Underlying Causes NOT Disease: Shifting our view of health

Cardiovascular diseases cause more deaths around the world than any other condition - more than 17 million, or about 30%. By 2030, the World Health Organization predicts these numbers to continue climbing upward, to about 25 million. And this global epidemic is not cheap. It's the principle driver of health care costs in many countries (including the U.S.), and is going to cost the global economy $47 trillion by 2030 - yes, that is trillion with a "t".

But as important as it is to diagnose a health condition like heart disease - particularly from a disease surveillance perspective - it unfortunately says little about the condition's underlying root causes. At the World Economic Forum's annual meeting in Davos last week, Dr. Mark Hyman described the issue by saying, "We have a naming problem...and we confuse the name [of disease] with the cause."

Dr. Hyman has been pioneering an approach to health called functional medicine, which is concerned more with ways to achieve health rather than treat disease. This may sound intuitive, but there are strong, built-in incentives in our health system that tend to favor doctors writing prescriptions rather than discussing strategies to prevent illness in the first place.

For those public health folks out there, this sounds quite similar to something called "social medicine," which looks at how social and economic conditions impact health (like socio-economic status, education, where someone lives), and has been recently championed by the public health physician/advocate Dr. Paul Farmer.

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As I've written in several previous posts, I strongly believe in the power of things like food, sleep, exercise, and relaxation to achieve better health (and therefore prevent illness). During his interview in Davos last week, Dr. Hyman does a wonderful job of explaining why this approach to health not only makes sense from a medical perspective, but also from a policy perspective, helping us reverse the seemingly uncontrollable costs associated with healthcare.

Let me know what you think. Leave a comment below.

Keeping your head in the game: Tips to prevent headaches

I have struggled with headaches since I was young. Playing soccer growing up, there were plenty of hot summer days with two long, draining matches - and my head was often pounding from the heat. Advil was a staple in my soccer bag. It was usually the only thing that helped. But there was a period, in late elementary and middle school, when I experienced frequent migraines. I was prescribed medication for when I felt a new one coming on, and I vividly remember spending an entire weekend, lights off, cold washcloth on my eyes, lying in bed, head throbbing.

While I don't experience migraines anymore, I do still get headaches from time to time - and still, mostly connected to exercising. But, I've found there are several easy dietary strategies to implement to help with headaches - and yes, I said dietary. For me, and many other people, headaches are the result of a pH imbalance in our body, specifically when it becomes too acidic. The body's blood pH is supposed to be slightly alkalinic (pH is on a 0-14 scale, with 7 being neutral; less than 7 is acidic, more than 7 is alkaline). In addition to stress and immune reaction, diet has a significant influence on pH.

Every food we eat, when digested, either has an acid-forming or alkaline-forming effect. A quick note, just because foods are acidic pre-digestion does not necessarily mean it remains that way after digestion. Here's a fairly comprehensive list of acid-forming and alkaline-forming foods. Generally, dairy, animal protein, vegetable oils, sugars, and alcohol are acid-forming, while vegetables, fruits, healthy fats, and some nuts/seeds are alkaline forming. Some other little-known items that are alkaline-forming, which have also made their way into my diet, are apple cider vinegar, green tea, cinnamon, and kombucha.

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Let me share a quick natural experiment on myself that has really shed light on the importance of dietary pH.

I generally swim about four times every week. During the week, these workouts are around 6am and before I eat breakfast. I'd come home, eat breakfast around 8am, then off to work. On some days, I would developed headaches later in the day - only on days when I swam that morning, and always around 3pm in the afternoon when I would get them. Over the past couple weeks I've experimented with a few different combinations of specific foods and the timing of when I ate.

Trial A: 1) Swam at 6:15am. 2) Did not include dark greens with breakfast. 3) Did not have apple cider vinegar. 4) Ate lunch (large salad and almonds) around 2pm. Result = headache around 3pm.

Trial B: 1) Swam at 6:15am. 2) Did include dark greens with breakfast. 3) About 1 tablespoon apple cider vinegar with 8oz of water (half before/half immediately after). 4) Lunch at 1pm. Result = No headache.

Trial C: 1) Swam at 6:15am. 2) Did include dark greens with breakfast. 3) About 1 tablespoon apple cider vinegar with 8oz of water before workout. 4) Lunch at 4:30pm. Result = No headache.

This is by no means a perfect scientific experiment. But, I do generally eat almost the exact same thing around the same time for breakfast and lunch, so it offers are fairly controlled situation. At the same time, it does allude to some interesting headache-preventions strategies.
 

Three Easy Changes I've Made to Prevent Headaches

 

1. Sufficient caloric intake post-workout. This wasn't something I specifically modified in my little experiment, but one major trigger for headaches post-workout (particularly long efforts) is simply getting enough calories down the hatch - and this is often not all done in one sitting, but over the course of a few hours. I find it helpful to think about refueling over time just because exercise can have an appetite-suppressing effect. Bottom line, insufficient calories (or fluid) post-workout could contribute to headaches, but it can't be the only piece to the puzzle. There were plenty of times when I ate sufficient calories after a 2 hour run workout, but I still had a headache later in the day. Why? This leads me to my second point.

2. Eat more alkaline foods, particularly post-workout.  In my little experiment I found that I don't usually develop headaches after swimming on days when I follow my workout with more alkaline-forming foods, such as kombucha, apple cider vinegar, and dark greens. The interesting part was that even on the day I ate a late lunch - almost 9 hours after breakfast (and after the time of day I would usually get headaches) - AND ate alkaline-forming foods at breakfast, I didn't develop a headache. When the time between meals was less (Trial A) I still developed a headache when I did NOT eat alkaline-forming foods with breakfast. So, the take-away seems to be that the type of food is the key factor, not necessarily the timing.

3. Use Apple Cider Vinegar. This has become a staple in my diet - and it's worked wonders so far. I've mostly used it post-workout, mostly 1-2 tablespoons with water or in a smoothie. But as I mentioned above, I've started to use it more and more pre-workout. Sure it takes a little getting used to the flavor, but I've found apple cider vinegar to be one of the easiest, cheapest, and most effective things to help balance pH.

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Many people suffer from headaches and there's a variety of reasons as to why they occur in the first place. But, if I've learned one major thing about headaches over the past several years its that diet can play a powerful role is balancing the body's pH and helping to prevent then from occurring in the first place. Let's just say, that bottle of Advil isn't a staple in my gym bag anymore.

What's on tap for 2013: Setting goals, devising a strategy

After my last race in 2012 there was one thing I couldn't stop thinking about...

I was dead-set on jumping up to half Ironman distance triathlons in 2013. This was going to be my major goal for next year - my "A" race.

Then a couple weeks ago, I got an email: "Congratulations from USA Triathlon." I opened it and right there, staring me in the face, was my new goal for next year...the 2013 USA Triathlon Olympic Distance Age Group National Championships.

Once I saw the email, I knew this was an incredible opportunity. I felt extremely privileged to even have the opportunity to compete is such an event. And as I started thinking about my goals for 2013, I kept going back to my urge to bump up to a half Ironman in 2013. "I know I'm ready," I kept thinking. "I know I can do it." But at the same time I was conflicted with this new opportunity. Should I stay at Olympic distance for 2013 and focus on the Age Group National Championships? Should I do both?

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This is probably a good point to take a slight detour to a seemingly unrelated story that turned into a very enlightening moment. Over the holiday my wife and I went back to New Jersey to visit family. Out to dinner one night for Chinese (an old family tradition on Christmas Eve), I opened a fortune cookie after dessert. Usually they simply add a little light-hearted humor to the end of the meal, but this time I found myself reflecting a bit longer after reading the short phrase. It took me a while to realize why, but it had everything to do with my aspirations in triathlon.

"Faith is knowing there is an ocean when you can only see the stream," read the small piece of paper. I don't really believe in "signs," but this seemed an obvious clue - don't push it, be patient. There it was, in black and white, a message to take a step back and think about the opportunities - ALL the opportunities - for my 2013 season.

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It was pretty ironic that  I read this fortune just a few days before millions of people would make new year's "resolutions." It was even more ironic I read it while in the midst of planning for and setting goals for 2013. I think this is why it's so important to structure down time between seasons. As was the case for me, setting the next step in the journey isn't necessarily always the result of systematic analysis (though the analysis part is key to achieving the next step), but feel. Allowing the opportunity for your heart and mind to drift, and be open to all possibilities.

And with that, I knew my focus - I'm going to put everything into the National Championships.

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So, I have a new "A" race for 2013 - the Age Group National Championships. Now that I've decided on a focal point for the season, it's time to structure other races around it. With the National Championships in early August, I want to make sure I have a good progression through late spring and early summer, where training becomes much more specific (but that's the subject of a future posting).

Now, with an Olympic distance triathlon focus for 2013 (at least for now - who knows, always room to add a 70.3 in late summer/early fall), it's time to prioritize and focus on weaknesses. This is where the analysis comes in (and also where it really pays off to keep a detailed training log). With a better idea of the types of triathlons I'll be doing for 2013, here are 3 things I plan to focus on during my training this winter and the reasons why.

Efficiency in the water
Any swimmer knows it's all about reducing drag. It's not always the strongest who is the fastest swimmer, but the most efficient. Coming from a running background, the swim is undoubtedly my weak link. So, this winter I'm focusing a lot of my attention on perfecting my stroke - and this means lots of drills. During my month break in December and now into January, I already started a block of heavy drill-oriented swim sessions; and I'm starting to notice some slight improvements in my 100 and 50 meter times. In addition to incorporating more drills in each individual session, I'm also increasing the frequency of sessions to develop a better feel for the water. This isn't to say that each session needs to be extremely long, but a 30-40 minute session 5 days a week will allow for strong focus without taxing the body too much. In addition to drills, I'm keeping a heavy emphasis on high-intensity-interval-based sessions.

Power on the bike
As the longest segment of the triathlon, a good bike split is key, no matter what the distance is. Just think, a half Ironman is 70.3 total miles, and 56 of those are spent on the bike - that's about 80% of the total distance. For an Olympic distance race, I'll spend about half of my time on the bike. So, when I thought about the best place to shave off minutes, the bike split was first on the list. Now, when it came to identifying where I needed improvement, there's two obvious places - first is overall power and the second is the ability to sustain that higher level of power output for longer.

With chilly temperatures and daylight at a premium, long rides or hill repeats are going to be hard to come by. But that's alright, I almost feel indoor training is more conducive to building strength and power. Here's how. First, a continued emphasis on lifting - trying to incorporate heavy lifts for power, mix in some higher repetition lifts for muscular endurance, and include a variety of single-leg movements to isolate each leg (like you do while cycling). Second is a lot more big gear, interval work - and this can be done on the indoor trainer. Cycling in bigger gears provides a similar strength-building effect because of the increased force needed to turn the pedals over. Third, and similar to swimming, I'm increasing the frequency of bike workouts, particularly since many are inside on the trainer, and decreasing the overall time of workouts, but keeping intensity high.

Running off the bike
This is somewhat related to the previous point. Any good way to improve endurance on the bike is going to subsequently help how much is left in the tank for the run. Neglect sufficient bike-specific training, and your legs will be too taxed to have a solid run split. One major improvement I noticed as my 2012 season progressed was a much better run split. This has everything to do with building a bigger base in cycling endurance over the year so my legs were better prepared to take on the run.

This goal is the most race-specific, so my training approach is equally specific. Instead of trying to address this now, it will be something I progressively work on throughout the spring as I'm able to spend more time training outside. The most important strategy to simulate running off the bike is to incorporate it into training - and this means brick workouts, or a run segment immediately following a bike segment. Brick workouts can come in all shapes and sizes (longer rides with shorter runs; shorter rides with slightly longer runs; short ride with a short run and then repeated; and so on), but the main point is to do them!

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I'm really looking forward to 2013 - a new year; new goals; and new training ideas. Stay tuned to hear more about how they are working out.

Happy new year!