Monday, December 24, 2012

It's that time of the year: 2012 Reflections

It's that time of the year. Temperatures are dropping. Days are shorter. We're in the middle of the holiday season. Which means one thing...

It's time to recharge the batteries, take stock, and plan for next year.

I love the holiday season. Yes, it's cliche and the saying is often over-used, but it's nice to be with family and friends. Many of them (and mostly my wife) graciously support my individual pursuits in triathlon and running. She selflessly puts up with my early morning swim workouts; my not being around when she wakes up in the morning; my need to get a good nice sleep to do it all again tomorrow; my structured diet. For 11 out of 12 months of the year, it's seemingly all about me.

There is a lot of sacrifice that goes into it all. And that's why that one month a year (or two) - during the holidays - is so important. It's not about whether I swim 3000 meters that morning. It's not about making sure I get in four bike workouts that week. It's not about going to bed at a decent time knowing I need to be at the pool at 6am the next morning. For one month out of the year, it's not about me. It's a time to sleep in a little on the weekend. It's a time to spend the afternoon at the cafe with my wife sipping coffee and chatting. It's a time to share a bottle of wine with some friends. It's a time to let go of the pressure of "I need to train today."

But, as much as the end of the season is about reconnecting on the other important aspects of life, it's also time to reflect back on 2012 (the good and the bad), and start setting specific goals for 2013. This is the fun part. To look at the entire body of work for the year, analyze where things went well, where they didn't, and find small nuggets of information to help lay the foundation for next season's training. The big thing is to identify very specific aspects, whether nutritionally, biomechanically, or otherwise, and dedicate a solid training block to improving those deficiencies (more on this in my next post).

What I'll remember about 2012 


I would be lying if I said I wasn't thrilled with qualifying for Boston. But, I'm also proud that I made a number of very solid advancements in my training over the past year. Here are three things I'll remember about 2012:

1. The mental game. Five years of marathon running and 18 months of triathlon, I'm finally figuring out the mental game; even enjoying the mental game. Whether you say 50% or 75%, what goes on between your ears has a lot to do with what happens in your chest, arms and legs. Researchers are figuring out there is a closer link between the heart and brain than previously thought, and things like sleep and stress play a major role. Tim Noakes has long expressed the idea of a "central governor," or essentially the idea that exercise is neurally-mediated. The brain calculates a safe pace for the body, and limits exertion and endurance by the number of muscle fibers recruited.

But forget all the scientific stuff, mile 25 of a marathon or mile 95 of a century bike ride is all about the decision to endure pain and keep going, or pack it in and stop. The biggest mental adaptation for me over the year is one of perception. How much can I really endure? As I discussed in previous posts, I've focused a lot on improving my lactate threshold with high intensity interval work. Yes, it has a lot of physiological advantages, but the mental component of the training is equally as important. Run 2 minutes as fast as you can along slightly rolling hills. Rest for 30 seconds. Then do it again another 10 times. By the eighth or ninth interval your legs are screaming; you're hearts pounding out of your chest; you can taste the lactic acid building up. Then you have to decide if you're going to bang out this last interval (and how hard you're going to go), or if you're going to cut it short, and pack it in for the day. This is the same game you play at mile 25 or mile 95.

2. Recovery. If there is one thing I've learned since taking up endurance sports, it's that it's all about recovery. Doing those hill repeats or swim drills seems like the work part, but it's really afterwards when your body gets to work. Recovery is when your body goes about fixing all the damage created during exercise - and then rebuilding. But in order to rebuild, the body, of course, needs the right tools. These come in the form of quality amino acids for muscle repair; or antioxidants for all the free radicals produced during exercise; or dark leafy vegetables to alkalize the body's pH after it became acidic during a hard workout; or cold therapy and compression to reduce inflammation. Bottom line, I've seen my best performance improvements when I'm recovering properly. Not to mention, mastering the art of recovery is also critical when taking a high-intensity-interval-based training approach. Doing the right things between workouts ensures I'm able to maximize performance during workouts.

3. My first coaching experience. On the day before I ran the Philadelphia Marathon, about 2,000 people lined up for the Rothman Institute 8k, including my wife and me. This was her first time running anything more than a 5k. She was definitely nervous. Yes, I was a little conscious of not "over-doing it" with a marathon the next day, but these were nerves of "coach" rather than "athlete." It was a tough task: how to help Stephanie prepare for her first 8k and structure a useful program within her busy schedule of attending law school, serving on law review, and holding down a job. Not to mention, trying to carve out time for her training separate from my own. But in the end she was great - a minute under her goal minute/mile pace and she ran the entire thing. More than anything, it was something we did together, and that's what made it so enjoyable.

She even beat me to the finish line...

Now, she's talking about doing another...maybe a 10k or half marathon...who knows what the limit is...


2012 was a good year. Not only am I happy with my race results (my next post I'll talk about one triathlon-specific achievement that's shaping my training approach for 2013), but I also dedicated a lot of attention to mastering many of the "non-race" things, like nutrition, sleep, recovery, etc. Many of these things, of course, have a carry-over effect with performance, but I'm most pleased with how I've optimized all the different variables for overall health and well-being.

But 2013 is another year, and another opportunity to recalibrate and find ways of doing things even better. 2013 will be filled with a new set of goals, challenges, achievements and setbacks. That's all part of the journey...

Stay tuned for my next post where I go into a bit more detail on how I identified some weaknesses from my 2012 season, and what I'm doing to improve them in preparation for next year's races.

But for now, it's time to relax and enjoy the downtime.

Happy Holidays!

Thursday, December 13, 2012

"Pink" 5-hour ENERGY Drink: Inherent contradiction to public health?

 Some facts on energy drinks...
  • Energy drinks are consumed by an estimated 30% to 50% of adolescents and young adults, but some experts suggest this number is even higher.
  • A recent review of the health effects of energy drinks on children, adolescents, and young adults concludes, "for most children, adolescents, and young adults, safe levels of consumption have not been established."
  • Energy drinks are not regulated by the U.S. Food and Drug Administration because they are marketed as nutritional or dietary supplements (see the bottom left of any 5-hour Energy bottle).
  • According to a recent New York Times investigation, 13 deaths over the last four years have cited the possible involvement of 5-Hour Energy.


Behind non-melanoma skin cancer, breast cancer is the leading cause of death among women in the U.S. Breast cancer is also the most common cancer among women worldwide. In this regard, I am all for raising awareness about breast cancer. I also recognize the very specific role caffeine can play in exercise performance (this is of course within limits). 

With this all in mind, is this a fundamental contradiction to public health?

Sunday, December 9, 2012

Challenging Nutrition Dogma: Is it really all about calories?

Along with cholesterol, there may not be a more misunderstood nutrition concept than fat. Is it bad? Is it good? What kinds are good? What's the difference between triglycerides and fatty acids? Why do I hear so much about omega-3s? Why do people say saturated fat is bad?

I recently finished reading Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health, by science writer Gary Taubes. More so than many other nutrition books out there, Good Calories, Bad Calories puts into perspective current nutritional guidance with what the evidence shows - and I mean all the evidence. The book is several years old (published in 2007), and Taubes has since written another book on similar issues called Why We Get Fat (which is much more accessible for the less technical audience), but for anyone truly interested in nutrition, food policy, and health, this is a must-read.

Coming from a science writer, I expected a fairly thorough presentation of the research. At the same time, though, journalists and the media don't necessarily have the best record when it comes to accurately and objectively writing about health and medical studies (but that's an issue for another article). But, taking one look at the 44 pages of notes and the book's 66-page bibliography, there's an immediate appreciation for the full picture Taubes attempts to paint.
The essential thesis of the book is that "obesity is caused by a defect in the regulation of fat metabolism." In other words, "obesity is a disorder of fat accumulation NOT a disorder of overeating."

To better understand what this exactly means, lets consider several important points.

First, Taubes argues that energy expenditure and energy intake are independent variables. This essentially turns the classic "calories in/calories out" paradigm on its head, which assumes energy intake and expenditure are dependent. In the classic "caloric balance" model, the assumption is that energy change (or fat accumulation), and therefore obesity, is the result of (or dependent upon) overeating (energy intake) or physical inactivity (energy expenditure). 

Taking a little detour back to physics, energy is neither created nor destroyed. So, the change in energy (or change in fat mass) is the difference in energy consumed and energy expended. But, this equation says nothing of causality. Is fat accumulation caused by increased food intake, or does increased fat accumulation cause increased food intake?

This is a good time to introduce a major piece to this entire puzzle -- hormones. In the book, Taubes gives a very illustrative example about why hormones play such an important role in fat metabolism. Think about growing children. The energy balance is obviously positive, which is why children grow. But, children aren't growing more because they eat more. Instead, the causality is reversed, and children eat more because they are growing. "They require the excess calories to satisfy the requirements of growth; the result is positive energy balance. The growth is induced by hormones and, in particular, growth hormone."

One could think of a similar example with pregnant women. Weight gain during pregnancy is the result of hormonal changes. "This hormonal drive induces hunger and lethargy as a result. In the context of evolution, these expanded fat stores would assure the availability of the necessary calories to nurse the infants after birth and assure the viability of the offspring." In essence, fat metabolism, including the distribution of fat, is a hormonal issue. And its these hormonal changes that influence energy consumption.

In terms of fat metabolism, there may not be a more important hormone than insulin. Insulin is produced in the pancreas, and is said to be the "principal regulator of fat metabolism," which has been known since the 1960's. How does it work? Essentially, if fatty acids are to be mobilized from inside fat cells (and burned as fuel), insulin levels must be low (Quick distinction on terminology: fat is stored as triglycerides - the reason being triglycerides are three fatty acid molecules held together with a glycerol making it too big to cross the cell membrane. Fatty acids are burned as fuel. Fat enters/exits the cell as fatty acids, a smaller molecule). Conversely, when insulin levels are high, fatty acids are shuttled into fat cells and stored rather than burned as fuel. This happens when glucose (when burned as the primary source of fuel) produces something called glycerol phosphate, which assembles fatty acids into triglycerides in fat cells. (A good overview can be seen in this series of video clips.)

Basically, the accumulation of fat in fat cells is regulated by the availability of glycerol phosphate, and the production of glycerol phosphate is directly related to the amount of glucose available. Conversely, "when blood sugar levels decrease, fatty-acid levels rise," and therefore become the predominantly energy source. As Taubes puts it, "the one fundamental requirement to increase the flow of fatty acids out of adipose tissue...and so decrease the amount of fat in our fat tissue, is to lower the concentration of insulin the bloodstream."

Taubes recounts early experiments on insulin from the 1920's (just after insulin was discovered) that demonstrated the role of insulin as a "fattening hormone." These studies showed that "when insulin was injected into diabetic dogs in the laboratory, or diabetic human patients in the clinic, they put on weight and body fat. As early as 1923, clinicians were reporting that they had successfully used insulin to fatten chronically underweight children...and to increase their appetite in the process."

Now what causes high levels of insulin? In short, carbohydrates (insulin is also released when eating protein, but a much smaller amount), and most commonly refined carbohydrates and sugar (fructose has a particularly unique effect, which Dr. Robert Lustig discusses in great detail in this now popular lecture 'Sugar: The Bitter Truth'). "The more carbohydrate flooding the circulation after a meal, the more will be converted to triglycerides and stored as fat for future use."

Taubes goes into a bunch of other related issues, such as issues of hunger, satiety, diabetes, and the like (all of which are extremely interesting and thoroughly researched), but here are two basic take-aways:

All calories are NOT created equal. One hundred calories of bread has a distinct physiological and hormonal response compared to 100 calories of salmon. And it's this hormonal response - principally the high levels of insulin - that drives fat metabolism, not necessarily the number of calories.

Fat isn't a bad thing. Two quick examples: Fat is fundamental to the many cells that make up our body. Without fat, there would be no cell membrane to maintain the cell's integrity. Second, without fat, nerve cells would not have something called myelin, which is essential for cell signalling (or how our nervous system communicates, or 'tells' our body to do certain things). This article on fat consumption in children and depression reinforces the close link between fat and cognitive functioning. 


Nutrition science isn't clear-cut. It's littered with studies that claim "associations" and "links," but few point to causality. More so than anything, Taubes reminds us of this in his book. Just because obesity may be associated with something, doesn't mean that it is caused by it. It is this short-coming by which much of current nutrition and dietary guidelines are based. And if for no other reason, this book is worth the read because it firmly puts into context current dogma, and underscores the need for rigorous science to better inform nutrition policy, guidelines, and the general public's understanding of the issue.

Tuesday, November 27, 2012

How I ran less to run better: 5 things I did to qualify for Boston

This post is the final part of a series of posts on endurance sports and heart health.

Training is both a science and an art form. There are, of course, scientifically supported ways to optimize performance - training structure, duration, intensity, biomechanics, etc. But, as much as I've learned from books, podcasts, and other coaches, I've learned even more from simple experimentation. That's where the science starts to blend with the art form.

To me, training has always been about testing myself and finding new ways to achieve even greater performance. By developing an intimate understanding about my physiology - how my body responds best; when it's tired; when to up the intensity; and what type of fuel is best - I've been able to make huge improvements and go beyond what I originally thought were my physical limits.

In my previous post I talked about how nervous I was leading into the 2012 Philadelphia Marathon. It wasn't the distance, but my preparation. My training was dramatically different than what I was doing just a few years ago. I basically had two fundamental goals with my 2012 training: 1) maximize performance (particularly speed); but at the same time 2) optimize overall health and well-being. The first part is fairly obvious, but the second is a much greater recognition and appreciation for many of the negative health effects resulting from chronic endurance exercise. I wrote about this in greater depth here and here.

5 things I changed to improve my training and qualify for Boston:

1. Biomechanics

Running is all about efficiency and economy. One of the greatest causes of stride inefficiency is over-striding, or when your foot lands in front of your center of gravity. Think physics - force is always equal and opposite. When you over-stride, the force generated comes back up into your heel, your knees, and your hips, slowing you down, but also increasing the risk of injury. The biggest warning sign is a significant heal foot strike. (I'll admit, I followed the classic "heal-toe" advise for several years and even wound up with a slight hamstring injury from overstriding.) So, the goal was to make sure my foot always struck under my hips.

To get there I changed three things: 1) I started actively picking up my feet (as opposed to pushing off the ground); 2) I increased my cadence; and 3) I ditched my old clunky shoes with tons of cushion for a more minimalist shoe, which forced me to address some of my faulty biomechanics I was getting away with, and assumed a more natural stride and foot strike.

2. Training volume

Less became more and quality replaced quantity. There's a growing body of research that points to the benefits of high intensity interval training, particularly when comparing metabolic and biochemical adaption with traditional endurance training. In addition, interval-based training is one way to get around some of the longer-term negative health effects, particularly with the heart (which I reference above), from chronic endurance training. I made intervals the foundation for my training approach.

My weeks usually included three days of solid run sessions, with a fourth optional recovery day. One week always included a shorter interval-based workout (never more than 40 minutes), a shorter tempo or fartlek run, and a longer interval-based session. The focus was always on intensity during the workout, and recovery afterwards. Long workouts were never more than 2 hours or longer than 16-17 miles total, and total weekly mileage was never more than 30ish miles. This is in stark contrast to the 40+ miles a week of old.

Training philosophy was the hardest thing to change, mostly because it was totally counter to everything I previously thought. But, I trusted it, and it worked. 

3. Training style

Becoming a better runner isn't necessarily always about running more. I think my many of my improvements over the past 18 months have a lot to do with the non-running parts of my training. Triathlon training has been key. First, cycling forced me to improve the strength, power, and endurance in my legs, particularly my quads and glutes, offering a great carry-over effect with my running. Also, incorporating sessions that improved my cycling cadence had a similar effect that "taught" my legs to turn-over faster, which was essential for the tweeks I made in my biomechanics.

Second, swimming had less of a carry-over effect, but my interval-based training in the pool improved my cardio-pulmonary capacity in ways that complemented my running. Not to mention, including kicking drills on a regular basis were great for both strength and recovery.

Lastly, I religiously incorporated at least one (and often two) days of strength training and/or plymometric work to increase power and develop functional strength. This has been vital for injury prevention, longevity, and speed.

4. Overall Nutrition

Goodbye processed food, wheat and many carbohydrates. Hello real, whole foods.

I was never overweight, but my diet wasn't necessarily "clean." In other words, because I was playing sports and exercised (and probably from a genetically faster metabolism), I found I was able to get away with not always paying close attention to what I ate. Things like pasta, bread, chips, pancakes, cookies, etc, were pretty routine. I even thought I had to eat this way because my body was burning so many calories and carbohydrates.

Now, vegetables, fat, and protein form the foundation of my diet, with carbohydrates, such as oats, lentils and quinoa cycled into my training based on when my hardest workouts are. By keeping carbohydrates in check, and being strategic with intake, my body adapted to burn more fat as the primary fuel source. Not to mention, I'm able to maintain a much more constant blood glucose level, rather than the peaks and valleys that go along with massive insulin spikes. One of the simplest (though hardest at first) things I found was to eliminate wheat, which is one of the biggest culprits with blood glucose fluctuations. Not only are there a variety of ways wheat contributes to chronic disease (a must read on the subject is "Wheat Belly" by Dr. William Davis), I also found eliminating wheat (and all refined carbohydrates and sugars) helps me 1) maintain more constant energy levels; 2) allows for better recovery post workouts (particularly long/intense workouts), and 3) because stored carbohydrates carry more than double their mass in water, drop about 15-20 pounds of what I call "junk weight."

One of the huge advantages of dropping this "junk weight" - where I went from weighing about 20lbs less during the 2012 Philly Marathon compared to 2007 - was it's effect on running economy. In what is probably one of the most comprehensive book on running, Dr. Tim Noakes writes in "The Lore of Running" that research has shown that "the addition up to 4kg to the torso increased the oxygen cost of running by...2.5%." Further, that "the addition of 0.5kg to each thigh or to each foot increased the oxygen cost of running by 3.5% and 7.2% respectively." In short, a lighter runner can more easily be a more efficient runner.

5. Race-Day Nutrition

I said goodbye to sports drinks and gels, both in training and on race day. Instead, I used UCAN Superstarch for workouts over 90 minutes and on race day. UCAN Superstarch is a slow-releasing, high molecular-weight carbohydrate that results in a much smaller insulin spike compared to simple sugar-based products like sports drinks and gels.

Why is this important?

Two points. First, the body has a limited supply of glycogen, or storage sugar, which, if used exclusively, is exhausted over the course of a couple hours (faster at higher intensities). This is the basic reason behind consuming sugar in the form of sports drinks or gels during a marathon or triathlon. However, this leads me to the second point. When suger is ingested, huge insulin spikes follow, resulting in the body preferentially burning glucose and essentially shutting down its ability to burn fat. When blood glucose levels are maintained in a more moderate range, the body is better able to tap into its massive fat stores. And for those more fat adapted through their everyday diet, like myself, this has huge performance and endurance benefits.

There ya have it. Five big changes I made to improve my running performance. These weren't all done overnight, and many were things that took a lot of patience. But in the end, it was about trusting the approach, and trusting myself.

Let me know your thoughts.

Monday, November 19, 2012

Achieving My Goal to Qualify for the Boston Marathon

Almost six years ago I made the decision to run my first marathon.

I was still in college at Villanova and recently decided to end my soccer career - one that stretched all the way back to the days when I first starting walking. I needed something to fill the competitive void. More of a convenience factor than anything, the Philadelphia Marathon seemed like a great place to attempt my first 26.2.

After the 2007 Philly Marathon
I finished that first marathon in under 4 hours (3 hours and 52 minutes I think), but man did it hurt those last 7 miles. I thought I was ready. I ran 40+ miles a week. I ran several training runs of 20 miles. Yet, after the race, I found myself laying on the ground, asking my dad to stretch my legs out to try and relieve some of the sharp pain I felt in my legs.

At some point after the race I overheard two finishers asking each other if they qualified for Boston. They swapped times in the low three hours. I thought to myself, "how the heck can you run a marathon that fast?" I felt like I was just hit by a truck and to think of going even a few seconds faster seemed like a daunting task. But I couldn't help but imagine, "man, I really want to know what that feels like."

Flash forward five years, with five marathons under my belt, about the same number of half marathons, a few more short 5k's, and a couple triathlons, I found myself contemplating running a half marathon to cap out my 2012 (which was my busiest year, with a half marathon, 10 miler, two triathlons, and a century bike ride). Ironically, my cousin was attempting her first half marathon in Philly and wanted me to join.

I thought about it. But I couldn't stop thinking about one thing - why not give a go at a Boston qualifying time? My times have gotten significantly better of the years, and why not head back to the city where my love for endurance sports began, and to the place where I set the hardest endurance goal I thought possible at the time?

That was it. I wanted to test myself and see if I was up for the challenge. If I could translate my year of shorter, faster races to a longer distance. If I could cut just over 20 minutes from my best marathon time. So it was decided. I was heading back to Philly for another crack at 26.2 in the city of brotherly love. I have an older brother, and I was certainly hoping for more of the loving rather than the older brotherly.

Naturally, I was nervous going into race weekend. But I wasn't nervous because I didn't know the course, or because it was a marathon. Instead, I was hoping all the changes I made to my training would pan out the way I saw it in my head. (Stay tuned for my next posting where I'll discuss exactly what changes I made and why)

"One minute to the start of the 2012 Philadelphia Marathon," the announcer declared. I felt the energy, but unlike five years ago, it was a controlled energy. After pushing my way up to my assigned corral just behind that for the seeded and elite athletes, I put my sunglasses on, squatted down, thought about my race preparation, my race strategy, and embraced the moment. Then, before I knew it, the countdown was on, the horn blared, and we were off.

The first three miles were a warm-up. "Stay controlled," I thought to myself. My goal was a pace 45 seconds or so slower than what pace would be during the peak miles of the race. I was just behind the 3:05:00 pace group - a nice pace to get going.

Then, around mile 3 or so, I began feeling a pain on the top of my right foot. Maybe my shoe was a little too tight. I stopped once. Ripped off my gloves; untied my laces; loosened them; and retied them. Ran a few hundred meters - no change. I stopped again. Repeat. Gloves came off; untied my laces; loosened; and retied. All the while I kept thinking, "stay calm, it's early; it's a few seconds, but THIS BETTER NOT HAPPEN ALL RACE!" Good news - I got more comfortable. Bad news - the issue came and went the entire race.

What might have helped were the crowds. After my little shoe issue, the crowds seemed to grow and grow. Going across the downtown area, people lined the curb, and many were even standing in the street, making the already narrow Philadelphia streets seem even narrower. I came up on the 3:00:00 pace group and fed off their energy up the two main hills in the first half.

Coming up on the halfway point I began to pull away from the group. glanced at my watch - 1:28:00 - right on pace. I felt my legs start to feel just a little labored, but then came up on a small group of three other runners with a great pace. Two of them dropped off my pace after a couple miles, but there was one - Mark - who I stayed next to. Over the next 8 miles or so, our strides never differed. He took the lead for a little, and I would draft. Then we switched. We worked together and fed off each other.

The second half of the course (and out and back) is notoriously flat, but also relatively void of spectators (except for the turnaround). This is when you start to play the mental games. And at mile 20, that's when I started playing. There's always the point - in any race - when you hit that inner hurdle. The point when you're body starts to hurt and thoughts of doubt start to creep in. But, as world champion Ironman triathlete Chris McCormack says, "embrace the suck." You know it's coming, so don't fight it. Acknowledge it - maybe even talk to it. My legs were starting to hurt; quads were burning, calves were the same.

Regardless of how my body felt, I kept seeing those time splits, and they kept showing me I was on track to break 3 hours. And once I hit mile 25, and seeing my dad, hearing him yell "finish strong," I knew I just about had it. With about a mile left, I let the crowd take over. I came up the small hill around the Art Museum. I could hear the announcer. I felt the energy of the thousands of people who lined the finish chute. Then I got my first glance at the finish clock - 2:58:00. One last sprint and I broke the finish line.

2:58:22. And all I could think was, "Wow, I did it."

Thumbs up after the 2012 Philadelphia Marathon

Tuesday, November 13, 2012

Food marketing to children: How big a problem is it?

Food marketing is a more than one billion dollar a year industry. The comparison often made is that the marketing budget of food companies alone far and away exceeds the entire budgets of organizations like the World Health Organization to address the negative health ramifications associated with chronically consuming the types of foods most often marketed on TV, on the radio, or (and increasingly) on the Internet.

One of the biggest public health battles currently being waged is the marketing of unhealthy food products to children and adolescents. The argument is such advertising is coercive, as children this young are not cognitively able to understand or deconstruct the advertisements they see. Many of the world's largest and most powerful food and beverage companies, like Coca-Cola, General Mills, Kraft and others, have recently made voluntary pledges to market their products more responsibly to children under the age of 12. And they report some progress, but the fact is, marketing of unhealthy foods, loaded with sugar, refined carbohydates, and unhealthy fats, is still a major issue and is playing a huge role in the exploding obesity and diabetes epidemics, particularly among children and adolescents.

Recently the Rudd Center for Food Policy & Obesity at Yale University published a report of findings from a recent survey of almost 2,500 parents about food marketing practices to children and adolescents. Parents of children ages 2-17 who were living at home in June-July of 2009, 2010, and 2011 were asked questions about where their children see food and beverage advertising, what types of products they see most often, and how often they see them.

Though the findings reveal some fascinating insights into the concerns of parents, one word of caution when interpreting the results below. The study used a non-probability based panel, which means the findings can't be generalized to the entire U.S. population. In addition, the results were not weighted to adjust for any possible oversampling of key demographic groups, such as females, or Hispanics, or Caucasians.

Here are some of the study's main findings...


1. TV is by far the most common food and beverage marketing vehicle, but the Internet, radio and in-store advertising where the next three most common. From 2009 to 2011, Internet overtook Radio as the top place where children see/hear food marketing after TV, according to respondents. With the constant changing role of the Internet, the growing use of social media, and the increasing hours adolescents spend 'connected,' the Internet will undoubtedly be a major marketing channel in the years to come. More on this below.

2. Fast food, cereal, and soda/pop are the top three food and beverage categories children see advertised most often (at least once per day). A worrying trends seen in all categories is the slightly higher percentage for non-white respondents - essentially providing support that minorities (as well as low-income and less-educated) are often the targets of food and beverage marketing. The percent of African American parents whose children saw ads at least once a day was significantly higher than both Hispanics and Caucasian parents for ALL food categories.

 3. The cost of healthy foods was perceived as the biggest obstacle to ensuring healthy eating habits in children - fast food restaurants, prevalence of junk food, and too much TV/computer were the second, third, and fourth biggest obstacles. Though cost is undoubtedly a major consideration, particularly for low-income families, the argument that health food "costs too much" is often made by only thinking of food in terms of calories, rather than nutrient content. I wrote more about the limitations of this approach in this posting.

4. Parents of all races view the media as the most negative influence on healthy eating for their children, followed closely by the food industry and government. Media and the food industry are obvious villains here, but to see more than half of parents view the government as a negative influence is quite interesting, particularly as the government holds the regulatory and legislative power to control food marketing. More interesting is the significant difference between white and minority (both African American and Hispanic) parents and their negative views of government (white parents rated government roughly 10 percent more negative than minority parents).

5. Schools held the least negative views among parents, and were seen as the best place to intervene to promote healthy eating habits among their children, particularly through nutrition standards for school lunches and other available foods (like vending machines).

6. Regulation of a wide range of communication channels is strongly supported, with the most support for stricter controls on TV commercials. The largest support by parents (and the largest increase between 2010 and 2011) is for regulations to limit TV commercials marketing unhealthy foods to children under 12. Interesting, more than 50% of all parents in the survey supported regulation to limit unhealthy food marketing through all communication channels list in the survey. The overwhelming support of parents for government regulatory intervention is, I think, a strong indicator of just how big an issue this has become.


Some Final Thoughts

Food marketing to children and adolescents is a huge issue. There is a lot at stake - like many other products, brand loyalty is important. A 10 year old who develops a taste for Pepsi, might just stick with having a 20 oz bottle with lunch everyday for the next 60 years -- that's $27,375 over the course of a lifetime. Not a bad profit...and that's just one person. Now imagine what this picture looks like not just across the US, but increasingly in countries like India and China, where there are huge cohorts of youth, an attraction to "Western" brands, often a favorable business environment, and the potential for huge profits. 

My second thought is on the Internet. Children born in the 21st Century are growing up, quite literally, attached to technology. It's no longer just watching TV, but kids are spending more time on computers, tablets and smartphones. And these are children under 5 years old! Technology hold tremendous potential, and enormous power. However, we haven't even scratched the surface on the range of developmental effects that technology have on children. One major variable in this is not just the technology itself, but the information children consume by using the technology, such as advertisements about cereals, or soda, or fast food. This is going to be one of the next major battlegrounds, and parents are already very concerned.

Lastly, it seems regulation will need to play a key role in all this, and there is almost unanimous consensus on it (even from industry). But at the same time, food and beverage companies are spending more and more on marketing, and spending for health and nutrition education keeps declining. There has even been considerable research, including this recent study, showing medical schools fall short on teaching students about obesity and nutrition. I wonder how effective food advertisements would be if understanding about basic food and nutrition concepts was just a little higher. 

It's an over-used saying, but knowledge in this case really is power. The knowledge scale about nutrition is grossly in favor of food and beverage companies. What can we do to tip the scales back?

Let me know your thoughts. 

Wednesday, November 7, 2012

Endurance Sports and Heart Health (Part II): What are the benefits?

This is the second part in a series of posts on endurance sports and heart health.

2,466,115,200. That's how many times my heart will beat if I live as long as the average American is expected to (78.2 years). (My wife says it better beat for longer.) My resting heart rate is about 60 beats per minute. That's a fascinating number to think about. For almost eight decades my heart will supply my entire body (and itself) with the oxygen it needs to survive, and never stopping. 

When it comes down to it, the heart is a relatively simple organ - essentially a four-chambered pump with some tubing going into it and coming out of it. But of course the devil is in the details. Over the course of more than 2 million beats, there is a lot of opportunity for things to go wrong, and many times these things are the result of accumulated issues over time.

As I discussed in the first part of this series, with endurance exercise, there is a fine line between performance and pathology - something referred to as the "grey area" in the scientific literature. There are risks when it comes to endurance sports. But risks can be managed and risks must also be viewed in the context of benefits (it's all about optimizing). 

In this post I discuss some of the benefits of endurance sports and regular exercise, particularly from a physiology perspective, as well as a public health standpoint. But I close with some cautions about maximizing exercise while neglecting other areas of daily life that contribute to heart disease and heart issues.

Popularity of Endurance Sports is Increasing

Endurance sports, such as half-marathons, marathons and triathlons, are becoming more and more popular. The previous post in this series showed the increasing level of participation in USAT-sanctioned triathlon events. Half-marathons and marathons held in the U.S. show a similar trend. Not only are there more races, but more people are participating. For example, according to Running USA, a non-profit that tracks trends in U.S. distance running events, the number of marathons in the U.S. more than tripled between 1985 and 2011, from 200 events to 720 events., an online community for sports and event registration hub for a variety of activities (including running, cycling, triathlon, and more), revealed similar increases based on race registrations between 2008 and 2010. During these three years, marathon registrations increased 203%; half marathons rose 154%, 10K events rose 155% and 5K events rose 144%.

Why is This a Good Thing from an Individual Health Perspective?

Your heart is a muscle, and like other muscles, it responds to stimuli like exercise. It can grow stronger and increase in size similar to other muscles in our body after periods of exercise. And generally (and up to a point), the more exercise, the stronger, more efficient, and sometimes larger the muscle. Endurance activities markedly improve the efficiency of your heart, increasing stroke volume (or the amount of blood pumped by the heart with each beat) and thereby decreasing the number of overall beats needed.

Other markers of heart health have also been positively linked with endurance exercise, such as lower blood pressure and increased HDL cholesterol.

There is also evidence to suggest that exercise plays a strong role is energy partitioning, or the type of energy (such as carbohydrates or fat) our body preferentially burns for fuel. One study of 55 years old women found a more than 9% increase in energy derived from fat after 12 weeks of endurance exercise training.

The weight-bearing movements of regular exercise and strength training support bone health and improve longevity, particularly as people age. Exercise is also associated with lower stress levels, higher energy levels, and overall positive mental health.

Not a bad list of benefits.

Why is This Essential from a Public Health Standpoint?

Physical inactivity is becoming a new norm and the trends don't look promising. A recent review from researchers from the University of North Carolina looked at trends of metabolic equivalent hours (just a fancy way to show the amount of exertion by your body doing different activities) from 1965 to the present, and also projected trends through 2030. Between 1965 and 2009, MET-hours per week decreased by about half (235 to 160), and they are projected to decrease to roughly 126 by 2030. You can see the trend in the graph below, which traced MET-hours in several different areas, such as physical activity during work, transport, domestic activities, and leisure time. The black line is the average hours per week of being sedentary.

The rising trend from 2010 to 2030 represents one of the major public health challenges we face. 


What These Trends Don't Tell Us  

Even though registration and participation levels in endurance activities, such as triathlon and marathon, are increasing for a range of age groups, a couple things to remember.

First, this is still a relatively small proportion of the overall U.S. population, which is almost 315 million. From a sports, competition, and individual health perspective, increasing participation is a great thing. For people like myself, it provides a great opportunity to continue competing, setting and working towards new individual goals, staying in good overall health (though my third point mentions another counter-argument to this), and traveling to new and interesting places. However, one must keep this all in perspective that we're still talking about a fairly exclusive cohort of people.

Second, inequalities, particularly in regards to access, are major issues. Opportunities to participate in physical activity pay huge dividends with individual physical and mental health, population health, and create millions of dollars of health care cost savings annually. But, not everyone can afford a gym membership; or can safely walk to a park; or can spare the $120 marathon registration or the extra 30 minutes a day to train. The challenge is to celebrate record numbers of people taking on the endurance challenges of running, triathlon, cycling, etc, but to also ensure environments are conducive to regular physical activity for everyone.

Third, all the effort put into exercising everyday could be for naught if you spend hours sitting for the rest of the day. A recent review examining the link between sedentary time and diabetes, cardiovascular disease and cardiovascular and all-cause mortality in adults older than 18 years of age found that "higher levels of sedentary behavior are associated with a 112% increase in the RR of diabetes, 147% increase in the risk of cardiovascular disease, 90% increase in the risk of cardiovascular mortality and 49% increase in the risk of all cause mortality." Even more frightening are the results from a recent National Health and Nutrition Examination Survey. The study looked at almost 5,000 adults 20 years of age or older and found "Independent of potential confounders, including moderate-to-vigorous exercise, detrimental linear associations of sedentary time with waist circumference, HDL-cholesterol, C-reactive protein, triglycerides, insulin, HOMA-%B, and HOMA-%S were observed." (emphasis added) This essentially is saying that even if someone exercises in the morning, and the rest of the day is spent sitting, this could have a detrimental effects on risk factors - high levels of triglycerides, higher inflammation, higher waist circumference (a fairly good measure for dangerous visceral fat), etc - for heart disease and other chronic diseases.

So, I come back to this theme of optimizing. Sure there are a lot of health benefits to exercise and endurance training. But at the same time, if you're trying to maximize in this area of your life, and neglect other things (such as diet, stress, amount of time sitting during the day, etc), are you really optimizing for better overall health?

Let me know your thoughts and post a comment below.

Thursday, November 1, 2012

The Show Will Go On in NYC: Inspirational or Disrespectful?

As New York City, New Jersey and many parts of the northeast continue battling the devastating impact of Hurricane Sandy, Mayor Bloomberg confirmed on Wednesday that the iconic NYC Marathon will go on this Sunday. According to the race's website, this year's event will be held in honor of the "city of New York, the victims of the hurricane, and their families." Race organizers have also made a number of modifications to the schedule, cancelling the opening ceremony, the Dash to the Finish Line 5k, and revising the race's cancellation policy.

But the Mayor's commitment to proceed with the marathon - an event that he says "epitomizes the spirit of New York City, the vitality, the tenacity, the determination of New Yorkers" - has brought on a spirited debate as to whether the decision was the right thing to do. "Right" of course is always subjective and there are many unresolved moral questions at play. Is is disrespectful to those who lost their homes or loved ones? Is the NYC Marathon "just a sporting event?" Could the resources devoted to the race be better used in the relief effort? Do sporting events provide some sort of coping mechanism - a way to escape reality, if only for a couple hours?

Mario Fraioli, of Competitor running magazine, argued the "show mustn't go on." Describing how the race could provide a "much-needed boost to the city's economy and help increase morale," there are unavoidable risks with staging the event, which has roughly 47,000 registered runners (though many will undoubtedly not to make the trip). Still early in the recovery efforts, the argument is that the massive logistics and human resources needed to pull off the race could be better used elsewhere.

"There are a limited number of public resources, such as policemen, firemen and paramedics, available to aid the recovery effort, and every single one of them absolutely needs to go toward helping the folks who pay tax dollars to take advantage of them, not to a race that will pay those very same resources to shut down roads and work to ensure that an event goes off without a hitch."

However, other articles are quick to point out that the race is now heavily relying on volunteers and has established ways for participants and volunteers to donate to the relief effort. Even more, however, marathons, and even endurance events more broadly, have deep meaning with personal stories for many who do them. As one runner of this weekend's race put it, she is running "because on Sunday I’m not just running to affirm my survivorship and fund-raise for a cause I passionately believe in. I’m running to put my feet in all five boroughs of this wounded city I love with everything in my heart. I’m running to be out among my friends and neighbors and my children."

Whichever point of view you come from - and both are valid and important to consider - the debate about whether to hold the NYC Marathon this weekend reminded me of a similar debate that took place around the 2001 Marine Corps Marathon in Washington, DC. Yes, the race took place more than a month after the 9/11 attacks (whereas the NYC race is less than a week), but I can't help but wonder what is going through the heads of the runners in this photo, running past the Pentagon and the site of tragedy just a few weeks before.

We all have different ways of processing and coping. If this weekend's marathon can provide a solace for thousands of New Yorkers and others from the region during a time of struggle, uncertainty and hardship, maybe that's it's contribution to the relief effort.