Sorry kids, your wellness is an inconvenience

This morning I read an interesting article in the local paper about a recent school board decision about school start times. As more research on the connections between sleep, health, learning, and development surface, many school boards across the country are reassessing the feasibility of later school start times. 

The question came up at a school board meeting in a Saint Paul, Minnesota suburb called Mounds View. Last month the board even commissioned a study looking at the effect of pushing back start times. Evidence from the American Academy of Pediatrics was considered, which recommends "middle and high schools delay the start of class to 8:30am or later," to address chronic sleep deprivation among adolescents and better support healthy development. They also consulted researchers from the University of Minnesota's Center for Applied Research and Educational Improvement.

Armed with the latest scientific evidence demonstrating the potential health and development improvements of later start times, the board decided to....do nothing.

One board member said, "I think there was consensus across the board that the science is there: teens would benefit from a later start time."

But in the end, the status quo prevailed because putting the wellness of children first would create too much of an inconvenience. "We're back to keeping things as it is," one board member was quoted as saying.

Yes, school start times effect other school functions. There is a "ripple effect," as many board members said. But, putting health first has never been an easy choice. If it were, we wouldn't be facing such monumental health challenges in this country. 

Women Make Tough Choices When it Comes to Family and Wellness

Working mothers make difficult trade offs when it comes to career and family. While trying to pursue career aspirations, mothers often try to balance the responsibilities of being a parent.  

Workplace policies aren't always supportive of a healthy balance between the two. Inflexible work arrangements mean mothers make hard choices when it comes to taking care of a sick child or earning a paycheck. 

A recent poll by the Kaiser Family Foundation, a nonpartisan think tank, sheds light on some of these trade offs that working women (now comprising about half of the US workforce) must make.

In the majority of households across the country, women manage health care decisions for the family. Roughly three out of every four women decide on a doctor, take children to appointments, and then execute a health provider's recommendations on care.  

When doing these things though, many women take time off from work. And 60 percent of women who take time off are not compensated.

   
Such inflexibility has a number of ripple effects:

1. Women lose out on valuable pay, which is already not on par with their male counterparts.

2. Seeking health care turns into a last resort. Out of fear of losing pay, women may opt to forgo seeking heath services for a child.

3. Decisions related to health and illness are major sources of stress by themselves. Work challenges and trade offs only add to this stress.

The good news is that more employers are thinking about employee wellness. Organization policies and culture, however, don't always find their way into these conversations. If wellness is indeed a priority, we need to think about the ecosystem of factors that influence our entire physical, mental, emotional and spiritual well-being.     

Should children be using standing desks in schools?

"Sitting is killing you." It might even be worst for your long-term health then smoking, suggests some research. The headline is a bit sensational (in this case by TIME magazine), but the underlying message isn't. In many respects, movement has been engineered out of our daily lives. Now, I'm not talking about the 30 minute jog in the morning or weight session after work. These are laudable activities. I'm talking about the regular movement involved in our everyday activities - essentially, being on your feet for more then a few minutes. 

One technical fix to move (pun intended) people in the direction of increased activity is a standing workstation. They've been around for quite some time, but have become quite the craze recently. 

What's the point? 

Why should we be standing morel? The answer in many public health circles is less about standing for a long duration of time, but rather getting people out of a seated position because of sitting's link to a variety of long-term health consequences. For example, a number of studies, such as this one, have shown a dose response association between sitting time and death from all-causes and heart disease. The more sitting, the higher the risk. Even more important, these results were found to be independent of leisure time physical activity. In other words, your morning/evening run, cycle, swim, row (insert your activity or workout of choice here) does not make up for the eight hours spent sitting at your desk everyday. A similar study, called the Sax Institute 45 and Up Study, which is the largest ongoing study of healthy aging in the Southern Hemisphere, has found a 40% increased risk of death for adults who sit 11 or more hours per day compared to those who sit fewer than four. 

Armed with the data, many individuals and employers are making changes. Enter: the standing workstation. More offices have them, and more options are available now than ever before. Some, like this one, can easily shift from a standing desk to a regular seated desk. For employers, it's about trying to minimize ill health-related costs and increase productivity.

Schools, on the other hand, are more of an unknown. Standing desks are still not very common, but new research suggests maybe they ought to be. It's a similar rationale with workplaces. Standing desks would help keep kids healthier and boost learning and academic performance. 

Standing Desks for Kids?
 
A new, first-of-its-kind study that tested the use of standing desks in 24 classrooms in three north-Texas elementary schools showed some interesting results, at least from an energy expenditure perspective. Researchers compared energy expenditure (EE) data and daily step counts for 337 students from two different grades within the three schools. Four different classrooms were measured per grade. Below is a picture of the standing desk used by students in the intervention groups (right) alongside the desk used for the control group (left), which were just the normal desks used at the schools before the study. Two control classrooms had to be excluded from the study because they opted to use exercise balls in place of chairs during the school year. As a result, the number of students in the treatment and control groups were not balanced.

The results?  

It's a mixture of good and bad. 

Good news: 
All students, regardless of gender or ethnicity, took more steps and expended more energy if they used a standing desk compared to those using seated desks. The following two graphs illustrate this point. In addition, students who were overweight or obese had a greater EE of 0.24 kcal/min and 0.40 kcal/min respectively compared to students of normal weight range. (One point of clarification: 1 kcal roughly equals 1 calorie). One could then conclude that from a purely EE standpoint (i.e. not considering the limitations of an energy-based way of thinking - in other words, only calories - about weight gain/loss and metabolic dysfunction), a standing desk is more effective then a sitting one, particularly for those children who are already overweight or obese.  

Students who had standing desks also took more steps per minute on average throughout the day. In the fall semester it was 1.61 steps/minute more among standing versus sitting students. This difference essentially disappeared in the spring semester, though, calling into question whether it was the desk per se that caused the increase number of steps, or simply the fact that it was something new. Similar to EE, greater benefits were observed among overweight and obese students.

Graph of average energy expenditure (measured in kilocalories) per minute by each student.


Graph of average steps taken per minute by students.



Bad news: 
A few points of bad news:

1. The overall effect of the intervention was relatively small. If you take the combined average increase in EE for all students using a standing desk compared to sitting, it amounted to a 0.08-0.16 kcal/min increase. Over a four hour period, this only amounts to an increase of 19.2 - 38.4 kcals. For some perspective, a single cup of fresh-pressed orange juice is 112 calories; a single hard-boiled egg is about 70 calories; and a single slice of Nature's Own whole wheat bread has 60 calories. The basic point is that we're not talking about much here. 

2. A 50% smaller increase in EE was observed among students using the standing desk in the spring semester compared to the fall. Basically, the longer students used the desk, the more they adapted to them, expending less energy.

A few Unanswered Questions

Two significant areas went untouched in this study.

1. Alignment: Standing in an anatomically aligned position requires significant postural muscle strength in the legs, glutes, abdominals and lower back. When these muscles cannot sufficiently support the body in a functional way, bad habits form, impacting overall body alignment. For a crash course on alignment, read Katy Bowman's blog or book titled, Alignment Matters. One specific area she discusses at length, and warrants highlighting, is the role of footwear. A straight line should be able to be drawn from the top of the head, down to the heals, perpendicular to the floor or ground. When one introduces a healed shoe (in other words, the large majority of commercially available footwear today), this changes the angle by which this imaginary line intersects with the ground. The result? Muscles unnaturally shorten, like those in the calf, hamstring and lower back, changing the entire alignment of the posterior muscle chain as a result. Ever have tightness, soreness or pain in your lower back? Tight calves and/or hamstrings could be the cause.

2. Productivity and/or education outcomes: The link between physical activity and improved brain functioning is well established. For more on this, read the book Spark: The Revolutionary New Science of Exercise and the Brain. Exercise essentially turns on parts of the brain associated with learning, creativity, and other executive functions. This is the basic argument for retaining (and even increasing) the amount of physical activity opportunities offered to students during the school day. Though lower impact and less cardiovascularly taxing then say running, standing still has its benefits. Really, anything other then sitting is preferable. Unfortunately, none of these non-health benefits were examined in the study, though the discussion section of the paper says otherwise. Despite the fact that the study did NOT measure any education-related variables, the authors still concluded, "the results of this study and previous pilot studies have established that activity-permissive classrooms...improve behavioral engagement." Popular media outlets picked up on this assertion and expanded upon it, such as Fast Company who ran a story on September 26th about the study with the headline "Standing Desks Are Coming to Schools, To Cure Obesity and Increase Attention Spans." This despite the fact that the study did NOT actually measure attention span or "behavioral engagement."

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I've used a standing workstation for several years now, whether commercially bought or one I rigged up using various office supplies. But, is this something that should be standard practice in schools in the US? Should children be forced to use standing workstations? Should they be given the option? Are standing workstations simply overrated? I'd love to hear your thoughts.

Sleep: The Non-Negotiable and 5 Tips to Get More Out of It

I'm sure you've met someone who talks up their lack of sleep. I live in a city filled with them. Lack of sleep is worn as a badge of honor, demonstrating how much our lives are ruled by work and external validation. It's almost like a game of "can you top this," with the winner always claiming to have slept the fewest number of hours the night before or woken up the earliest. Several years ago, I was one of those people. I thought, "life is short and I want to spend as much time as I can awake, doing things. Sleep is a waste of precious time."

Don't get me wrong, I'm an early riser, but I now recognize and appreciate the power of sleep, from both a physical and mental performance standpoint.

Like many teenagers, I used to watch the show "Cribs" on MTV (don't worry, there's a point to this). During almost every house tour, when it came time to show the person's bedroom, its unveiling was too often preceded by the cliche "and this is where the magic happens." In a weird way, they are right!

Sleep is all about repair and rebuilding. Take for example muscle tissue. When it's trained, whether from hard running or performing heavy squats, the muscle tissue becomes damaged. The soreness that is felt is the result of small tears in the actual muscle tissue itself. Ever touch a muscle (say your quads) after a really tough workout or race? It feels tender and inflamed, right? This is all apart of the body's natural response to damage. It sets in motion a cascade of inflammatory processes to help repair the damaged tissue. 

A lack of sleep also negatively impacts health in a host of ways, evening increasing diabetes, heart disease, and obesity risk, as well as contributing to mental health conditions such as depression.

Because sleep is so foundational to human health, I focus a lot on finding ways to optimize it. Here are a few things: 

Upgrade Your Sleep

1. Go to Bed at the Same Time - Ever have the experience when you go to bed after a late evening, plan to "sleep in" and end up waking up at the same old time you always wake up? I've had this happen countless times. Even if I hit the sack at midnight, my body doesn't get the memo to shift it's wake time back two hours. I'll still be wide awake, ready to go around 6am (I normally wake up anywhere between 5am and 6am). Keep doing this and it's the surest way to accumulate fatigue, compromise your immune system, stifle athletic performance, increase stress, and throw your cardio-metabolic system out of whack, which is why chronic lack of sleep is linked to obesity, diabetes and heart disease. The list of athletic performance factors affected by lack of sleep is quite long, but to name a few: decreased motivation, low body temperature, increased degree of exertion, and increased duration of task (among others). Beyond physical functioning, consistent quality sleep of roughly 7 hours is associated with higher levels of cognitive performance. Basically, if you want to think better, remember things, and be mentally sharp, sleep is a must.

2. Magnesium - Every night, about 30-45 minutes before bed, I'll have about one tablespoon of Natural Calm magnesium with 8oz of water. This powerhouse of a mineral is a cofactor in more than 300 enzyme systems throughout the body. Everything from protein synthesis, to the structural development of bone, to the synthesis of our body's DNA and natural antioxidants are to thank, in part, for magnesium. What happens when the body doesn't get enough magnesium? Well, quite a lot, potentially. There's a fairly long list of symptoms associated with magnesium deficiency. And unfortunately, about half of the U.S. population doesn't consume the recommended amount of magnesium from food. But, related to sleep, magnesium is a natural relaxant, particularly for muscles. On a hormonal level, magnesium deactivates adrenaline, essentially calming the body's "fight of flight" mechanism. This is why magnesium has been so helpful for me the night before races, when I'm hopped up with excitement and nervousness.

3. Cold Exposure - There are some pretty complex biochemical reactions in your body triggered by cold exposure. If you're interested in the details, check out the blog series by neurosurgeon Jack Kruse. The take away with exposure to cold (which can be cold showers for example) is that not only does it stimulate increased caloric burning through brown adipose tissue, it helps the body enter into deeper sleep. Most of my post-workout showers are cold, which usually consist of about 5 minutes in the morning and then another 5 minutes in the evening. 

4. EMF Exposure - Not too long ago I began learning a bit more about the potential impact of EMF exposure on sleep. I've seen research that has gone both ways (difference and no-difference). One of the largest sources of EMF in our homes is the wireless router. Having a router is obviously convenient as laptops, tablets and other devices have become more popular. But, until recently, I really never thought about how it could influence my health. Turns out, it did (and does) more than I thought. So, about nine months ago I began to unplug our wireless router every night before going to bed (not just turn off, but actually unplug). I was shocked at the difference. Yes, this was not a controlled experiment and there could've been any number of factors as to why I slept better, but I'm convinced this is one of them. A good way to compare now is when I sleep in hotels versus at home. Most hotels have a fairly extensive wireless system, and I often find my sleep quality diminishes when I sleep at a hotel. Again, there is no way to draw any causal relationships, but it's one thing I've modified in my sleep routine and I've noticed a difference in sleep quality.

5. Darkness- This may seem obvious, but limiting the amount of light (especially artificial) in the bedroom makes a huge difference. I've found that even the small amount of light from a digital clock on a night stand can be enough to throw me off. In the case of the clock, my wife fashioned a shade that's taped onto the clock and flaps over the clock to cover the light. When I'm traveling and staying in hotels, I'll simply place a shirt over the clock. Shades over the windows are also helpful. Though I've found that blackout shades are a double edged sword because they don't allow any light - even natural sunlight - in the morning that triggers your circadian rhythm.

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This evening, when it's time to hit the sack, give one of these a shot. Better yet, if there are things I've missed that are helpful for sleep, leave a comment below.

Are you spending time on the things you care about?

A couple months ago I gave a short presentation to my co-workers on self-management. I chose the topic from a grouping of traits associated with "Level 5 Leadership," a concept articulated by Jim Collins in his book Good to Great. 

It was a bit challenging at first to try and wrap my head around the concept. There are countless strategies and habits I've developed to perform better, be more productive and optimize my health and well-being (I use this term in its broadest sense: physical, mental and spiritual). In my presentation I called this "managing your holistic self." Many of us don't really take the time to think about how we go about our day-to-day life. In a sense, we're often on autopilot. We eat a bowl of cereal for breakfast because, well, that's what we've always done. Habit loops are formed (this is another story, and the topic of a future posting). They generally persist if we don't consciously alter them.

But, I want to step back. For me, this concept of "self-management" has everything to do with time. If there is one constant to think about, it's that we'll always have 24 hours in a day. No more, no less. And this is where our management skills come in. If I only have a certain amount of time in a day, how do I want to be spending those hours? There are endless possibilities for how you can divide up the pie to spend more or less time on certain aspects of your life, whether sleeping, eating, working, your hobbies, relationships, exercising/training, and on and on. Everyday, can be thought of as a series of trade-offs.

 
The question then becomes how? How am I currently spending my time and how do I want to be spending my time? The answer to these questions lies in your priorities. What's important and am I allocating the time, energy, attention and passion to those things that I want to be.

Thanks to his interview on the Bulletproof Executive podcast a while back, I came across the leadership work of Stew Friedman from the University of Pennsylvania. He developed a program called Total Leadership, but I found one tool particularly valuable. It really gets to the crux of this question: "are you spending time on the things you care about?"

It's call the Four Way View. Here's how it works:

1. Think about your daily life in terms of four major buckets: work/career; home/family; community/society; and self. 

2. Allocate a percentage to each of these four buckets to total 100% based on their level of importance in your life. How important is work? How important is family? etc. The total for each category should add to 100. 

3. Now think about your daily life and how much you focus on each of these same four categories. Allocate the same 100% into the same four buckets.

4. Rank each of the four categories on a scale of 1-10 (1=not at all; 10=fully) in terms of your satisfaction with that aspect of your life.

5. Do the same thing in terms of how well you believe you are performing (1=poorly; 10=excellent) in that category.

And now it's time to repeat the question: Are you spending time on the things you care about?

New Coaching Business

And we're off and running. Pun intended. I spent New Years at my in-laws, and my father-in-law is known for his over-the-top puns. They must've rubbed off.

I recently started my own coaching business, Craig Moscetti Training Systems. It's still in the early stages and a work in progress. But I'm excited to be working with a couple clients already and that it's finally off the ground.

My mission is simple, to help clients - of all ages and ability levels - achieve higher levels of performance to meet their personal health and fitness goals. 

I don't use pre-formulated training programs. Your body type, metabolism and physiology are all unique. That's why my advice is 100% tailored to my client's individual performance goals. Whether you're looking for helpful tips from time to time, or a personalized training approach based on your upcoming race calendar, my approach is based on client training needs. You can read more about my coaching philosophy here.

Looking for a coach? I offer one-on-one running and triathlon coaching services (both in-person and virtual), general health coaching, and individual consultations.

Contact me here for your free introductory consultation.

Top Posts from 2013

Well, 2013 is officially in the books. It's been a great year - my first full year of blogging. I hope you have enjoyed reading my posts as much as I've enjoyed writing them.

Here are the most popular posts from the past year:

1. Minimalist running shoes: Are they really what we want them to be? 

2. What's wrong with the conventional wisdom on cholesterol and how it could actually be harming us

3. Making the best of it when things don't go your way: NJ State Triathlon race report

And, of course, if there are specific topics you'd like to hear more about, let me know. I'm always looking for new ideas and would love to hear from you.

Happy New Year and best wishes for a healthy and successful 2014.

New Paleo, Low-Carb & Health Blogs

I always love finding new resources. Thanks to Jimmy Moore for his great work compiling new blogs in health, low-carb and Paleo.

Here's his list of "46 New Paleo, Low-Carb & Health Blogs for November 2013" -- stoked to be included as #6 on this list!

So, as you take a few days off from work, kick your feet up on the couch and eat Thanksgiving left-overs, take a look at some of these resources.

What's wrong with the conventional wisdom on cholesterol and how it could actually be harming us

I just finished reading health blogger and podcaster, Jimmy Moore's, new book called Cholesterol Clarity: What the HDL is Wrong with My Numbers. For those interested in diving deeper into one of nutrition's most misconstrued and contentious issues, or simply want the "straight dope on cholesterol" (borrowing from the name of Peter Attia's unparalleled blog series on the issue, which I HIGHLY recommend), this is a must read book. Not only does it provide some of the latest research and thinking on the topic through a series of interviews with 28 leading experts in the field, but Moore packages the information in an accessible way for the widest possible audience, whether you're a lipid researcher or someone who just wants to stay healthy.

So, let's dive into some the main issues in the book and some of my key takeaways. 


Cholesterol is actually a good thing that plays an irreplaceable role in the body. Bottom line: if you don't have cholesterol, you die. Morbid, but true. Here are a few essential things it does or supports in the body:

• Hormone production, including estrogen, progesterone, testosterone, pregnenolone, adrenaline, cortisol, and DHEA
• The health and efficiency of cell membranes
• Nervous tissue, including the white matter in your brain
• Optimal adrenal gland function, which modulate a number of different vital hormones like adrenaline as well as kidney function
• Water and electrolyte balance
• Formation of Vitamin D
• Immune function

By far, one of the most important things influenced by cholesterol is something called coenzyme Q10, or CoQ10. Some, like Nora Gedgaudas, the author of Primal Body, Primal Mind, have called CoQ10 the "single most important nutrient for the functioning of the heart."

When cholesterol is too low, bad things can happen. Based on the important functions listed above, you can probably guess some of the negative things that can happen in the body when cholesterol is too low. For example, cholesterol actually plays a very important role in tissue repair, specifically with stem cell production. As a result, blood vessels can become stiffer - not a good combination with small, dense LDL particles. Research has also shown a close link between low cholesterol and a higher risk of infection, cancer, and a variety of mental side effects, such as depression and a higher likelihood of suicidal behavior.

In fact, research has documented that people with the lowest cholesterol levels actually had the highest rate of death from coronary heart disease and demonstrate a greater risk for some cancers. In addition, this study actually found that almost half of patients hospitalized for heart disease (80% experiencing acute symptoms), had LDL cholesterol levels less than 100 mg/dL, which is the current recommended level by the American Heart Association. As Moore argues, LDL cholesterol (and total cholesterol) are bad predictors of heart disease risk.

Dietary cholesterol doesn't really impact your numbers. The amount of cholesterol from food makes up only about 15-30 percent of your body's total cholesterol. In fact, the overwhelming majority of cholesterol our bodies use - up to 2 grams every day - is actually produced within the body itself, mostly in the liver. Cholesterol is tightly regulated by the body and as Dr. Chris Masterjohn explains in Cholesterol Clarity, "if we eat a lot of cholesterol, our bodies make less of it; if we eat less cholesterol, our bodies make more of it. In most people, the majority of cholesterol that is circulating in the blood is made by their own bodies."

All LDL isn't "bad cholesterol." There are actually two kinds, or patterns, of LDL cholesterol. Pattern A is large and fluffy, regarded by experts as generally harmless. Pattern B, on the other hand, are potentially more dangerous since they are small and dense. Many will say that this measure of particle size and number, or LDL-P, is a much better way of determining risk, than the traditional LDL-C measure that shows up on a standard lipid panel (which is actually a calculated number, not one that's directly measured - more in the next section on this).

Thankfully, there are more and more options available to test for this. One such test is called the NMR LipoProfile test made by the relatively new diagnostic testing company in North Carolina, LipoScience. The test uses NMR technology (which stands for nuclear magnetic resonance and is regarded as one of the best technologies on the market) to actually measure the number of LDL particles in a blood sample.

Of course, certain dietary choices can influence the ratio of Pattern A and Pattern B LDL in the blood, which Moore also flags as quite concerning. He particularly focuses in on the relatively recent trends towards promoting polyunsaturated fats, mostly in the form of vegetable oils (things like canola oil, soybean oil, etc). It is true that there is a fair bit of research showing the effectiveness of polyunsaturated fats (PUFAs) at lowering LDL in the blood. The problem is that PUFAs help achieve this reduction in LDL primarily through decreasing the number of good Pattern A LDL particles, leaving mostly Pattern B. You can see how this can be extremely concerning for heart disease and atherosclerosis risk. One of the best ways to increase the number of good Pattern A particles and decrease the number of Pattern B particles is by eating quality saturated fats from things like coconut, and grass-fed beef and butter.

LDL is actually a calculated number on your standard lipid panel. If there is one number from the standard lipid panel that doctors focus on, along with total cholesterol, it's LDL. The entire statin-prescribing system, argues Moore, has been built upon artificially defining a certain threshold for LDL and total cholesterol (which isn't really rooted in any solid evidence as mentioned above) and teaching physicians (very well) to automatically prescribe the drug once your numbers exceed these thresholds. Usually any conversation about diet is secondary or nonexistent. This is essentially how Lipitor and other statin drugs have become some of the most commonly prescribed medication on Earth.

Among some alternatives, like testing for LDL particle size and number, there is also pretty strong consensus that your ratio of HDL cholesterol to triglycerides is a better gauge of current heart health. Both numbers are on the standard lipid panel, which makes them a bit more accessible. The easiest prescription to maximize HDL while minimizing triglycerides is by avoiding carbohydrates and eating more fats.

Keeping total cholesterol low, as guidelines recommend, is 100% counter-intuitive. The prevailing guidelines by a variety of public health authorities focus exclusively on total cholesterol and LDL, and specifically keeping these two numbers low. In the case of total cholesterol, guidelines suggest this number should be kept under 200. But the irony of all of this is that if you're trying to keep total cholesterol low, you're assuming all components that make up the total should be kept to a minimum.

Most people know this is hardly the case. As I mentioned, having a lot of large, fluffy Pattern A LDL particles is not nearly as harmful as having a lot of Pattern B. Also, when it comes to HDL cholesterol, or the so-called "good" kind, every leading health authority suggests we need to keep this number as high as possible. This seems like a big contradiction to say keep some cholesterol particles, like HDL, high, while applying an arbitrary cap to total cholesterol.

Statins do a lot more harm than good. Though statins do lower LDL cholesterol (which I hope I've already convinced you is not necessarily a good thing), here are a few examples of the documented negative consequences of taking statins:

• This 2013 article found a 21% increased risk of death among women with breast cancer who took statins compared to those who didn't. Other studies have documented the link between statin use and musculoskeletal diseases and joint pain.
• Compared to people who did not use statins, statin users had had a 50% increased risk for any musculoskeletal pain, a 59% increased risk for lower back pain, and a 50% increased risk for lower extremity pain.
• This review article documents the ample evidence showing increased risk of cardiovascular disease in women among statin users, including a three-fold increase in risk of coronary artery and aortic artery calcification.
• Statin use has been shown to hinder the positive effects of exercise among overweight and obese individuals. 

It's all about inflammation. If there is one thing to worry about instead of cholesterol, Moore argues, we should be much more concerned about inflammation in the body and the things that cause it. This is the true cause of atherosclerosis. In his words, "without inflammation, cholesterol can't harm you." It's really all about cholesterol oxidation, which is nearly a two-fold better predictor of heart disease risk than simply looking at cholesterol alone. So, we should be focusing more on things that cause chronic inflammation in the body, which results from poor diet, smoking, lack of sleep, infrequent exercise, elevated stress, and a compromised gut, just to name a few that Moore references. One of the best blood markers for determining the amount of chronic inflammation in the body is something called high-sensitivity C-reactive protein, or hs-CRP. Many experts have argued that hs-CRP is a much better biomarker to track because it's a much better predictor of heart disease and health complications than total cholesterol or LDL.  

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This book is definitely for everyone. I thoroughly enjoyed the balance struck between offering practical guidance while underpinning it all with sound science. If you're trying to cut through all the noise out there on cholesterol or you're interested in tracking your own health and wellness, this is definitely worth the read. My only critique - but this is coming from a researcher who loves evidence - is the lack of citations in the book. Moore does provide some suggested references for additional reading, but I personally could've really benefited from the book to a greater degree with citations, particularly for many of the chapters discussing the science.

Nonetheless, I highly recommend taking a look at this book. It'll definitely challenge (and maybe even change) the way you think about cholesterol.

Note: I was not compensated in anyway for writing this posting. Views are my own.

Tools to Track (and Hack) Your Own Health

One of the most exciting trends over the past few years has been the proliferation of tools to track your own health. No longer is your health a conversation reserved for a doctor's office, but there are more and more opportunities for people interested in their own health to track various aspects of it.

Whether the number of steps taken in a day, sleep duration and quality, heart rate variability (a measure of stress, which is being used more and more - this is a good podcast done by Ben Greenfield if you'd like to learn more), or even keeping track of individual lab results that measure a whole host of biomarkers, technology has allowed for more data. This has allowed for a unique niche of health and wellness experts, called biohackers, to spring up, but it's also allowed for something the online lab and personalized wellness company, WellnessFx, likes to call the "democratization of health."

I've become a huge fan of this individualized approach to health, including from a nutrition perspective. Our body's are unique ecosystems and what works for one person might not work for another. That's where this concept of individualized wellness comes in. I'm sure you've heard the saying that "you're the best expect of your own body," (or something like that) but I think there is a lot of validity to that statement. And technology has made it possible for an even deeper, more intimate expertise of our own physiology, genetics and health.

Over the past year or so I have been experimenting with a variety of apps to track different aspects of my own health. Here are a few of my favorites.

Sleep Time - Made by Azumio, which also makes a variety of other health and wellness apps (including the next one on my list), this particular app allows you to track the duration and quality of your sleep through your smartphone (I've only used the iPhone). The app uses sensors within your smartphone that can detect movement, and tells you the time you spend in deep sleep and light sleep. I found the app was pretty accurate, but practically was sometimes difficult to use. For example, you need to sleep with your phone fairly close to your pillow so it can most accurately sense movement. There can also be a counter-productive mental game that you play with yourself, wanting to score well on your sleep score, but by over thinking it, I found it even harder to fall asleep. 
 
Argus - Another app by Azumio (no they don't pay me), Argus is a so-called lifestyle app that functions as a pedometer, calorie counter, and keeps track of your meals and daily water intake. I'm a big fan of the reminders Argus has when you've been sitting for too long. Getting caught up in our work is a frequent occurence, and I'm no exception, and these are helpful reminders to make sure we all step away for a few minutes and go for a walk. My favorite part of the app, though, was that you could take pictures of your meals, which are stored directly in the app. Also, because it's an Azumio app, Argus conveniently syncs with other Azumio apps, such as Sleep Time or Instant Heart Rate, to create a useful dashboard of data.

Food Sense -Not by Azumio, this is an app by the Bulletproof Exec, Dave Asprey, and one I've actually been using the most recently. I haven't quite tapped into it's full capabilities, which also include measuring heart rate variability, but one of its main functions is to detect food sensitivities through a series of heart rate measurements around meal times. It also includes a handy relax function, which takes you through deep breathing exercises, which can be used by itself, or in conjunction with the heart rate variability function. I also like that the app is compatible with a number of wireless heart rate monitor straps, which can be used to measure heart rate, or it also has options of measuring it through the camera lens of your smartphone.

So, give these a try and let me know your thoughts. Also, post your favorite health and wellness apps in the comments. I'm always looking for new ones to try.

How to cycle carb intake to improve performance

Over the past couple years I've slowly adapted my body to become more efficient at burning fat as a primary fuel source. This has meant that carbohydrates have become a smaller and smaller part of my overall diet. But, that's not to say there isn't a time and place for strategic carb intake, especially to improve performance. So instead of relying on carbohydrates as my body's primary fuel source on a daily basis, I cycle carbohydrate intake around certain times of the day and certain times of the week depending on when I really need them.

Here are the three basic rules I follow:

Limit overall carbohydrate intake on easy days.
Monday is generally a recovery day for me with some foam rolling in the AM, some more in the PM, and usually a 30 minute yoga session in the evening. Because this is my least active day of the week, carbohydrate intake is also at its lowest. As a general rule of thumb, the more aerobic the workouts, the greater proportion of my daily calories come from fat and protein.

Plan carbohydrate intake around hard workouts, especially fasted workouts.
Hard sessions, particularly hard and longer sessions, when I'm really tapping into glycogen as a fuel source, recovery is key. This is especially the case if I'm planning another session that day or even the next day. There's been a bit of research looking at the optimal timing and ratio of macro-nutrient intake post-exercise, and many researchers and trainers will say a carbohydrate to protein ratio of about 3:1 consumed anywhere between 20 minutes to 60 minutes post-workout. I don't measure anything out, count calories, or really track much, but after a long-hard session I'll make I'm eating a good balance of fat, carbs, and protein from all quality whole food sources. Post-exercise nutrition is a lot more important for fasted workouts since almost all of the research to date has been on subjects in a fasted state.

Gradually increase carbohydrate over the course of the week leading up to a race.
The week of a race is when I most often step up the carbohydrate intake -- gradually. As mentioned in the first point, I'll start the week relatively low-carb. Then, as the week progresses, I'll slightly increase carbohydrate intake, usually starting around Wednesday. These usually aren't huge changes: adding a banana to my lunch, a small sweet potato to dinner, or a handful of oats for breakfast. The biggest benefit to this approach is if you're anticipating tapping into a fair bit of glycogen as a fuel source during the race (for example with a shorter olympic distance triathlon, which is at a much higher intensity). In training your body was so used to running on a small amount of carbohydrates that when there's a larger than "normal" influx, there's almost a sensation of increased energy at higher intensities (similar to something like an athlete training at altitude and coming back to sea-level but certainly a lot less pronounced).

Now, what kinds of carbohydrates do I tend to use? Here's a list of a few of my favorites:

1. Sweet potatoes - packed with anti-inflammatory properties and antioxidants, these have quickly become my go-to for pre-race carbohydrates. Add some grass-fed butter and quality sea salt and you're good to go!

2. Quinoa - actually a seed rather than a grain, quinoa is really growing in popularity in health and nutrition circles. Why? In addition to it being a fairly slow release carbohydrate, it contains 14-15 gram of protein per 100 grams and has all nine essential amino acids. (The 20 amino acids are the building blocks of protein and essential amino acids are those that cannot be made naturally by your body.) The major issue before eating, however, is to make sure they are soaked and sprouted to remove the harmful saponins.

3. Nuts - these are one of my daily staples and I will usually have a handful with lunch, especially walnuts, almonds, cashews, or Brazil nuts. Though a great carbohydrate, protein, and fat source, a word of caution to not consume too many, since nuts do also contain decent amounts of pro-inflammatory omega-6 fatty acids along with the beneficial omega-3 fatty acids.

4. Squash - this is an absolute go-to during the fall and winter when squash is in-season. For those who stay away from gluten, like myself, spaghetti squash is a fantastic substitute.

5. Bananas - an endurance athlete's best friend. A single banana can really go a long way for pre- and post-workout fueling. It's simple and easily digested. For longer workouts on the weekend, I might have half before and half afterwards. You really don't need much.

So, give these strategies a try and let me know what you think.

Obesity the disease: Is it really about health?

The media and blogosphere lit up after the recent American Medical Association annual meeting.

Why?

The prestigious, 165 year-old organization of 225,000 doctors voted to recognize obesity as a "disease." Yup, let me say it again, according to the AMA, obesity is now considered a disease.

Now, of course, there are fairly convincing arguments on both sides of the spectrum (here is an interesting compilation of arguments from members of the Obesity Society). The popular obesity blog Weighty Matters lays out a pretty good listing of reasons against obesity as a disease. Interestingly, the article starts off by applying the common definition of disease, and seeing if obesity fits - "A particular quality, habit, or disposition regarded as adversely affecting a person or group of people."

At first glance this seems to make a lot of sense. Obesity is a quality or disposition that adversely affects an individual and society (a prime example being the health care costs associated with obesity).

This is the argument taken by Lee Kaplan, director of the Obesity, Metabolism and Nutrition Institute at Massachusetts General Hospital, associate professor of Medicine at Harvard Medical School, and chairman emeritus of the Campaign to End Obesity:

"The simple fact is that obesity is a disease, a chronic, frequently progressive, and rarely remitting disorder that triggers an additional 65 or more other conditions ranging from arthritis and sleep apnea to many forms of cancer."

On the other hand, will the AMA's announcement simply medicalize the issue rather than addresses the miriad of factors that influence it. Public health expert David Katz makes this point when illustrating the irony of the AMA’s announcement and the recent introduction of the first FDA-approved obesity drug into the market. This obviously begs the question of who really stands to benefit: those who suffer from obesity or big pharma? Dr. William Davis, the preventive cardiologist and best-selling author, answers in pretty simple terms:

"To the system, you are worth more obese than slender. You are worth more diabetic than non-diabetic. And you are worth more as a wheat-eater than as a non-wheat eater."

One might go as far as to say that this is a classic example of "disease mongering" - a phenomenon described by Lynn Payer as the ability to control the destinction between health and disease, thereby allowing drug companies to determine the size of their own markets. From the enlightening book The Bottom Line or Public Health,

"Since disease is such a fluid and political concept, the providers can essentially create their own demand by broadening the definition of diseases in such a way as to include the greatest number of people, and by spinning out new disease."

It wasn't long after the AMA's announcement that its implications were already being seen. Only a few days later, Members of Congress introduced the Treat and Reduce Obesity Act (H.R. 2415/S.1184), a bill that would  allow Medicare coverage of prescription weight-loss drugs.

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The Wall Street Journal importantly points out that even if obesity is characterized as a disease, there is still a pretty big grey area in terms of how to actually measure and track obesity trends. Traditional "diagnosis" of obesity has been using the imprecise Body Mass Index, which is simply weight divided by height. One can easily guess why this can be a challenge -  just think of a fairly fit athlete with good dose of lean muscle mass. Unfortunately, BMI doesn't distinguish between fat mass or muscle mass, which, of course has some severe limitations. Other research has shown (see here) waist circumference to be a much better predictor of obesity-related health risk and subsequent health costs (see here).

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Might characterizing obesity as a disease actually be counterproductive to prevention efforts? A new study released a few weeks ago found that if parents discuss weight issues with their children they are in turn more likely to diet, use unhealthy weight-control behaviors, and engage in binge eating. By classifying obesity as a disease, won't doctors be more apt to discuss it in terms of "treatment" options for their condition - i.e. in the context of weight (remember how obesity is classically measured - BMI = weight/height)? And, my fear, is that by framing conversations between health providers and children/adolescents and their parents in terms of weight alone, children and teens might turn to some of the same negative dietary behaviors mentioned in the study.

The current President of the AMA doesn't think so, and recently defended the organization's decision.
She makes the argument, "Recognizing obesity as a disease will encourage a dialogue between patients and physicians to determine which behavioral, medicinal or surgical options may be right for them." But an honest dialogue between physicians and patients about options is only as useful as doctors are informed and able to accurately communicate the range of options.

Take for example nutrition.

Now, I think doctors are good at a lot of things, but offering nutrition advice (i.e. behavioral option) is not one of them. And medical schools themselves agree with this statement. A 2010 survey found that among 105 accredited U.S. medical schools, only 26 (25%) required a dedicated nutrition course! In other words, medical students (or our nation's future doctors) from three out of four U.S. medical schools received ZERO training on nutrition. The average contact hours of nutrition instruction medical school students received was 19.5 hours, and this was about 3 hours LESS than the average time from 2004.

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My biggest fear, however, is that by placing the emphasis on obesity we neglect the underlying physiological processes contributing to weight-gain in the first place. Some research has already suggested that the link between obesity and shorter life expectancy may not be as clear cut as we once thought (i.e. being obese might not be the real issue. More on this below). The research was published earlier this year in the Journal of the American Medical Association and found that "Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality." (Yes, this is pretty ironic coming from the academic journal of the same professional organization that just a few months later deemed obesity as a disease.)

Dr. Peter Attia made a strong and eloquent case at this year's TEDMED conference about why obesity might not be the real issue. What if we have the causality backwards? What if obesity doesn't lead to issues of diabetes and metabolic syndrome, but the real issue (and whether our body stores or burns fat) has everything to do with insulin - i.e. the hormone at the crux of diabetes and metabolic syndrome? What if obesity is just a by-product of the metabolic firestorm caused by chronically consuming excessive sugar, starches, and refined carbohydrates?

What do you think - was the AMA's announcement beneficial or harmful?

Now Available on Google: Searchable Nutritional Data

Want to know how much sugar is in an apple; or how much potassium is in a banana; or the amount of saturated fat in coconut?

Well, Google has made the answers to those questions much more accessible.

A couple weeks ago Google announced it would make all kinds of nutritional information searchable. Typing in the search command "how much fat is in coconut milk" brings up your standard nutrition facts panel, much like the nutrition fact labels on products you see in the grocery store. Specific data includes calories, fat (saturated, polyunsaturated, and monounsaturated), cholesterol, sodium potassium, total carbohydrates (fiber and sugar), protein, and vitamins and minerals.

The function primarily pulls data from a database maintained by the U.S. Department of Agriculture and looks like this:

 

While this function is certainly helpful in providing a quick glimpse of basic nutrition data for general foods, it does lack a bit of detail. You are able to distinguish between whole milk and skim, but you can't look at the labels for specific brands. Or if you search for nutritional facts on "crackers," there isn't the capacity to look at data for all the various kinds, such as those that primarily use seeds instead of flour.

Though nutrition facts tell part of the story about food, it doesn't tell the whole thing (and in my opinion, not even the most important part). The most important part of the nutrition facts on a product isn't how many calories or grams of sugar, but the INGREDIENTS. The ingredients list can generally tell you everything you need to know and alert you to any red flags for things that can impact your health (for example, things like hydrogenated oils).

Regardless of its limitations, the function is a great example of the power of big/open data to help inform consumers. The extent to which consumers are actually able to understand and use this data is another story, but kudos to Google for making it available. I'm looking forward to seeing how the function evolves and if additional information is added in the future.

How exercise can wreak havoc on your body

We endurance athletes and fitness enthusiasts are in a perpetual state of more, more, more. We're constantly testing ourselves and pushing our bodies to the max.

But, what does this actually do to the body?

There has been quite a bit of conversation in the media and scientific literature about the diminishing returns associated with exercise. Not enough is associated with a range of health and chronic disease issues, while too much can be just as harmful to the body. In previous posts I've written about some of the cardiovascular risks associated with prolonged endurance exercise.

In lieu of this month's regular "Monthly Reading Roundup," there was really one major article I wanted to share. Why, because it takes a detailed and comprehensive look at what exactly a hard workout, marathon, or triathlon does to your body's lipids, hormones, enzymes, and major organ function, like your kidneys.

Fitness expert and Ironman triathlete Ben Greenfield undertook his own personal experiment to test the damage that back-to-back triathlons caused on his body. A few weeks ago he did both the long-course (half Ironman distance) Wildflower Triathlon and the Olympic distance in one weekend; one race on Saturday, the other on Sunday. He had comprehensive blood work done a couple days before the races, and then again afterwards.

The results were both fascinating and scary, especially since my training protocol probably isn't too far off from what he does.

By far, the most concerning aspect is the huge rise in cortisol and inflammatory biomarkers. He writes:

"Yes folks, that’s nearly a seven-fold rise in inflammation. In other words, this type of brutal event creates a complete inflammatory firestorm in your body."

And the biggest issue isn't necessarily producing some inflammation following exercise (which is a good thing in terms of recovery and muscle development), but the cumulative effect:

"The problem is that in the absence of proper recovery, round after round of this acute inflammation can eventually become chronic inflammation, and that is when lack of blood flow to tissue, poor mobility, and risk for chronic disease or serious injury set in."

 He sums up by saying:

"You need look no further than my cortisol levels, TSH, insulin, testosterone, growth factor, creatinine, blood urea nitrogen, white blood cell count, and liver enzymes to see this to be true.

And heck – I actually take care of myself pretty darn well. I sleep 7-9 hours, eat a healthy diet, meditate, and avoid excessive training. Just imagine what someone who doesn’t do all those things looks like.

But I’ll be the first to admit that despite the healthy measures I take, I’m brutally beating my body up with the sport I’ve chosen (triathlon), and if you’re reading this, you probably are too (Crossfitters – you don’t get off that easy – I’ve seen hundreds of these blood panels and you have the same issues)."

So if you're an endurance athlete, or you simply exercise frequently and beat up your body, this article really shines a spotlight on the delicate balance between performance and health.

It's a very detailed article, but well worth the time. Click here to read.