Forget talent or intelligence - It's all about GRIT

This weekend I watched a short TEDtalk by Angela Lee Duckworth, and had to share. In my opinion, she captures the one thing that's needed to excel in all facets of life, but seemingly overlooked - grit.

In her words:

"Grit is passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with your future, day-in and day-out, not just for the week, not just for the month, but for years. And working really hard at making that future a reality."

So, dream big. Aim high. Set goals. Don't settle. And work as hard as you possible can to get there. Life's a journey and an adventure. Decide how you'd like to spend those precious days and go for it. Search for and embrace the things that truly make you happy - the things that make you feel alive.

For me, and in the words of Rudyard Kipling, I'll be "fill[ing] the unforgiving minute with sixty seconds' worth of distance run."

Less statins, not more

Earlier this week I wrote about Jimmy Moore's new book Cholesterol Clarity, which really dives into many of the misconceptions around the issue and tries to cut through the noise, so to speak.

You can read the full post here.

One of the main take-aways for me from that book was around the prescription and use of statin drugs, particularly how much of a "well oiled machine" this system has become. Most importantly, there are a variety of documented side effects and negative impacts on long-term health, which often get swept under the rug because they do one thing (which doctor's have been taught is really the only important thing about cholesterol) really well - lower LDL cholesterol.

As it turns out, however, we're likely to see the prescription of statin medication dramatically INCREASE in the coming years. Here's why.

On Tuesday of this week, the American Heart Association and the American College of Cardiology released new guidelines on obesity, cholesterol, risk assessment and lifestyle. In addition to stating that obesity "should be managed and treated like a disease" (that's the topic for an entirely different posting, and one that's stirred up quite a bit of controversy) the guidelines also suggest that "more Americans could benefit from statins."

Here are the groups who they recommend should take statin drugs:

• People without cardiovascular disease who are 40 to 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.
• People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.
• People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
• People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

 So, if you find yourself in one of these categories and weren't taking a statin drug previously (and this (and this particularly applies to women where there is a great deal of evidence showing the significant drawbacks of taking statins), chances are your likely to hear the recommendation from your doctor the next time a cholesterol test shows high LDL-c levels.

I think a recent New York Times opinion article by Harvard Medical School lecturer John D. Abramson sums it up quite nicely:

"We believe that the new guidelines are not adequately supported by objective data, and that statins should not be recommended for this vastly expanded class of healthy Americans. Instead of converting millions of people into statin customers, we should be focusing on the real factors that undeniably reduce the risk of heart disease: healthy diets, exercise and avoiding smoking. Patients should be skeptical about the guidelines, and have a meaningful dialogue with their doctors about statins, including what the evidence does and does not show, before deciding what is best for them."

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.  

****

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.

What do other countries think is American food?

My wife and I spent the past week on vacation in Europe, splitting our time between Paris and Rome. One of the most fascinating parts about the trip came on our third day in Paris, and I had to share.

The French are, of course, known for their delectable food: freshly-baked croissants and bread, cheese, and meats. So, we thought it would be interesting to check out a well-known grocery store in Paris. We strolled past the bakery with all the deliscious breads, macaroons, and pastries on display. We checked out the meat counter, the wine, and the cheese.

But, we also took a quick look at some of the international sections of the store, including one shelf of "USA" food. In this case, this picture says a 1,000 words.

It's almost embarrassing to think that this is the kind of food that other countries really think of when they think of American food -- processed junk! Shelves filled with mac 'n' cheese, salad dressings (in Italy they serve extra virgin olive oil and vinegar - that's it!), canned soups, beef jerky, roasted nuts, and all sorts of condiments, many with sugar as the first or second ingredient.

Is this the food culture we want to be perceived as having in the United States? I sure don't!

Then again, the items weren't too far off from what fills the shelves of many convenience stores across the country.