research showed that if an athlete pushed significantly beyond their baseline average, such as more than a 30% increase in a week, their risk of injury went up. On the other hand, since the only way to reliably improve physical capacity (strength, power, etc) is to actually overload the system, so it can bounce back stronger, finding the sweet spot which allows for maximum gain with reasonable risk, has become a major focus for other research teams and coaches who have picked up the trail.
One athlete type that is particularly attuned to this fine balance is runners. They are not only notorious for overloading (and therefore experiencing a high rate of injury), but they also tend to like gadgets, which means between their training device (usually a watch) and the app it pairs with, they have access to lots of training data. Knowing this, a research team from Australia sponsored by Garmin recruited more than 5,000 runners to analyze their training data and injury histories in hopes of determining with a greater level of understanding "how much is too much?". What they found, as reported late last week, is something worth knowing: in runners (and possibly other athletes who repeat movements in high volume), a single session overload (compared to baseline) presented significantly more risk than the same overload if it increased gradually over days or weeks and not by a small margin. Specifically, if a run was more than 10% longer than the longest recorded in the previous 30 days, the risk was 50-64% higher. If the spike was very high, such as double or more the longest session recorded in the previous 30 days, the risk more than doubled by 2.28X (228% increase).
While we can't assume the change in risk is the same for those who are experiencing non-running-related spikes, such as seasonal workloads or intensive environmental conditions in tactical or industrial athletes, the principle makes sense - pushing ourselves beyond what we are used to all at once adds significant risk.
Humans can do amazing things. Our systems adapt to almost any stress we throw at them and get stronger most of the time...just not all at once. It's said that the original interpretation of the famous two-word inscription on the temple of Apollo, which reads "know thyself," was something close to "know your limits"...for the runners and all of us who grind out lots of repetitive motion at work, home, or play, perhaps that really means "know thy baseline".
Have a great weekend,
Mike E.
Aug 29
Muscles may finally be making their way to the main stage. Sure, there has always been a crowd that cares - just walk into any gym, fitness studio, or whatever trendy term is being used today to find them - but solidly typecast in athletics and aesthetics, they've had a hard time crossing over into the mainstream conversation on health. Not even their proven track record for lowering injury risk when strong, in this recent study by 25% or more, even for healthy and fit athletes, has gotten them a shot at the big-time. Recently, however, the idea of maintaining muscle mass and prizing power is gaining traction with a larger and more widespread audience.
While we clinical folks might like to believe that it's the rising importance of "sarcopenia", that is, abnormal age-related muscle loss, that's driving the conversations, results like these, which show a generally low understanding even among professionals, suggest otherwise. Ironically, it may be the attention-grabbing "baby with the bathwater" headlines associated with popular appetite suppression medications that are providing the spark. While there is much hope for the health impact of lowering body fat this way, possible side-effects of doing so too aggressively, which include strength and muscle mass loss, may be driving the conversation beyond muscle as a body mover, to muscle as sugar sponge and, maybe most importantly, myokine maker.
First, let's review the concept of a sugar-sponge. It's a relatively simple idea. Every time we load our muscles via exercise, active hobbies, or physical work, we are priming them, like squeezing a sponge, to soak up blood sugar for energy production. All physical activity works, but combining resistance (the more muscles engaged, the better) and aerobic exercise is even more effective in both the short term and the long term. However, the trouble with this analogy is that sponges work both ways - they not only "soak up" the overflow (in this case, blood sugar) but they also release whatever they're storing when we next squeeze them, which is where things really get interesting for muscles.
Somewhere around 2008, researchers started using the term "myokine" to refer to certain small proteins produced by muscles and known to play important roles in our health. From reducing inflammation to improving metabolism and lots in between, these proteins play big roles. However, it wasn't until more recently that we learned of their critically important role in supporting brain and nervous system health as well as in lowering cancer risk. It turns out that one of the reasons exercisers have a significantly lower risk of certain types of cancer is directly related to these powerful little proteins. Just last week, an impressive new paper profiled an experiment where researchers added a few droplets of a blood sample taken from cancer survivors after a single bout of high-intensity exercise to a petri dish of aggressive breast cancer cells and showed that they could slow the rate of growth by as much as 30% compared to a sample taken at rest. In plain English, after an hour of exercise and for at least the first 30 minutes of recovery, our blood becomes a potent anti-cancer agent...adding yet another reason to make muscle work a priority.
OK, it's not actually magic, the results in the mirror never seem to show up as fast as we'd like, but within minutes, the myokines will be on the move and the benefits will start. If it's been a while since you wrung out your sponges and soaked up some sugar, there's never a bad time to restart the habit. Whether a structured routine or something as simple as a few push-ups and air squats by your bedside, it all counts.
Have a great weekend,
Mike E.
Aug 22
Most everyone believes that movement matters. That is, we humans are built to MOVE, should do so often and with reasonable intensity in order to prevent and reverse disease. Of course, as we always like to point out, it doesn't end there. We think clearly, feel better, and even get more out of social interactions when we are on the MOVE. However, when we explore the details of healthy and efficient movement, such as what it "should" look like, things get fuzzier.
On one side of the spectrum, somewhere in the weeds, is a group that sees movement through a lens of mechanical precision; let's call them "the engineers". On the other end, zoomed way out as if hovering far above the weeds, lives a second group, which sees movement as an entirely unique expression, heavily influenced by our personal experience of the world; let's call them "the artists". The engineers tend to argue that there is a "right" way to move, something that is efficient, can be taught, and should be replicated by all, in order to minimize risk and promote thriving. The artists, while acknowledging the clear advantages of leveraging our, well, levers, as well as our fulcrum and pulley (aka musculoskeletal) system, point to the almost countless variations in even the highest performing humans as evidence that there really isn't a standard. As is usually the case, it's a bit more nuanced than either extreme, and we now have stronger proof. What started a decade or so ago with a team of biomechanists (i.e. "the engineers") who were studying one of the fundamental human movements - gait (that is, walking) and common changes associated with knee arthritis, has grown into a simple and powerful alternative for those who might want to stave off a surgical correction or replacement.
To provide context and in a wild oversimplification in hopes to save words, the inside (medial) portion of the knee, where the round thigh-bone (femur) sits on the flat-ish shin-bone (tibia), is a major load-bearing structure when we walk. The combination of compression and the requirement to bend under that load in order to walk makes the area susceptible to wear, especially in those with reduced leg strength or elevated body weight. While staying strong, reasonably limber, fueling for health, getting good sleep, and a variety of other health behaviors can significantly lower our odds of developing arthritis, even when a genetic risk is on board, the engineers theorized that improving the way a person moves could also help.
In the late twenty-teens the idea was put to the test. One group of researchers found that when individuals with knee arthritis were trained to "toe out" while walking, their biomechanics improved. Around the same time, a different group at Stanford's Performance Lab found that a more personalized change, having individuals either "toe in" or "toe out" based on their unique mechanics, produced better results. They found that a personalized approach more consistently lowered the pinch force on the inner side of the joint. The results were so promising that they expanded the study and, in 2022, reported continued positive results, some of which were discussed in a 10-minute video here. As it turns out, and as published last week, even under the most rigorous testing conditions (a randomized controlled trial), 6 weekly sessions to retrain participants to move differently, in a way that complemented their unique mechanics ("gait retraining"), resulted in not only pain reductions on par with those expected from medication but also a clear improvement in cartilage health on MRI over time.
Said another way, both the engineers and the artists were right. Like a function-fingerprint, if you look close enough, our movement is uniquely ours. There is no "one perfect pattern" that works best for every human. However, exactly how we interface with the world through our movement can be optimized to lower risk, improve health, and ultimately maximize performance. If you think you could benefit from improving the way you move, let us know. We are happy to help.
Have a great weekend,
Mike E.
Aug 15
Our brains LOVE leaderboards and rankings. They are one of the most popular tools used to gamify learning for a reason and, if well designed, can improve motivation and striving. Although it's more nuanced than simply generating a list, for example, one study showed that the boost in motivation was more powerful for those at the top and the bottom than the middle, the essential premise that social comparison is one of the most powerful levers related to human motivation holds. Preseason rankings get us to scroll, Top 10 lists get us to click, and labels that indicate something has been listed among "the best" grab our attention. Not surprisingly, the rise of "super foods" is not all that much different.
According to the Harvard School of Public Health, the banana was the first real superfood, given that title around the time of World War I to help market the fruit to American consumers. It worked, but the term went dormant for decades until the blueberry was given the label for its powerful antioxidant capacity. From there, things snowballed. Growers and sellers began to realize the power such a label had in grabbing our attention (and our money), and despite the fact that it is more pop culture than rigorous science, many scrambled to show their product belonged on the list. Grape growers, for example, funded research to make their case in a paper that was published only a few weeks ago in hopes they might ascend the rankings to be up near greens, grains, berries, and seeds, which currently hold 4 of the top 5 spots.
We are often just as curious about foods on the other end of the spectrum. Although "junk food" doesn't seem to have the same branding power as "super food" (maybe because there are so darn many of them), "ultra processed food" is a term that is definitely gaining popularity as a way of pointing out that health is not only the result of "what" (ingredients and nutrient profile), but also "how" things are prepared. A few days ago, the American Heart Association published a scientific advisory that dove a little deeper. Unsurprisingly, the essential conclusion was "limit their consumption". This is generally in line with a study published a week earlier, which compared the impact of minimally processed versus ultra-processed diets on weight loss. Even when the diets were "nutritionally balanced", people got double the benefit when eating minimally processed. Then on Monday of this week, the British Medical Journal dropped the results of a massive study which propelled one particular food to super-villain status.
If you guessed "the egg", guess again. Although often the center of debate, at least for its role in raising cholesterol and for the time being, the egg (when consumed in relatively low doses) has been taken off the naughty list, according to a recent study. The French Fry, however, is another story. After working with the health data of more than 200,000 people, which spanned more than 5 MILLION person-years cumulatively, researchers found that it wasn't consumption of the starchy spud per se that drove metabolic disorders in the more than 22,000 individuals who developed type 2 diabetes during the time, but rather how it was prepared that mattered. Individuals who consumed 3 servings of fries per week increased their likelihood of developing the disease by 20%, a number which continued to grow in cases when consumption was higher. Those who ate similar portions of potatoes prepared differently (mashed, boiled, baked, etc.) did not experience an increased risk. Of course, replacing those same three servings with whole grains (which are often on the superfood list) was even better, lowering the risk by 8%.
Simply put, we continue to learn it's never quite as simple as we might like when it comes to nutrition. Just as the effect of what we eat extends far beyond the individual nutrients contained within, how foods are prepared plays a significant role in determining what winds up on our plate. Can you guess which other foods have made the top 10 according to our research? Ask a member of the team, they got the list hot off the press just a few hours ago.
Have a great weekend,
Mike E.
Aug 8
We dropped our youngest off at college this week. Although by the third repetition, it'd be reasonable to assume the process would be more routine and easier this time (that was, in fact, the hope), it certainly didn't feel easy. Always a bit of an adventurer, Andrew's choice was the furthest from home and will start in a rigorous military environment. To complicate things, always fairly independent, he's probably the least likely to call home and tell us how everything is going. Combine all of this with the fact that those in charge describe this place as "the road less traveled" and even the locals referred to it as "in the middle of nowhere," and maybe it's no surprise that good sleep has been a little more elusive than usual this week. The upside, of course, is that it made deciding which avenue of health to explore for the blog a lot easier. :)
As an unapologetic sleep-geek, along with my Garmin, which, similar to their new sleep-focused product, calculates a daily sleep score, our usual go-to sleep hygiene tactics are already well-integrated in my life. However, for those who might be just starting or ready to take a second look, let's start with a wildly unscientific self-assessment of those key areas we know matter to set the stage:
Bedtime - My bedtime is as close to set-in-stone as it gets (25 of 25 points).
Long Runway - I try to ramp down a few hours before that time, first by stopping calorie intake (hours prior) and then by leaning on a cup of Sleepy-Time tea to reinforce my "habit loop". (20 of 25 points)
Environment - My bedroom is set up for something about as close to hibernation as possible with generous use of blackout shades and a temperature that is cool but not cold (25 of 25 points).
Physical & Mental Readiness - although not typically as part of a bedtime routine, my heavy reliance on to-do lists to stay organized (a known tactic to help swirling minds before bed) combined with the fact I usually cram enough into any given day to be physically tired, ensures that I am ready when my head hits the pillow (20 of 25 points).
Total = 90%
So what could possibly be left?
One recent study that caught my eye was on the use of Creatine, a supplement which is gaining attention for brain benefits, along with its more well-known benefits associated with physical training. The 2024 study showed that a single dose of creatine could combat the brain fog of sleep deprivation. While I wouldn't say I'm sleep deprived (yet), it's certainly one I'll keep looking at.
However, more recently, and as reported last month, certain exercise modes might be particularly beneficial for those who struggle with sleeplessness. When the research team reviewed the randomized controlled trials on the subject, they found that of the 13 different intervention types tested, exercise was most effective. In particular, yoga and Tai Chi had the greatest number of benefits (including reducing the time required to fall asleep by 25-30 minutes each), while moderate intensity rhythmic aerobic exercise (like walking and jogging) showed improvements in the general severity of sleeplessness.
While I suspect my bout of insomnia may be temporary and things will settle in now that I'm both back in my normal timezone and got a text that things were going reasonably well (especially now that he knows about the fire ants, oof!), sleep can be challenging at times. If you find yourself struggling and need some ideas or a place to start, reach out anytime.
Have a great weekend,
Mike E.
Aug 1
Move enough, Fuel with high-quality sources, Recover fully, repeat. It's a remarkably simple formula that produces impressive results for just about anyone who can figure out how to make it work in their life. However, not unlike the difference between longevity (years alive, aka lifespan) and healthy years (disease-free years, aka healthspan) - which is more than a decade on average in America - the gap between "should do" and "can do" often feels more like a chasm. This is especially true for anyone who gets caught in the all-too-common trap of all-or-nothing thinking and misses the many available rewards for those who even do a little bit.
The good news is, there are many rewards for implementing micro-habits. For example, just this week, 3 great new studies provided additional proof that the "3-legged stool" we so often talk about (Physical Activity, Healthy Diet, and Restorative Sleep) are each extremely powerful in helping us maximize our health.
MOVE: The first showed that a 15-minute "fast walk" per day lowered the risk of dying prematurely by 20% in a group of 85,000 high-risk individuals in the Southeastern US over a 15+ year observation period. Interestingly, the short/fast walk provided 5X the benefit in 1/12th the time when compared to long-slow walking minutes. The long, slow walkers got a 4% average benefit at the 3-hour per day mark.
FUEL: The next showed that achieving and maintaining one of 3 healthy diets decelerated the progression toward disease in a sample of nearly 2,500 seniors over a 15-year period as compared to a reference diet, which accelerated the same progression. The net gain was as much as 10%.
RECOVER: The last showed a link between low sleep quality (i.e., more than just hours per day) and 172 different diseases...92 of which had at least a 20% increased risk when sleep quality was low and 42 of which had double or more the risk.
The less good news is, the trade-off for the stronger statistical confidence research teams get when isolating single habits (a good thing), is a more limited understanding of the synergies and compounding effects we can get with stacked habits or something closer to a diversified habit portfolio or index-fund of habits for those who use similar tactics for a financially healthy future. Unfortunately, there just aren't that many studies that look at combinations...but there are 2 this year that considered the combined benefit of Sleep, Physical Activity, and Nutrition, and how powerful it could be to help us SPAN the gap (see what we did there?).
The first, published in February of this year, showed that people who maintained the optimal daily SPAN of at least 7.2 hours of sleep, 42 minutes of moderate to vigorous physical activity and a dietary score of at least 57.5 on a 100 point scale (which gives points for adding fruits/veggies/whole grains and cutting back on processed meat, refined grains and sugary beverages) had 64% lower risk of dying during the 15 year study period when compared to those in the bottom 20% who averaged 5.5 hours of sleep, 7.3 minutes of physical activity and a dietary score of 36.5. However, and where it really got interesting, was in teasing out the benefit available for those in the bottom 20% if they could nudge each habit a little bit. While a "minimum dose" of 15 extra minutes of sleep, 1.6 extra minutes of physical activity and a diet quality bump of 5 points (1/2 serving of veggies per day) could cut risk by 10% - about the same amount as adhering to a healthy diet in the study above - combining an extra 1.25 hours of sleep with 12 minutes of physical activity and 25 diet points could cut the risk of dying in half.
The second SPAN study (in pre-print), which looked at the same population to assess gains in disease-free "healthspan" years, found that those in the top 20% gained more than 9 years of healthspan compared to those in the lowest 20% which just about closes the average gap. In addition, by getting as little as 19 additional minutes of sleep, 4 extra minutes of physical activity and adding 21 diet quality points (such as by adding a cup of veggies and a couple of servings of fish per week) the folks who were most likely to struggle in the healthspan gap (alive but not healthy) could add 4 additional disease free years.
The power of small investments in a diversified portfolio allowed to compound over time isn't reserved for financial investments, and the quality of life divide is neither inevitable nor impassable...we just have to be willing to SPAN the gap. Let us know if we can help.
Have a great weekend,
Mike E.
July 25
If we work at something long enough, despite how distant the horizon, there's an occasional breakthrough to celebrate. A month ago it felt a little bit like that when the American Heart Association released a "scientific statement" which critically reviewed one of the oldest, most obvious, and yet still wildly polarizing concepts in health care - that since food quality has the power to restore health, professionals (including physicians) should prescribe it like a medication. While this seems like common sense to many who agree with the fundamentals of the idea, not everyone does. Whether the lack of formal training health professionals receive in the area of nutritional science, or the claim that eating healthy is inconvenient or costly compared to the "ease" of medication or even questions related to effectiveness, getting to a point where "food is medicine" has been a slog. However, over the last 5 years, things have begun to shift, and the idea is gaining steam. A growing number of people are realizing that trading the convenience of cheap ingredients enhanced with ultra-processed flavor profiles now for a hefty quality of life cost in the future is not a good bet, and since the microbes in our gut (microbiome) play an oversized role, they are worth learning to take care of.
Making sense of exactly how the many-trillion microbes on board actually drive our health is no small task. However, an exponential growth of studies in this area has helped. Before 2010 for example there were hundreds and even thousands of references on the topic depending on how far you go back, but in the last 15 years there have been hundreds OF thousands...and more than a quarter million since 2020, bringing far more clarity to the picture; and with it, a few themes that have become reasonably well established:
(1) Healthy bacteria feed on fiber and fermented plants, so consuming a wide variety and volume daily helps grow the population of "good guys". On the other hand, bacteria implicated in disease prefer an industrialized diet, heavy in sugar and highly processed, so limiting these whenever possible can help keep their population in check.
(2) It's not only food that matters - other lifestyle factors like physical activity, sleep, and stress management can also play an important role and often have a bidirectional relationship with the microbes - they both drive each other.
(3) Supplementing or replacing colonies in order to restore health is an interesting but still mostly experimental idea, so our best chance to reset things may be to restore our diet to one which mimics a pattern far more common before the industrialization of food...a theory which was tested in Canadian adults.
Researchers recruited and randomly assigned 30 people to consume a diet which they called the NiMe Diet (short for non-industrialized microbiome restore), an eating pattern of times gone by for most of the world. Typical of "ancestral" diets, this one was primarily plant-based, contained no dairy or wheat, and was low in process, which means it was low in sugar (as measured by glycemic index) and high in fiber. From a macronutrient perspective, it was 60% carbohydrate, 15% protein, and 25% fat, and the menu featured foods like beans, sweet potato, rice, cucumber, and cabbage as well as foods which were known to feed the particular bacteria they were hoping to grow, such as Jerusalem artichokes, peas, and onions.
Following the intervention, their deep-dive analysis of participants' health showed impressive changes in only 3 weeks. The findings, published earlier this year, showed that participants had a significant change in the makeup of their microbiome, including growth of a particular bacteria found in tribes that still eat this way, like those in rural Papua New Guinea. They also had meaningful clinical changes, including significant reductions in cholesterol, blood sugar, and body weight, which paralleled a significant drop in health risk.
It seems less likely that the "Father of Western Medicine" is the one who said it, but whoever gets the credit for "let food be thy medicine and medicine thy food"...the data says they're right. I hope your garden is growing as fast as my lawn and you're benefiting greatly from feeding those microbes.
Have a great weekend,
Mike E.
July 18
In the 2009 best seller "Emotional Intelligence 2.0" (and in a more recent follow-up), the authors make a very clear statement - our emotions drive our actions, whether good, bad, or otherwise, and therefore, when we understand and manage them with skill, we are more effective and can be happier. They then go on to show that, different from traditional markers of intelligence (e.g., IQ) which are mostly fixed throughout life, "EQ" can be developed over time...and that it might actually be the more important of the two types of intelligence.
It was a strong and maybe even a bit of a controversial statement at the time since IQ-powered abilities such as quickly solving problems with information and logic were still almost exclusively the domain of humans and therefore highly prized. However, in today's context, where AI can handle a rapidly growing number of IQ tasks faster and more accurately, the scales may be tipping the other way. According to some new research, developing our EQ may also shed light on a path for improved health and well-being.
It starts with self-management, which the authors describe as one of the 4 key areas associated with EQ and is similar to self-regulation theory in psychology. Distilled way down, self-regulation is "the control [of oneself] by oneself," and puts emphasis on emotions, thoughts, and behaviors, as well as the brain structures that control them. Since neural connections get both stronger and faster with use, when we practice self-management deliberately and healthily, the circuits that control emotions, thoughts, and behaviors get easier to access and more automatic. And, since many of those same circuits are called to action when calm and focused in an otherwise noisy world serves us best, they are critical for the long-term health and safety we want for ourselves and those we care about.
With that in mind, this week we offer up a few places where we can leverage the practice to get especially powerful results:
1. Take back Monday: It's easy to find ourselves a little more amped up on Sunday evenings as the weekend comes to a close and the work (or school) week looms. While it doesn't have to be a full-blown "case of the Mondays", recent research shows that if this emotional ramp-up becomes a habit, it can have longer-lasting negative impacts on our physiology than we may expect. On the other hand, other research showed that people who deliberately inserted a healthy habit on Mondays (in this case, a dietary effort) improved their odds of growing the habit by as much as 15 times. For most of us, Monday offers a natural opportunity to practice "starting strong"...take it back.
2. Walk Away From The Screen: Not yet convinced that screen-time and the addictive overstimulation that comes from the media & gaming tractor beam it wields is taking a toll on our health? New research, published in the Journal of the American Medical Association this week, showed a clear and concerning connection with screen time and high-risk mental health trends in US Youth. However, since walking and other recorded movement minutes are strong predictors of both mental and physical health, there's a strong case for walking away from the screen when able. Doing so with a strong "why", such as a way to CONNECT with friends, enjoy a beautiful space, or challenge oneself to build a new healthy habit, may enhance the effect. If for no other reason than achieving 100 or more moving minutes per day, which may be the threshold required to prevent chronic back pain, getting good at getting away can be a powerful tactic.
3. Empty the Tank: Although more nuanced for people with certain risks or conditions (check with your healthcare provider if you're unsure), there is a growing body of evidence that shows metabolic health improves when we self-regulate our consumption patterns in a way that temporarily restricts energy intake. Whether calorie restriction, regular fasting (such as a 5 day "on", 2 day "off" model) or time-restricted eating (eating all calories in a 10 hour window for example), new research presented at The 2025 Annual Conference of the Endocrine Society last Sunday, showed that while some markers of metabolic health improved across all groups reasonably evenly, the fasting group did the best at lowering blood sugar and triglycerides, while improving insulin sensitivity. However, this may not be purely a physical phenomenon. One new study showed that the health benefits of fasting were linked with baseline measures of well-being before the fast even began. Said another way, it's proof that emotional states impact our physiological response to the food we eat. Fascinating stuff.
We can't always control the moments that spark our emotions, but if they drive our actions, which drive our habits and thus our health...getting good at recognizing and managing that spark may be the most intelligent thing we can do.
Have a great weekend,
Mike E.
July 11
Under the heading of "practice what you preach", I've been focusing on increasing my total exercise volume lately. Since I'd much prefer to be outdoors, I've found my way to a local rail-trail for a few jogging miles more regularly. While "easy and enjoyable" is not my typical default which is less surprising given new research on the links between personality type and exercise preference I suppose, on Tuesday I was reminded of how powerful an equalizer the heat & humidity of July can be; after two 15-ish minutes of jogging separated by a bout of walking, I was fried. My legs felt like they were made of lead, and I really just wanted to lie down, pretty clear signs that I had overloaded and possibly strained my system more than intended.
Maybe this sounds like a bad thing. It certainly can be if not given the respect it deserves, but doesn't have to be. In fact, despite hype phrases like "you need to shock your system" that make it sound scarier than need be, unlocking the adaptations that make us stronger and healthier is, at its root, a conversation about controlled overstress. The better we are at staying on the right side of the fine line that separates "functional overreaching" (the good and stimulating stress) and "over training" (the excessive overload which delays recovery or sets us up for injury), the more we can leverage the power of our physiology - we get stronger through stress. For most of us, that means if we dial in strategies that help us RECOVER, we can get stronger this summer.
Of course, this isn't exclusive to athletics, and it doesn't have to be all at once. Recent studies, such as this one and this one, have shown that allostatic overload, the more technical term for the accumulation of strain, is connected to overuse injuries and physical performance decline in tough environments like Officer Candidate School (OCS) with the US Marine Corps. Although the blood markers and survey data collected may not be practical in our daily lives, and three of the other five proven markers would require a blood draw, newer technology can provide a close approximation. Whether using a smartwatch or an app on the phone, most of us can easily and routinely measure heart rate and heart rate variability (HRV) if we want to. These two data points, which don't fluctuate all that much if measured in a true resting state (shown here) and therefore can tell us when our "engine is idling a bit high", have been effective in quantifying overload in higher stress occupational scenarios. For me, after the jog, those same data points suggested it might be the perfect opportunity to test a new recovery framework that had recently caught my eye - the 4Rs of Sports Nutrition: Rehydrate, Refuel, Repair, and Recuperate.
It's a relatively simple idea - by accounting for current body mass and activity profile along with the symptoms I was feeling, I could leverage the latest in sports nutrition and focus on replacing the nutrients needed to bounce back quickly and fully. With the help of the web tool that accompanied the article, I was able to generate a plan for the next 24 hours. In truth, I didn't follow it to the letter, but instead used it as a guideline to help me be a bit more deliberate than I might typically be. I rehydrated more aggressively than usual and worked to make sure my next meal had the amount of carbohydrates and protein needed to restore quickly. The results were promising. While restless sleep or other signs of extended stress are not uncommon, the night after a heavy physical load, I slept like a log, my resting heart rate returned to within 2 beats of my baseline, and my overnight HRV was within my normal range...a good first test.
The heat and humidity are likely here for another couple of months...that could mean risk , or it could mean more opportunities to test the 4Rs. Give it a try, and I'll let you know how it goes on my end.
Have a great weekend,
Mike E.
July 3
Resolutions becomeTax Day then Memorial Day, oh my - the days are long but the years do fly. It's hard to believe, but as of yesterday we are closer to '26 than '24, past this year's halfway point, a great time to think about where we've been and where we're trying to get to. When we set out this year there were a few themes that were top of mind and felt important enough to keep an eye on. The value of building health assets (reserves) now which could be drawn on later, strategies to enhance and improve metabolic health and how our connections at work, home and play are impacting our effectiveness, were all on the watch list.
Even in what has felt like the blink of an eye, there have been some cool findings since January. While many have added refinements to already well established themes, this week we found a few that relate back to those original 3 we identified.
First - the need for speed. There has been a resurgence of interest in gait as a fundamentally human movement and therefore worthy of attention. Coaches who have an interest in power, which is critical for both sport and longevity, are emphasizing the value of practicing it at top speed. As it turns out, it's not just sprinting that matters. Our "reserve", the difference between how fast we are able to walk (top speed) and how fast we choose to (self-selected speed), called "Gait Speed Reserve", might be an important indicator of overall health. In a 2025 study of more than 5,000 adults, height adjusted gait speed reserve tracked closely with handgrip strength (a well known health indicator) as well as cognition and balance. It was negatively associated with smoking, leg pain and body weight. Building health assets may mean keeping our top gear accessible, longer.
Next - a whole new take on "base" training: Loading up on fiber helped lower the impact of dietary acid. In a randomized crossover study published this month which asked participants to swap foods known to increase the dietary acid load (meat, cheese, eggs and dairy) in favor of high-fiber foods which lower it (fruits, veggies, legumes, etc), researchers found a significant difference, especially in body weight. Participants lost almost 1 pound per week for 16 weeks on average.
Last, and also out in the first half of this year, a look at emotional contagion in teams showed a strong connection to wellbeing. While the study did not explain why certain teams are more susceptible than others, it found that when measures of contagion were high, wellbeing suffered more during stressful times. This suggests that investments in team dynamics might hold an important key. If the people around us have a strong influence on our mood, one of the known indicators, they are also likely to be having a strong influence on our health.
If the first half of 2025 is any indication of how fast the second half will fly, we will be talking about the holiday season and the best way to celebrate a semiquincentennial before you know it.
Have a great weekend...and happy 249th birthday USA.
Mike E.
June 27
The list of "important things we should probably do for our health" is almost endless. Some of them are big foundational things that never seem to change (ELEMENTS). Others, like coffee consumption, are generally positive and seem to be gaining steam - for example, 3 new studies say it supports healthy aging in women, improves heart risk when taken "without", and may even flip a cellular stress switch. Yet others, like consuming seed oils (which have attracted a LOT of attention recently), are still probably in the "need more info" stage. Research from April, which said seed oils are a negative for cancer risk...in contrast to a recent talk at a nutrition conference earlier this month, which suggested they are possibly good for metabolic risk, only complicates things...stay tuned on that one.
However, in an otherwise busy life, trying to keep track of, or even more daunting, actually "execute" on the whole list is probably impossible. Ranking, prioritizing, and honing, therefore, is one of the most important things we can do in deciding where to place our limited (and possibly dwindling) attention. If we asked the American Heart Association which are the critical bits, they might suggest their Essential-8: be more active, quit tobacco usage, get better sleep, manage weight, cholesterol, blood sugar, and blood pressure. Research from this year, which shows better biological aging in those who do, appears to confirm the claim. If you ask us, we think those 8 (and a few others, perhaps) can be trimmed to 5 major headers: Move, Fuel, Recover, Endure, and Connect. But what if you had to pick just 1? Which is the most powerful?
It's a fun exercise, but context matters. The "most powerful to what end?". For example, when AHA number 4 (manage weight) is the priority, perhaps the old fitness idiom "you can't outrun a bad diet" applies. If so, Fuel might be the best starting point. For those who are trying to protect future brain health, a fascinating new theory that blends biology and physics suggests that our brain works best on the brink of chaos, which is primed while we sleep. If that's the goal, Recover (via sleep) should be near the top of the list. However, for the populations we often serve, those groups who push themselves physically as part of everyday life, often in stressful environments, which can leave bodies hurting, the answer may be Move.
This 2022 study showed for example that stress levels experienced by professional firefighters were cut in half when exercise was a regular part of their routine; a reduction of about 16% per 1 hour of exercise added per week and more recently, this small study (March 2025) showed moderate aerobic activity had a significant and positive impact on sleep quality. However, one of the more intriguing recent studies on the topic was completed by a team in Chile and published in January of this year. It showed overwhelmingly, in a population of nearly 30,000 older adults, that low physical activity loads increased the odds of experiencing severe pain. While all the usual culprits increased the odds of experiencing severe pain later in life - smoking by 21%, poor diet by 78% and poor sleep by 81% - physical activity was far and away the heaviest hitter, increasing the odds by a multiple of 4.35 (i.e., 435% increase). And, if this study on individuals with back pain is on the right, getting these loads in nature might be even better.
It's never a bad time to get moving. Start slow, keep it fun, and respect the heat.
Have a great weekend,
Mike E.
June 20
It was a trip that had been on my radar for a long time. Unfortunately, between the cost and the long list of calendar competition, we could never quite make it happen. So this year, when the stars seemed to align, the trip to Italy was a go. Throw in the perfect Father's Day gift, which included a few Mediterranean superfoods in the moments between breathtaking art and history, and I was all in.
We got off the train in Florence and immediately onto the bus toward the grape & olive farms of Tuscany, thankful that things were running on schedule. The 45-minute drive flew by as we learned about warring kingdoms, the few castles that remained, and how their towers, a bit like Lord of the Rings, were used to signal the approach of enemies. At the first location, the 5th generation owner proudly showed us their view. It was like something you'd see in a book; rolling hills of grape vines and olive trees as far as the eye could see, touched by a blue sky which just begs you to exhale and slow down. We sat at their table as they explained the process and took our first bite of local bread drizzled with home-grown olive oil. We were blown away.
While not all of the studies support findings like these from 2018 which showed that a Mediterranean diet supplemented with olive oil was related to a significantly lower risk of cardiac events in high risk individuals (approximately 30% lower), many do suggest that this dietary style is at or near the best from a health perspective. So while a very recent animal study which warns that a fatty acid contained within the oil can trigger fat-cell growth (and possibly obesity) seems like a downer, we can feel good knowing that the general consensus is very positive. The even better news may be that we don't have to get things perfect to benefit - two new studies from Canada point the way.
The Portfolio Diet which invites people to choose from "a portfolio of cholesterol lowering foods" like nuts & seeds, fiber, plant protein, plant sterols and MUFA (monounsaturated fatty acids like those found in extra-virgin olive oil) to improve the health value of their overall diet was found to work well in a sample of 15,000 studied. An 8-point increase in the Portfolio Diet Score was associated with a 12% lower risk over the 22-year study period. In another study (also out last month), the approach proved positive for a younger population as well. The analysis indicated that while those who followed the diet closely might add more than a decade of life in the low-risk category, it also showed that even for those who only got it done 50% of the time, 6 years could be added - a fantastic result for relatively low adherence.
While I could easily be convinced to head back and collect more data soon or make a recommendation if you're looking, I'm betting The Portfolio Diet App will be a whole lot easier to implement.
Have a great weekend,
Mike E.
June 13
If you subscribe to the notion that "smarter is better than "harder", you probably love the idea of a shortcut. Truth be told, you're not alone - effort takes energy, which we humans try to conserve. While the thinking part of our brain understands for example that regular physical activity has the power to add years to our life AND life to our years, the part of our brain that controls our action is wired to stay put and opt-out, and so we often do. Brain-scan studies like this one from 2021 confirm this imbalance, providing support for the "Theory of Effort Minimization in Physical Activity", a fancy way of saying that it is neurologically more natural to sit on the couch than get up from it. Coupled with our equally powerful problem-solving circuits, we find ourselves on a quest to have it both ways - to get the benefit without all that pesky effort - a drive which has produced many innovations...as well as some unfortunate fallout. Whether it's moving walkways and e-scooters everywhere which make it easier to get around but also lower the odds we will hit a healthy number of steps per day (+/- 7K for most people) or any other number of conveniences, we have to make choices every day on when efficiency goes bad.
Dietary conveniences follow a similar pattern. Messaging on supplementation can feel like a game of chutes and ladders. Taking multivitamins, protein, omega 3s, vitamin D, or others can be an easier way to meet recommended daily units, however, the research on their health value is far from conclusive. While our thinking brain knows that getting enough healthy greens in our diet the old-fashioned way (by eating them!) is probably the way to go, the convenience of having something similar in a powder appeals to enough of us to generate $70 Million in sales each year...we're just not sure if it actually works. On the other side of the spectrum given the known risks associated with consuming diets heavy in animal proteins and the generally positive story related to creatine supplementation which might help fill their gap, one might assume this switch would be well underway. A recent small study even showed it could improve our ability to think clearly when we are sleep deprived, an interesting gap-filler despite not making up for a good night's sleep. Of course, things get even more complicated as new threats emerge.
The trifecta of safe, effective, and convenient is becoming increasingly difficult to find.
The growing body of research on microplastics and their negative impact on health, for example, has certainly gotten me wondering about ways to limit exposure. Coffee consumption, which is generally in the "healthy" column (and something I look forward to each morning), could get murky if the way we prepare it needs to be drastically changed. While filtering coffee makes a major difference in limiting cholesterol-raising compounds that come along for the ride when coffee is brewed unfiltered, the trade-off of a steaming cup of plastics depending on what the filter is made of may need deeper consideration. Of course, unfiltered coffee steeped through a convenient tiny plastic cup might be especially problematic.
In a world where "time is money" and "no free lunch" can both be true, we are always trading something. With any luck it doesn't have to be our future health.
Have a great weekend,
Mike E.
June 6
Whether it's the Teachers College at Columbia, the approximately 40,000 or so articles found on Google Scholar, or the countless videos on YouTube, the idea that eating a naturally colorful diet is related to good health is both simple and widely promoted. Most people have heard of it and generally accept it. However, when asked why the approach is so effective, people tend to falter. With that, here is a very short, slightly more nuanced dive into the idea.
First, we know that a diet rich in fruits and veggies tends to be healthy. We talk about it almost every week here and have at least a few references in each of our monthly sessions for groups who get them. There are almost too many sources to point to which prove the point. We know it's not only the micronutrients on board, known to help with specific diseases (e.g. vitamin C and prevention of scurvy, circa 1747) but also the fiber that healthy gut bacteria like to eat and grow on that matters. As our understanding of the link between gut health and whole health has grown, so has the relative importance of adding variety to our daily consumption patterns. We've mentioned several times the power of eating "30 different types of plants per week", a challenge that started when a massive data-collection effort reported in 2018 showed that a healthy gut was related more to dietary diversity than any one generally healthy pattern (e.g. vegan, Mediterranean, etc). Then, just last week, we wrote about the power of foods like garlic to improve aerobic performance and perhaps even rejuvenate aging cells in our arteries, a build on other super-foods we've mentioned in the past (berries, walnuts, beetroot juice, etc). But the question remains, is our dietary color profile as important as we tell the kids? If so, why?
The beginning of an adequate answer came earlier this week courtesy of a multinational team from Australia, Austria, and Spain. They found, in reviewing the records of more than 100,000 people, that as the overall consumption of flavonoids (micronutrients that give plants their color) went up, health risks went down. However, and this is where it gets especially cool, the risk dropped even further for those who were getting both a high quantity and sourced from a wide variety of plants...and not by a little bit. Specifically, they found that "Holding the quantity of flavonoid intake constant, participants with the highest (compared to lowest) diversity (Q5 versus Q1), characterized as consuming an additional 6.7 effective flavonoid types per day, had a 14% lower risk of all-cause mortality, a 10% lower risk of CVD, a 20% lower risk of T2DM, an 8% lower risk of total cancer and an 8% lower risk of respiratory disease.". The authors went on to say that they believe their study could be an important contributor in updating healthy eating guidelines from 2022 which suggested that getting "enough" flavonoids (400-600 mg per day for heart health) was the target to one that adds in something like "from a wide variety of sources".
Need some ideas? A fruit salad with berries, grapes, and maybe even a little bit of local honey to add sweetness or a couple of glasses of tea during the day could go a long way in incorporating the list of foods specifically mentioned as strong sources in the study: Tea, (green and/or black), Berries, Apples, Oranges, and Grapes....or, as they tell the kids, eat the rainbow every day.
Have a great weekend,
Mike E.
May 30
Recovery is at the heart of prevention and health promotion this time of year. It's an easy time to get over-stressed, overdone, and maybe even run down to the point of injury or illness. Since, on one side of the (load) balance, work and life demands are often not under our full control, it tends to be the recovery side where we can gain the most ground. With that in mind, we are always on the lookout for ways to tip the scales. This week, a team in Switzerland opened a rabbit hole to a whole new idea, and it starts with the lining of our arteries.
Inside the muscular pipes known as our arteries are a layer of cells called the endothelium. This thin layer of specialized cells plays an oversized role in our health, acting as both a physical barrier between the arterial wall and the bloodstream, and is also critical in regulating blood flow, controlling some of our inflammatory responses, and repairing the vessels from the day-to-day wear of a busy life. Their ability to recover and repair is directly related to how and when our vessels begin to age. When the endothelial cells can no longer replicate but are still active, called senescence, the entire system slows down. It stands to reason then, that if we could influence this cellular switch, we might be able to keep our systems healthier for longer...and a research team in Switzerland may have just solved the puzzle.
They found that as our bodies break down certain foods they leave a key byproduct (aka metabolite) that in a high enough concentration, flips the cellular switch to prompt cardiovascular system aging. Determining how to counteract this byproduct, which accumulates over time and is related to the consumption of foods high in phenylalanine, such as red meat, dairy, and certain artificial sweeteners, could act as a fountain of youth. While the initial experiments used antibiotics to kill off the gut bacteria which produces the negative byproduct, they also found that adding in another more positive metabolite (acetate) can restore and rejuvenate the aging cells. While the concentration of good bacteria and therefore the capacity to rejuvenate seems to get lower with age, the researchers believe that diets rich in fiber and foods with antioxidant and anti-inflammatory properties could boost the body's own "fountain of youth", something they have begun testing.
This may explain why another recent study showed that a garlic supplement was linked to improved cardiovascular endurance in recreational athletes and a third study showed that curcumin helped control cellular stress before and after exercise.
We may not be able to limit the stress and strain we face this time of year, but we may be able to recover better and therefore age a little slower...and it starts in the gut.
Have a great weekend,
Mike E.
May 23
We started this year with a nod to the growing body of research that points to metabolic health, that is, our body's ability to efficiently break down and utilize food as FUEL, as a major driver of overall health. From early January until mid-February I wrote about it. In April the team gave presentations about it and now, here we are nearing the end of May and another big contribution to the evidence has been published.
This time, it was a profile of nearly 50,000 women over more than 30 years in an effort to tease out whether carbohydrates are actually the villain many seem to make them out to be. The article, which was published in the Journal of the American Medical Association on May 16th, made it clear that if we want to be accurate in our understanding, it's a whole lot more nuanced than standing in a "carbs are good" or "carbs are bad" camp.
How the study was conducted:
Researchers used sophisticated math (multivariate logistic regression) to determine the odds that a person would age healthily over the 32 years between 1984 and 2016 based on their self-reported dietary habits with a specific focus on their carbohydrate consumption and where those carbs came from. After statistically scrubbing out a variety of known health contributors and detractors, they had more answers.
Healthy aging was defined as reaching the age of 70 years old while not only avoiding 11 different highly prevalent chronic diseases (1 of 4 domains) but also receiving high marks on measures of physical, cognitive, and mental health (the other 3 domains, defined here)...or as my colleagues might say, "stronger, happier people through better health"....thriving.
What they found:
The short, short version is - most people's general definition of good carbs (sourced from fruits, veggies, whole grains, and legumes) which the research team called "high-quality carbohydrates", did indeed increase the odds of aging well, providing an overall boost of 31%, while lower quality carbs (sourced from refined grains & sugars) and less-good carbs (starchy vegetables) lowered the odds of healthy aging by 13% and 10% respectively. Not surprisingly, fiber consumption was also a good thing, improving the odds of aging well by double digits, with fruit (14%) and veggies (11%) providing better results than cereals (7%).
The slightly more in-depth version is - high-quality carbohydrate consumption improved the odds of healthy aging across all domains of health (8-24%) with carbohydrates from fruit (6-9%) and fiber consumption (5-15%) being the only subsets which increased the odds in all 4 domains of health. Veggies, whole grains, and consumption of fiber from cereals impacted 3 of 4 domains positively, while starchy vegetables lowered the risk of chronic disease but were not positively related to the remaining 3 (physical, mental & cognitive health). Refined carbs performed the worst, lowering the odds in 3 of 4 domains of healthy aging.
Finally, when they considered substituting macronutrients, which often occurs when people adopt an eating style that minimizes any one macro (such as low-fat or low-carb), swapping high-quality carbs improved the odds of aging healthily in most cases. Only plant-based protein and healthy-sourced saturated fats outperformed high-quality carbs. On the other extreme, substituting "any carb" for other macros was only positive when swapping out total fat and trans fat (graphic here).
The Take-Away:
This is another great analysis of a lot of people over a long period of time which says if you wonder if carbs are good or bad for health...the answer is "yes". However, when we consider the source, things become a lot clearer. If you spend time in the garden or the farmer's market this time of year, you're on the right track.
Have a great weekend,
Mike E.
May 16
When it's on our own terms, we humans tend to change slowly. We think about it for a while, maybe first by imagining what it would look like. Then after we decide the vision is worth the effort, we might build a how-to plan and maybe even dabble for a bit before we actually go all in on the set of new actions that will lead to an adaptation. If the change we are looking for is a physiological one, such as a lifestyle change leading to a health-risk improvement like the effort of pushing heavy things around to gain strength or getting on a stationary bike to improve our heart health, it could be weeks, months or even years before we arrive at the intended outcome...the "change"....which can feel painfully slow.
It's not uncommon for the belief that "it takes forever" to add to the inertia required to get started. It can easily create a reevaluation doom loop ("Is this REALLY worth it?" over and over) which from the outside might even look like procrastination. But this isn't the whole truth on the speed of change, something we often try to highlight when we are asked to weigh in on the pros and cons for those considering one.
The deeper truth, if we zoom in far enough to see it, is that while long-lasting or permanent change, if there even is such a thing, is slow, the initial changes that lead to it are not slow at all. They happen immediately when we take on a new action, and in some cases even prior to the action as our systems anticipate the needs to fulfill the request. For example, this small (but super cool IMO) 2022 study showed that when subjects were told in advance how hard an exercise session would be, their bodies "readied" for the challenge by ramping up resources BEFORE they actually started the session, an effect that wasn't seen in those who weren't told the session parameters. Not unlike the heart-pumping excitement we might feel while we anticipate something jumping out at us in a horror movie, our bodies are ready to meet the ever-changing demands of our environment.
This of course can be a double-edged sword. On the not-so-wonderful side, another small study out this week showed that even after 3 days of short sleep (+/- 4 hours) the body reacted by ramping up inflammatory markers in and around the heart - signs of strain similar to those we see in cardiovascular disease. Interestingly, however, the same study showed that while definitely not the same, physical activity, even on short sleep, might blunt some of those negative changes. Given some of the natural load ramp up that accompanies the Summer season we talked about last week, going to bed early and maintaining physical activity habits this time of year could be a powerful combination to keep stress from becoming strain.
And while 30 minutes of cycling was the method they used to test individuals in the study above, when it comes to the speed of change from exercise, we should never forget that if dosed correctly, a little can go a very long way. While high-intensity efforts aren't best for everyone (check in if you're unsure), this 20-year-old classic is one of my favorites. Similar to the now famed Tabata protocol, It showed that 4-7 repetitions of max effort for 30 seconds (separated by 4 minutes of recovery) prompted significant change in the body in as little as 2 weeks.
The key takeaway then is that although it may seem slow on the surface, change is also fast (deeper in) and always. If we know which combinations pair well, we can stay strong, enjoy the adventure and still arrive at our preferred outcome on-time.
Have a great weekend,
Mike E.
May 9
If you've ever pushed your physical limits - no matter if at work, at home, or in sport - you've likely experienced a strain or sprain. They account for about one of every three injuries in the American workplace and when lumped together into the more broad category of "soft tissue" or "movement-related pain" are by far the most common type of injury, representing more than half (58.3%) of the 6.7 million non-fatal injuries reported in the last year on record (2021-22). It's a BIG number and it not only represents a lot of people who are hurting, but also a largely preventable drag on both the quality and, as one 2017 study, showed knee arthritis to be an even greater predictor of dying over 15 years than smoking or diabetes, quantity of life for those impacted. Movement, as we are fond of saying, is a window into future health.
Six weeks from today, on Friday, the 20th of June, we will once again enter the official Summer season, a particularly high-risk period for aches, pains, and injuries of this type. While many forces and factors impact total risk at play during the Summer, the heat, as a fatigue accelerant, is one of the most important. Cardio-fitness improvements (4-6 weeks), acclimating (10-20 days of exposure), hydrating (ongoing), and "cooling" the working tissues in order to maximize recovery time are all important. However, as the Pro-Activity team began to pull resources for our annual dive into Summer-preparedness for clients who get regular educational content, 3 studies jumped out at me that are worth sharing - 2 with new ideas and 1 with even better proof of an old standby.
First, the standby. Strength training reduces injury risk. This 2025 review of 15 randomized controlled trials of team-sport athletes set out to determine whether strength training could reduce soft tissue injury risk. The answer, which shouldn't surprise anyone, was "yes". Strength training improved movement proficiency, corrected muscular imbalances, and not only reduced injury incidence but also improved performance. If we want to strain-proof our muscles, maximizing their capacity to do work makes sense. Starting now with even as little as 10 minutes of bodyweight-oriented exercise will make a difference when peak Summer is here.
Next, a really "cool" idea that sounds a bit like sci-fi could be the future of risk screening for strains. A research team from China set out to determine whether infrared imaging combined with artificial intelligence models could accurately scan and find body areas showing localized and abnormal inflammatory responses after physical activity and whether these "hot spots" were precursors of injury. It passed the first test - the team concluded that the infrared thermal monitoring system "can effectively identify the abnormal hot area of the athlete's body". Now, while I suspect most of us who try to "listen to our bodies" would be close if asked which body areas were a little "angry" after a hard bit of physical activity, we might be more inclined to actively cool those hot tissues if we saw red on the screen. However, since most fires require 3 elements to start or persist, one of which we can't live without (oxygen) and the other which ramps up dramatically in the summer (heat), the final question is - can we strain proof ourselves by minimizing the last component, inflammatory fuel?
Of course, this is a concept that we've pointed to many times - lowering whole-body inflammation by changing the gut biome through diet can make a risk-lowering impact. This study from March showed that both fiber and protein sources impacted detectable inflammation in the body. Individuals who reported higher fiber intakes and lower animal protein consumption had lower levels of resting inflammation. "If only you could package the inflammation-lowering benefits of a healthier diet into a pill," you say. Well, people are trying. It's still early days (this was a rodent study), but the results are certainly interesting. The research team found that by giving rats a probiotic to stimulate the gut biome for 8 weeks, they were able to protect the skeletal muscles mostly by improving their efficiency in processing fuel. While not the first time the connection between metabolic health and muscular health has been made - this 2020 study for example showed that adults with metabolic disease (less efficient at converting fuel to energy) are more likely to have musculoskeletal pain, inching closer to knowing exactly which levers to pull is certainly intriguing.
It's time to start strain-proofing for Summer. Changing the FUEL mix, cooling the hotspots, and adding capacity with strength is a great way to start.
Have a great weekend,
Mike E.
May 2
In 2022, the most recent year on record, heart disease once again claimed the ominous title of "the leading cause of death for Americans" accounting for more than seven hundred thousand cases. Cancer was next (608,000) and accidents, primarily falls, motor vehicle accidents, accidental poisonings (which include drug overdoses), and self-harm, were third on the list, accounting for 227,000 deaths. The math of it is staggering. 1.5 million friends, family members, and coworkers lost, a number which stays consistent for most years making it common but definitely not inevitable. It's not a stretch to say that most of these cases were preventable. So while we can't change the past, those of us who prefer to not repeat it can certainly manage, mitigate, and ultimately minimize the risks we face so as not to. We have many levers in our hands, some of the most powerful are shaped like tableware and what we allow ourselves to consume with it.
This is the essential message of a wide-reaching new study into a major (and growing) risk factor that we often talk about here on this blog; one which we mentioned again last week as an immediate threat to brain function - those easy-to-get consumables that tend to have ingredient lists which read more like a chemistry kit than food and are commonly referred to by their initials UPF, which of course stands for "ultra-processed foods". In 2024, a massive study published in the British Medical Journal linked regular consumption of UPF to 32 different diseases and disorders which ranged from heart disease to metabolic health disorders to poorer mental health and beyond. This month, this study put some numbers on it to illustrate exactly how big a threat it is.
A research team from across the globe analyzed historical data from 8 different countries including the United States and found that for every 10% increase in UPF consumption, there was a 3% increase in the risk of dying. In countries like the US where as much as 50% of daily calories consumed in the average diet are from UPF, this translates to 124,000 deaths in 2018 when the data was collected. To give some sense of how many that is, UPF would have been the 6th leading cause of death in the US that year, just ahead of Alzheimer's disease on the list of top causes. Still, other studies this year have shown that it harms our gut microbiome, harms our kidneys, and may be especially bad in males. Although probably inflammatory and possibly even insensitive to use terms like "poison", the outcomes are similar.
It's gardening season. Do yourself and your family a favor—get out in the dirt and cultivate health instead.
Have a great weekend,
Mike E.
Apr 25
Historians group periods of time in eras. Terms like Prehistoric, Middle Ages, and Modern are some we recognize. While it's possible that history will show artificial intelligence acted to spark a new era where we humans directed our limited resources toward new discoveries and let machines summarize the past, right now many are still trying to ride the tidal wave of information which is estimated to double every 17 years, by surfing the headlines. The pitfalls of this strategy should be obvious, especially in cases where proprietary algorithms decide which undercurrents we are actually exposed to. And so, in an effort to do our part, this week we bring you an update on FUEL, which compares Pro-Activity's essential message on the topic (gleaned from decades examining the research), artificial intelligence's take, and a few recent and intriguing updates which add to the discussion.
First, Pro-Activity's historical take:
Eating primarily real food, loaded with nutrients and fiber, low in sugar and other inflammatory agents, which can provide the energy needed to stay strong both physically and mentally without straining the body to actually utilize can prevent disease, lower injury risk, improve recovery from the day to day and dramatically increase the odds of living a long healthy high-quality life for those who do so consistently. Said another way - eating primarily perishable foods with heavy doses of plants in an effort to avoid extra sugars and processing, with a nutrient profile we can use without straining the system to do so yields the best results.
Or, as summarized by one of two AI tools -
Nutrition helps prevent and manage chronic diseases like heart disease, diabetes, and obesity. Diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats have been linked to a lower risk of chronic diseases.
Plant-based and Mediterranean diets are especially effective. These diets are shown to reduce inflammation, improve metabolic health, and protect against heart disease and cancer.
Micronutrients are essential for long-term health. Vitamins like D, B-complex, omega-3 fatty acids, and antioxidants help reduce the risk of age-related diseases such as dementia, osteoporosis, and cardiovascular issues.
Nutritional monitoring by professionals enhances prevention. The involvement of trained nutritionists significantly improves the prevention and management of noncommunicable diseases through dietary planning and education.
Early-life nutrition impacts long-term disease risk. Proper infant and childhood nutrition is linked to reduced risks of allergies, obesity, diabetes, and cardiovascular diseases later in life.
Conclusion: A nutrient-rich, balanced diet is one of the most powerful tools for preventing chronic diseases and promoting long-term health. View the full AI review (and references) from two sources, HERE
And last, adding some of the latest wrinkles in the literature and zooming from wide to narrow -
In a study of more than 100 countries that looked at dietary patterns and longevity, concluded that in particular, where we get our protein (animals vs plants), plays a significant role in longevity with a decreasing value of animal-based protein after the age of 5 with the risk-benefit tipping toward plant-based protein by 15 years old (figure 5).
Zoomed further to the small-group level, in generally healthy young adults (50 university students), new research showed that dietary patterns high in processed sugar and saturated fat (i.e. those mimicking the "Western diet") had immediate impacts on brain-body function, most specifically in students' ability to navigate a virtual reality maze which relied heavily on spatial awareness.
Zooming way in, at the tissue level, a new randomized-controlled trial showed that in regards to building muscle, after stimulating growth with strength training, as long as we get enough protein, the source (animal vs. plant) may not matter all that much. The individuals eating an omnivorous diet did about the same as those eating vegan.
Or in the fewest words possible, it seems Michael Pollan's message is still generally right - "Eat Food. Not too much. Mostly Plants.".
Have a great weekend,
Mike E.
Apr 18
If you ask some of the most well-known evolutionary biologists they might tell you running long distances is the human movement pattern that defines us. More than 20 years ago, that's essentially what the two in this article which reviews some of their research and theories essentially said. If running is such a natural and species-defining movement, why do approximately half of runners (with some reports approaching 80%) experience injury while (or from) performing it? The question is far simpler than the answer. However, at some level every time we get a step closer we learn more about how and why overused tissues break down, even those of us relying on the endurance to get through long days or stressful seasons who might never toe the starting line, can benefit.
There are a few relatively simple prevailing theories. Ramp-rate, the idea that the body can only "ramp up" so fast without becoming overextended beyond the capacity to recover, has been an intense focus over the last decade. Guidelines suggest that even seasoned athletes who increase loads (training intensity or volume for example) by more than 30% are at increased risk. Baseline fatigue is another. Knowing that our physiology fluctuates constantly in response to the complex demands (both internal and external) we face, should make it reasonably obvious that some days we will have a "fuller tank" than others. Running on empty from an energy perspective increases our odds of pushing too far. Lastly, changing conditions play a major role. Ask a group of runners what the perfect racing conditions are and they probably won't all say precisely the same thing. However, it's a reasonably safe bet that super cold, super hot, or quickly fluctuating between the two won't get many (if any) votes. Our physiology relies on prediction to adapt to changing conditions (called allostasis), therefore volatile or extreme conditions pose a challenge and eventually a threat. Yet these three ideas don't seem to capture all of the risk. Runners who follow a well-structured plan, monitor their physiology, and train in well-controlled conditions so they can more accurately predict when to push (or pull back) have better odds, but still aren't without risk. Something must be missing. As it turns out, a team from Australia thinks they may have discovered something that can help fill the gap and it starts with how we fill our bellies.
We know that FUEL plays a critical role in human performance. In longer triathlons, for example, it is often referred to as the "4th discipline" that gets tacked on to the more well-known first 3 of swim-bike-run. However, in this new review of nearly 6,000 runners, researchers were able to get a bit more specific. They found 3 interesting predictors of injuries that related to fueling strategies - the first two, calorie deficit and lower intake of fat, were specific to women and the third, low fiber consumption was generalizable across men and women.
Specifically, they found that injured female runners consumed (on average) 450 fewer calories per day than uninjured runners. The fuller tank analogy above might track literally with running on empty. They also found that of the three macronutrients (protein, carbohydrates, and fat), there were no differences in protein and carbohydrates between those who sustained injuries and those who did not. There was however a difference in fat consumption with the injured runners not getting enough of it. Injured female runners tended to be at the lower end of the fat consumption spectrum (around 20% total calories) whereas uninjured runners tended to be in the middle of the healthy spectrum (27-29% where 35% is considered the high end of healthy).
The final risk which was noted in both men and women was dietary fiber intake. The authors pointed out that while both injured and uninjured runners tended to consume adequate amounts of fiber (while average consumers miss the mark), there was a distinct difference with injured runners falling on the lower end of the healthy spectrum and uninjured runners on the higher end. The authors pointed to potential causes we've discussed in the past when it comes to the relationship between fiber and injury, most notably the gut-promoting and inflammation-tempering benefits of a high-fiber diet.
If history is any indication of the future, our tissues are about to experience more stress. Loads tend to increase at both work and home, the conditions can fluctuate rapidly this time of year and it can be hard for our bodies to predict and possibly even keep up as life races by. In the next 30 days, many of our clients groups will have access to our version of a summer survival guide. Until then, do your moving parts a favor and consider your FUEL and whether you're eating enough of the right stuff...if the biologists are right, that's probably what we were running toward 4 million years ago anyway.
Have a great weekend,
Mike E.
Apr 11
When it comes to health, some bits of information have proven so reliable that they have attained the lofty standard of being a generally accepted truth. "Eat Right, exercise and get good sleep" certainly fall within this category, and "don't smoke, learn to manage stress and practice good hygiene to minimize the spread of disease" are also on most people's lists. However, and as we hope is made clear each week here, the details contained within those truths are always being examined. Occasionally, new information is so impressive it shifts the narrative toward something simpler than we previously thought, making the benefits of a healthy lifestyle more accessible to an even larger number of people. Exercise has experienced such a shift. The last few years have seen significant refinements in what we thought we knew, showing clearly that benefits can be gained earlier, easier, and in a way that fits into more people's lives.
For example, while knowledge that there are major benefits in accruing 150 minutes per week at a moderate intensity, we also (now) know that to some extent we can trade time for intensity and either cut the total time required if we are willing to push a little harder or still get impressive gains when we need to go a little easier. We also know that so much of the benefit comes so early in the process that even "movement microdosing" (stairs, squat breaks, etc) inserted into an otherwise sedentary day can be especially powerful; and in March of 2023 we learned that the beneficial threshold for incidental movement (as measured by steps per day) might be lower than we previously thought - 8,000 steps is enough to make a major difference in risk - even when only achieved twice per week.
Over the last six months, we learned that the frequency of exercise sessions can also be compressed without losing much benefit. This study, which we blogged about in October of last year, was great news for those who feel too busy during the workweek to fit in a consistent movement practice. Contrary to conventional wisdom, it showed that even "weekend warriors" who do all of their exercises in a compressed two-day window, can get most of the benefits that those who have a more consistent pattern get. New research that tested the weekend warrior method against a different dataset found that for some risks, we might even do BETTER this way.
When a research team looked at data from nearly 100,000 accelerometers (such as those in our phones or watches that measure movement) worn by individuals who they tracked for nearly a decade, they found that those who got a full week's worth of exercise (e.g. 150 minutes) over a two-day window, such as the weekend, actually did marginally better than those who had a more consistent pattern of exertion. "Weekend Warriors", who accounted for about 42% of the total group (nearly double the 24% classified as "regularly active"), had more than a 30% lower risk of dying from any cause or from heart disease when compared to the sedentary group as well as more than a 20% lower risk of dying from cancer. While the active group also had a significant risk-lowering effect for all causes, cardiovascular disease, and cancer, the benefit was 6-8% less in each area. The only caveat, as mentioned in the American Heart Association's press release, is that "ramp rates" matter - that is, muscles, joints, bones, and connective tissue (the moving parts) need to be ready for heavier loads so while "winning the weekend" is clearly a win for future health, building up a load-tolerance before (literally) jumping in with both feet, would be a wise choice.
It's a great time of year to get out there. There's wisdom in working up to it but there's health in making this weekend one that moves.
Have a great weekend,
Mike E.
Apr 4
Sometimes we run across a study that is just too big to ignore. The pool of data is so large and the findings are so impressive there's nothing else to do but just get into it. This study, led by a researcher in Australia and published in the British Journal of Sports Medicine is one of those studies.
The backstory, as laid out in this recent article and this review of a series of posts on X and BlueSky by the chief data reporter at the Financial Times, is a reasonably simple one - on the whole, a worldwide decline in language & math capability, which began in the 2010s (but was likely made worse during the pandemic), hasn't improved; by these measures, humans are getting less intelligent. One theory suggests that as we rely on other systems (algorithms, smarter machines, etc) to do the reading, summarizing, and possibly even thinking for us, we are getting worse at it.
While it's probably not a capacity thing - clearly, we are capable of doing calculations, learning new things and thinking critically - it may be a distraction and, like atrophy, a disuse thing. Sadly, it seems "if you don't use it, you lose it" applies to cognition and since one of the greatest predictors of future brain health is current brain health as shown here when comparing our "brain age" vs the "actual age", if we don't challenge our brain to stay as strong as possible now, things will likely get even worse in the future.
If this leaves you wondering what can be done, you're not alone...that gets us back to our original story, a study of studies from an international research team that looked at a massive dataset of more than a quarter million subjects across the lifespan. They found conclusively that movement, of just about any type and intensity, when done consistently, improves cognitive function across every age. Simply put - they found that those who MOVE more can think better. However, where it gets really cool is when they dove deeper into specifics and subgroups.
When it came to memory and executive function (decision-making and more), children and adolescents improved more than adults and older adults and individuals with attention-deficit/hyperactivity disorder (ADHD) exhibited greater improvement in executive function than other populations.
The lead author was quoted as saying: "For children and teens, exercise was especially beneficial for developing memory, while for people with ADHD, it helped improve focus, reduce impulsivity, and enhance executive function."
When it came to the preferred intensity, he went on to say "We also found that mind-body exercises, like Tai Chi and yoga, had the most significant impact on memory, while exergames -- such as Pokémon Go -- were highly effective for general cognition. This is an encouraging finding, suggesting that engaging, low-impact activities can offer real cognitive benefits."
To make things even better, the effect came on fast - with clear gains noted in 30-90 days.
There is no body-mind connection...it's all one thing. Find an excuse to MOVE...and drag everyone you care about with you.
Have a great weekend,
Mike E.
Mar 28
Imagine watching someone getting ready to do a "push-up" for the first time, maybe your child. They assume the position with hands on the floor, body straight, core tight, and knees off the ground and then suddenly they let go of all muscle tension, flop to their belly with a loud thud, slowly push up, return to the starting position and proudly exclaim "one"...only to repeat it a few more times and then look to you for approval. You might think of a creative way to suggest that something seems a little off...can you spot it?
It may not be obvious to everyone, but, despite the name of the exercise, most people who've done it know that "pushing-up" is only part of the movement...and that "controlled lower" and "brief stop"(or sometimes "hands off" even) broadly represent the other parts. As humans, we are constantly changing directions...which means we are also accelerating, decelerating, stopping, and then accelerating again. When it comes to injuries, it's during the deceleration and stopping where things often go wrong and yet few people actually focus on improving or maintaining the ability to do so.
Recently, however, eccentric training (the technical term for focusing on the controlled deceleration of the load more than the acceleration of it) has gained more attention. Studies from the last few years have shown that focusing on getting stronger by resisting while the muscle lengthens can improve strength and also promote gains in joint flexibility, muscle performance, and injury risk over time (especially in the lower body), and may even have more holistic health benefits like lowering blood pressure. This week, from a team in Australia, the news got even better after they found improvements in strength, flexibility, fitness, and well-being scores after 4 weeks of a low-dose home-based plan that emphasized eccentric exercise.
The protocol, a 5-minute bodyweight circuit that included 10 repetitions of chair squats, chair reclines, wall push-ups, and heel drops was performed daily. While there were no appreciable changes in global health measures or muscular power movements (such as body composition, resting heart rate, blood pressure, or various jump tests), there were notable gains in strength, flexibility, fitness, and mental health (such as isometric leg strength, push-ups, sit-ups, sit and reach, 3 min step test and the SF-36 as wellbeing survey).
While in the study's press release, the author acknowledges that 5 minutes doesn't achieve physical activity guidelines, he makes a point of saying it's a great starting point for those who need one. I couldn't agree more...don't be surprised if your local Pro-Activity professional incorporates a few eccentrics into your next visit.
Have a great weekend,
Mike E.
Mar 21
"Biological Aging" is a way of measuring the rate of change in our genetic material as compared to statistical norms. It has grown from an idea (circa 2013) to a more accurate way of predicting our health trajectory than chronological age (years alive) because it can account, at some level, for the variety of exposures to risk we have (or haven't) had through the years. To use a mechanical analogy, if our chronological age is our "model year", then our biological age is something closer to our odometer reading or multipoint inspection. Both are important, but the biological age may give us a better idea of how hard our years have been on us. "GrimAge" is one of the models that stands out for the accuracy of its predictions.
There are many factors known to influence our biological age. In 2025 alone, more than 100 studies have been published on the topic, with age accelerators ranging from environmental exposures to lifestyle patterns. Whether adverse childhood experiences, growing up around smokers and/or in economic stress, or exposure to heavy metals, it's clear that the environment we live in matters. Regular, unresolved stress takes its toll. However, our day-to-day choices also factor in significantly. Our movement patterns (or lack thereof driving muscular losses), our dietary patterns (especially fiber consumption), and our sleep patterns (especially as we age) all relate to our biological age about as we might expect. Trading movement for screen time, stepping back from sugar and opting for higher quality carbohydrates (defined as a better carb-to-fiber ratio), and working to develop good sleep habits all help. However, a study published by a team in Switzerland last month may be a help in understanding exactly how much benefit can be gained by making a few small changes.
As part of the "DO HEALTH" study, a multisite randomized controlled trial of more than 2,000 people truly in their golden years (that is, healthy and active at 70 years or older), researchers split the group in order to test two commonly advocated dietary supplements alone, combined together and in combination with a simple strength training regimen to determine whether, according to the biological aging score, they could slow the biological clock. In order to tease out the effects, they had to break the group into 8 subgroups:
Group 1 took Vitamin D and Omega 3 fatty acids and completed simple strength exercises
Group 2 took both supplements but didn't exercise
Group 3 took Vit-D + exercise
Group 4 took Omega 3s + exercise
Group 5 took Vit-D only
Group 6 took Omega 3s only
Group 7 took exercise only
Group 8 took a placebo
As it turns out, it worked. Omega 3s (sourced from algae) had the strongest stand-alone effect, slowing biological aging between 2.9 and 3.8 months over the 3-year lookback period, however, the effect was even stronger when Vitamin D and exercise were also on board.
While we normally "spring ahead" this time of year, maybe 2025 is the year when we decide to slow time down a bit...at least on the biological clock. The "recipe" may be as simple as: (1) step away from the screen and (2) into moderate sunshine (Vit-D). Grab some tools and (3) turn over the garden until you break a sweat (exercise). (4) Plant and tend to some fresh stuff that's loaded with fiber and when your bounty is ready (5) try Algae Oil (Omega 3s) in your vinaigrette. (6) go to bed knowing you've just put a bit more gold into your golden years and, of course, (7) do it all again all Summer long.
Have a great weekend, and Happy Spring,
Mike E.
Mar 14
Life moves pretty fast these days. At times, it seems like what was new yesterday is commonplace today and outdated by tomorrow. Of course, the speed of innovation wasn't always so fast. By some accounts, it took at least 1800 years from the first proposal of the sun as the center of our planetary system (heliocentrism) to become conventional wisdom. However, as communication improves and ideas are less degraded by "the telephone game" of person-to-person verbal transfer (stories), they can spread much faster. In a very simplified way, this may explain why the "meme" has become so powerful as an agent of change. It is fast to transfer and arrives mostly intact, passing on from person to person quickly and often aided when it is funny, strange, or too emotionally gripping to not pass along to those you care about most.
Health information is often at the mercy of the meme. What actually works (eat right, exercise, get good sleep, manage stress, and connect with others) is not particularly exciting or funny or emotionally gripping. Unless used as a lever for an adventurous life, ironically it is the lack of health and the chaos it tends to bring, which is more emotionally gripping than the relative ease and low-stress nature of many generally healthy days. It's just not that exciting to tell friends over and over and over that no matter how many times they are studied, those same 5 actions pile up to success.
On the other hand, since the funny and weird ARE super entertaining, every once in a while, I like to bring you a few of those. It's entirely possible that these ideas will grow up to be major changes in our thinking - that we here on earth are not, in fact, the center of the universe, for example - or, they may just be entertaining health memes for around the dinner table...only time will tell. So in that spirit, here are three bits of strange science that caught my eye:
1 - Fish is CONNECT Food: Changing the inflammatory load in our diet can have an almost immediate impact on our brain. This animal study from The Ohio State University for example, showed that older rats eating a diet more heavily loaded in saturated fats had rapid changes in memory and learning functions. However, where it gets a little strange is on the other end of the age spectrum. This study observed that children who ate fish more frequently, a known source of "good fat" among other nutrients, were more prosocial. That is, by the time they were 8 years old, they showed a better ability to work in teams and with peers. The researchers recommend 2 servings of fish per week. It's probably a stretch, but if yours is the child who is not playing nice in the sandbox, or you find yourself with the same tendency in the work "sandbox", check your FUEL.
2 - Long Ring Fingers Return: In March of 2024, I wrote about this study, which showed a connection between long ring fingers (4th finger) as compared to index fingers (2nd) called a 2D:4D ratio. That study concluded that soccer players with longer ring fingers, which the authors suggest arise from more testosterone exposure when a developing fetus, tended to have better maximum exercise capacity than those who didn't. It was an idea that was super intriguing but just too strange for me to buy into. Well, they're back again in this study, where they show in a small group that long ring fingers also correlate to lower levels of lactate accumulation during exercise, which means an ability to exercise harder, longer. I'm still not convinced, but I am a bit less self-conscious of my weirdly long ring fingers, if I'm being honest. More to come.
3 - Finding the Flow Signal through the Noise: Creative and extreme sports (BMX, Skateboarding, Aerial Skiing, etc) are amazing to watch. The boldness required to hurl yourself through space and the concentration required to defy the laws of physics in order to land draws the spectator in. Clearly, it requires a finely tuned nervous system. New research on skateboarders suggests it's not just the "skater's eye" that drives things... but also their ear. While blocking sound is a smart choice when the world is loud enough to create harm (such as an industrial workplace), it's possible that skaters are proof positive that working with the sounds around us might help us get better at finding enjoyment and flow in a noisy world. While there is definite peace found in blocking out the noise with earbuds and headphones at times, it's possible that in order to achieve creative flow, those who practice finding the signal through the noise may have better odds. Protected hearing is good for our brains; sheltered hearing may not be. This may especially be true for nature-based sounds, which are shown to calm the nervous system. You may not need to be on a skateboard, but the science says to get "out there" and listen.
Hope you found these as interesting as I did.
Have a great weekend,
Mike E.
Mar 7
Saving for the future can be a tricky business. Most everyone believes it is important and that when it comes to answering "how much should I save?" there is a general guidance that is tried and true: "anything is always better than nothing, but more is probably better". This doesn't make it any easier. At some level, saving requires delaying (or deferring outright) what we want now for the promise of something better in the future. This is not only a self-discipline or mental-toughness challenge, it's a physiological one. Our brains have been honed over generations to look for, detect, and avoid short-term threats, but they are not as well-tuned to long-term forecasting. Combine this with our natural curiosity and the ultra-modern-double-edged-sword of having whatever information we want, in whatever format we want it, at our fingertips instantly, and the risk gets real. While social media scrolling (whether for laughs or on the slippery slope of doom) has often been implicated as making things worse, the speed of artificial intelligence, which makes life easier and faster, may come with strings attached. There's a brain-chemistry and plasticity thing going on here, and it's important.
If we consider for example the landmark "marshmallow studies" from Stanford published decades ago, which asked preschoolers in the 70's to delay eating a treat (now) in order to double their reward (later) and then showed that those who waited did better on a variety of measures years in the future including achievement and stress management as well as health measures, having a saver's brain could be powerful. If we compare those ideas to the results from studies like this one from 2023, which showed a negative impact on brain activity and development trajectory in American 12 year-olds who habitually checked social media platforms as compared to peers who didn't (including more activation in stress-centers of the brain in those who "checked"), there could definitely be a risk of trading away our future for the bliss of the now. While some more recent attempts to replicate the marshmallow studies have shown a less powerful effect, animal studies that required delay to increase rewards have shown a definite brain chemistry (dopamine specifically) change in those who "practiced" waiting. The most important question for our future selves and possibly our children might then be, "How do we start building the structures that lead to a saver's brain?".
One powerful answer might be - the same way we build most healthy structures - MOVE, FUEL, RECOVER. For example, this 2022 study showed a significant link between physical activity and fruit and veggie consumption and life satisfaction (happiness), using delayed gratification measures to show the contribution that doing so for a better tomorrow made. This 2024 study, which showed a powerful connection between sleep health and difficulty delaying (impulsivity), adds the third leg of the stool. But where should we start? A brand-new preliminary study out last month, which will be presented at the American Academy of Neurology in April, suggests the best first step might be, well, more steps.
When the research team looked at the data from more than 70,000 individuals who wore activity trackers they found something simple and powerful - those who moved more and sat less, even enough to burn only a few extra calories per day, were as much as 40% more likely to have healthier brains and better sleep than those who didn't. How much is a few extra? Well, as stated in the press release "The people who did not develop any of the diseases had an average daily moderate to vigorous physical activity energy expenditure of 1.22 kilojoules per kilogram, compared to 0.85 for the people who developed dementia, 0.95 for those who developed sleep disorders, 1.02 for stroke, 1.08 for depression and 1.10 for anxiety.". To put this in terms most of us understand, 1.22 kilojoules is about .3 calories, so for a 200 lb (90 Kg) body, that's expending enough energy to burn about 27 calories per day...which can be done in 2-3 minutes of cycling or 7-8 minutes of brisk walking.
If health is an asset, the time to start banking minutes of MOVE is now. It should be hard enough to break a sweat, but doesn't have to feel like torture. Even a few minutes invested now can produce meaningful savings in the future.
Have a great weekend,
Mike E.
Feb 28
I had the great fortune of meeting a new-to-me client group this week: people we have worked with for a long time, but I have never personally had the opportunity to meet. It required some travel to a city I've never been to. It was, as always, an honor to be given the stage to share Pro-Activity's essential message - that investing time and effort into health is a worthy pursuit; that consistency (even a little bit) will outperform attempting to catch up (even with extra intensity) later and that, although there is great personal benefit from being stronger and happier, the real "why" which gives it such great power, is the far-reaching ripple-effect that pass on to those we care about the most, even for generations.
Since rule number one in these situations is "know thyself", I did what I always do - I set my watch so I wouldn't run over - and then dove into the information containing some of the latest health headlines. In what felt like a few minutes and after a little Q&A, the hour was up. We exchanged thanks, and I got off the stage...and then something really cool happened: a small group used the well-timed break to ask individual questions. This attracted more friends, who eventually became a group of folks who were genuinely curious about using their health to thrive in an otherwise complex world. They asked great questions and allowed me to poke at the barriers that stood between today and an even better tomorrow. I felt lucky to be there working on behalf of one of a growing number of employers who understand that good health is good business...who make easier access to good information a priority for their teams.
Here are 3 great questions that I wish they would've asked in front of the full group as I am sure many people would benefit from the discussion:
(1) Sleep Health: I currently get 5-6 hours of sleep per night. Why is short sleep such a problem if I feel fine in the morning?
This is, of course, a great question with a really long answer... but the short-short version is that our sleep cycle generally follows a pattern with deep non-REM sleep cycling in the earlier part of the sleep window and REM cycling in the later part. If we are constantly chopping off an hour or more at the end, we are chopping off a critical portion of our recovery, one that has been implicated in worsening cognitive health as we age. Although there is a minuscule portion of society that can go well on short sleep, it's more likely that you are waking when you are in a higher arousal state, that is "closer to the surface", and have been doing it so long your body is trained to wake up. It would be worth diving a little more deeply into, but one question that's easy to ask yourself is - are you sleepy during the day? If so, that's a pretty good sign your body is under-rested.
(2) Keeping Arthritis "at bay": I'm active and enjoy soccer. I had a knee injury that I rehabbed, and everything is going well, but colleagues have told me I'm more susceptible to arthritis in the future - should I worry about this, and is there anything I can do to keep it under control?
This is a great question that impacts a lot of people. The most important thing to poke at, in my opinion, is - is arthritis (i.e., roughening of the joint surface) always "bad"? What if it's there but not limiting you? Almost everyone who lives an active life will have some roughing of the surfaces of the joints - we work them hard - but if what you see on an x-ray isn't impacting your function, maybe it's not super worrisome. By staying strong and mobile, joints keep working for a very long time. By eating a healthier diet which may decrease dietary acid load, the roughening exists, but it's not as painful or limiting. Google "blueberries and knee arthritis" and dive into the findings a little - it's fascinating stuff (here is 1). Punchline: it's a risk, but maybe it shouldn't be as much of a worry if you have a plan and follow it.
(3) What's the Future: Do you think there will ever be a blood test or marker that tells us enough information early enough to do something about?
Well, yes and no. With studies clearly showing that our health is impacted before we are born and maybe even influenced by the actions and environment of our family tree generations before us, I'm not sure I really believe there is such thing as "early enough". Health is a generational asset - investing in it now will help your grandkids! Now, if I get off my soapbox, I'd say it's promising. This study out just this week showed that proteins from our organs and how they are "aging" can tell us about our health risk DECADES before disease. Most of them were direct lines - if your heart was showing signs of aging, heart disease was the future problem, for example, BUT not all. Kidney aging was tied to a variety of diseases, and, counterintuitively, immune system aging was the strongest predictor for brain risk. There's a lot more to learn there, but that definitely makes me want to keep my fitness up, eat in a way that doesn't over-inflame my system, and get plenty of rest - all of which are tied to immune health.
There were so many more great ones...I sort of wish we recorded the conversation because it's always SUPER fun for me to see the lightbulb go on for people and them realize how much power over their future health they really do have.
Thriving is complex, but we don't have to over-complicate it. If we invest some time, every day, even if only a few minutes when life is especially busy, we and everyone around us will be rewarded for the effort.
Have a great weekend,
Mike E
Feb 21
I got a video this week of my nephew and Godson readying for one of the most daunting challenges an American 20-something can face, his final "haircut" before stepping into the legendary training that earns the very very few the right to say "yes" when the very very best, whether Sea, Air or Land, are called. It had him all smiles, but it conjured up another emotion for me, one that is filled, strangely, with both worry and pride. It's a mix that sort of short-circuits a parent's brain, which for me was in June of 2022 after a very formal, "you have 60 seconds to say goodbye", which still rings in my ears and pulls at my heart. It's an emotion I'm certain my sister and brother-in-law are wrestling with now.
Little did I know that 3 years later (this past Wednesday), as part of my regular evidence search, I would find a study in which my child had taken part that looked at physiological and mindset variables that might predict injuries during the rigors of training. The researchers looked at physical factors (physical performance testing), mindset factors (self-efficacy, aka the extent a person is confident that they can succeed), injuries on-board (whether recovered fully or not), demographic differences (age, sex), anthropometrics (height, weight), athletics history (varsity athlete vs club athlete vs other) and personal goals of 781 cadets and tracked them throughout the initial phase of training.
In a previous (landmark) study from nearly 20 years ago, the psychological factor "grit", which is defined as "perseverance and passion for long-term goals" was shown to be a strong predictor of success in this setting, whether getting through the initial training or on the longer time horizon, such as graduation. In 2014 and again last year, grit was shown to be a strong predictor of success, suggesting that mindset and mental fortitude were some of the best tools we have to get through hard things. Interestingly, however, and perhaps a bit boring by comparison, which might explain its lack of headline attention, aerobic fitness & power was right there too...shown to be equally (or even more) powerful in predicting success. In study after study, including this most recent one from January, which looked at predictors of musculoskeletal injuries, cardio-respiratory fitness, in this case measured in a 2 mile run, was the strongest predictor after accounting for all variables. It doesn't take the worry away, but having talked with my nephew about some of the run, ruck, and swim fitness prep he has been doing in his lead-up to this next endeavor, based on the science of what predicts success, he is well prepared.
Most of us won't be training as an elite soldier this year, but any of us can choose to approach the challenges we face with the same physiological and psychological tools being used by those who are. March will be here soon and with it, the ramp up to hotter temps, heavier work, and the fatigue and injury risk that comes along for the ride. If you are not preparing already, now is a great time to start. If you need ideas, reach out anytime.
Have a great weekend,
Mike E.
Feb 14
So here we are, our final chapter in the blood glucose monitoring experiment. 30 days of experimentation went by pretty fast. We've learned a ton about our habits, how surprisingly easy they can be to change under the right conditions, how counterintuitive that feels to write, and a bunch about why metabolic health is truly a priority along the way. Honestly, it's too much to capture in a blog that is designed to be a few minutes read each week, so if you're looking for the "TLDR" version of this journey, I'd say the following 4 sentences contain most of what you should know:
If you are a US-based consumer, sugar is everywhere, and you are probably ingesting more than is healthy. Unless you are training for something, even if you do hard physical work every day, it is unlikely you are moving enough to use it all for FUEL. This creates an energy log-jam that our bodies & brains are valiantly fighting to keep up with, but, sad as it may be, are losing over the longer term if we consider the millions who are progressing to diseases now tied to this root cause. For those who desire to more deeply explore their day-to-day AND are evidence-oriented enough to actually follow the path it lays out, a continuous blood glucose monitor can make it easier to change course when needed. In short, this is a story of hope...but not necessarily ease.
Let's start with 3 observations from this week:
1. Doubling down on deferring, getting the most from the important meal of the day: Building on last week, changing the AM routine was hard at first, but it's been good enough to work to make it a keeper. By replacing the order of our eating from one that is carb-dominant in the AM to one that shifts more toward protein and fat in the morning, we saw cool changes. Sugar spikes were blunted, and we felt fuller longer, but that's not all. Early indicators say our bodies are getting more efficient at using the "other" physiological fuel, the energy stored as fat during the day, which is also known as "fat adaptation," a phenomenon studied as early as 1985. It feels important to point out, however that while this approach DOES likely turn the dial toward burning more fat throughout the day, it is not a "keto diet" or an attempt to enter ketosis per se. This website does a nice job of illustrating the differences, but it's not all about fat burning. This review, for example, showed that a higher protein breakfast was linked to better muscle mass in adults and a cardiometabolic effect was also seen in groups as young as adolescents. HOWEVER, there are ripple effects. I noticed a clear need to increase my water consumption after making this switch, a factor associated with increased protein consumption that has been known for a while.
2. Context Matters a LOT - as the 30 days have gone on, we have seen a wide variety of spikes and drops of blood glucose under a variety of conditions. At times, it took some effort to remind myself that spikes are not necessarily good or bad in the absolute sense, but rather a normal response from the body...which can become problematic if too extreme or left unchecked for too long. For example, after moderate-intensity exercise, glucose values dropped as expected, one of the main reasons why post-meal exertion is so powerful and, in my opinion, why a movement break after eating should become a routine for almost everyone. But after intense or "fasted" exercise (i.e., before eating in the AM) things were very different. My glucose values actually climbed. While this makes total sense physiologically - when it is not readily available in the bloodstream, the body taps the liver's reserves to solve the immediate need (intense muscle work or an adrenaline spike), it could EASILY be confusing to the point of being alarming.
3. Better RECOVER means better everything - one of the most impressive findings has been in the "energy" category. Waking up refreshed is not only a nice way to start the day, it also provides greater ease in every action taken and decision made. For Lindsay in particular this change has been hard to put into words but very positive overall; as blood glucose has become more tightly controlled, her energy levels have become not only more abundant (more energetic overall) but also better, including outlook, stress, etc (more energized about making the change). In an otherwise busy world, everything gets a little easier when energy levels rise. Again, this is less surprising when diving into the evidence. The link between metabolic health and brain health seems to be getting more and clearer all the time. For example this review published in January, showed a strong link between metabolic risk (insulin resistance) and brain risk (future dementia) and this new research from Rutgers University showed that the same things that improve one (brief exercise) made a difference in the other (brain markers) in as little as 2 weeks.
So, where does this all leave us? To try to wrap it all up succinctly, we posed 4 questions: "which changes could become permanent?", "Are there any learnings you'll use more as a tactic or tool?", "How will you prevent slipping into old habits when it comes to shopping, snacking or other zombie sugars?" and last, "If a friend asked to summarize the 30 days in one sentence, what would you say?".
So what would we keep? For me, the shift to more protein and less carbs at breakfast, timing movement breaks before or after meals, and being more cognizant of the order in which I eat (goal = fiber first) are all impactful enough and still doable enough to strive to make them permanent. For Lindsay, it was similar. She said, "The savory breakfast, the order in which you eat and working to consume more veggies overall are worth the effort".
In regards to tactics or "good to know for use when needed," Lindsay said "being aware of what a high-carb meal can do makes 'prioritizing priming' (e.g. with a salad) and 'blunting the spike' (e.g. with a walk) good tactics for future use". For me, switching to oil & vinegar instead of something more creamy could be an easy one to use when the opportunity presented.
When it comes to shopping, snacking, and other ways to keep the gremlins at bay, Lindsay said shopping smarter became the clear strategy - there has been a notable and deliberate drop-off in foods that are designed to sit on a shelf in the pantry these last few weeks. For me, trying to continue to get myself to recognize the difference between "sweet" and "treat", now that I have seen the impact, will be important. For example, the contrast between unsweetened Greek yogurt (a high protein) snack and the sweetened version of the same brand was striking. The first showed almost no sugar jump (and therefore no need for an insulin response from my body), and the second behaved like I had eaten a cookie. It was powerful and obvious. While this is not to demonize foods or even sweet treats...it seems to me that we should at least know when we are eating one.
Lastly, to wrap it all up in one sentence to a friend, Lindsay said "the real-time feedback has made it easier to make changes and those changes have produced positive benefits - I can't quite put my finger on it because it's as much a feeling as it is a metric, but I just feel better, more energetic and maybe even more comfortable in my body which I know is a struggle for many; I think the experiment helped me kickstart something good". For me the sentence to a friend would be less interesting and about what any friend might expect. It would go something like this "you know I love this stuff...the more we know about how things are working BEFORE they are breaking or broken the easier it is to stay that way. If you can approach it less like a dieter and more like a scientist, picking apart what you see and learning as much as possible along the way, it might be worth the effort.".
All said, this was fun and enlightening. We hope you enjoyed tagging along and are considering ways you can benefit, too. Reach out with questions.
Have a great weekend,
Mike E.
Feb 7
It's been said that it takes 21 days to establish a new habit, a narrative many people have heard of. It has also been said that this is largely a myth originating in an old text that described in a very rough way, how long it took for a person to adjust to their "new look" after a serious plastic surgery, making it pretty far out of context regarding lifestyle change. One team which, more than a decade ago, actually put this idea to the test, found that the time required showed high variability (from 18 to 254 days), but that most people had achieved a level of automaticity by day 66. For us, now around day 25 of this 30-day effort to monitor, learn from, and ultimately better manage blood glucose, it is definitely getting easier, but not yet automatic. However, it's also getting easier to hyperfocus and perhaps even over-prioritize what we are seeing. I can't be sure the statement "what gets measured, gets done" is always true, but it seems to fit pretty well here.
This week, we implemented the final hack in our 4-hack protocol, a "savory" breakfast. Ultimately, this means shifting the profile of the first meal of the day to one that is lower in carbs and higher in protein, fats & fiber while still avoiding the trap of ultra-processed options, which might help the numbers or the narrative but lose the point of doing so to improve health. This took some creativity, especially for Lindsay, who, as a "mostly plant-based" eater (i.e. eats fish and occasional dairy-based cheese but otherwise no animal products), had fewer choices to work with than me (occasional meat, but will eat eggs for example). It really brought to light some of the complexities in using a dietary approach to improve health - getting the benefit of making a change in the right direction without letting convenience dictate the choice is not easy. We found ourselves making use of refried beans, which have a much more balanced carb-to-fiber ratio of 3 (less than 5 is generally "good") as well as higher fat and protein, along with veggies that pair well like peppers, onions, and baby spinach to make a tasty "skillet". This was definitely a shift from our more standard but still generally healthy fare - rough cut oats with berries, almonds, etc - but the difference was significant. There was almost no spike of blood glucose, and we each noticed we were less hungry for longer as the morning progressed.
As we compared notes and readings, it launched us into a conversation of whether this shift might tip the balance of our eating profile toward too much protein and fat, which can come with its own set of problems. It's reasonably easy to see how this could happen to anyone who loves a challenge or sees an improvement in the mirror, on the scale or in other metrics. Thankfully, we found that compared to general guidelines, our baseline protein intake was at the lower end of the healthy spectrum, so we were safe to bump it up a bit, and this might even be a good change to try to keep in order to stay closer to the ideal. We also found that, 25 days in, while these changes aren't automatic, it feels a lot less like we were limiting ourselves or missing something. It's possible that in line with this 2011 study (which we now know is likely related to gut microbiome changes) - our cravings do shift based on what we are eating and what bacteria we are fueling. After the initial period of missing them, it's gotten a lot easier because the simple-carb gremlins call less loudly. Lindsay, for example, has found the right snack combination in a green apple with peanut butter and some (no-sugar added) granola.
Another super interesting finding this week for me has been in my internal dialog. I've known for a while about the Japanese idea of "Hara hachi bu" - which essentially is a tactic to avoid overeating, of striving to eat until no longer hungry (80% full), which of course is different than eating until 100% full. It's always sounded like a great idea and makes a ton of sense for those of us who could easily over-consume and suffer the health consequences of doing so regularly, but it also always felt unrealistic to me. I LOVE to eat, not only the experience of the meal, but in having a moment to share the table with people I care about. Family dinner, which doesn't always come to fruition in a busy life, is a sacred thing, and wanting to extend the time "at the table" makes it SUPER easy to eat and eat and eat. This week, I found myself more able to untangle that mental knot. During the experiment, I have found on multiple occasions that eating a "big meal" (even bigger portions of an otherwise healthy meal, unfortunately) was far more likely to cause a spike on the glucose monitor. Seeing that spike has given me the prompt to ask myself how I was feeling at that moment and take a few seconds required to think about my body's "answer". While normally I'd just ignore and push through those sensations to the next thing on my list, this week I found myself far more in tune with internal signals (interoception) and feelings of fatigue and even brain fog in those moments which made it a whole bunch easier to equate "not feeling full" with "feeling good" in my mind...and maybe it's working: compared to the 30 days "pre-experiment" my exercise minutes per day are up 2.5X, my step counts are up 1.3X, my number of good night's sleep (using Garmin Body Battery as a proxy) are up 1.7X and I'm closing in on 10 lbs of body weight lost.
What's the bottom line this week?
Learning about how food and movement are impacting our glucose has set us up for a solid exploration into habits, tendencies, and even internal dialogs. It hasn't been easy to zoom out in order to avoid too narrow a focus on only 1 (of many) health indicator(s), but in a time and place where excess sugar seems almost unavoidable, zooming in for a little while has had its benefits. While the data definitely isn't perfect and, therefore, I'd recommend working with your doctor to get a calibrated sensor for anyone who is at high risk (pre-diabetes, etc), it has definitely been enlightening. We're in the final stretch now; my sensor has 5 days left, and Lindsay's has closer to 10 (after the malfunction we talked about last week), and so now will be the time when we test a few other things that weren't squarely in the list of 4 hacks. We'll wrap it up next week - thanks for reading along.
Have a great weekend,
Mike E.
Jan 31
When we left our heroes last week things were mostly novel & new. They were uncovering a few buried truths about their daily habits, finding a few ways to make them a little better, and maybe even nudging their health in the right direction in the process. The undeniable data in front of their faces made it easier to confront the brutal facts, which like a trailer for some sort of terrible movie was a realization that they sort of LOVE simple carbs but the feeling wasn't mutual - they mostly just felt tired and empty inside. And, since this is usually when the hero starts their slog through the dark cave which inevitably includes a fight with some beast that was previously too big to defeat without newfound inner strength, we pick up our story with our heroes in a similar environment - the pantry. Filled with snacks, some that were previously thought to be "mostly OK", it turned out the shelves were actually packed with sneaky little gremlins just waiting for the clock to strike the witching hour. Now back to our story...
Onto Hack 3
If hack 1 (the vinegar preload) was interesting but not super tasty, then hack 2 (the veggie preload) was far more likable. Not a huge surprise from a preference perspective, we both generally like the freshness of a good salad, but having one consistently every evening makes the benefit much more obvious.
For Lindsay, the changes have been most clearly related to energy levels. In her words, "It's hard to quantify 'feeling better' but you definitely know it when you do - more energetic and less lethargic at the end of the day for sure". In regards to measurable changes - "I haven't really lost any weight per se, but I do notice my clothes fitting a little better and I feel like my workouts are better" - which of course are all early signs of progress for those working to make health changes.
For me, as someone who is typically trolling for snacks by 4 PM, hungry enough for two servings by dinner, and still easily swayed by the snack gremlins a few hours before bed, the effect of consistently putting in a fiber "fill" before the main dish was real and obvious. Timing it before dinner made it easy to push off the late afternoon snack and, in line with one of the major health benefits of consuming foods that are both high in fiber and low in process (slower digestion makes you feel fuller), I have found myself far less hungry when starting on the main dish. I now eat a little slower and 1 serving at dinner feels filling enough. It's a small change but a lower calorie-load later in the day is generally a good thing, as this review of the research shows. The pantry gremlins still called in the hours before bed in the first few days, but since progress is motivating it was easier to say "no". The result? I was down more than 5 lbs in the first 14 days, and my sleep, which was pretty good to begin with, has continued to get better as going to bed "fully empty" has become the standard.
It probably shouldn't surprise me since shifting eating to match wake-sleep cycles tends to improve metabolic health as reviewed here, but in addition to my Garmin sleep and HRV data continuing to improve, I have definitely been feeling more refreshed in the morning which makes everything easier, including starting hack 3 (5 minutes of exercise immediately before or after eating). We've tested stairs, various forms of push-ups (wall, stairs, floor, etc), air squats, walking fast enough to be huffing and puffing, and even a rowing machine - all seem to work pretty well. To be clear, it doesn't outright stop the rise in blood sugar, as expected there is a normal rise and it's sharper after high-carb foods but logically the blip resolves far more quickly when the muscles are primed and ready to soak it up for use.
Crowd-sourcing
One of the coolest things that's happened during our little experiment of ours, is YOU. I've had several people reach out, curious to learn more, ask good questions and even offer some ideas. One person suggested kombucha over vinegar as a tastier & gut-biome-boosting option. As it turns out, there is a small study from a team in New Zealand that supports it. I could definitely see this becoming part of the final ("extra") 5 days. Another wondered (paraphrasing) "Are you trying to eliminate the rise and fall totally?" - the answer here is no, this is a normal and healthy metabolic reaction, however like most things seeing extreme reactions by the body only in extreme circumstances is probably closer to "right"...so that's the goal.
Device Hiccups
Several people have also inquired about the devices we are using and whether we like it so far. For those considering a similar experiment I would say, up until day 15 it would've gotten a strong thumbs up. On day 15 however, when it was time to change out the sensor (each lasts 15 days), things got a little off track. Lindsay's new sensor didn't pair with her phone and so she had to pause her portion of the test while a replacement was being sent and my values were very different from my first sensor. To be fair - Dexcom's (the parent company) customer support bot was great and Lindsay's replacement was in the mail within 24 hours of the issue being reported and I am getting my brain wrapped around the sudden jump in my baseline, something that, given our sensors' inability to calibrate against a fingerstick blood test to give the truest value, like a prescription-only model does, is probably reasonable. So while building in 5 extra days in our experiment for glitches now seems smart, it also reinforces the fact that these devices are on the health side of the spectrum and more educational than medical or diagnostic.
Last up (hack 4) is starting the day with a "savory breakfast". Tune in next week to learn how it went.
Have a great weekend,
Mike E.
Jan 24
If last week was the "setup", this week we're "in the thick of things". To recap, Lindsay (my wife) and I have pledged to wear a continuous glucose monitor for 30 days and trial a handful of strategies (1 every 5 days) known to support better metabolic health. The hope is that by smoothing the spikes and drops of blood sugar that tend to be exaggerated when we consume highly processed and/or sugary foods, and therefore lead to both energy drain now and health and injury risk in the future, we will learn something, feel better and maybe see some beneficial outcomes. The first 5 days were to establish a baseline with the first "hack" - vinegar consumption before our biggest meal of the day, in our case dinner - added at day 5. All types of vinegar are known to blunt the sugar spike through a variety of mechanisms, but we chose apple cider vinegar in hopes it would taste a little better.
We've already learned a ton...but here are a few of our biggest takeaways so far:
1. Seeing Is Believing - Seeing the rapid rise and drop in blood sugar has made it MUCH easier to question, think about and ultimately change eating and snacking habits that aren't ideal. For me, it has meant quickly abandoning the honey in my cup of sleepytime tea before bed - a sleep hygiene habit I lean on to remind myself to slow down before trying to actually sleep. Now, to be honest, this one made me a little sad. As a beekeeper, I have grown to LOVE honey and as a health professional, I'm partial to the evidence that says it actually helps blood sugar control (among other great health benefits). However, the takeaway was timing. Having a sharp rise in blood glucose right before bed was not ideal...and so, while I still use and enjoy honey in tea, I just avoid it before bed. Anecdotally, my sleep quality according to my Garmin's sleep score and HRV, has trended in a positive direction since going to bed fully empty...always a welcome improvement.
Lindsay's take: "Using the monitor has definitely had an influence on food choices - I have altered what I eat because I want to avoid spiking or going above my upper threshold.".
2. It's Nuanced....and could easily be misleading. Metabolism is complex; we want it to be simple, straightforward, and maybe even easy to influence, but it isn't. Foods can be BOTH generally healthy AND still cause blood glucose to rise rapidly (certain types of fruit for example), while other foods that might generally be accepted as "less healthy" can actually blunt the sugar response. So there are definitely priorities to consider. For example, seeing the flattening of the curve or even drop in blood glucose after having a beer or glass of wine was surprising to me...even after being told to expect this exact phenomenon from a friend with experience in monitoring. While the mechanism isn't super well understood, the effect has been documented, especially when alcohol AND sugary meals are combined. Some suggest it is the liver effectively "slowing" its blood glucose functions in order to "switch on" and prioritize the alcohol processing function - not necessarily a good thing. We had dinner out over the weekend and I had a black bean burger, fries, and a couple pints of Guinness...not a healthy meal per se, but certainly not the worst combo on that menu. And, you know, it's for science! Seeing the difference in my blood glucose overnight that night compared with my typical was a jolt. It was high (for me) all night long.
Lindsay's take: "I was surprised to see such a minor jump from a glass of wine. I guess I expected it to really spike my readings. However, seeing the delay, with a spike long after eating and even while sleeping has been super interesting and something I hope to understand better when this is all over."
3. Exercise is REALLY impressive - whether it's strength-oriented work which taxes and primes the muscles to "soak up" and use sugar or aerobic effort which quickly burns what is available, the effect has been strong and obvious. This is not meant to let the cat out of the bag on "hack 3" which is more about the deliberate timing of movement, it's been unmistakable even as part of our normal routine. I suppose it's not a huge surprise, the effect is well documented, especially when both strength and aerobic exercise are combined, but knowing that almost any routine movement can induce a blunting effect (even something as low intensity as stretching) is useful in the more wholistic effort of feeling energetic throughout the day and making a small investment in future health.
Lindsay's take: "I was surprised how strong the exercise effect really is. Strength exercise has been especially impressive for me, but even a light walk makes a notable difference in the shape of the curve."
4. Not the tastiest but still kind of cool - As expected the vinegar + water preload hack isn't particularly tasty. We've been using a ratio of 1 tablespoon of apple cider vinegar to 8-12 oz of water which waters it down just enough to be palatable and easy, but not something most would look forward to. The results however have been pretty cool to see. Instead of a rapid rise after eating, the blood glucose curve seems to either slowly climb in a gradual but steady pattern - as if it was giving a more sustained release effect - or bounce up and down a little if the meal was heavier in carbs.
Lindsay's take: "Kind of gross and it hasn't been as strong as exercise for me, but the effect is pretty consistent and easy enough to do".
We are now onto hack 2, which is to change the dinner preload to low glycemic veggies (fiber first!), and will move the vinegar to lunchtime so we can, at some level, compare. The devices are living up to daily life so far (they're estimated to last 15 days per) and, although I'm sure it'll be easy to slip backward when the data isn't staring us in the face, there are some early signs of health risk improvement (weight, body fat %, etc). Super interesting stuff so far. Stay tuned for more.
Have a great weekend,
Mike E.
Jan 17
Just last week I got an increasingly common question - "What is that little pod I'm seeing people stick to the back of their arms...and is it a good thing?". As a data geek and someone who loves the idea of wearables and biosensors to help me be more precise in my day-to-day actions, the Continuous Glucose Monitor (CGM) has been an intriguing idea for a few years. Like a heart-rate monitor for how we process food into energy (metabolism), this little plastic pod, smaller than a silver dollar, sticks onto the skin and sends data on blood sugar (glucose) to an app on the phone, creating a digital trace of the ups and downs, both normal fluctuations and responses to activity and diet. Over the last few years, they've become more common but as a prescription-only device and harder to get without boxing out someone who needed it more than me during the post-pandemic supply chain woes, up until recently the idea was frivolous at best.
Fast forward to late last year when one of the leading manufacturers received FDA approval for an over-the-counter version along with our recognition that metabolic health was a big area to watch in 2025 and now seemed like a perfect time to see what we could learn and share.
How it works - an overview: At the risk of wildly oversimplifying an incredibly complex process that impacts almost everything we experience daily, metabolism is the biochemical act of converting our FUEL to energy. When we are healthy, we do it predictably and efficiently, changing carbohydrates into "fast energy", which tends to be better for higher-intensity efforts, and fats more slowly which is ideal for lower-intensity sustained efforts. Whatever we don't use gets stored. Too much all at once, low-quality foods, or simply not using what is available through physical activity increases the risk that the system will lose efficiency and eventually become diseased, the most common of which is diabetes type 2, which impacts 40 to 130 million Americans depending on whether we include those with prediabetes in the tally. At least 1 expert's research into what drives cancer says it's a common root in that category of diseases too.
Most of us know that with low-quality, sugary, and cheap foods everywhere and daily routines that make it easy to NOT be physically active, we are definitely all at some level of risk. Things get even more urgent when we consider data like this which shows a clear connection between metabolic disease and injuries. This is not a "someday" problem, it's a now problem that seems to only get worse if left alone. Since it also only gets harder to reverse as time passes, if we can take the mystery out of it and know where we stand - which is what the CGM + app is built to do - it can be a good thing...and so, we experiment.
The Experiment:
For the 30 days from Jan 12th to Feb 12th I (and my wife b/c she's a good sport and there are definite differences between men and women) will be wearing a CGM and trying to closely track and document the experience. The first 5 days (ending today) will be a baseline week, where no significant changes will be made. Then, every 5 days after that, we will implement 1 strategy known to help smooth out blood sugar spikes and keep people in a healthier range. We will be putting 4 of the "hacks" discussed by a popular expert & influencer on the subject (@glucosegoddess) to the test, "stacking" them each time we add one so that by the end, we are doing all 4 things simultaneously. We've built in 1 extra 5-day block as a buffer for any difficulties we run into but may also use it as a bonus block if everything goes smoothly. Our first will be to consume vinegar before the "biggest meal of the day" - about 1 tablespoon mixed in a glass of water, something that has been shown (for example here and here) to blunt the rise in blood glucose and "flatten the curve" - before dinner.
Disclaimer
Now, while I generally LOVE the idea of people making small "experimental" changes to learn more about what works for them, such as "don't eat a slice of cake as the first course of lunch", a micro-test I ran (and failed miserably) on Tuesday, I can't in good conscience, recommend it this time. Without knowing someone's health or relevant history, possible interactions with medications, or any number of other factors that might make "playing along" unsafe or unadvisable, doing so would be irresponsible. With that, we will not be making recommendations in any way - these are observations only.
For those who read along, I hope it's fun and you learn something you can talk about around the dinner table or with a friend. As always - feel free to send questions or ask you local member of the Pro-Activity team.
Have a great weekend,
Mike E.
Jan 10
It always feels so validating when a major news service points to the same essential message as we do here. This time, it was the New York Times in their New Year's series on health and wellness, which featured a couple of articles (here and here but unfortunately both behind their firewall) covering the topic of how to live healthier for longer, with both scientific evidence and interviews with experts.
In one article they pointed to a really cool study from last year which looked at the health records of nearly 1M US service veterans' to determine the full potential of a healthy lifestyle. That is, they looked at the number of years of life gained (on average) in those who followed an "ELEMENTS+ Lifestyle" throughout adulthood and found that the investment paid off in about 2 decades of extra years of life. Said another way, those who did the hard work of Move, Fuel, Recover, Endure, Connect (and stayed clear of unhealthy add-ons like alcohol, tobacco, and drugs) on average gained 2-3 years per habit resulting in 20 extra years for men and up to 24 extra years for women. Said yet another way, and although NYT was careful to point out their belief that "super agers" (those who will live to 90's and beyond) likely have some genetic advantage, stacking all the same habits resulted in enough years gained to get the chance to meet another generation of the people we care about most - pretty amazing stuff.
For those interested in the specific behaviors that scored points the authors described it as "adhering to a whole-food, plant-predominant eating pattern, having regular consistent physical activity, managing negative stress, not smoking, having restorative sleep, no excessive alcohol consumption, no opioid use disorder, and having positive social connections". Specifics can be found on pages 128 & 129 of the study.
In the second article, they describe the "7 Keys to Longevity" which...although didn't use the same exact terms certainly got close:
1. Move More
2. Eat more Fruits & Vegetables
3. Get enough sleep
4. Don't smoke and don't drink too much
5. Manage chronic conditions (blood pressure, blood sugar, etc)
6. Prioritize relationships
7. Cultivate a positive mindset
There's really no surprise here, the evidence on each is overwhelming. However, since just knowing something to be true doesn't make it easy to turn into a lifelong habit, the question remains - where should we start?
One doctor quoted in the article said "Do some version of physical activity...if you can't do that, then focus on being positive". Researchers at The University of Iowa Health Center might agree. They surveyed 7,000 patients on their movement habits, which they called the "Exercise Vital Sign" by asking 2 simple questions between 2017 and 2022.
1 - On average, how many days per week do you engage in moderate to vigorous exercise (like a brisk walk)?" (0-7 days)
2 - On average, how many minutes do you engage in exercise at this level?
They found that those who reported physical activity that achieved guidelines (about the same as the amount advocated above) had significantly lower odds of nearly 20 different diseases in the future. Amazing.
However, while getting "out there" for a walk might be inviting when the weather is gorgeous, it's easy to find reasons not to during a cold blast like the one we've been facing in many of our territories. What then?
Well, according to a research team who published findings showing substantial effects on the second target area for 2025 we identified last week, the microbiome and metabolic health, the answer might be Elderberry juice.
In a randomized, placebo-controlled trial, drinking 12 ounces per day for a week significantly improved the gut and metabolic health of those studied. While, not nearly as well-studied as the more common but similarly low-sugar, nutrient-dense blueberry (perhaps because eating elderberries raw can be poisonous), the results showed a double-digit blood sugar reduction, a nearly double-digit insulin reduction, a significantly improved biome, and even some evidence which suggested a better ability to burn fat as fuel.
There are only 355 days left in 2025, the time to return to the groove is now.
Have a great weekend,
Mike E.
Jan 3
With my youngest child now old enough to be out celebrating with friends, it would be the first "quiet" New Year's Eve in a very long time. Although, to be fair, since 2024 was just the usual chaos and nothing really to complain about, it had been busy enough that getting in bed at a reasonable hour (well before Auld Lang Syne) felt like a win. After a couple of hours which felt like minutes, I woke to the sound of Charlie the Yellow Dog loudly protesting a neighbor's use of fireworks to commemorate the moment. Then, after a few minutes that felt like hours (oh, the barking!), I knew 2024 was a thing of the past and I could go back to sleep.
It's one of the reasons I love New Year's Day. At a time when we often hear about the benefits of quieting thoughts about the past and/or future to "stay in the moment" (aka mindfulness), it is one of few scheduled pauses, brief as it may be when the mental time travel of reflecting on the past 12 months to help plan the next twelve (future) is a good thing.
So what if we apply this approach to the goal of staying safe, living healthy now, and improving our odds of thriving longer? What fascinating findings from 2024 should help inform our plan for 2025?
Here are few of the most important to know about in my opinion:
(1) Build Reserves: Whether it's this massive study of studies published in September which showed that for every 1 unit increase in cardiorespiratory fitness, adults had a double-digit drop in the risk of dying or this March 2024 review of 130 different studies which showed that "inadequate physiologic reserve" as we age (aka frailty) was definitively linked with important social drivers of health such as loneliness and isolation, the big message is clear: Improving or maintaining fitness, strength and power now can be one of the best investments we can make.
(2) Fiber First: If a headline read "Eat enough of this every day and lower your risk of dying by more than 20%" many of us might take a look. If the fine print said it was a study of more than 3 million people, even those who like to dive into the details might be satisfied. Well, that is exactly the observation made in this January 2024 review of 64 different studies on the subject. As a bonus, this study which does a deep dive into interventions shown to improve blood sugar control showed that not only does consuming more fiber (>=10g/day) help lower the risk of metabolic disease (sections 6.4 and 7.2 in the article) but points to emerging evidence that suggests if we eat it first, that is, order our eating patterns so we eat the veggies first and the carbs last, we might get an even better effect.
(3) Energy Vampires are REAL: This review from a team in Italy early in 2024 points to an important theme when it comes to the well-being and performance of groups and teams - attitudes really are contagious. While most of the work in this area has been done on leaders as the "sender" and followers as the "receiver", the authors point out that this relationship has also been established in those who tend to command attention (i.e. the loudest or most expressive person in the group). If you are on a team or work in a group, assessing and creatively addressing the emotional energy in that group might be a powerful risk-lowering strategy in 2025.
Of course, these are only 3 themes...and fascinating is most definitely subjective, but there's enough here to build on. Keep an eye out for more as we journey through 2025.
Have a great weekend and Happy New Year,
Mike E.