Great Health is Not a Mystery…It’s a Puzzle

puzzleMalcolm Gladwell, the best-selling author, has written about the differences between a mystery and a puzzle.  Solving a mystery requires gathering clues that often are hard to come by and sometimes impossible to find.  

Puzzles are totally different.  Think of a jigsaw puzzle.  Once you open the box and spill all the pieces on the table, you don’t need to find any clues…they are all right in front of you.  In order to solve the puzzle, you just need to figure out a way to put all of the pieces together.

Attaining great health is not a mystery, it’s really a pretty simple puzzle.  Despite that fact many individuals invest significant time and money trying to find a missing clue, or “the magic bullet.” The solutions are staring us right in the face…and, as you probably suspect, you already know what they are.

Genetics, (i.e. your mom and dad), are responsible for about 20-30% of your health.  The balance, which is obviously substantial, is completely up to you.  The majority of your overall health is about personal habits (what you do, or don’t do, on a regular, often daily, basis) and your environment.  These are both things you can control.

There are all sorts of habits that can significantly impact your health, either positively or negatively.  The Big Three are nutrition (what and how much you choose to put in your mouth), physical activity and sleep.  Of these, nutrition and sleep are essential for life while physical activity is optional.  Obviously, you can live without physical activity…however, you can’t live well.  

On a scale of 1 to 10, I encourage you to rate yourself on the categories of nutrition, physical activity, and sleep…1 being terrible and 10 being terrific.  Now add up the three numbers.  If your total is 27 or higher, congratulations!  If not, no worries. The good news is, it’s never too late to improve your health and the solutions are not complicated.  

Spoiler alert! I don’t consider what follows to be “breaking news!” It also does not qualify as “fake news.”

Nutrition

I like to separate the topic of nutrition into two buckets, weight and health.  While the two often overlap, I believe it’s helpful to differentiate in order to clarify your game plan.  If you are interested in losing weight, then you must develop new skills to help moderate your caloric intake.  Many Americans are awful at portion control.  Believe it or not, it’s not what you eat, but when and how you eat that will help you lose weight and, more importantly, keep the weight off.  Learning the difference between appetite and hunger and slowing down your eating experience are two of the most critical skills that lead to permanent weight loss.

From a health perspective, the quality of what you put in your mouth is important.  The research is clear that the Mediterranean Diet (which is not a diet, but a lifestyle) is a fantastic way to improve your health and lower your risk of disease.  Whole grains, along with plenty of green leafy vegetables, fruit, seeds, beans, nuts and berries, should be staples if you are interested in maximizing your health.

Physical Activity

To many, “exercise” is a four-letter word, but make no mistake, incorporating regular physical activity into your routine is one of the best ways to improve both the quality and quantity of your life.  Time is always the most popular excuse as to why individuals don’t exercise, but I don’t buy it.  We all have 168 hours in a week and we know, if you embrace HIIT (high-intensity interval training), you can get all you need with about 30 minutes a week…total.  Please understand, I am not promoting a “something for nothing” strategy as it relates to physical activity…the science here is solid.  I will admit you have to be in pretty good shape to reap the rewards of HIIT, but if you’re avoiding exercise because you are just “too busy,” then it’s time for you to come up with a better excuse.  

Note to overachievers… (guys, this means you).  If you are currently deconditioned from a lack of regular exercise, please don’t try to jump off the high dive, boil the ocean or go from zero-to-60 immediately.  You didn’t get out of shape overnight, so you are not going to recapture your fitness overnight either.  Start where you are and be sure to check with your primary care doc if you have any concerns about your capacity for exertion.  A great place to start is to walk the dog…even if you don’t have one!  

Sleep      

When it comes to optimal health, I call sleep the “third leg of the stool.”  We’ve heard the “diet and exercise” drumbeat for years, but statistically many Americans are trying to get by on too little shut-eye.  Don’t fool yourself.  Without adequate sleep, you will never hit on all cylinders.  

Adults need at least seven hours of sleep per night, but the research shows that 71% of us are either moderately or severely sleep deprived.  The benefits of a good night’s sleep are substantial…more energy, lower blood pressure, better glucose metabolism, improved memory, enhanced mood, a stronger desire to exercise, greater immunity, less stress, longer life and maybe most importantly, a better sense of humor.

Having a consistent sleep routine seems to be the key.  This is known as “sleep hygiene.”  Try to be consistent with when you go to bed and when you get up, even on weekends.  Keep your bedroom like a cave…dark, cool and quiet.  

Try winding down at least an hour before you want to get to sleep.  It’s helpful to avoid one last check of your email, texts, Twitter or Instagram before turning out the lights.   Preparing your brain for sleep is important, so avoid violent television shows or Stephen King novels right before bedtime.  If you have trouble falling asleep, try a hot shower or bath just before sliding under the cool, crisp sheets.  The quick reduction in your core temperature will facilitate relaxation and help set the table for an excellent night of rest which can be the difference between an “average” or “excellent” tomorrow.

There are plenty of other pieces to the “health puzzle,” but the three mentioned above are a great place to start.  One critical point to remember is you can’t outsource your health.  Improving your odds of living a long and healthy life is absolutely possible, you just need to put the puzzle together.

Stay well!

Don’t Die from Embarrassment!

Phil-LawlerEvery now and then, if you’re really fortunate, you get to meet someone like Phil Lawler. Phil was special. He was one of those individuals that make you think, “Wow, how blessed I am to count this incredible man as my friend!”

I met Phil in the early 2000s when I was hosting a nationally syndicated radio program that focused on health and fitness. He became a regular guest because of his contagious positive energy and passion. Even over the radio, you could tell he had been put on this earth for a reason. Phil had been instrumental in the founding of PE4Life, a non-profit dedicated to improving the fitness of children worldwide. He liked to say he “was just a gym teacher,” but Phil realized that teaching kids the dimensions of a volleyball court was ultimately not going to have any substantial impact on their health or quality of life. That insight led to the development of what he called “New P.E.”

Phil spent twenty-nine years as the P.E. teacher at Madison Junior High School in Naperville, Illinois. When you walked into his gym, you knew immediately that something was different at Madison. They had treadmills and a rock climbing wall. All the kids knew how to wear and read heart rate monitors. The math, reading, and science teachers all loved Phil. When they sent him their academically challenged students they would suddenly see a marked improvement in those kids’ grades. Phil had heard there was a link between physical fitness and academic achievement, and he was out to prove it on a daily basis!

Slowly but surely, the word on physical fitness spread throughout the Naperville School District. Test scores soared and rates of childhood obesity plummeted. Phil did all he could to promote the cause. He worked tirelessly raising money from corporate sponsors in the community, hosting workshops, giving tours, and doing interviews. Journalists called from all over the country and eventually from all over the world. Phil, along with his good friend and colleague Paul Zientarski, ultimately trained over seventeen hundred educators, administrators, and community leaders from forty-two states and ten countries. His promotion of healthy children positively impacted over twenty-four hundred schools and more than two million kids. TWO MILLION KIDS!

Today is April 23rd. Exactly seven years ago, Phil Lawler died from colon cancer. He was sixty years old.

In the News

You may have read recently that rates for colorectal cancer, which had been declining for decades, are surging among young and middle-aged adults (as reported in the March 2017 issue of the Journal of the National Cancer Institute). Researchers are not exactly sure of the reason, but the main suspects include obesity, inactivity and poor diets. In other words, the increase is believed to be related to lifestyle and bad habits.

Like most cancers, age is a primary risk for colorectal cancer which is why since 2008 The U.S. Preventive Services Task Force has not recommended screening for colorectal cancer before age fifty. Statistically, getting a colonoscopy before fifty didn’t make much sense. Given the new data, however, that bar may need to be lowered. Of the 135,000 new cases of colorectal cancer diagnosed in 2013 (the latest data available), 11,000 were people in their forties and 4,000 were younger than that.

Certain cancers go in the “bad luck” category, but colorectal cancer is not one of them. Because it grows so slowly, most experts consider colorectal cancer to be preventable by simply getting a colonoscopy. With early detection, pre-cancerous polyps can simply be “clipped out” well before they become life-threatening tumors. If you receive an all clear report, usually you don’t need another colonoscopy for ten years.

I’ll be the first to admit that getting a colonoscopy is not an enjoyable adventure. I’ve had two. The actual procedure is not nearly as challenging as the preparation, however, which starts the day before the exam. “The Prep” includes fasting and drinking copious amounts of a horrible tasting laxative designed to help give the gastroenterologist a clear view of your colon’s nooks and crannies. (The idea of a stranger snaking a flexible tube with a camera on the tip into “your Southern end” does not sound like much fun, but IT SURE BEATS THE ALTERNATIVE of colon cancer!)

Back To My Friend Phil

After he was diagnosed with colon cancer, Phil admitted repeatedly he had made what turned out to be a fatal mistake. Although he had spent most of his adult life helping teach others the critical importance of taking care of their health, he had ignored his own advice. Had Phil simply gotten a routine colonoscopy when he was fifty, he would most likely be alive today. His magnetic smile and driving passion would still be influencing countless others to lead better, healthier, more fit lives. That’s what he loved to do. That’s why he was here.

I miss Phil. I’m confident there are literally thousands that miss him as well. I know what he’d say if he could: Although getting a colonoscopy is not on the top of anyone’s wish list, it certainly doesn’t make any sense to die from embarrassment!

Stay well!

Here Comes the Tsunami

Tsunami waves

There are three kinds of lies: lies, damned lies, and statistics. Mark Twain often gets credit for that statement although it most likely originated in England in the late 1800s. Regardless, the takeaway is simple, statistics can often be manipulated to support or detract from just about any position or argument.

A major exception to that would be diabetes. It’s impossible to ignore how quickly the numbers are climbing.

February is always American Heart month. Each and every year, right around Valentine’s Day, we are inundated with all sorts of stats regarding heart disease:

*It kills more Americans than any other disease.
* 750,000 Americans will have a heart attack this year.
* 70% of heart disease is preventable.

These numbers are all true but they also are old news. Deaths from heart disease have fallen dramatically over the past 50 years in the United States. What we really need to be paying attention to is the rate of how quickly diabetes is exploding!

WHAT WAS THE CAUSE OF DEATH?

When someone passes away the official death certificate has to include the “cause of death.” The problem is it’s rare that someone dies from just one thing. What if an individual is obese, physically inactive, smokes, has heart disease, diabetes, hypertension, some type of cancer and they then suffer a fatal stroke? What should the attending physician list as the “cause of death”? That’s a good question since there obviously were multiple factors at play.

From 1997 to 2011, for adults 30-84, only 3.3% of death certificates listed diabetes as the underlying cause of death. A study, published January 25, 2017 in PLOS ONE, indicates that number should be closer to 12% which would move diabetes from the 7th leading cause of death to 3rd (behind heart disease and malignant neoplasms (i.e. cancer)).

Now you may be thinking “meh!” but…let’s look downfield. Well over 90% of diabetes is classified as “Type 2” which is primarily a function of obesity and physical inactivity…in other words, it’s preventable. The prevalence of diabetes in the United States has tripled from 1976-1980 until now. Of greater importance, it’s now predicted that for American’s born after the year 2000 at least 40% will develop diabetes at some point in their life (up from the current 12.3% of adults 20 and older). Yes, you read that right: 40%!

If that does not have your attention then consider the economic cost! The Journal of the American Medical Association (JAMA) published a paper in December, 2016 that shows the cost of diabetes is clearly at the top of the list of most costly health expenses…over 101 billion dollars a year!
More importantly, the cost of diabetes is growing 36 times faster than the number two condition which is ischemic heart disease:

10-most-costly-health-expenses

What does all this mean? Well, as my dad used to say: We’re in deep yogurt!

From a health perspective where we’ve been is interesting, where we are is important, but where we’re going is frightening. Although we can outsource many things in our lives, including our laundry, our meals, and our lawn care, we simply cannot outsource our health. Individually and collectively we must recognize most of diabetes is preventable and if we don’t correct course soon then no one is going to have a checkbook big enough to pay for what’s coming.

Stay well.

Just a Reminder

I have a friend, Kathy Duran-Thal, who is a dietician in Dallas. She loves to say that, “Your feet cannot outrun your mouth.” In other words, it takes a whole lot of exercise to burn all the calories you can eat in just a matter of minutes. I was reminded of that last weekend.

For the past several years I have served at the host of the live television broadcast of the Dallas Marathon. This year’s race will be held on December 14th and because of all sorts of street construction the course has been dramatically altered from years gone by. In order to get a feel for the subtle nuances of the new layout I cycled the course on Sunday with my good buddy, Kevin Spivey, who also serves as the producer of the broadcast. Now while riding a marathon is much easier than running one, it still was a pretty decent workout.

After returning home and grabbing some lunch I then spent much of the afternoon helping my son-in-law move furniture and boxes from a house into a storage unit. For over three hours we were climbing up and down stairs, carrying heavy loads to and from the house to the car and then from the car into the storage unit. It was hard work, especially on the heels of a fairly long bike ride. Between the ride and move I got pretty close to six hours of pretty strenuous physical activity.

After dinner that night I felt guilty that I had not taken my dog, Emma, on a walk or run that morning. She’s a seven year old black Lab that LOVES to go to the park, chase squirrels, and sniff to her hearts delight. I always try to make sure that Emma gets at least two workouts every weekend. Since I had skipped that morning I grabbed her leash and we took a brisk walk around the neighborhood. We were gone about 15 or 20 minutes so I’m guessing we probably covered a little over a mile.

KEEPING TRACK

For the past several months I’ve been wearing an accelerometer, one of the so-called “wearables” that tracks my activity and sleep. There are all sorts of brands available. The space is exploding because the technology has really evolved. FitBit is by far the market-share leader but there are all sorts of quality options. I wear an UP by Jawbone, primarily because that’s what many of my colleagues use and we can monitor each other’s activity. This comes in handy if we want to talk smack or encourage one another.

After Emma’s walk I decided I was pretty much out of gas. I sat down, turned on my phone, hit my “UP” app, and waited for my wrist device to sync with my phone. When my totals popped up it indicated I had logged 21,259 steps for the day (The technology automatically converts the cycling mileage into steps. As a general rule, and I do mean general, every four miles on a bike equals about one mile of running or walking). Because of stride variance everyone is a bit different but there are approximately 2,000 steps in a mile. My accelerometer estimated I had covered the equivalent of about 11.7 miles for the day.

AccelerometerWhen I initially activated my accelerometer I entered my gender, height, and weight so the device also automatically gives me caloric estimates; both calories burned at rest (“resting burn”) and calories burned while active (“active burn”). For the day it showed I had burned 1,582 calories just living and another 1,505 calories through activity for a grand total of 3,087 calories expended. Now these numbers are not by any means 100% accurate but they are pretty close so for the sake of discussion let’s assume they are a pretty fair estimate.

We also need to keep in mind that I ate that day…a banana with peanut butter before my ride plus a hearty lunch and dinner. I estimate I probably consumed about 2,400 calories through food and snacks.

So let’s do the math. I ate 2,400 calories and burned 3,087 calories so the difference was obviously a negative 687 calories…I burned more than I ate. Since there are no more than 3,500 calories in a pound (see 1/6/14 post) that means that for the day, at the most, I lost 1/5th of a pound…despite “exercising” for somewhere around six hours. That’s why my friend Kathy says, “Our feet cannot outrun our mouth.” I easily could have eaten another 500 or 600 calories and would have actually gained weight for the day despite six hours of activity!

This just reinforces what the science shows, and what we’ve talked about in the past…If you want to lose weight you need to really focus on caloric restriction (i.e. how much you put in your mouth). However, once you reach your target weight, if you want to keep it off, you must be physically active on a regular basis. I meet people all the time that insist they can just “sweat off the pounds.” To them I say, with a slight smile: Good for you!

Stay Well,

Todd

 

 

CHICKEN LITTLE WAS RIGHT!

Henny_pennyWhen it comes to the health of our country, Chicken Little was right…the sky IS falling!

While healthcare and the Affordable Care Act dominate the headlines it seems that actual health gets very little attention. In June the American Diabetes Association released new statistics regarding the rate of diabetes in the United States. 12.3% of American adults (29.1 million) are now diabetic. More troubling is that 37% (86 million) are pre-diabetic…and nine out of 10 of those don’t know it.

That means that 49.3% of us are now diabetic or pre-diabetic!

The A.D.A. also pointed out the cost to treat diabetes has increased 41% between 2007 and 2012.

Then, two months later (August 12, 2014), the Centers for Disease Control and Prevention announced that forty percent of Americans born between 2000 and 2011 will develop diabetes…double the risk of those born just a decade earlier. The numbers are even more ominous for minorities. More than half of all Hispanics and non-Hispanic black women born between 2000 and 2011 will develop diabetes in their lifetime. For black men the lifetime risk is 45%.

Just to top it off, on September 17th, the Journal of the American Medical Association published a study indicating that 54% of American adults, both men and women, had waist circumferences that were too large. “Abdominal obesity” is defined as a waistline of more than 35 inches in a woman and more than 40 inches in a man. This fat, also known as visceral adiposity or belly fat, is different than the fat we carry in our hips, thighs and buttocks. It’s been described as “angry fat” and dramatically increases our risk for a number of conditions including heart disease, stroke and diabetes. That 54% total is up from 46% reported in 1999-2000.

If these trends and predictions hold true, and there’s no reason to think they won’t, then the dialog about who is going to pay for healthcare becomes irrelevant. Why?…because no one has a checkbook big enough to pay for what’s coming!

Diabetes dramatically increases the risk of heart disease, stroke, blindness, neuropathy, amputation, kidney disease, and liver failure. Besides the tragic impact on quality of life all of these conditions cost a great deal to treat.

Here’s the real tragedy…and it has nothing to do with economics. The vast majority of diabetes is preventable. Type 2 diabetes, which accounts for well over 90% of diabetes, is considered a lifestyle disease. It’s primarily a result of obesity and inactivity.

Americans are eating more and moving less than ever in our history. Processed food laden with added fat, sugar and salt dramatically increases what the Big Food companies define as “craveability.” According to a May 2011 study by Dr. Tim Church and colleagues (PlosONE) at least eight out of 10 Americans now sit for a living compared to just five out of 10 in 1960. The majority of us are now classified as “thought workers.” That means the average woman today is burning 120 fewer calories per day at work and men 140 less calories per day than we were 50 years ago. These numbers correlate perfectly with the obesity epidemic where right now well over a third of American adults have a body mass index (BMI) above 30 (a ballpark of at least 30 or more pounds above ideal).

What’s the solution? Great question! It’s clear this is not a result of bad genes. It’s a result of habits and environment. We now live in an obesigenic world where a wide variety of factors are producing a society that struggles to move, sleep, connect, and enjoy the phenomenal gifts we’ve been given.

One thing is clear. We can’t outsource our health. Of the over seven billion people in the world no one can move for us, sleep for us, or eat for us. We need to all start taking personal responsibility and then decide what we can do to make a difference in our homes, schools, churches, companies, and communities. The solutions are available. We need to start by getting off the couch.

Otherwise, Chicken Little’s prediction will come true.

Stay Well,

Todd

A Little Pep Talk

(Note…this is intended to be more motivational than informational.  If you need some “fuel” for your “fire” I hope this helps).

TW-bike-2014

Yes, that’s a selfie.  Never thought I would post a selfie, but hey, I also never thought I’d have a website either.

Sunday afternoon

I went for a solo bike ride this morning.  Nothing too crazy.  Just over 20 miles…about an hour and 20 minutes.  It’s August in Texas so, no surprise, it was warm but there was a mild breeze and it actually was pretty pleasant.

During a long straightaway I was passed by a car that had a “0.0” sticker on the back window.  I actually find those pretty funny.  I’m sure you’ve seen the 13.1, 26.2, 70.3 and 140.6 stickers.  Those let the world know what kind of athlete you are:  half-marathoner (13.1 miles), marathoner (26.2 miles), half-Ironman triathlete (1.2 mile swim+56 mile bike+13.1 mile run), and then full Ironman (2.4 mile swim, 112 mile ride, 26.2 mile run…”amazing!”).  Those numbers sorta represent an insider code for endurance/extreme athletes.

The “0.0” sticker announces to the world, “I’m a couch potato and proud of it!” It also might be sending this message:  Hey, all you self-absorbed Lance Armstrong wannabes…get over yourselves!

There’s an incredible difference between a “0.0” and a “140.6.”  While I certainly admire and respect anyone who has done an Ironman I also know that if your goal is to improve your health and immunity, lower risk of chronic disease (including dementia and Alzheimer’s), sleep better, feel better, look better, manage stress, have more energy, and push back the onset of disability then you don’t have to spend hours upon hours in the water, on a bike, or running on a trail, street or treadmill.

Basically, you need to get off the couch…on a regular basis!  Another way to think about it is, “Walk the dog…even if you don’t have one!”

Hard to Watch

I spend a great deal of time in airports and recently while waiting on a flight I was blown away by the number of individuals that were having problems walking.  Simply walking.  I could tell the incredible effort being expended just to walk a couple hundred feet between gates.  It was painful to watch but I suspect much more painful to experience.  It really made me sad.  Many of these people were in their 20s and 30s.

This morning on my bike ride I started thinking about all the benefits I was receiving.  First of all, my heart rate was elevated and blood was flowing at a faster rate than if I was just sitting home reading the paper.  Endurance, or aerobic exercise, has hundreds of benefits but one I tend to concentrate on is something called “collateral circulation.”  Basically, when you “stress” the cardiovascular system on a regular basis through exercise you, in essence, grow more blood vessels and increase the options to get blood from “point A” to “point B.”  That means if one vessel becomes clogged or “occluded” you have alternative pathways to bypass the congestion.  I think about this since my father died from heart disease.  I’d like to have as many “alternative routes” as possible.

But my heart was not the only organ receiving benefit during my ride.  Several large muscle groups, including my quads and hamstrings (front and back muscles of the thigh) and calves were being challenged.  Not so much that they burned but just enough to let me know they were working.  The human body is beautifully designed and will always do what you ask it to do…good or bad.  By pushing myself just a bit I was sending a message to “get stronger.”  Since the body responds to stress by adapting I was helping to maintain my strength.

Staying strong is important to me since my daughter and son-in-law just celebrated their one-year wedding anniversary and have a new puppy.  By my rough calculations that means I’ll be a grandfather within two years, probably sooner.  My goal is simple; I want to play with my grandchildren.  I don’t want to watch my grandkids play.  Big difference!

It wasn’t just my legs that were working this morning.  My back, abs, and triceps were also engaged so I was really getting a great overall workout.  Again, nothing crazy but just enough to feel “alive.”  I was breathing fresh air, enjoying the scenery, working up a sweat (much better than “cleansing” to remove toxins), and soaking in a bit of vitamin D…although it was still early and there wasn’t much UVB light yet (Remember, the longer your shadow the lower UVB light that’s available.  UVB is what triggers the synthesis of vitamin D in the body).

Bob Bowerman, the late, great track coach at Oregon, and co-founder of Nike, used to say, “If you have a body, you’re an athlete!”  I LOVE that quote!  It doesn’t matter if you ever competed on a team or in an event.  You were born to move!  To run, jump, play, fall, dance…all the things we used to do when we were young.  When we were, as Mark Fenton likes to say, “free-range kids.”  Yes, we can “get by” by avoiding physical activity but we aren’t going to thrive.  We aren’t going to be able to take advantage of all the great things our world has to offer.

Regular, consistent physical activity, a.k.a. exercise, is the single best investment you can make in yourself.  You don’t have to join a gym, buy an expensive bike, invest in all sorts of shoes, clothing or equipment.  You just need to move.  Invest in yourself!

When I finished my ride this morning I felt great.  I had just spent 80 minutes setting the table for the day.   I was back home before 9:30 and already had amassed the equivalent of over 10,000 steps (that’s for those of you with “wearables,” i.e. FitBits, Jawbones, Fuel Bands, Vivofits, etc.  By the way, the science says the true benefit of “steps” starts at 7,500/day…not the 10,000 that everyone assumes is the magic number.  More is always better but benefit starts at 7,500…Thank you Dr. Tudor-Locke!).

So, for the guy that passed me with the “0.0” sticker…I get it!  I know that there are plenty of folks like you that don’t like to exercise.  I also know there are plenty of people that are tired, hurt, depressed and struggling just to get through the day, or from gate to gate at the airport.  All I suggest is to understand that the only person that can improve your health is you.  The answer is not a pill or a procedure.  The answer is to recognize the awesome gift of life that we have and to get moving.

Stay well.

Is Sitting the New Smoking?

The enormous benefits of exercise have been well-documented in literally thousands of scientific publications.  There can’t be many people that don’t know that “exercise is good.”  Now we’re learning something new…and it’s pretty frightening.

Sitting can kill you!  That’s right…sitting.  Especially sitting for long periods of time.  While physical activity (i.e. exercise) is good, it appears that physical inactivity is dangerous.  Very dangerous!  Let’s take a look at the emerging data.

is-sitting-the-new-smoking

A paper published in Diabetes Care in 2008 reported that:  Frequent breaks in sedentary activity may explain lower health risk related to waist circumference, body mass index (BMI), triglyceride levels, and 2-hour plasma glucose levels.  (as you may know, those risk factors, along with triglyceride and HDL levels, are the factors that define the metabolic syndrome which dramatically increases risk of heart disease, stroke, diabetes and probably Alzheimer’s disease).

A study in the Archives of Internal Medicine in 2012 concluded that 30 minutes of physical activity is as protective an exposure as 10 hours of sitting is a harmful one.

Also in 2012, a paper in the British Journal of Sports Medicine indicated that one hour of sitting is the equivalent of smoking two cigarettes.

Holy smokes!  Think about that!…especially if you have a desk job where you are paid to sit and stare at a screen, type on a keyboard, and talk on the phone all day.

According to Professor David W. Dunston, a researcher associated with the Australian Obesity, Diabetes and Lifestyle study, the most striking feature of prolonged sitting is the absence of skeletal muscle contractions, particularly in the large muscles of the legs (think quads, hamstrings and calf muscles).

This all should be rather alarming especially in light of my colleague Dr. Tim Church’s 2011 study that was published in PLoS.  Using U.S. Department of Labor statistics, Dr. Church and his team at the Pennington Biomedical Research Center found that in 1960, 50% of Americans had jobs that required caloric expenditure.  In other words they exercised  as part of their work.  By 2010 that number had dropped to 20%!  Today, only one in five U.S. workers is physically active on the job.  Most all of us today are “thought workers”…we are compensated for our brains, not for our bodies.  We get paid to sit, stare at a screen, type on a keyboard and talk on the phone.  For hours at a time!

This new body of data also is concerning for those that are retired.  A 2014 paper published in the Journal of Physical Activity and Health found that “for those 60 and older, every additional hour per day of sitting is linked to a 50% greater risk of being disabled…regardless of the amount of moderate physical activity you get.

Wow!…that’s amazing!  Even if you exercise 30 or 60 minutes a day, prolonged “couch potato” behavior will still dramatically increase your risk of becoming disabled!

What can be done?  Simple, stand up!…on a regular basis.  Just the simple act of getting out of your chair every 30 to 60 minutes has tremendous benefit.  If you’re willing to do some toe-raisers, desk push-ups, or chair squats all the better!  A short walk around the office works wonders as well.  It doesn’t have to be much or be long.  Just one minute every hour of so is all it takes.

Using the alarm on your smart phone can serve as a reminder (i.e. a trigger).  ACAP Health offers a sophisticated, yet simple, software program to deliver customized anti-sitting programs into the workplace.  Utilizing the concept of gamification this solution makes breaking up sedentary behavior easy and fun (“fun” is good!).  Add in a simple incentive or two, and some social engagement, and you would be amazed how easy it is to change the behavior of desk-bound employees.

Remember that health is mostly a function of habits.  Unhealthy habits, like prolonged bouts of sitting, over time are extremely damaging.  It makes sense to pay attention to the science and intentionally develop ways to put your body in position to function at its peak for years to come.

Stay well!

Sometimes Conventional Wisdom is Not All That Wise

Food facts controlBack in 1958 Dr. Max Wishofsky developed what came to be known as Wishofsky’s Rule, which states that 3500 calories equals one pound of body weight.  In other words, if you want to lose one pound of weight you need to burn 3500 more calories than you consume.

This made for simple math.  For instance, if you ate 500 fewer calories than you burned every day for a week (seven days) then you would lose one pound of body weight (7 days x 500 calories/day=3500, or one pound of weight loss).

This rule is basically universal.  It’s cited in over 35,000 websites as well as in textbooks, scientific articles, and expert guidelines (including from the US Surgeon General).

Here’s the only problem…The Wishofsky 3500 Calorie Rule doesn’t work.  In fact, it seems to only be about half right.

The reason is pretty simple.  The research tools and data we have available today are vastly different than they were over 50 years ago.  The 3500 calorie rule does not take into account age, height, weight, body composition, and physical activity.  As it turns out, weight loss is REALLY complicated.  There is no such thing as one size fits all.

Something called metabolic adaptation appears to play a big role in weight loss.  In essence, as you lose weight your basal metabolic rate changes…meaning you don’t need as many calories every day “just to exist.”  As you lose more weight the calories needed to maintain your weight also goes down.  The result is that weight loss is rarely “linear” it’s actually “curvilinear.”  This means that most individuals entering a weight loss program tend to lose more weight in the first few weeks than they do as time goes on.  Over time, additional weight loss becomes more challenging.

(I know, if you’re looking to lose weight this is not the kind of news you’re wanting to hear but my goal is to give you the truth…not to provide false promise.)

This new concept of weight loss is known as the Dynamic Model.  Much of the research has been done by Dr. D.M. Thomas at Montclair State University (full disclosure: Dr. Martin is a colleague of my colleague and good friend, Dr. Tim Church, the Chief Medical Officer of ACAP Health).

There are now free, downloadable applications of the Dynamic Model, housed in Microsoft Excel and Java platforms available at:

http://www.pbrc.edu/sswcp

If you enter your baseline age, height, gender, weight, duration of the intervention, and target caloric intake the app will provide you with dynamic predictions of weekly weight change.  I should warn you this is a free, research tool so don’t expect some slick website with all sorts of bells and whistles.  It’s pretty basic but it will provide you with realistic expectations based on solid, credible science.

For those of you “geeky” enough about these things, like myself, you can read more in the International Journal of Obesity (2013) 37, 1611-163, which you can access for free at:

www.nature.com/ijo/archive/index.html

Once there, click on “Archive by Issue” then Dec 2013.  Then scroll down to the “Short Communications” section and click on the article:

Can a weight loss of one pound a week be achieved with a 3500-kcal deficit?

Since we now have close to 70% of Americans either overweight or obese it would be great if there were a simple solution for weight loss.  Obviously that is not the case.  However, by arming yourself with the latest credible, scientific research you can at least increase your odds of success.  Please be sure to enjoy the journey.

Stay well,

Todd

Let’s talk about HABITS

OK…time for some personal questions.  Don’t worry; no one has to know the answers other than you.

How many hours has it been since you last brushed your teeth?

  1. In the last ten times you rode in a car how many times did you wear your seatbelt?
  2. How many days has it been since you exercised for at least 30 minutes?
  3. I’m fairly confident that your answer for #1 is somewhere less than 24 hours and that for #2 you answered “ten.”

habits

Now how about #3…the dreaded “E” word?  When was the last time you exercised?  Ideally you didn’t have to think too long and the answer was less than 48 hours.  Unfortunately though most Americans, if they are telling the truth, can’t remember the last time they exercised.  Research indicates, based on objective data, that less than 5% of adults get 150 minutes of moderate physical activity per week (which is the recommended target…i.e. 30 minutes, five days per week).  Between 25 and 33% say they exercise but when you strap on accelerometers and actually measure activity then the results show a much different story.

(It’s well documented that what people say and what they do rarely correlate.  Over the phone, men are always taller than in person and women always weigh less than when actually placed on a scale.)

So, if I’m accurate in my predictions then brushing your teeth and wearing a seatbelt are two of your healthy habits.  A habit is something that you don’t have to “think” about…you just do it.  Years of research indicate that the more you have to think about something then the less likely it will ever happen.  Turns out that health is about 70% habit and about 30% genetic (you can only blame mom and dad for so much).

There are plenty of habits that contribute to outstanding health besides brushing your teeth and wearing your seatbelt:  maintaining an appropriate weight, eating plenty of fruits and vegetables, avoiding tobacco products, managing stress, getting enough sleep, taking the right supplements, and getting the right age and gender appropriate exams (like mammograms and colonoscopies).

However, at the very top of the list I would place exercise, or physical activity if that term feels more palatable.  The odds are overwhelming you already know this.  Nothing is going to give you a better return on investment than exercise.

Nothing!

We are designed beautifully and we’re designed to move.  Stop moving and the body ceases to function on all cylinders.  The key though is that physical activity has to be consistent.  Not just every now and then.  It needs to be a habit (there’s that word again).  Regular physical activity should be something you don’t have to think about.  It should be just what you do…much like brushing your teeth and wearing your seatbelt.

I’ll leave “How to Make Exercise a Habit” for a future posting but in the interim I’ll give you a hint…Start where you are!  Don’t try to go from zero to 60 overnight.  The body is incredible at doing what you ask it to do but before you can get the benefit you need to build the habit.  Studies show that baby steps are the key to building habits so MAKE IT SIMPLE…and consistent.

Stay well!

Todd

If Only

So it’s been almost a week since the passing of Kidd Kraddick (see previous post) and I still can’t seem to let it go.

Primarily because it was preventable!

As it turns out, Kidd did die of heart disease rather than an aneurism that was initially reported.  According to the deputy coroner, a preliminary autopsy showed Kraddick had an enlarged heart and three coronary arteries were blocked to varying degrees, somewhere between 40 and 80 percent.  Equally critical is that it’s now being reported that he’d had warning signs in the days before he died.

Kidd’s premature death was preventable!

I can say that with confidence even though I’m not a doctor or a coroner.  The reason is that for 14 years I’ve had the privilege of working at the CooperAerobicsCenter and there is not a week, or more often a day, that goes by that the doctors at Cooper Clinic don’t identify heart disease in patients of varying conditions; young and old, obese and skinny, fit or unfit.  Heart disease doesn’t care who you are or what you look like.  It doesn’t care about your parents or if your cholesterol level is below 200.  It also doesn’t care if you’ve run a marathon or completed an Ironman.  No matter who you are please stop thinking that you’re Superman or Superwoman-you’re not!

Dr. Cooper has been practicing medicine for over 50 years and he’s said many times that the hardest thing he ever hears are the two words, “If only.”  As in, “Doc, if only I had listened to you years ago I wouldn’t be in the condition I am now.”  And those are the lucky ones.  Even though their quality of life is compromised at least they are still alive!

The thing that bugs me so much about the passing of Kidd is that he had such an amazing gift that touched literally millions of lives and now he’s gone. At 53. 53!

I’m 56 and I keep thinking about all the things I would have missed out on if I had died three years ago…heck, even three months ago!

Lo and TW-Walk

In May my son Andrew graduated from college and one week later I walked my daughter, Lauren, down the aisle as she married a wonderful man named Scott.  In June, Andrew and I climbed Mt.Kilimanjaro in Tanzania.  These were all huge life events that I would have never had a chance to experience had I prematurely succumbed to a PREVENTABLE event!

TW-Drew-Killi Summit-6-27-13We are all here for a very short period of time.  It’s a cliché but every day truly is a gift.  Please don’t take your health for granted….and yes, men, I’m mostly talking to you.

I get it. Our healthcare system in the U.S. is complicated, expensive and frustrating.  However, our health care is the best in the world!  I guarantee that with the combination of blood work, a maximal stress test, and coronary calcification assessment Kidd would still be here.

The odds are huge that there are many people who love and depend on you.  Please don’t be selfish and ignore your health.  Don’t put yourself in a position where you’ll have to tell your doctor or loved one, “If only.”