Jan 16

First, the recap. We started the year like we often do, talking about steps we could take in order to make it a stronger and happier one. We discussed the results of a survey of thousands of individuals across 29 countries, which revealed 3 health tactics that were cited most often as a possible direction for setting a few New Year's resolutions. 2 of the 3 were fairly tried and true: MOVE more, as measured by exercise minutes, and ENDURE better (that is, distress less). However, the third, "incorporate more home cooking", struck a different chord because it has the potential to unlock many other healthy doors along the way, including literally growing health in the garden. Then, last week, we folded in the idea that energy, and the body's ability to efficiently use it, may be the most important door of them all to unlock this year. 

Whether we buy it or grow it, the full physiological benefit of a home-cooked meal lies in our body's ability to transform the stored energy in the food into a usable form AND transport it from cell to cell in a well-regulated way. Energy flowing too easily acts like a leaky bucket, and we drain quickly, while the opposite, too much resistance, is like a log jam where it builds up but never quite gets where we want it to be. We gave an example of how the sensation of fatigue, an early energy management warning sign associated with health decline and even death after the age of 50, when it becomes excessive or persistent, isn't always low energy reserves (running on empty) but also potentially energy stagnation (the log jam).

The idea can help us understand why yet another large study showed that inadequate time to RECOVER was a highly significant predictor of life expectancy. Cellular energy systems can't perform as well when sleep quality is lower, so this finding probably shouldn't surprise us. Using data from every county in the US in order to smooth out differences in risk from town to town, short sleep, defined as less than 7 hours, was a stronger predictor of early death than all but 2 risk factors considered. Only smoking and obesity, both of which are linked to smoldering low-grade inflammation, which is in itself an energy-intensive scenario, had a greater impact. It may also help to explain the global doubling of cancer cases from 1990 to 2023 and the grim forecast released last week of a continued surge over the next 25 years. As we are learning, a hallmark of cancer is the change it makes to the energy transformation and communication apparatus, commonly known as the Warburg effect. There is even a theory, published last week by a team from Italy, that suggests the negative impacts on the same energy apparatus may be the bridge between emotional distress and poorer physical health. Common roots indeed.

So what's the action? Where do we start if we want to lower our risk by investing in our own energy apparatus?

We'll cover that in our final segment next week.

Until then, have a great weekend, 

Mike E.

Jan 2

President Dwight D. Eisenhower is quoted as saying, "Plans are worthless, but planning is everything." In an excerpt from that speech in 1957, he goes on to clarify, "There is a very great distinction because when you are planning for an emergency, you must start with this one thing: the very definition of 'emergency' is that it is unexpected, therefore it is not going to happen the way you are planning."

I love that quote. While planning for a healthy life is definitely not the same as the war-planning he was referring to, the main point holds. The act of gathering current information to help inform, envision and prepare for the potentials of the future is one of the best ways we have to gain power over it; to be adaptable enough, resilient enough and ultimately ready enough, to both absorb and grow from whatever life throws at us this year, even while acknowledging things almost definitely won't actually go according to plan. And so, with another calendar flip upon us, it's a great time to do some planning in hopes of unlocking an even better way to maximize our effort this year.  

Under the header of "gathering current information" and against the backdrop of 2025, a year that again proved that investments in any of the ELEMENTS, even very small ones, can pay off, zooming out to look at our entire personal health "portfolio" is a great first step. If we are anything like the 16,000 individuals across 29 countries surveyed in this study, 3 tactics could be particularly impactful to include in our plan. While the first two, (1) working to build the skills to ENDURE emotional distress in a world that seems more tightly-wound than ever, and (2) increasing our MOVE-minutes per day, didn't surprise me much, the third got me thinking. The act of "home cooking, which can be so much more than good FUEL, could easily become a central power-habit that others lock onto this year. Using the kitchen or family table in order to CONNECT is definitely not perfect for every situation, but the known benefits certainly deserve an effort where possible. However, for those who are really ready to let things compound in 2026, planning to support that effort with fresh ingredients sourced from a garden may open a whole new portal to better health.

This review, for example, showed a strong mental health benefit and even some physical function gains for those willing to roll up their sleeves and step into the garden, but that might just be the tip of the iceberg. Not a lettuce joke, but enjoy!. For most of us, there's exploration and learning to be done to build gardening skills. And since there's a beneficial link between curiosity and brain health, stimulating our brain while also getting the gut-health benefit enjoyed by gardening families (but not by those who don't), as shown here, seems like a no-brainer. Who knows, it might even send you down a similar wormhole as me, considering how to unlock an important, long-term investment by way of soil improvement. While it may not be an emergency just yet, it is a problem we probably shouldn't ignore if we'd like to turn the tide on the sliding food quality discussed here. To be honest, I didn't expect to have the "magic of composting" on my personal resolution list, but here we are. 

Of course, this won't be the only path we walk down in 2026. There will undoubtedly be more fascinating updates and nuances to be learned and leveraged. As always, we resolve to scour and dive deep each week in hopes of elevating the strategies that work and combat the growing risk of  "mis-", "dis-", and even "mal-" information on health mentioned here.

From the entire team, we wish you a stronger and happier 2026 through better health. Reach out any time we can support your planning...or, if you've got it dialed in already, send some gardening tips or pics you're proud of when the time comes!

Happy New Year,
Mike E.

Dec 19

I can already imagine the social media clickbait. A title like "everything you've ever been told about diet is wrong," which overlays an image of a person with a perfect physique or a distinguished-looking professional in a lab coat. Then, for those who decide to expand beyond the headline, a short summary of one or both of the two studies out this week, quite possibly burying or leaving out critical details, depending on the source. Maybe it's a sign of the times, or maybe it's just what commandeers our attention. Either way, since I prefer to pick them apart for my own understanding, I figured, why not share? So, for others who might be curious, here's my summary of the deeper dive. 

Study 1 - from the Annals of Internal Medicine (a publication of the American College of Physicians), dated 12/16/25. The big finding on this one is that after a review of randomized controlled trials, researchers found little to no benefit in measures of heart health by reducing saturated fat in certain groups. At face value, this is a potentially big finding with implications for everything from public policy to health advice. The risk, however, is in missing the details, which make this a far more narrow finding, limited to a far more narrow group of people in a relatively short time frame. 

What the research team really found was that in at-risk groups, lowering saturated fat produced a significant benefit, while in low-risk groups (i.e., healthy people), there was little to no additional benefit in a 5 year period. There is nuance here, and it's important. First, it's entirely possible that a risk "floor" exists - healthy people (those at low risk) didn't get even healthier. However, if current projections are correct, this is, sadly, a very small number of people. The most recent statistics show that 2 out of 10 US adults transition from high risk to diagnosable heart disease in their 20's and 30's, with more and more each year. By the time we are in our retirement years, more than 7 out of every 10 have been diagnosed. This means not only are there very, very few who are in the applicable low-risk category, but in a disease that takes decades to develop, a 5-year window is probably not long enough to set a lifetime plan to. 

In addition to a risk-floor, it is also possible that the strategies that lower risk (in those who have it) are not the same as the things that prevent risk (in those who don't). There might definitely be more important levers for these few, but to me, it seems shortsighted to ignore the up to 25% risk lowering effect seen when the at-risk group changed from saturated fats to polyunsaturated fats. There's almost definitely more to come on this one, but one thing feels certain: the headline doesn't quite capture the story.

Study 2 - this one from The Lancet as part of their December 2025 Europe Regional Health journal. The sexy headline finding on this massive data review (63,000 participants over 9 years on average) was that certain plant-based diets were associated with an increase in cardiovascular disease risk. Unfortunately, anyone who stops there will likely be misled. What the study really found was that when they compared the effect of dietary choices across 3 different known risks including: dietary makeup which ranged from mostly plant-based, such as the often heralded Mediterranean diet to minimally plant-based which might be something closer to a standard American diet as well as quality (high nutrient to low nutrient) and level of processing (low process to ultra-processed), all 3 groupings mattered. 

While a mostly plant-based diet is widely regarded as a powerful preventative choice (which might be scary in some professions), it probably shouldn't surprise anyone that more data now supports what seems obvious - when we eat highly nutritious foods that are close to their natural state (fruits, veggies, nuts, seeds, legumes, etc) we do significantly better than when we try to use only the parts that are easy, convenient or taste good. In much the same way that fruit and fruit juice may come from the same source but can yield very different effects, something that is minimally changed from how it started is wildly different than something that has been significantly altered to look, smell, or taste different and sit on a shelf longer before it spoils. Junk food is junk food, even if it started as a plant.

At the end of the day, these two big studies, which are sure to make waves in some areas and might even sell some news, don't change things all that much for me. Author Michael Pollan may still be able to lay claim to the most accurate and simplest take on how to eat for health - "Eat Food, Not Too Much, Mostly Plants.

Have a great weekend,
Mike E.

Dec 5

Tuesday was the first dreary day of the season here in New Jersey. It started sleeting just in time for the morning commute, and then things settled into a cold rain for most of the rest of the day. The good news is that when it comes to seasonal weather change, we humans are expert-level adapters; such a day won't feel all that cold in a month or so. The less-good news is, the process takes a few weeks, and with Winter still (officially) out on the horizon, we're only just beginning our "winterizing" phase.

The winter months come with a unique set of risks. Although there isn't a ton of strong research documenting the phenomenon, and we don't really know whether it is due to decreased consumption or increased fluid loss (or both), it's not uncommon to feel a little dried out during the colder months. Add to this our tendency to move a little less easily (tissue stiffness) and a little less often this time of year, and it's no surprise that soft tissues and joints tend to be a little more cranky. As if that weren't enough to be tedious, unlike most animals, which burn extra calories staying warm, we do the opposite and add body mass, which, of course, tends to be in the wrong direction for a long list of health indicators, including brain age, according to a release last week.

If only there were a few simple (and intuitive) tactics that could put the odds back on our side...well, we're so glad you asked. :) Two new, otherwise unrelated studies out in the last week can provide direction.

The first was a review on the impact of increasing body temperature before exercise or athletics, quite literally warming up. For anyone who gets regular workplace visits from our team, the results should DEFINITELY NOT be a surprise - while it doesn't make a person stronger (per se), muscle warm-up consistently improved power output and speed.  Specifically, for every 1°C increase in muscle temperature, performance improved by about 3.5%. The interesting twist on this one, however, was that passive warm-ups (such as sitting in a sauna to raise body temperature), although not nearly as practical as a quick dynamic warm-up, by and large produced similar results. The study authors, however, still favored mimicking the intended movements when able due to the added benefit of priming the nervous system. One author was quoted as saying, "While both active and passive warm-ups result in better speed and power, a lot of research shows that the warm-up exercises should be similar to the exercise you will be doing." He went on to say, "The practice actually helps us to activate our muscles more and to use more efficient movement patterns -- the nervous system can learn on the spot."  

The second study, which wasn't exactly targeting body temperature, did show interesting preventative effects that could be very beneficial this time of year. This time, it was the impact of a hot cup of flavanols on arterial performance in sedentary healthy individuals. The researchers used unprocessed cocoa, but high-quality green tea would work well here too. They found that after the dose of flavanols, declines in arterial performance from prolonged sitting were effectively halted. Interestingly, this was consistent across both low and high-fitness subgroups, ruling out baseline fitness as a possible driver. Of course, given that exercise snacks (bouts lasting < 1 min) have also been shown to improve arterial responsiveness similarly, combining both strategies is probably better than 1 alone. 

For most of us, it's bound to get colder from here. Add some flavanols to your hydration and prime your power with some warm-up movements to lower risk, especially while we are in the early phases of adaptation.

Have a great weekend,
Mike E.

Nov 21

I am always drawn to stories about people who seem to quietly make words like "unstoppable", "invincible", and "limitless" their personal brand statement. Whether in the smashing of a 20-year-old course record in NYC a few weeks ago or in becoming the first female Army Ranger to compete (and then complete) the Best Ranger Competition, something 70% of the best-of-the-best entrants aren't able to do, 2025 has been a good year for human achievement. However, to me, where things get really amazing is when we try to understand how these "otherwise normal humans" work through the choice to stop and instead keep going; to deal with inevitable setbacks, leverage the years (or even decades of preparation), and ultimately find a way to ENDURE.

It's tempting to believe that the ability to conquer such amazing challenges is heavily, if not solely, psychological. Whether we call it grit, resilience, or extreme discipline, people who ENDURE seem to tap into an almost super-human toughness. Interestingly, however, new findings suggest otherwise. The limits of our performance are located, anatomically speaking, further south and are far more predictable than we might expect. While we've known for a while that over the very short term (minutes) our ability to physically perform work is largely limited by resource delivery (for example, getting oxygen to the muscles), which is measurable and therefore predictable, over the longer term (hours or days) things get a little less clear. We humans, with our advanced ability to "push past" our limits, haven't always seemed to fit the models that explain how other species survive by finding the balance between energy availability and activity intensity in tasks such as migration, hibernation, or others. It's not quite as simple as "calories in and calories out," but as new research out this week has shown, it's closer than we might think.

According to nutrition labels, the average human burns about 2,000 calories per day. Some portion, called the Basal Metabolic Rate or BMR (1500-1700 calories perhaps) is required for basic functions like breathing, digestion, and alertness to danger. Online calculators such as this one can provide a reasonable estimate by taking into account age, sex, height, and weight. The remaining calories burned get added with the activity requirements of our day, whether occupational or recreational, to give us a total daily energy expenditure (TDEE). Ultra-endurance athletes who might train more than 20 hours per week can obviously far exceed the 2,000 per day threshold and, of course, get the performance benefits of doing so. Impressive as they might be, they, too, however, have limits. As we learned this week, the amount of energy they can consume, convert, and utilize before they either can't keep up or things begin to breakdown trying is finite.

To determine this limit, a team of researchers recruited 14 world-class ultra-endurance athletes. It measured their energy expenditure across training and competition of varying intensities and durations over the course of an entire year. As it turns out, a biological limit did, in fact, exist, and it was approximately 2.5 times the BMR for each, a finding that confirmed previous research. While they found that the athletes had far higher peaks in short term capacity, as much as 6-7 times BMR in bouts lasting hours or even a few days, things consistently leveled out by the one month mark ultimately proving that even at the world class level, our ability to push ourselves in activities that last for more than 4 weeks is governed by the gut and its ability to supply energy...which appears to be capped.

There is almost definitely more to learn here, but when it comes to pushing our performance, the real discipline might start with the dinner plate.

Have a great weekend,
Mike E.

Nov 7

When was the last time you had a great night's sleep? You know, the kind of sleep where you wake up refreshed, feeling rested, energized, and ready to conquer the day. If it's been a while, you probably shouldn't feel alone. According to recent data reported by Garmin, the wearable tech giant that measures and scores sleep for its millions of users, only 5 of every 100 people are super-sleepers, scoring in the "excellent" range (at least 90 of a possible 100) on average. The rest of us sit closer to 70, which may partly explain why we spend an estimated $64 billion per year trying to improve it. According to this market survey, many are willing to spend even more. 

While supplements led all categories in the survey above, new research suggests it might be time to reconsider, especially for those leaning on melatonin. As reported by the American Heart Association earlier this week, results of a 5-year look at the effects of long-term melatonin use (defined as 1 year or more) showed that users had nearly twice the risk of developing heart failure as non-users and 3.5X the risk of being hospitalized for the condition. While research on the effectiveness of many other sleep supplements is limited, and some show more promise than others, those looking for a safer and more effective option might do better in the produce section.

As summarized in this 7-minute companion video we asked AI to create, most research on the subject shows that both "what" we eat and "when" we eat it can have an impact on how well we sleep. Refined carbohydrates, saturated animal fats, and any calories within an hour or two of sleep are generally negative, and fiber is generally positive, but exactly "how" they impact us is still coming to light. A review from February of this year showed that not every measure of sleep dysfunction was related to a high dietary inflammatory index, a reasonable estimate for diet quality, which may be good news for those who struggle to limit or eliminate unhealthy foods. Even better, finding ways to add healthy foods may be a very strong stand-alone strategy.  

New research from the University of Chicago and Columbia University last week showed that individuals who ate at least 5 servings (cups) of fresh fruit and vegetables during the day enjoyed 16% better sleep quality that same night as compared to those who did not. It was the first study to show such an immediate and objectively measured effect. While fiber and naturally sourced magnesium (nuts, seeds, and legumes in addition to fruits and veggies) also trended toward a positive impact, red and processed meat consumption trended toward more sleep disruption. 

So, whether it's berries with breakfast, grab & go fruit at lunch, or the "good full" of a dinner that starts with a salad, we can rest-easy knowing an investment of 5 servings today was a good one...quite literally.

Have a great weekend,
Mike E.

Oct 24

For some, it started with an injury from way back when. For others, it was a more gradual combination of tissues that got a little bit stiffer with age and a change in the strength-to-bodyweight ratio, which allowed things to get a little irritated. For many, it's easy to notice after not moving for a while, like those first few steps out of bed in the morning or standing up from a kneeling position. However, for most, as discussed here, it's probably time for a reframing of the conversation.

Osteoarthritis (OA) is a massive, worldwide problem. Some recent data shows that more than 600 million people across the globe work through it every day. The knee(s) is the most common site, accounting for 56% of the cases. Not surprisingly, a significant amount of effort is directed at finding out how to prevent, reverse, and better manage the problem. The good news is, over the last few decades, a lot has changed, including how we talk about the disease; instead of "degeneration" with the sound of inevitability, there is renewed hope in the many promising ways to manage it. The less good news, as is the case with many complex problems, there is no single best or definitive strategy. And so, with that in mind, this week we thought it might be helpful to review some of the current narratives around knee pain with an eye toward those that have a strong or growing evidence base. 

Dial-in Your Diet: Healthy Eating improves knee pain trajectory - the connection between diet and pain of all types continues to gain strength. There appears to be a particular benefit for knee pain sufferers who get adequate fiber. Whether it's this 2017 study, which showed between 24-44% lower odds of experiencing moderate or severe knee pain for those who consumed the most fiber, or this review from a few months back, which included more than 30,000 people over 20 years and showed a 27% risk reduction for those who got enough fiber, the connection is worth our attention. For those wondering "how much is enough?", the research team found that the benefit started between 14 and 27 grams per day. To provide perspective, this equates to only a few servings of common fruits, veggies, nuts, seeds, or legumes as listed here.

Out with the Old: Exercise (and yes, even running) helps - The old narrative, that running is somehow "bad" for the knees, thankfully, seems to be on the way out. A few years back, one review was inconclusive at best, with some data showing the repeated and rhythmic joint loads of running actually had a protective effect. Then, last year, another review concluded there wasn't a link between common forms of physical activity (including running) and disease progression. Yet another, which surveyed 37,000 marathoners, found the usual suspects (a history of hip/knee injuries, advancing age, family history, and body mass index) added risk, but years running, number of marathons, weekly mileage, and average pace were not predictors. In fact, just last week, an extensive review that compared a variety of exercise types to determine which was best found that aerobic exercise, which includes running, outperformed the rest. 

More than "mass" alone - For years, we've known that elevated body weight (usually measured by body mass index, a weight-to-height ratio) is related to knee pain and OA. The compressive forces at the knee during even routine daily activities like climbing steps can near the injury-risk threshold when we are carrying extra weight. However, a more nuanced narrative, that it's not only our weight-to-frame ratio that matters, but the source of the weight that counts, is emerging. This 2024 review showed that both muscle mass index (a ratio of muscle mass to height), as well as sarcopenic obesity (i.e., both low muscle mass AND excess bodyweight), were related to knee OA, but low muscle mass without obesity (sarcopenia) was not. Of course, this was not a perfect review (as pointed out in follow-up commentary here), but it provides an interesting new vantage for those of us trying to ease the knees - lose the weight if able, but stay strong.

There are, of course, many others, including regenerative therapies and approaches to whole body inflammation that should be on the radar, but staying strong, feeding on plenty of fiber, and maximizing movement remain near the top of the list.

Have a great weekend,
Mike E.

Oct 10

Legendary UCLA Basketball Coach John Wooden once said: “Little things make big things happen.”. It's a philosophy many would agree with, whether in sport or in other domains of life, and one that I was happy to see recognized, even if indirectly, earlier this week on Pro-Activity's "Athlete of the Week" post. The accomplishment is clearly a "big thing"; however, the years of steady build-up can't be understated. When we first met Mike, he was a busy professional, a Dad, and an involved member of the local community. He decided it was time to invest in his health, and along with a few of the other ELEMENTS, he got moving, literally, in that direction. What made him different from many, however, is that he never stopped. Running miles became cycling miles, which eventually became hiking miles. Mountains became milestones with selfies from epic (and enviable) locations, and as the post makes clear, steady steps forward became summits with the included bonus of strength, fitness, and health - exactly the kind of adventure many of us hope for in retirement.
 

But maybe you find yourself asking the question we so often get: "Could it really be that simple"? 

Thankfully, the answer is yes...but we should never confuse "simple" with "easy", something a cool new study reinforces this week.

Some history - Before 2010, the American Heart Association promoted "The Simple 7", a group of habits and health measures that they advised to be the most critical in preventing heart disease. The habits included: Avoiding Smoking, Eating Healthy, Getting Active, Maintaining a Healthy Weight, Managing Blood Pressure, Controlling Cholesterol, and Maintaining Healthy Blood Sugar levels. Those who were able to achieve some or all 7 had significantly better health and saved money on healthcare. Then, with growing evidence that showed the connection between sleep habits and health, they added "Get Healthy Sleep" and rebranded the habit cluster as "Life's Essential 8" (4 health behaviors and 4 health factors).

Around that same time, a research team was tracking the health habits of more than 4,000 young adults across 4 major cities in the US in an attempt to understand exactly how protective, over a longer term, these habits could be. With at least 20 years of data, as reported this week in the Journal of the American Medical Association, they found resounding evidence that the effect was massive and that consistency was critical. 

Individuals who achieved and maintained a high healthy habit score (80% average score or better across all 8 markers as listed on page 11 here) and remained consistent over the course of time were nearly 10 TIMES less likely to have heart disease or a heart-related incident by the end of the study period when compared to those who averaged 50% or less. However, the effect wasn't only seen at the two ends of the spectrum. Every 10-point difference in average score changed a person's risk by 53%. 

It's not always easy, but it isn't super complicated - get started as early as possible and keep going until it's a habit - there are amazing views that await!

Have a great weekend,
Mike E.

Sep 26

The story on hydration can be complicated. While we know that dehydration (too little) negatively impacts performance, both physical and mental, we also know that the other extreme, excessive intake of fluids to the point of impairing electrolyte balances (e.g., hyponatremia), can be equally (if not more) dangerous; a counterintuitive risk being seen in some vulnerable groups during heat waves. While some experts have suggested the narrative on dehydration has gone too far, heavily influenced by marketing designed to make us worry - pointing to many of us who rarely leave home without a water bottle in tow as evidence - others cite many known benefits for mind and body and conclude it's worth the effort to get right...which isn't always easy in a world of distractions. While our body has an elegant method for knowing when we need more fluid (thirst) and a variety of processes to deal with scenarios when we truly can't get it, it's relatively easy to misinterpret the signs or miss them entirely. Naturally, therefore, many look for guidance, which in itself can be complicated.

The old rule of thumb (8 x 8-ounce glasses = 64 fluid ounces) has been debated, with sources like the Mayo Clinic suggesting significantly more fluid overall based on guidance from the National Academy of Sciences.  They cite 90 to 125 ounces for women and men, respectively, of which 20% comes from fresh foods. However, they also recognize that the "right" amount can vary significantly depending on personal factors, so "it depends". As someone who isn't always great about sipping on water throughout the day but has found a clear connection between running a little dry and the signs of a more strained system (poorer sleep quality, delayed recovery after exercise and for the wearable crowd, altered measures of heart rate and HRV), any time there's a simpler method being tested I try to pay attention. With that in mind, a new study which focused on something closer to a functional daily intake - an amount that is far enough above dehydration to minimize system strain without being overly concerned with perfection - caught my eye this week.

The study team compared the stress responses in a small, 32 person, group which was made up of roughly half that were in a low hydration state, habitually consuming less than 50 ounces (1.5L) of water per day and half that were adequately hydrated, consuming between 68 oz (2L) to 85 oz (2.5L) per day for women and men respectively. They confirmed hydration status both in the lab (urine osmolality) and by real-world observation (darker urine color first thing in the AM). They then put both groups through a battery of tests known to induce stress, one of which is the gold-standard "Trier Social Stress Test," and monitored 3 markers of stress at various time intervals afterward, including anxiety (as measured by a validated survey), heart rate, and changes in cortisol (a hormone we release in stressful situations). While the sensation of anxiety and the heart rate changes were similar, they found that in the low-hydration group, there was an exaggerated stress response, as measured by cortisol, 50% greater than in the hydrated group. Given the known connection between exaggerated stress responses and poorer long-term health, hitting the minimum in otherwise healthy individuals is a solid first step for those who regularly do not.

What's the catch?

It is worth noting that in the press release made by the UK University where the study was performed, the team made it clear that funding for this study was provided by the research division of a consumer products company, which owns at least one famous water brand. Not enough to dismiss the findings in my opinion, but perhaps enough to suggest the findings should be replicated and verified to make them stronger, which is almost always the case.

Bottom line on this one is that, in addition to keeping an eye on urine color as a reasonable hydration indicator for most of us, if you've got a deadline looming or some other known stressor on the horizon, topping off the tank might be a simple stress-reducing strategy.

Have a great weekend,
Mike E.

Sep 12

Sometimes the health headlines are pretty sparse. The team has to really dive deep to find something that is both interesting and applicable to serve as the focal point of the weekly blog. This week wasn't one of those times. While the FUEL-related headlines over the last few months have been dominated by the pros and cons of appetite-lowering drugs, this week, it was like something let loose, and a backlog of healthy eating studies poured onto the scene. The theme doesn't change much, but the details are getting more and more dialed in.

First, and maybe most importantly, a great new study helped to reinforce an important concept - the compounding effect of stacking good habits by combining FUEL with other ELEMENTS. Whether yours is a "SPAN" (combined emphasis on Sleep + Physical Activity + Nutrition) approach or some other combination, this new study out late last month showed that 2 out of 3 could also have a strong effect. A team compared the effects of a healthy Mediterranean diet (with no other restrictions or parameters) to a combined protocol of calorie-restricted Mediterranean (approximately 600 calories per day less) and regular physical activity, such as a brisk walk and/or balance and strength exercise over a six-year period. In 5,000 adults 55 and older, who were at risk for diabetes, the combined group outperformed the diet-only group (which we know to be powerful by itself) by an impressive 31%. Yet it doesn't end there, especially for those who are ready to zoom further in. 

One really cool study in the British Journal of Ophthalmology, which caught our eye (pun intended) reported on the impact of dietary fat intake on vision in children. They found a clear link between saturated fat intake and nearsightedness, which was significantly less in those who consumed more Omega-3 PolyUnsaturated Fatty Acids (PUFA). While studies like this are only the start of the discussion and not universally applicable, it's probably fair to assume that it's not only carrots which help maintain or improve vision health...if the fats in your diet lean heavily toward saturated fats, it may be time to consider foods rich in Omega 3s like certain types of fish, nuts/seeds and perhaps soybeans. There's definitely more to learn here, but it's possible (and maybe likely) that given the pro-inflammatory profile of saturated fats and the small "pipes & wires" (vessels & nerves) that supply the eye, fats with a better profile are, quite literally, easier on the eyes.

A little lower down the anatomy ladder, another great FUEL study out recently showed that older adults could "rebuild" their oral biome by supplementing a popular endurance-enhancing root vegetable. Yes, it's beetroot juice for the win again, but this time as a way to lower blood pressure by restoring the bacterial makeup of the mouth. Participants, who were broken into groups by age in this double-blind placebo placebo-controlled study, drank a few ounces of nitrate-rich beetroot juice twice daily for 2 weeks. While the older participants saw a notable blood pressure benefit, their younger counterparts, who had a healthier biome in this regard (and therefore maybe didn't need as much of a reset), did not. The takeaway on this one is that our bacterial profiles likely change with age, and although we're not sure if this is "cause" or "effect", there does appear to be a link to this change with heart health. The good news is, these changes are, in part, reversible by eating a diet rich in plant-based nitrates. Beets and arugula are near the top of the list; however, another family of plants may do this and more, according to a couple of studies we had previously missed.

Putting a little more power in the cruciferous column, this randomized controlled trial last year compared the effects of the powerhouse veggie family, which includes broccoli, cauliflower, brussels sprouts, cabbage, and others, with root vegetables and squash. As it turned out, the cruciferous veggies outperformed when it came to blood pressure-lowering effects, but that's not all...another study out this past May showed an intake of +/- 1 serving per day had a significant impact on as many as SEVEN different types of cancer. Specifically, the minimum effective "dose" ranged from 3 to 7.4 servings per week, depending on the type of cancer studied. Those who ate the minimum weekly dose had lower odds of developing cancer (on average) by 23%. Impressive.

Once again, it seems that when we focus on quality foods, mostly plants and not too much, we can put prevention on the menu. Fold in some physical activity and consistently restful sleep, and we've got a very strong platform to build on. Now is as good a time as any.

Have a great weekend,
Mike E.

Aug 29

Muscles may finally be making their way to the main stage. Sure, there has always been a crowd that cares - just walk into any gym, fitness studio, or whatever trendy term is being used today to find them - but solidly typecast in athletics and aesthetics, they've had a hard time crossing over into the mainstream conversation on health. Not even their proven track record for lowering injury risk when strong, in this recent study by 25% or more, even for healthy and fit athletes, has gotten them a shot at the big-time. Recently, however, the idea of maintaining muscle mass and prizing power is gaining traction with a larger and more widespread audience. 

While we clinical folks might like to believe that it's the rising importance of "sarcopenia", that is, abnormal age-related muscle loss, that's driving the conversations, results like these, which show a generally low understanding even among professionals, suggest otherwise. Ironically, it may be the attention-grabbing "baby with the bathwater" headlines associated with popular appetite suppression medications that are providing the spark. While there is much hope for the health impact of lowering body fat this way, possible side-effects of doing so too aggressively, which include strength and muscle mass loss, may be driving the conversation beyond muscle as a body mover, to muscle as sugar sponge and, maybe most importantly, myokine maker.

First, let's review the concept of a sugar-sponge. It's a relatively simple idea. Every time we load our muscles via exercise, active hobbies, or physical work, we are priming them, like squeezing a sponge, to soak up blood sugar for energy production. All physical activity works, but combining resistance (the more muscles engaged, the better) and aerobic exercise is even more effective in both the short term and the long term. However, the trouble with this analogy is that sponges work both ways - they not only "soak up" the overflow (in this case, blood sugar) but they also release whatever they're storing when we next squeeze them, which is where things really get interesting for muscles.

Somewhere around 2008, researchers started using the term "myokine" to refer to certain small proteins produced by muscles and known to play important roles in our health. From reducing inflammation to improving metabolism and lots in between, these proteins play big roles. However, it wasn't until more recently that we learned of their critically important role in supporting brain and nervous system health as well as in lowering cancer risk. It turns out that one of the reasons exercisers have a significantly lower risk of certain types of cancer is directly related to these powerful little proteins. Just last week, an impressive new paper profiled an experiment where researchers added a few droplets of a blood sample taken from cancer survivors after a single bout of high-intensity exercise to a petri dish of aggressive breast cancer cells and showed that they could slow the rate of growth by as much as 30% compared to a sample taken at rest. In plain English, after an hour of exercise and for at least the first 30 minutes of recovery, our blood becomes a potent anti-cancer agent...adding yet another reason to make muscle work a priority.

OK, it's not actually magic, the results in the mirror never seem to show up as fast as we'd like, but within minutes, the myokines will be on the move and the benefits will start. If it's been a while since you wrung out your sponges and soaked up some sugar, there's never a bad time to restart the habit. Whether a structured routine or something as simple as a few push-ups and air squats by your bedside, it all counts. 

Have a great weekend,

Mike E.

Aug 15

Our brains LOVE leaderboards and rankings. They are one of the most popular tools used to gamify learning for a reason and, if well designed, can improve motivation and striving. Although it's more nuanced than simply generating a list, for example, one study showed that the boost in motivation was more powerful for those at the top and the bottom than the middle, the essential premise that social comparison is one of the most powerful levers related to human motivation holds. Preseason rankings get us to scroll, Top 10 lists get us to click, and labels that indicate something has been listed among "the best" grab our attention. Not surprisingly, the rise of "super foods" is not all that much different.

According to the Harvard School of Public Health, the banana was the first real superfood, given that title around the time of World War I to help market the fruit to American consumers. It worked, but the term went dormant for decades until the blueberry was given the label for its powerful antioxidant capacity. From there, things snowballed. Growers and sellers began to realize the power such a label had in grabbing our attention (and our money), and despite the fact that it is more pop culture than rigorous science, many scrambled to show their product belonged on the list. Grape growers, for example, funded research to make their case in a paper that was published only a few weeks ago in hopes they might ascend the rankings to be up near greens, grains, berries, and seeds, which currently hold 4 of the top 5 spots.

We are often just as curious about foods on the other end of the spectrum. Although "junk food" doesn't seem to have the same branding power as "super food" (maybe because there are so darn many of them), "ultra processed food" is a term that is definitely gaining popularity as a way of pointing out that health is not only the result of "what" (ingredients and nutrient profile), but also "how" things are prepared.  A few days ago, the American Heart Association published a scientific advisory that dove a little deeper. Unsurprisingly, the essential conclusion was "limit their consumption". This is generally in line with a study published a week earlier, which compared the impact of minimally processed versus ultra-processed diets on weight loss. Even when the diets were "nutritionally balanced", people got double the benefit when eating minimally processed. Then on Monday of this week, the British Medical Journal dropped the results of a massive study which propelled one particular food to super-villain status.

If you guessed "the egg", guess again. Although often the center of debate, at least for its role in raising cholesterol and for the time being, the egg (when consumed in relatively low doses) has been taken off the naughty list, according to a recent study. The French Fry, however, is another story. After working with the health data of more than 200,000 people, which spanned more than 5 MILLION person-years cumulatively, researchers found that it wasn't consumption of the starchy spud per se that drove metabolic disorders in the more than 22,000 individuals who developed type 2 diabetes during the time, but rather how it was prepared that mattered. Individuals who consumed 3 servings of fries per week increased their likelihood of developing the disease by 20%, a number which continued to grow in cases when consumption was higher. Those who ate similar portions of potatoes prepared differently (mashed, boiled, baked, etc.) did not experience an increased risk. Of course, replacing those same three servings with whole grains (which are often on the superfood list) was even better, lowering the risk by 8%.

Simply put, we continue to learn it's never quite as simple as we might like when it comes to nutrition. Just as the effect of what we eat extends far beyond the individual nutrients contained within, how foods are prepared plays a significant role in determining what winds up on our plate. Can you guess which other foods have made the top 10 according to our research? Ask a member of the team, they got the list hot off the press just a few hours ago.

Have a great weekend,
Mike E.

Aug 1

Move enough, Fuel with high-quality sources, Recover fully, repeat. It's a remarkably simple formula that produces impressive results for just about anyone who can figure out how to make it work in their life. However, not unlike the difference between longevity (years alive, aka lifespan) and healthy years (disease-free years, aka healthspan) - which is more than a decade on average in America - the gap between "should do" and "can do" often feels more like a chasm. This is especially true for anyone who gets caught in the all-too-common trap of all-or-nothing thinking and misses the many available rewards for those who even do a little bit. 

The good news is, there are many rewards for implementing micro-habits. For example, just this week, 3 great new studies provided additional proof that the "3-legged stool" we so often talk about (Physical Activity, Healthy Diet, and Restorative Sleep) are each extremely powerful in helping us maximize our health.

 MOVE: The first showed that a 15-minute "fast walk" per day lowered the risk of dying prematurely by 20% in a group of 85,000 high-risk individuals in the Southeastern US over a 15+ year observation period. Interestingly, the short/fast walk provided 5X the benefit in 1/12th the time when compared to long-slow walking minutes. The long, slow walkers got a 4% average benefit at the 3-hour per day mark. 

 FUEL: The next showed that achieving and maintaining one of 3 healthy diets decelerated the progression toward disease in a sample of nearly 2,500 seniors over a 15-year period as compared to a reference diet, which accelerated the same progression. The net gain was as much as 10%.

 RECOVER: The last showed a link between low sleep quality (i.e., more than just hours per day) and 172 different diseases...92 of which had at least a 20% increased risk when sleep quality was low and 42 of which had double or more the risk. 

 The less good news is, the trade-off for the stronger statistical confidence research teams get when isolating single habits (a good thing), is a more limited understanding of the synergies and compounding effects we can get with stacked habits or something closer to a diversified habit portfolio or index-fund of habits for those who use similar tactics for a financially healthy future. Unfortunately, there just aren't that many studies that look at combinations...but there are 2 this year that considered the combined benefit of Sleep, Physical Activity, and Nutrition, and how powerful it could be to help us SPAN the gap (see what we did there?).

The first, published in February of this year, showed that people who maintained the optimal daily SPAN of at least 7.2 hours of sleep, 42 minutes of moderate to vigorous physical activity and a dietary score of at least 57.5 on a 100 point scale (which gives points for adding fruits/veggies/whole grains and cutting back on processed meat, refined grains and sugary beverages) had 64% lower risk of dying during the 15 year study period when compared to those in the bottom 20% who averaged 5.5 hours of sleep, 7.3 minutes of physical activity and a dietary score of 36.5. However, and where it really got interesting, was in teasing out the benefit available for those in the bottom 20% if they could nudge each habit a little bit. While a "minimum dose" of 15 extra minutes of sleep, 1.6 extra minutes of physical activity and a diet quality bump of 5 points (1/2 serving of veggies per day) could cut risk by 10% - about the same amount as adhering to a healthy diet in the study above - combining an extra 1.25 hours of sleep with 12 minutes of physical activity and 25 diet points could cut the risk of dying in half. 

The second SPAN study (in pre-print), which looked at the same population to assess gains in disease-free "healthspan" years, found that those in the top 20% gained more than 9 years of healthspan compared to those in the lowest 20% which just about closes the average gap. In addition, by getting as little as 19 additional minutes of sleep, 4 extra minutes of physical activity and adding 21 diet quality points (such as by adding a cup of veggies and a couple of servings of fish per week) the folks who were most likely to struggle in the healthspan gap (alive but not healthy) could add 4 additional disease free years.

The power of small investments in a diversified portfolio allowed to compound over time isn't reserved for financial investments, and the quality of life divide is neither inevitable nor impassable...we just have to be willing to SPAN the gap. Let us know if we can help.

Have a great weekend,
Mike E.

July 18

In the 2009 best seller "Emotional Intelligence 2.0" (and in a more recent follow-up), the authors make a very clear statement - our emotions drive our actions, whether good, bad, or otherwise, and therefore, when we understand and manage them with skill, we are more effective and can be happier. They then go on to show that, different from traditional markers of intelligence (e.g., IQ) which are mostly fixed throughout life, "EQ" can be developed over time...and that it might actually be the more important of the two types of intelligence. 

It was a strong and maybe even a bit of a controversial statement at the time since IQ-powered abilities such as quickly solving problems with information and logic were still almost exclusively the domain of humans and therefore highly prized. However, in today's context, where AI can handle a rapidly growing number of IQ tasks faster and more accurately, the scales may be tipping the other way. According to some new research, developing our EQ may also shed light on a path for improved health and well-being. 

It starts with self-management, which the authors describe as one of the 4 key areas associated with EQ and is similar to self-regulation theory in psychology. Distilled way down, self-regulation is "the control [of oneself] by oneself," and puts emphasis on emotions, thoughts, and behaviors, as well as the brain structures that control them. Since neural connections get both stronger and faster with use, when we practice self-management deliberately and healthily, the circuits that control emotions, thoughts, and behaviors get easier to access and more automatic. And, since many of those same circuits are called to action when calm and focused in an otherwise noisy world serves us best, they are critical for the long-term health and safety we want for ourselves and those we care about.

With that in mind, this week we offer up a few places where we can leverage the practice to get especially powerful results:

1. Take back Monday: It's easy to find ourselves a little more amped up on Sunday evenings as the weekend comes to a close and the work (or school) week looms. While it doesn't have to be a full-blown "case of the Mondays", recent research shows that if this emotional ramp-up becomes a habit, it can have longer-lasting negative impacts on our physiology than we may expect. On the other hand, other research showed that people who deliberately inserted a healthy habit on Mondays (in this case, a dietary effort) improved their odds of growing the habit by as much as 15 times. For most of us, Monday offers a natural opportunity to practice "starting strong"...take it back.

2. Walk Away From The Screen: Not yet convinced that screen-time and the addictive overstimulation that comes from the media & gaming tractor beam it wields is taking a toll on our health? New research, published in the Journal of the American Medical Association this week, showed a clear and concerning connection with screen time and high-risk mental health trends in US Youth. However, since walking and other recorded movement minutes are strong predictors of both mental and physical health, there's a strong case for walking away from the screen when able. Doing so with a strong "why", such as a way to CONNECT with friends, enjoy a beautiful space, or challenge oneself to build a new healthy habit, may enhance the effect. If for no other reason than achieving 100 or more moving minutes per day, which may be the threshold required to prevent chronic back pain, getting good at getting away can be a powerful tactic.

3. Empty the Tank: Although more nuanced for people with certain risks or conditions (check with your healthcare provider if you're unsure), there is a growing body of evidence that shows metabolic health improves when we self-regulate our consumption patterns in a way that temporarily restricts energy intake. Whether calorie restriction, regular fasting (such as a 5 day "on", 2 day "off" model) or time-restricted eating (eating all calories in a 10 hour window for example), new research presented at The 2025 Annual Conference of the Endocrine Society last Sunday, showed that while some markers of metabolic health improved across all groups reasonably evenly, the fasting group did the best at lowering blood sugar and triglycerides, while improving insulin sensitivity. However, this may not be purely a physical phenomenon. One new study showed that the health benefits of fasting were linked with baseline measures of well-being before the fast even began. Said another way, it's proof that emotional states impact our physiological response to the food we eat. Fascinating stuff.

We can't always control the moments that spark our emotions, but if they drive our actions, which drive our habits and thus our health...getting good at recognizing and managing that spark may be the most intelligent thing we can do.

Have a great weekend,
Mike E.

July 3

Resolutions becomeTax Day then Memorial Day, oh my - the days are long but the years do fly. It's hard to believe, but as of yesterday we are closer to '26 than '24, past this year's halfway point, a great time to think about where we've been and where we're trying to get to. When we set out this year there were a few themes that were top of mind and felt important enough to keep an eye on. The value of building health assets (reserves) now which could be drawn on later, strategies to enhance and improve metabolic health and how our connections at work, home and play are impacting our effectiveness, were all on the watch list.

Even in what has felt like the blink of an eye, there have been some cool findings since January. While many have added refinements to already well established themes, this week we found a few that relate back to those original 3 we identified.

First - the need for speed. There has been a resurgence of interest in gait as a fundamentally human movement and therefore worthy of attention. Coaches who have an interest in power, which is critical for both sport and longevity, are emphasizing the value of practicing it at top speed. As it turns out, it's not just sprinting that matters. Our "reserve", the difference between how fast we are able to walk (top speed) and how fast we choose to (self-selected speed), called "Gait Speed Reserve", might be an important indicator of overall health. In a 2025 study of more than 5,000 adults, height adjusted gait speed reserve tracked closely with handgrip strength (a well known health indicator) as well as cognition and balance. It was negatively associated with smoking, leg pain and body weight. Building health assets may mean keeping our top gear accessible, longer.

Next - a whole new take on "base" training: Loading up on fiber helped lower the impact of dietary acid. In a randomized crossover study published this month which asked participants to swap foods known to increase the dietary acid load (meat, cheese, eggs and dairy) in favor of high-fiber foods which lower it (fruits, veggies, legumes, etc), researchers found a significant difference, especially in body weight. Participants lost almost 1 pound per week for 16 weeks on average.

Last, and also out in the first half of this year, a look at emotional contagion in teams showed a strong connection to wellbeing. While the study did not explain why certain teams are more susceptible than others, it found that when measures of contagion were high, wellbeing suffered more during stressful times. This suggests that investments in team dynamics might hold an important key. If the people around us have a strong influence on our mood, one of the known indicators, they are also likely to be having a strong influence on our health.

If the first half of 2025 is any indication of how fast the second half will fly, we will be talking about the holiday season and the best way to celebrate a semiquincentennial before you know it. 

Have a great weekend...and happy 249th birthday USA.
Mike E.

June 20

It was a trip that had been on my radar for a long time. Unfortunately, between the cost and the long list of calendar competition, we could never quite make it happen. So this year, when the stars seemed to align, the trip to Italy was a go. Throw in the perfect Father's Day gift, which included a few Mediterranean superfoods in the moments between breathtaking art and history, and I was all in.

We got off the train in Florence and immediately onto the bus toward the grape & olive farms of Tuscany, thankful that things were running on schedule. The 45-minute drive flew by as we learned about warring kingdoms, the few castles that remained, and how their towers, a bit like Lord of the Rings, were used to signal the approach of enemies. At the first location, the 5th generation owner proudly showed us their view. It was like something you'd see in a book; rolling hills of grape vines and olive trees as far as the eye could see, touched by a blue sky which just begs you to exhale and slow down. We sat at their table as they explained the process and took our first bite of local bread drizzled with home-grown olive oil. We were blown away.

While not all of the studies support findings like these from 2018 which showed that a Mediterranean diet supplemented with olive oil was related to a significantly lower risk of cardiac events in high risk individuals (approximately 30% lower), many do suggest that this dietary style is at or near the best from a health perspective. So while a very recent animal study which warns that a fatty acid contained within the oil can trigger fat-cell growth (and possibly obesity) seems like a downer, we can feel good knowing that the general consensus is very positive. The even better news may be that we don't have to get things perfect to benefit - two new studies from Canada point the way.

The Portfolio Diet which invites people to choose from "a portfolio of cholesterol lowering foods" like nuts & seeds, fiber, plant protein, plant sterols and MUFA (monounsaturated fatty acids like those found in extra-virgin olive oil) to improve the health value of their overall diet was found to work well in a sample of 15,000 studied. An 8-point increase in the Portfolio Diet Score was associated with a 12% lower risk over the 22-year study period. In another study (also out last month), the approach proved positive for a younger population as well. The analysis indicated that while those who followed the diet closely might add more than a decade of life in the low-risk category, it also showed that even for those who only got it done 50% of the time, 6 years could be added - a fantastic result for relatively low adherence.

While I could easily be convinced to head back and collect more data soon or make a recommendation if you're looking, I'm betting The Portfolio Diet App will be a whole lot easier to implement.

Have a great weekend,
Mike E.

June 6

Whether it's the Teachers College at Columbia, the approximately 40,000 or so articles found on Google Scholar, or the countless videos on YouTube, the idea that eating a naturally colorful diet is related to good health is both simple and widely promoted. Most people have heard of it and generally accept it. However, when asked why the approach is so effective, people tend to falter. With that, here is a very short, slightly more nuanced dive into the idea.

First, we know that a diet rich in fruits and veggies tends to be healthy. We talk about it almost every week here and have at least a few references in each of our monthly sessions for groups who get them. There are almost too many sources to point to which prove the point. We know it's not only the micronutrients on board, known to help with specific diseases (e.g. vitamin C and prevention of scurvy, circa 1747) but also the fiber that healthy gut bacteria like to eat and grow on that matters. As our understanding of the link between gut health and whole health has grown, so has the relative importance of adding variety to our daily consumption patterns. We've mentioned several times the power of eating "30 different types of plants per week", a challenge that started when a massive data-collection effort reported in 2018 showed that a healthy gut was related more to dietary diversity than any one generally healthy pattern (e.g. vegan, Mediterranean, etc). Then, just last week, we wrote about the power of foods like garlic to improve aerobic performance and perhaps even rejuvenate aging cells in our arteries, a build on other super-foods we've mentioned in the past (berries, walnuts, beetroot juice, etc). But the question remains, is our dietary color profile as important as we tell the kids? If so, why?

The beginning of an adequate answer came earlier this week courtesy of a multinational team from Australia, Austria, and Spain. They found, in reviewing the records of more than 100,000 people, that as the overall consumption of flavonoids (micronutrients that give plants their color) went up, health risks went down. However, and this is where it gets especially cool, the risk dropped even further for those who were getting both a high quantity and sourced from a wide variety of plants...and not by a little bit. Specifically, they found that "Holding the quantity of flavonoid intake constant, participants with the highest (compared to lowest) diversity (Q5 versus Q1), characterized as consuming an additional 6.7 effective flavonoid types per day, had a 14% lower risk of all-cause mortality, a 10% lower risk of CVD, a 20% lower risk of T2DM, an 8% lower risk of total cancer and an 8% lower risk of respiratory disease.". The authors went on to say that they believe their study could be an important contributor in updating healthy eating guidelines from 2022 which suggested that getting "enough" flavonoids (400-600 mg per day for heart health) was the target to one that adds in something like "from a wide variety of sources".

Need some ideas? A fruit salad with berries, grapes, and maybe even a little bit of local honey to add sweetness or a couple of glasses of tea during the day could go a long way in incorporating the list of foods specifically mentioned as strong sources in the study: Tea, (green and/or black), Berries, Apples, Oranges, and Grapes....or, as they tell the kids, eat the rainbow every day.

 Have a great weekend,
Mike E.

May 23

We started this year with a nod to the growing body of research that points to metabolic health, that is, our body's ability to efficiently break down and utilize food as FUEL, as a major driver of overall health. From early January until mid-February I wrote about it. In April the team gave presentations about it and now, here we are nearing the end of May and another big contribution to the evidence has been published.

This time, it was a profile of nearly 50,000 women over more than 30 years in an effort to tease out whether carbohydrates are actually the villain many seem to make them out to be. The article, which was published in the Journal of the American Medical Association on May 16th, made it clear that if we want to be accurate in our understanding, it's a whole lot more nuanced than standing in a "carbs are good" or "carbs are bad" camp.

How the study was conducted:

Researchers used sophisticated math (multivariate logistic regression) to determine the odds that a person would age healthily over the 32 years between 1984 and 2016 based on their self-reported dietary habits with a specific focus on their carbohydrate consumption and where those carbs came from. After statistically scrubbing out a variety of known health contributors and detractors, they had more answers. 

Healthy aging was defined as reaching the age of 70 years old while not only avoiding 11 different highly prevalent chronic diseases (1 of 4 domains) but also receiving high marks on measures of physical, cognitive, and mental health (the other 3 domains, defined here)...or as my colleagues might say, "stronger, happier people through better health"....thriving.

What they found:

The short, short version is - most people's general definition of good carbs (sourced from fruits, veggies, whole grains, and legumes) which the research team called "high-quality carbohydrates", did indeed increase the odds of aging well, providing an overall boost of 31%, while lower quality carbs (sourced from refined grains & sugars) and less-good carbs (starchy vegetables) lowered the odds of healthy aging by 13% and 10% respectively. Not surprisingly, fiber consumption was also a good thing, improving the odds of aging well by double digits, with fruit (14%) and veggies (11%) providing better results than cereals (7%).

The slightly more in-depth version is - high-quality carbohydrate consumption improved the odds of healthy aging across all domains of health (8-24%) with carbohydrates from fruit (6-9%) and fiber consumption (5-15%) being the only subsets which increased the odds in all 4 domains of health. Veggies, whole grains, and consumption of fiber from cereals impacted 3 of 4 domains positively, while starchy vegetables lowered the risk of chronic disease but were not positively related to the remaining 3 (physical, mental & cognitive health). Refined carbs performed the worst, lowering the odds in 3 of 4 domains of healthy aging.

Finally, when they considered substituting macronutrients, which often occurs when people adopt an eating style that minimizes any one macro (such as low-fat or low-carb), swapping high-quality carbs improved the odds of aging healthily in most cases. Only plant-based protein and healthy-sourced saturated fats outperformed high-quality carbs. On the other extreme, substituting "any carb" for other macros was only positive when swapping out total fat and trans fat (graphic here).

The Take-Away:

This is another great analysis of a lot of people over a long period of time which says if you wonder if carbs are good or bad for health...the answer is "yes". However, when we consider the source, things become a lot clearer. If you spend time in the garden or the farmer's market this time of year, you're on the right track.

Have a great weekend,
Mike E.

May 9

If you've ever pushed your physical limits - no matter if at work, at home, or in sport - you've likely experienced a strain or sprain. They account for about one of every three injuries in the American workplace and when lumped together into the more broad category of "soft tissue" or "movement-related pain" are by far the most common type of injury, representing more than half (58.3%) of the 6.7 million non-fatal injuries reported in the last year on record (2021-22). It's a BIG number and it not only represents a lot of people who are hurting, but also a largely preventable drag on both the quality and, as one 2017 study, showed knee arthritis to be an even greater predictor of dying over 15 years than smoking or diabetes, quantity of life for those impacted. Movement, as we are fond of saying, is a window into future health.

Six weeks from today, on Friday, the 20th of June, we will once again enter the official Summer season, a particularly high-risk period for aches, pains, and injuries of this type. While many forces and factors impact total risk at play during the Summer, the heat, as a fatigue accelerant, is one of the most important. Cardio-fitness improvements (4-6 weeks), acclimating (10-20 days of exposure), hydrating (ongoing), and "cooling" the working tissues in order to maximize recovery time are all important. However, as the Pro-Activity team began to pull resources for our annual dive into Summer-preparedness for clients who get regular educational content, 3 studies jumped out at me that are worth sharing - 2 with new ideas and 1 with even better proof of an old standby.

First, the standby. Strength training reduces injury risk. This 2025 review of 15 randomized controlled trials of team-sport athletes set out to determine whether strength training could reduce soft tissue injury risk. The answer, which shouldn't surprise anyone, was "yes". Strength training improved movement proficiency, corrected muscular imbalances, and not only reduced injury incidence but also improved performance. If we want to strain-proof our muscles, maximizing their capacity to do work makes sense. Starting now with even as little as 10 minutes of bodyweight-oriented exercise will make a difference when peak Summer is here.

Next, a really "cool" idea that sounds a bit like sci-fi could be the future of risk screening for strains. A research team from China set out to determine whether infrared imaging combined with artificial intelligence models could accurately scan and find body areas showing localized and abnormal inflammatory responses after physical activity and whether these "hot spots" were precursors of injury. It passed the first test - the team concluded that the infrared thermal monitoring system "can effectively identify the abnormal hot area of the athlete's body". Now, while I suspect most of us who try to "listen to our bodies" would be close if asked which body areas were a little "angry" after a hard bit of physical activity, we might be more inclined to actively cool those hot tissues if we saw red on the screen. However, since most fires require 3 elements to start or persist, one of which we can't live without (oxygen) and the other which ramps up dramatically in the summer (heat), the final question is - can we strain proof ourselves by minimizing the last component, inflammatory fuel?

Of course, this is a concept that we've pointed to many times - lowering whole-body inflammation by changing the gut biome through diet can make a risk-lowering impact. This study from March showed that both fiber and protein sources impacted detectable inflammation in the body. Individuals who reported higher fiber intakes and lower animal protein consumption had lower levels of resting inflammation. "If only you could package the inflammation-lowering benefits of a healthier diet into a pill," you say. Well, people are trying. It's still early days (this was a rodent study), but the results are certainly interesting. The research team found that by giving rats a probiotic to stimulate the gut biome for 8 weeks, they were able to protect the skeletal muscles mostly by improving their efficiency in processing fuel. While not the first time the connection between metabolic health and muscular health has been made - this 2020 study for example showed that adults with metabolic disease (less efficient at converting fuel to energy) are more likely to have musculoskeletal pain, inching closer to knowing exactly which levers to pull is certainly intriguing.

It's time to start strain-proofing for Summer. Changing the FUEL mix, cooling the hotspots, and adding capacity with strength is a great way to start.

Have a great weekend,
Mike E.

Apr 25

Historians group periods of time in eras. Terms like Prehistoric, Middle Ages, and Modern are some we recognize. While it's possible that history will show artificial intelligence acted to spark a new era where we humans directed our limited resources toward new discoveries and let machines summarize the past, right now many are still trying to ride the tidal wave of information which is estimated to double every 17 years, by surfing the headlines. The pitfalls of this strategy should be obvious, especially in cases where proprietary algorithms decide which undercurrents we are actually exposed to. And so, in an effort to do our part, this week we bring you an update on FUEL, which compares Pro-Activity's essential message on the topic (gleaned from decades examining the research), artificial intelligence's take, and a few recent and intriguing updates which add to the discussion.

First, Pro-Activity's historical take: 

• Eating primarily real food, loaded with nutrients and fiber, low in sugar and other inflammatory agents, which can provide the energy needed to stay strong both physically and mentally without straining the body to actually utilize can prevent disease, lower injury risk, improve recovery from the day to day and dramatically increase the odds of living a long healthy high-quality life for those who do so consistently. Said another way - eating primarily perishable foods with heavy doses of plants in an effort to avoid extra sugars and processing, with a nutrient profile we can use without straining the system to do so yields the best results.

Or, as summarized by one of two AI tools - 

• Nutrition helps prevent and manage chronic diseases like heart disease, diabetes, and obesity. Diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats have been linked to a lower risk of chronic diseases. 

• Plant-based and Mediterranean diets are especially effective. These diets are shown to reduce inflammation, improve metabolic health, and protect against heart disease and cancer.

• Micronutrients are essential for long-term health. Vitamins like D, B-complex, omega-3 fatty acids, and antioxidants help reduce the risk of age-related diseases such as dementia, osteoporosis, and cardiovascular issues.

• Nutritional monitoring by professionals enhances prevention. The involvement of trained nutritionists significantly improves the prevention and management of noncommunicable diseases through dietary planning and education.

• Early-life nutrition impacts long-term disease risk. Proper infant and childhood nutrition is linked to reduced risks of allergies, obesity, diabetes, and cardiovascular diseases later in life.

Conclusion: A nutrient-rich, balanced diet is one of the most powerful tools for preventing chronic diseases and promoting long-term health. View the full AI review (and references) from two sources, HERE

 
And last, adding some of the latest wrinkles in the literature and zooming from wide to narrow - 

• In a study of more than 100 countries that looked at dietary patterns and longevity, concluded that in particular, where we get our protein (animals vs plants), plays a significant role in longevity with a decreasing value of animal-based protein after the age of 5 with the risk-benefit tipping toward plant-based protein by 15 years old (figure 5).

• Zoomed further to the small-group level, in generally healthy young adults (50 university students), new research showed that dietary patterns high in processed sugar and saturated fat (i.e. those mimicking the "Western diet") had immediate impacts on brain-body function, most specifically in students' ability to navigate a virtual reality maze which relied heavily on spatial awareness.

• Zooming way in, at the tissue level, a new randomized-controlled trial showed that in regards to building muscle, after stimulating growth with strength training, as long as we get enough protein, the source (animal vs. plant) may not matter all that much. The individuals eating an omnivorous diet did about the same as those eating vegan.

Or in the fewest words possible, it seems Michael Pollan's message is still generally right - "Eat Food. Not too much. Mostly Plants.".

Have a great weekend,
Mike E.

Apr 11

When it comes to health, some bits of information have proven so reliable that they have attained the lofty standard of being a generally accepted truth. "Eat Right, exercise and get good sleep" certainly fall within this category, and "don't smoke, learn to manage stress and practice good hygiene to minimize the spread of disease" are also on most people's lists. However, and as we hope is made clear each week here, the details contained within those truths are always being examined. Occasionally, new information is so impressive it shifts the narrative toward something simpler than we previously thought, making the benefits of a healthy lifestyle more accessible to an even larger number of people. Exercise has experienced such a shift. The last few years have seen significant refinements in what we thought we knew, showing clearly that benefits can be gained earlier, easier, and in a way that fits into more people's lives. 

 For example, while knowledge that there are major benefits in accruing 150 minutes per week at a moderate intensity, we also (now) know that to some extent we can trade time for intensity and either cut the total time required if we are willing to push a little harder or still get impressive gains when we need to go a little easier. We also know that so much of the benefit comes so early in the process that even "movement microdosing" (stairs, squat breaks, etc) inserted into an otherwise sedentary day can be especially powerful; and in March of 2023 we learned that the beneficial threshold for incidental movement (as measured by steps per day) might be lower than we previously thought - 8,000 steps is enough to make a major difference in risk - even when only achieved twice per week.

Over the last six months, we learned that the frequency of exercise sessions can also be compressed without losing much benefit. This study, which we blogged about in October of last year, was great news for those who feel too busy during the workweek to fit in a consistent movement practice. Contrary to conventional wisdom, it showed that even "weekend warriors" who do all of their exercises in a compressed two-day window, can get most of the benefits that those who have a more consistent pattern get. New research that tested the weekend warrior method against a different dataset found that for some risks, we might even do BETTER this way.

When a research team looked at data from nearly 100,000 accelerometers (such as those in our phones or watches that measure movement) worn by individuals who they tracked for nearly a decade, they found that those who got a full week's worth of exercise (e.g. 150 minutes) over a two-day window, such as the weekend, actually did marginally better than those who had a more consistent pattern of exertion. "Weekend Warriors", who accounted for about 42% of the total group (nearly double the 24% classified as "regularly active"), had more than a 30% lower risk of dying from any cause or from heart disease when compared to the sedentary group as well as more than a 20% lower risk of dying from cancer. While the active group also had a significant risk-lowering effect for all causes, cardiovascular disease, and cancer, the benefit was 6-8% less in each area. The only caveat, as mentioned in the American Heart Association's press release, is that "ramp rates" matter - that is, muscles, joints, bones, and connective tissue (the moving parts) need to be ready for heavier loads so while "winning the weekend" is clearly a win for future health, building up a load-tolerance before (literally) jumping in with both feet, would be a wise choice. 

It's a great time of year to get out there. There's wisdom in working up to it but there's health in making this weekend one that moves.

Have a great weekend,
Mike E.

Mar 28

Imagine watching someone getting ready to do a "push-up" for the first time, maybe your child. They assume the position with hands on the floor, body straight, core tight, and knees off the ground and then suddenly they let go of all muscle tension, flop to their belly with a loud thud, slowly push up, return to the starting position and proudly exclaim "one"...only to repeat it a few more times and then look to you for approval. You might think of a creative way to suggest that something seems a little off...can you spot it?

It may not be obvious to everyone, but, despite the name of the exercise, most people who've done it know that "pushing-up" is only part of the movement...and that "controlled lower" and "brief stop"(or sometimes "hands off" even) broadly represent the other parts. As humans, we are constantly changing directions...which means we are also accelerating, decelerating, stopping, and then accelerating again. When it comes to injuries, it's during the deceleration and stopping where things often go wrong and yet few people actually focus on improving or maintaining the ability to do so.

Recently, however, eccentric training (the technical term for focusing on the controlled deceleration of the load more than the acceleration of it) has gained more attention. Studies from the last few years have shown that focusing on getting stronger by resisting while the muscle lengthens can improve strength and also promote gains in joint flexibility, muscle performance, and injury risk over time (especially in the lower body), and may even have more holistic health benefits like lowering blood pressure. This week, from a team in Australia, the news got even better after they found improvements in strength, flexibility, fitness, and well-being scores after 4 weeks of a low-dose home-based plan that emphasized eccentric exercise.

The protocol, a 5-minute bodyweight circuit that included 10 repetitions of chair squats, chair reclines, wall push-ups, and heel drops was performed daily. While there were no appreciable changes in global health measures or muscular power movements (such as body composition, resting heart rate, blood pressure, or various jump tests), there were notable gains in strength, flexibility, fitness, and mental health (such as isometric leg strength, push-ups, sit-ups, sit and reach, 3 min step test and the SF-36 as wellbeing survey).

While in the study's press release, the author acknowledges that 5 minutes doesn't achieve physical activity guidelines, he makes a point of saying it's a great starting point for those who need one. I couldn't agree more...don't be surprised if your local Pro-Activity professional incorporates a few eccentrics into your next visit.

Have a great weekend,
Mike E.

Mar 14

Life moves pretty fast these days. At times, it seems like what was new yesterday is commonplace today and outdated by tomorrow. Of course, the speed of innovation wasn't always so fast. By some accounts, it took at least 1800 years from the first proposal of the sun as the center of our planetary system (heliocentrism) to become conventional wisdom. However, as communication improves and ideas are less degraded by "the telephone game" of person-to-person verbal transfer (stories), they can spread much faster. In a very simplified way, this may explain why the "meme" has become so powerful as an agent of change. It is fast to transfer and arrives mostly intact, passing on from person to person quickly and often aided when it is funny, strange, or too emotionally gripping to not pass along to those you care about most.

Health information is often at the mercy of the meme. What actually works (eat right, exercise, get good sleep, manage stress, and connect with others) is not particularly exciting or funny or emotionally gripping. Unless used as a lever for an adventurous life, ironically it is the lack of health and the chaos it tends to bring, which is more emotionally gripping than the relative ease and low-stress nature of many generally healthy days. It's just not that exciting to tell friends over and over and over that no matter how many times they are studied, those same 5 actions pile up to success.

On the other hand, since the funny and weird ARE super entertaining, every once in a while, I like to bring you a few of those. It's entirely possible that these ideas will grow up to be major changes in our thinking - that we here on earth are not, in fact, the center of the universe, for example - or, they may just be entertaining health memes for around the dinner table...only time will tell. So in that spirit, here are three bits of strange science that caught my eye:

1 - Fish is CONNECT Food: Changing the inflammatory load in our diet can have an almost immediate impact on our brain. This animal study from The Ohio State University for example, showed that older rats eating a diet more heavily loaded in saturated fats had rapid changes in memory and learning functions. However, where it gets a little strange is on the other end of the age spectrum. This study observed that children who ate fish more frequently, a known source of "good fat" among other nutrients, were more prosocial. That is, by the time they were 8 years old, they showed a better ability to work in teams and with peers. The researchers recommend 2 servings of fish per week. It's probably a stretch, but if yours is the child who is not playing nice in the sandbox, or you find yourself with the same tendency in the work "sandbox", check your FUEL.

2 - Long Ring Fingers Return: In March of 2024, I wrote about this study, which showed a connection between long ring fingers (4th finger) as compared to index fingers (2nd) called a 2D:4D ratio. That study concluded that soccer players with longer ring fingers, which the authors suggest arise from more testosterone exposure when a developing fetus, tended to have better maximum exercise capacity than those who didn't. It was an idea that was super intriguing but just too strange for me to buy into. Well, they're back again in this study, where they show in a small group that long ring fingers also correlate to lower levels of lactate accumulation during exercise, which means an ability to exercise harder, longer. I'm still not convinced, but I am a bit less self-conscious of my weirdly long ring fingers, if I'm being honest. More to come.

3 - Finding the Flow Signal through the Noise: Creative and extreme sports (BMX, Skateboarding, Aerial Skiing, etc) are amazing to watch. The boldness required to hurl yourself through space and the concentration required to defy the laws of physics in order to land draws the spectator in. Clearly, it requires a finely tuned nervous system. New research on skateboarders suggests it's not just the "skater's eye" that drives things... but also their ear. While blocking sound is a smart choice when the world is loud enough to create harm (such as an industrial workplace), it's possible that skaters are proof positive that working with the sounds around us might help us get better at finding enjoyment and flow in a noisy world. While there is definite peace found in blocking out the noise with earbuds and headphones at times, it's possible that in order to achieve creative flow, those who practice finding the signal through the noise may have better odds. Protected hearing is good for our brains; sheltered hearing may not be. This may especially be true for nature-based sounds, which are shown to calm the nervous system. You may not need to be on a skateboard, but the science says to get "out there" and listen.

Hope you found these as interesting as I did.

Have a great weekend,

Mike E.

Feb 28

I had the great fortune of meeting a new-to-me client group this week: people we have worked with for a long time, but I have never personally had the opportunity to meet. It required some travel to a city I've never been to. It was, as always, an honor to be given the stage to share Pro-Activity's essential message - that investing time and effort into health is a worthy pursuit; that consistency (even a little bit) will outperform attempting to catch up (even with extra intensity) later and that, although there is great personal benefit from being stronger and happier, the real "why" which gives it such great power, is the far-reaching ripple-effect that pass on to those we care about the most, even for generations.

Since rule number one in these situations is "know thyself", I did what I always do - I set my watch so I wouldn't run over - and then dove into the information containing some of the latest health headlines. In what felt like a few minutes and after a little Q&A, the hour was up. We exchanged thanks, and I got off the stage...and then something really cool happened: a small group used the well-timed break to ask individual questions. This attracted more friends, who eventually became a group of folks who were genuinely curious about using their health to thrive in an otherwise complex world. They asked great questions and allowed me to poke at the barriers that stood between today and an even better tomorrow. I felt lucky to be there working on behalf of one of a growing number of employers who understand that good health is good business...who make easier access to good information a priority for their teams. 

Here are 3 great questions that I wish they would've asked in front of the full group as I am sure many people would benefit from the discussion:

(1) Sleep Health: I currently get 5-6 hours of sleep per night. Why is short sleep such a problem if I feel fine in the morning? 

This is, of course, a great question with a really long answer... but the short-short version is that our sleep cycle generally follows a pattern with deep non-REM sleep cycling in the earlier part of the sleep window and REM cycling in the later part. If we are constantly chopping off an hour or more at the end, we are chopping off a critical portion of our recovery, one that has been implicated in worsening cognitive health as we age. Although there is a minuscule portion of society that can go well on short sleep, it's more likely that you are waking when you are in a higher arousal state, that is "closer to the surface", and have been doing it so long your body is trained to wake up. It would be worth diving a little more deeply into, but one question that's easy to ask yourself is - are you sleepy during the day? If so, that's a pretty good sign your body is under-rested.

(2) Keeping Arthritis "at bay": I'm active and enjoy soccer. I had a knee injury that I rehabbed, and everything is going well, but colleagues have told me I'm more susceptible to arthritis in the future - should I worry about this, and is there anything I can do to keep it under control?

This is a great question that impacts a lot of people. The most important thing to poke at, in my opinion, is - is arthritis (i.e., roughening of the joint surface) always "bad"? What if it's there but not limiting you? Almost everyone who lives an active life will have some roughing of the surfaces of the joints - we work them hard - but if what you see on an x-ray isn't impacting your function, maybe it's not super worrisome. By staying strong and mobile, joints keep working for a very long time. By eating a healthier diet which may decrease dietary acid load, the roughening exists, but it's not as painful or limiting. Google "blueberries and knee arthritis" and dive into the findings a little - it's fascinating stuff (here is 1). Punchline: it's a risk, but maybe it shouldn't be as much of a worry if you have a plan and follow it.

(3) What's the Future: Do you think there will ever be a blood test or marker that tells us enough information early enough to do something about?

Well, yes and no. With studies clearly showing that our health is impacted before we are born and maybe even influenced by the actions and environment of our family tree generations before us, I'm not sure I really believe there is such thing as "early enough". Health is a generational asset - investing in it now will help your grandkids! Now, if I get off my soapbox, I'd say it's promising. This study out just this week showed that proteins from our organs and how they are "aging" can tell us about our health risk DECADES before disease. Most of them were direct lines - if your heart was showing signs of aging, heart disease was the future problem, for example, BUT not all. Kidney aging was tied to a variety of diseases, and, counterintuitively, immune system aging was the strongest predictor for brain risk. There's a lot more to learn there, but that definitely makes me want to keep my fitness up, eat in a way that doesn't over-inflame my system, and get plenty of rest - all of which are tied to immune health.

There were so many more great ones...I sort of wish we recorded the conversation because it's always SUPER fun for me to see the lightbulb go on for people and them realize how much power over their future health they really do have.

Thriving is complex, but we don't have to over-complicate it. If we invest some time, every day, even if only a few minutes when life is especially busy, we and everyone around us will be rewarded for the effort. 

Have a great weekend,
Mike E

Feb 14

So here we are, our final chapter in the blood glucose monitoring experiment. 30 days of experimentation went by pretty fast. We've learned a ton about our habits, how surprisingly easy they can be to change under the right conditions, how counterintuitive that feels to write, and a bunch about why metabolic health is truly a priority along the way.  Honestly, it's too much to capture in a blog that is designed to be a few minutes read each week, so if you're looking for the "TLDR" version of this journey, I'd say the following 4 sentences contain most of what you should know:

If you are a US-based consumer, sugar is everywhere, and you are probably ingesting more than is healthy. Unless you are training for something, even if you do hard physical work every day, it is unlikely you are moving enough to use it all for FUEL. This creates an energy log-jam that our bodies & brains are valiantly fighting to keep up with, but, sad as it may be, are losing over the longer term if we consider the millions who are progressing to diseases now tied to this root cause. For those who desire to more deeply explore their day-to-day AND are evidence-oriented enough to actually follow the path it lays out, a continuous blood glucose monitor can make it easier to change course when needed. In short, this is a story of hope...but not necessarily ease.

Let's start with 3 observations from this week:

1. Doubling down on deferring, getting the most from the important meal of the day: Building on last week, changing the AM routine was hard at first, but it's been good enough to work to make it a keeper. By replacing the order of our eating from one that is carb-dominant in the AM to one that shifts more toward protein and fat in the morning, we saw cool changes. Sugar spikes were blunted, and we felt fuller longer, but that's not all. Early indicators say our bodies are getting more efficient at using the "other" physiological fuel, the energy stored as fat during the day, which is also known as "fat adaptation," a phenomenon studied as early as 1985. It feels important to point out, however that while this approach DOES likely turn the dial toward burning more fat throughout the day, it is not a "keto diet" or an attempt to enter ketosis per se. This website does a nice job of illustrating the differences, but it's not all about fat burning. This review, for example, showed that a higher protein breakfast was linked to better muscle mass in adults and a cardiometabolic effect was also seen in groups as young as adolescents. HOWEVER, there are ripple effects. I noticed a clear need to increase my water consumption after making this switch, a factor associated with increased protein consumption that has been known for a while.

2. Context Matters a LOT - as the 30 days have gone on, we have seen a wide variety of spikes and drops of blood glucose under a variety of conditions. At times, it took some effort to remind myself that spikes are not necessarily good or bad in the absolute sense, but rather a normal response from the body...which can become problematic if too extreme or left unchecked for too long. For example, after moderate-intensity exercise, glucose values dropped as expected, one of the main reasons why post-meal exertion is so powerful and, in my opinion, why a movement break after eating should become a routine for almost everyone. But after intense or "fasted" exercise (i.e., before eating in the AM) things were very different. My glucose values actually climbed. While this makes total sense physiologically - when it is not readily available in the bloodstream, the body taps the liver's reserves to solve the immediate need (intense muscle work or an adrenaline spike), it could EASILY be confusing to the point of being alarming.

3. Better RECOVER means better everything - one of the most impressive findings has been in the "energy" category. Waking up refreshed is not only a nice way to start the day, it also provides greater ease in every action taken and decision made. For Lindsay in particular this change has been hard to put into words but very positive overall; as blood glucose has become more tightly controlled, her energy levels have become not only more abundant (more energetic overall) but also better, including outlook, stress, etc (more energized about making the change). In an otherwise busy world, everything gets a little easier when energy levels rise. Again, this is less surprising when diving into the evidence. The link between metabolic health and brain health seems to be getting more and clearer all the time. For example this review published in January, showed a strong link between metabolic risk (insulin resistance) and brain risk (future dementia) and this new research from Rutgers University showed that the same things that improve one (brief exercise) made a difference in the other (brain markers) in as little as 2 weeks.

So, where does this all leave us? To try to wrap it all up succinctly, we posed 4 questions: "which changes could become permanent?", "Are there any learnings you'll use more as a tactic or tool?", "How will you prevent slipping into old habits when it comes to shopping, snacking or other zombie sugars?" and last, "If a friend asked to summarize the 30 days in one sentence, what would you say?".

So what would we keep? For me, the shift to more protein and less carbs at breakfast, timing movement breaks before or after meals, and being more cognizant of the order in which I eat (goal = fiber first) are all impactful enough and still doable enough to strive to make them permanent.  For Lindsay, it was similar. She said, "The savory breakfast, the order in which you eat and working to consume more veggies overall are worth the effort".

In regards to tactics or "good to know for use when needed," Lindsay said "being aware of what a high-carb meal can do makes 'prioritizing priming' (e.g. with a salad) and 'blunting the spike' (e.g. with a walk) good tactics for future use". For me, switching to oil & vinegar instead of something more creamy could be an easy one to use when the opportunity presented.

When it comes to shopping, snacking, and other ways to keep the gremlins at bay, Lindsay said shopping smarter became the clear strategy - there has been a notable and deliberate drop-off in foods that are designed to sit on a shelf in the pantry these last few weeks. For me, trying to continue to get myself to recognize the difference between "sweet" and "treat", now that I have seen the impact, will be important. For example, the contrast between unsweetened Greek yogurt (a high protein) snack and the sweetened version of the same brand was striking. The first showed almost no sugar jump (and therefore no need for an insulin response from my body), and the second behaved like I had eaten a cookie. It was powerful and obvious. While this is not to demonize foods or even sweet treats...it seems to me that we should at least know when we are eating one.

Lastly, to wrap it all up in one sentence to a friend, Lindsay said "the real-time feedback has made it easier to make changes and those changes have produced positive benefits - I can't quite put my finger on it because it's as much a feeling as it is a metric, but I just feel better, more energetic and maybe even more comfortable in my body which I know is a struggle for many; I think the experiment helped me kickstart something good". For me the sentence to a friend would be less interesting and about what any friend might expect. It would go something like this "you know I love this stuff...the more we know about how things are working BEFORE they are breaking or broken the easier it is to stay that way. If you can approach it less like a dieter and more like a scientist, picking apart what you see and learning as much as possible along the way, it might be worth the effort.".

All said, this was fun and enlightening. We hope you enjoyed tagging along and are considering ways you can benefit, too. Reach out with questions.

Have a great weekend,

Mike E.

Jan 31

When we left our heroes last week things were mostly novel & new. They were uncovering a few buried truths about their daily habits, finding a few ways to make them a little better, and maybe even nudging their health in the right direction in the process. The undeniable data in front of their faces made it easier to confront the brutal facts, which like a trailer for some sort of terrible movie was a realization that they sort of LOVE simple carbs but the feeling wasn't mutual - they mostly just felt tired and empty inside. And, since this is usually when the hero starts their slog through the dark cave which inevitably includes a fight with some beast that was previously too big to defeat without newfound inner strength, we pick up our story with our heroes in a similar environment - the pantry. Filled with snacks, some that were previously thought to be "mostly OK", it turned out the shelves were actually packed with sneaky little gremlins just waiting for the clock to strike the witching hour. Now back to our story...

Onto Hack 3

If hack 1 (the vinegar preload) was interesting but not super tasty, then hack 2 (the veggie preload) was far more likable. Not a huge surprise from a preference perspective, we both generally like the freshness of a good salad, but having one consistently every evening makes the benefit much more obvious. 

For Lindsay, the changes have been most clearly related to energy levels. In her words, "It's hard to quantify 'feeling better' but you definitely know it when you do - more energetic and less lethargic at the end of the day for sure". In regards to measurable changes - "I haven't really lost any weight per se, but I do notice my clothes fitting a little better and I feel like my workouts are better" - which of course are all early signs of progress for those working to make health changes.

For me, as someone who is typically trolling for snacks by 4 PM, hungry enough for two servings by dinner, and still easily swayed by the snack gremlins a few hours before bed, the effect of consistently putting in a fiber "fill" before the main dish was real and obvious. Timing it before dinner made it easy to push off the late afternoon snack and, in line with one of the major health benefits of consuming foods that are both high in fiber and low in process (slower digestion makes you feel fuller), I have found myself far less hungry when starting on the main dish. I now eat a little slower and 1 serving at dinner feels filling enough. It's a small change but a lower calorie-load later in the day is generally a good thing, as this review of the research shows. The pantry gremlins still called in the hours before bed in the first few days, but since progress is motivating it was easier to say "no". The result? I was down more than 5 lbs in the first 14 days, and my sleep, which was pretty good to begin with, has continued to get better as going to bed "fully empty" has become the standard. 

It probably shouldn't surprise me since shifting eating to match wake-sleep cycles tends to improve metabolic health as reviewed here, but in addition to my Garmin sleep and HRV data continuing to improve, I have definitely been feeling more refreshed in the morning which makes everything easier, including starting hack 3 (5 minutes of exercise immediately before or after eating). We've tested stairs, various forms of push-ups (wall, stairs, floor, etc), air squats, walking fast enough to be huffing and puffing, and even a rowing machine - all seem to work pretty well. To be clear, it doesn't outright stop the rise in blood sugar, as expected there is a normal rise and it's sharper after high-carb foods but logically the blip resolves far more quickly when the muscles are primed and ready to soak it up for use.

Crowd-sourcing

One of the coolest things that's happened during our little experiment of ours, is YOU. I've had several people reach out, curious to learn more, ask good questions and even offer some ideas. One person suggested kombucha over vinegar as a tastier & gut-biome-boosting option. As it turns out, there is a small study from a team in New Zealand that supports it. I could definitely see this becoming part of the final ("extra") 5 days. Another wondered (paraphrasing) "Are you trying to eliminate the rise and fall totally?" - the answer here is no, this is a normal and healthy metabolic reaction, however like most things seeing extreme reactions by the body only in extreme circumstances is probably closer to "right"...so that's the goal.

Device Hiccups 

Several people have also inquired about the devices we are using and whether we like it so far. For those considering a similar experiment I would say, up until day 15 it would've gotten a strong thumbs up. On day 15 however, when it was time to change out the sensor (each lasts 15 days), things got a little off track. Lindsay's new sensor didn't pair with her phone and so she had to pause her portion of the test while a replacement was being sent and my values were very different from my first sensor. To be fair - Dexcom's (the parent company) customer support bot was great and Lindsay's replacement was in the mail within 24 hours of the issue being reported and I am getting my brain wrapped around the sudden jump in my baseline, something that, given our sensors' inability to calibrate against a fingerstick blood test to give the truest value, like a prescription-only model does, is probably reasonable. So while building in 5 extra days in our experiment for glitches now seems smart, it also reinforces the fact that these devices are on the health side of the spectrum and more educational than medical or diagnostic.

Last up (hack 4) is starting the day with a "savory breakfast". Tune in next week to learn how it went.

Have a great weekend,
Mike E.

Jan 17

Just last week I got an increasingly common question - "What is that little pod I'm seeing people stick to the back of their arms...and is it a good thing?". As a data geek and someone who loves the idea of wearables and biosensors to help me be more precise in my day-to-day actions, the Continuous Glucose Monitor (CGM) has been an intriguing idea for a few years. Like a heart-rate monitor for how we process food into energy (metabolism), this little plastic pod, smaller than a silver dollar, sticks onto the skin and sends data on blood sugar (glucose) to an app on the phone, creating a digital trace of the ups and downs, both normal fluctuations and responses to activity and diet. Over the last few years, they've become more common but as a prescription-only device and harder to get without boxing out someone who needed it more than me during the post-pandemic supply chain woes, up until recently the idea was frivolous at best.

Fast forward to late last year when one of the leading manufacturers received FDA approval for an over-the-counter version along with our recognition that metabolic health was a big area to watch in 2025 and now seemed like a perfect time to see what we could learn and share.

How it works - an overview: At the risk of wildly oversimplifying an incredibly complex process that impacts almost everything we experience daily, metabolism is the biochemical act of converting our FUEL to energy. When we are healthy, we do it predictably and efficiently, changing carbohydrates into "fast energy", which tends to be better for higher-intensity efforts, and fats more slowly which is ideal for lower-intensity sustained efforts. Whatever we don't use gets stored. Too much all at once, low-quality foods, or simply not using what is available through physical activity increases the risk that the system will lose efficiency and eventually become diseased, the most common of which is diabetes type 2, which impacts 40 to 130 million Americans depending on whether we include those with prediabetes in the tally. At least 1 expert's research into what drives cancer says it's a common root in that category of diseases too.

Most of us know that with low-quality, sugary, and cheap foods everywhere and daily routines that make it easy to NOT be physically active, we are definitely all at some level of risk. Things get even more urgent when we consider data like this which shows a clear connection between metabolic disease and injuries. This is not a "someday" problem, it's a now problem that seems to only get worse if left alone. Since it also only gets harder to reverse as time passes, if we can take the mystery out of it and know where we stand - which is what the CGM + app is built to do - it can be a good thing...and so, we experiment.

The Experiment: 

For the 30 days from Jan 12th to Feb 12th I (and my wife b/c she's a good sport and there are definite differences between men and women) will be wearing a CGM and trying to closely track and document the experience. The first 5 days (ending today) will be a baseline week, where no significant changes will be made. Then, every 5 days after that, we will implement 1 strategy known to help smooth out blood sugar spikes and keep people in a healthier range. We will be putting 4 of the "hacks" discussed by a popular expert & influencer on the subject (@glucosegoddess) to the test, "stacking" them each time we add one so that by the end, we are doing all 4 things simultaneously. We've built in 1 extra 5-day block as a buffer for any difficulties we run into but may also use it as a bonus block if everything goes smoothly. Our first will be to consume vinegar before the "biggest meal of the day" - about 1 tablespoon mixed in a glass of water, something that has been shown (for example here and here) to blunt the rise in blood glucose and "flatten the curve" - before dinner. 

Disclaimer

Now, while I generally LOVE the idea of people making small "experimental" changes to learn more about what works for them, such as "don't eat a slice of cake as the first course of lunch", a micro-test I ran (and failed miserably) on Tuesday, I can't in good conscience, recommend it this time.  Without knowing someone's health or relevant history, possible interactions with medications, or any number of other factors that might make "playing along" unsafe or unadvisable, doing so would be irresponsible. With that, we will not be making recommendations in any way - these are observations only.

For those who read along, I hope it's fun and you learn something you can talk about around the dinner table or with a friend. As always - feel free to send questions or ask you local member of the Pro-Activity team.

Have a great weekend,
Mike E.

Jan 3

With my youngest child now old enough to be out celebrating with friends, it would be the first "quiet" New Year's Eve in a very long time. Although, to be fair, since 2024 was just the usual chaos and nothing really to complain about, it had been busy enough that getting in bed at a reasonable hour (well before Auld Lang Syne) felt like a win. After a couple of hours which felt like minutes, I woke to the sound of Charlie the Yellow Dog loudly protesting a neighbor's use of fireworks to commemorate the moment. Then, after a few minutes that felt like hours (oh, the barking!), I knew 2024 was a thing of the past and I could go back to sleep. 

It's one of the reasons I love New Year's Day. At a time when we often hear about the benefits of quieting thoughts about the past and/or future to "stay in the moment" (aka mindfulness), it is one of few scheduled pauses, brief as it may be when the mental time travel of reflecting on the past 12 months to help plan the next twelve (future) is a good thing.

So what if we apply this approach to the goal of staying safe, living healthy now, and improving our odds of thriving longer? What fascinating findings from 2024 should help inform our plan for 2025? 

Here are few of the most important to know about in my opinion:

(1) Build Reserves: Whether it's this massive study of studies published in September which showed that for every 1 unit increase in cardiorespiratory fitness, adults had a double-digit drop in the risk of dying or this March 2024 review of 130 different studies which showed that "inadequate physiologic reserve" as we age (aka frailty) was definitively linked with important social drivers of health such as loneliness and isolation, the big message is clear: Improving or maintaining fitness, strength and power now can be one of the best investments we can make.

(2) Fiber First: If a headline read "Eat enough of this every day and lower your risk of dying by more than 20%" many of us might take a look. If the fine print said it was a study of more than 3 million people, even those who like to dive into the details might be satisfied. Well, that is exactly the observation made in this January 2024 review of 64 different studies on the subject. As a bonus, this study which does a deep dive into interventions shown to improve blood sugar control showed that not only does consuming more fiber (>=10g/day) help lower the risk of metabolic disease (sections 6.4 and 7.2 in the article) but points to emerging evidence that suggests if we eat it first, that is, order our eating patterns so we eat the veggies first and the carbs last, we might get an even better effect.

(3) Energy Vampires are REAL: This review from a team in Italy early in 2024 points to an important theme when it comes to the well-being and performance of groups and teams - attitudes really are contagious. While most of the work in this area has been done on leaders as the "sender" and followers as the "receiver", the authors point out that this relationship has also been established in those who tend to command attention (i.e. the loudest or most expressive person in the group). If you are on a team or work in a group, assessing and creatively addressing the emotional energy in that group might be a powerful risk-lowering strategy in 2025.

Of course, these are only 3 themes...and fascinating is most definitely subjective, but there's enough here to build on. Keep an eye out for more as we journey through 2025.

Have a great weekend and Happy New Year,
Mike E.

Dec 20

Around this time last year, we used "Holiday Heart Syndrome", the seasonal uptick of heart-related problems this time of year, to illustrate one of the most critical themes in thriving - sudden & heavy loads, no matter the type, leave us exposed to risk.

The idea is pretty simple - our biology (like all living creatures) is built for efficiency. Below the surface of our thoughts and like a seasoned holiday traveler who meticulously packs to avoid the pitfalls of "checking a bag", our body is constantly working to interpret our past experiences in order to anticipate our future needs and ultimately to "bring only what we need to survive". As unique individuals, we each interpret the statement differently, as this scene in a 1987 classic makes clear, but any way you slice it, wasted energy is biologically expensive, so we try to avoid it. 

Since our predictions, with a little buffer built in, are usually right, we get home about the same way we left...but not always. The trouble comes in when a sudden or heavier-than-expected load pushes us beyond the buffer. We scramble to deal with it, but the extra energy required puts us in a risky spot until we can recover. The type of load doesn't really matter. Whether it is a sudden temperature spike in the early summer before we've acclimated, a sudden sleep disruption from "springing ahead" or a sudden increase in the alcohol we consume because it's part of our holiday tradition this time of year, the risk is real. Thanks to a team in Germany whose dive into the cardiac physiology of Oktoberfest was published this month, we are now closer to understanding why.

Here are the basics: When we consume alcohol our system works harder to process it. Counterintuitively, and despite it being a depressant, our heart actually beats faster and our nervous system revs up toward fight/flight/freeze, an effect which took as long as 48 hours to resolve. In about 5% of the people studied the heartbeat became irregular enough to cause more serious problems (called atrial fibrillation). While, it may be easy to dismiss "only" 5 of every 100...when we consider this is about 10X typical, it's a risk worth managing. Here are 3 simple strategies:

1. Know thyself - if you are at heart risk or have been particularly stressed, overtired, or are fighting something else recently (e.g. a cold or other infection), the risk is higher, cut the consumption way back (or out entirely).

2. Counter the Salt - it's not just the alcohol this time of year, it's also the food, which is often packed with salt. While sodium is not inherently "bad", it plays a major role in our muscles' ability to contract, including the heart muscle. Getting too far out of the sweet spot can lead to heart conduction disorders like a-fib, as shown in this 2021 study. If you are surrounded by highly processed food this time of year, make sure to counterbalance with some fresh fruit and veggies (as well as nuts and seeds) which naturally have higher concentrations of potassium and magnesium, which can get depleted.

3. Monitor hydration - we may not be sweating like the summer, but it always matters. Even in young, well-trained athletes, dehydration alters the heart's ability to perform. The further we are from young or well-trained, the greater the risk. This can also compound the salt imbalance and can be accelerated by the diuretic effects of alcohol.

It's the beginning of the peak and it's easy to get beyond the buffers when traveling light. Have fun...but not too much. :)

Have a great weekend,
Mike E.

Dec 6

It's hard to believe it's December. Even with the sharpness of this morning's air temps, which well below freezing, had a bite and emails about the end-of-year planning deadlines starting to occupy my inbox, it feels like only yesterday when we were talking about the benefits of acclimatizing to the heat in a strategic and measured way...but here we are...entering the homestretch of 2024. If you are anything like most this time of year, it feels like a sprint to the finish, and you know every minute counts. We might even wish we could make more of it in order to get a few more items checked off the list. Here's the good news - for those who invest a few minutes wisely, the evidence says we can. It's a two-part story, and it starts with a little myth-busting.

Let's call part one the "don't judge a book by its cover" myth of health. This popular myth says that to be healthy the most important thing we can do is lose weight. Since we know excess weight DOES add risk, this myth is plausible, but not ironclad. There are more effective ways to lower risk - if you want more time, as measured in years of life, spend more time with the stairs than the scale. Or, in the words of the lead author of a recent "study of studies" from the University of Virginia: "Fitness, it turns out, is far more important than fatness when it comes to mortality risk.". Across 20 different studies and a combined population of nearly 400,000 people those who were fit but overweight (or obese) had a much better health trajectory than those who were normal weight but not fit...and it wasn't by a little bit. Specifically, the low-fitness group was 2-3 times more likely to die during the study period as compared to the fit group. Yet, where things get really interesting, especially for women, is in how shockingly small an investment required to kickstart the time making effect was...which gets us to part 2. 

A team from Australia studied activity tracker data from more than 20,000 adults in hopes of determining the minimum "dose" of physical activity required, if done in short bursts throughout the day, to have a meaningful impact on preventing major cardiovascular events in the future. Since these bursts are more like activity "snacks" than formal or structured exercise, the theory is that they may be doable for more people. The results were impressive, once again reiterating that the difference between "something" that gets us up, moving and preferably out of breath (enough to call it vigorous), and "nothing" can be, well, "everything" if we are trying to add years to our clock. 

Compared to sedentary individuals, and after ruling out a long list of other risk factors and health behaviors, it took only 5.6 minutes per day of vigorous activity (VILPA) to have a meaningful risk reduction of about 15% for men. The effect was even better in women who only 3.4 minutes per day to lower risk by a massive 45%. In plain English, for those of us who spend larger and larger portions of our lives sitting or driving or looking at screens (essentially everyone), finding a way to get a little out of breath by taking the stairs, sneaking in some air-squats or wall-push ups during that stretch break or just about any other way, can cut our risk substantially. 

The final sprint is on and every minute does indeed count. If whatever you're working on today is as important as it feels, we'll all need you doing it again tomorrow - the best way to make sure you'll have enough time then is to invest some now.

Have a great weekend,
Mike E.

Nov 22

We're pretty much there. The sugary primer of Halloween has given way to the richness of Thanksgiving and the start of the holiday season. In less than a week many hometowns and communities will be celebrating with traditions that range from "big games" between rivals to moments of reflection and gratitude for many good things (even if never quite perfect)...and in many places, there will be food; in some cases lots of it, including some which may not love us as much as we love it.

While not intended as rain on the parade, which at least as of now seems unlikely for NYC and Macy's 98th, today we offer some food-for-thought based on what we know about how our bodies respond to rich foods, larger than usual portions and possibly some stress that comes with the holidays. The physiology of it is pretty simple - fatty and sugary meals have an immediate impact on our blood flow. The vessels become a little less responsive and oxygen has a slightly harder time traveling through the system. This is especially true following a stressful event making the combination of stress and rich foods a more risky one. 

For example, a research team from the UK showed in 2023 that a high-fat meal following a stressful event resulted in significantly altered blood flow patterns in even young and healthy subjects. In plain English, after a stressful event, the subject's vessels presented in a constricted state (as measured by FMD) during the first 30 minutes, as we might expect in "fight, flight, freeze" reactions. However, those given the high-fat meal after the event remained in this state for another 60 minutes, which isn't ideal. The good news is, it doesn't have to be this way. There are simple strategies we can use to minimize this negative impact.

The first, and perhaps most well-studied, is the strategic use of MOVE. A small study at Penn State University in 2006 showed that a 45-minute walk at approximately 60% effort taken 2 hours after a high-fat meal counteracted the change. Then, in 2020, another team showed that mixing in some stair-climbing (5 min per hour for 4 hours) also helped restore vessel responsiveness. However, new research out earlier this week suggests there might be another way.

The same team from the UK mentioned above which showed the detrimental combination of stress and rich foods has now shown that the high concentration of healthy compounds (called flavanols) in foods like cocoa, green tea, certain fruits and spices, can also help reset things. They tested low-processed cocoa powder (12 g added to milk) and found better vessel responsiveness at 30 and 90 minutes after the fatty meal. According to the study's author, "This research shows that drinking or eating a food high in flavanols can be used as a strategy to mitigate some of the impact of poorer food choices on the vascular system. This can help us make more informed decisions about what we eat and drink during stressful periods."

If you haven't already, maybe this is a good year to take a walk, find some stairs, put the kettle on, and add a new healthy wrinkle to your tradition.

On behalf of the team and with our sincere gratitude as we roll into Thanksgiving, have a great weekend,

Mike E.

Nov 8

As Ryan tells it, Mary was interested in making a health improvement. She was engaged in the education sessions he provided at her workplace and she always had good questions, truly an inquisitive mind. Mary wanted to lose some weight and was organizing and strategizing how best to do so. In the world of health change, she was "contemplating", commonly referred to as the step before taking action. She felt there were more pros than cons, but it still had to fit within the many other priorities in her life. Understanding how easily we get off course in this stage, Ryan was careful to give something proven effective but not drastic. He suggested having a "calorie cutoff time", which effectively shifts the last meal of the day to a slightly earlier hour and consistently "closes the kitchen" to allow a slightly longer burn-only period, which is known to improve how well we can process FUEL (especially sugar and fat) and may even lead to weight loss since eating late can be detrimental to health. A few months later Mary was down 10 lbs and feeling good about making a positive health change...and rightfully so, since most studies show even a small weight loss can improve several health markers.

Of course, weight loss isn't the only outcome that matters, and shutting off calorie intake isn't the only viable strategy. Perhaps strength and fitness are on your mind - according to the Mayo Clinic if you can't do 10 perfect push-ups (all ages and more if you're younger) it probably should be. 

Could even 1 minute of daily exercise between now and New Year's Day make a difference? This study from 2021 says, for some folks, the answer is yes. 

Could small dietary changes known to increase our body's Omega 3 and 6 availability (such as eating fish twice weekly and adding walnuts and almonds daily) lower cancer risk? This study out last month says, that for 19 different cancer types, the answer is yes. 

Could adding in 5 minutes of exercise-like activity into our day lower blood pressure to a healthy range? This study, out last Wednesday says, especially in cases when we trade sedentary time for exercise, the answer is yes.

Many people feel the urge to take their foot off the gas and maybe even coast into the end of the year when it comes to health. Given the known risks of the season, this is not a great strategy for most. On the other hand, since small investments add up to meaningful outcomes, we believe now is a fantastic time of year to start building a habit. You might be surprised with how quickly that investment compounds into real results.

Have a great weekend,
Mike E.

Oct 25

Fatigue is a complex phenomenon. It is both physical and mental (body and mind) and can be impacted by the places we are in and people we are with - some that energize us and others that, well, don't. Most importantly, however, fatigue has significant power over our performance. When we are ready and fresh we are capable of amazing things but when we are tired or drained, we tend to be clumsy and struggle. It might show up as fumbling over our words or having difficulty staying relaxed in stressful situations, or as we've seen in every type of athlete we serve (traditional, industrial, lifestyle, etc), it might show itself in the momentary lapse in coordination or reaction time that so often precedes an injury. With that in mind, fatigue is a big target when it comes to prevention efforts. Understanding it better opens the door for approaches that can improve our resistance to it and put the odds more firmly in our favor.

One of the most important insights over the last 10+ years has been that in addition to training our body and its tissues to handle greater loads in order to become more fatigue-resistant, training our brain to handle greater loads during times of fatigue can also improve our ability to ENDURE. Brain Endurance Training (BET) as it is sometimes called, is an approach that not only challenges an athlete physically, such as cycling, but cognitively as well using tasks that load working memory for example, in order to improve physical performance. Some studies have shown it works well.

 For example, in 2015 a team from Denmark reported significant improvements in endurance using a "time to exhaustion" test in healthy subjects who were randomly assigned to either perform endurance exercise only or endurance exercise accompanied with cognitively loaded tasks like a "2 backtest" where a person is shown a sequence of items and asked to quickly recall which appeared 2 ago (try it here). Another study in 2021 had similar findings showing a 32% increase in muscular endurance in a group that had both types of training concurrently and a 2023 study showed significant improvements for those who performed the mentally fatiguing tasks prior to the physical exercise.

But what about average/everyday folks - could there be benefits for individuals who aren't super concerned about their cycling endurance and really just want to think more clearly and minimize health risks?  The answer seems to be yes. Last week, findings from a team from the University of Birmingham showed that along with physical performance, both attention and cognition (executive function) could be improved to a greater extent when physical exercise was combined with cognitive loading tasks even when the subjects were fatigued. Although the best protocols are still likely a way off, finding ways to challenge body and mind seems to promote a better ability to ENDURE in each. 

Not sure if we will see puzzles in the gym anytime soon, but for those who might benefit from being a bit more fatigue-resistant, throwing in some MOVE in the midst of a mentally tiring day might go a long way.

Have a great weekend,
Mike E.

Oct 11

Lower back pain is a complex beast. Decades of trying to make it simple have mostly failed and, even after nearly 80 years (since World War Two when it burst onto the scene) and hundreds of billions of dollars spent annually since, making "spinal pain" (lower back and neck) the most costly condition of 154 when ranked in 2020, we haven't fully decoded it yet. What we can say with some level of confidence is that if your back is hurting it is almost definitely a whole picture thing and not just a single or even a few simple factors.

Here's what we know: Occupational exposures like heavy physical work are often pointed to as the culprit. While they certainly add risk, they have not proven to be the sole "cause". In one recent review, and beyond the usual number 1 predictor (a history of lower back pain), the strongest predictors included both work-related risks (carrying heavy loads, heavy work, and awkward postures) as well as personal health risks (higher body weight, anxiety/depression) as well as unhealthy behaviors (smoking and maladaptive behaviors). Said another way, the movement risk (biomechanical) is real...but so is the psychological and psychosocial risk. Other studies have shown that metabolic disease (small vessel disease like diabetes) may add risk, while others have focused on dietary risk (especially high inflammation), poor sleep, and the benefits of social support.

Finally, sedentary time alone is a strong possible driver.  If this all sounds like a tangled mess, well, we agree.

With that in mind, a team in Finland set out with the hope of unraveling some of it. They decided to take on the metabolic component by looking at energy utilization (glucose uptake and percentage of fat) in the muscles of the lower back by reducing sedentary time by 1 hour per day in a sample of overweight but otherwise healthy individuals with back pain. They recruited +/- 60 subjects and randomly assigned them to either the control group or the movement group. The headline findings were interesting but certainly not earth-shattering: those who reduced sedentary time slowed (or stopped) the progression of pain but didn't reverse it and standing alone wasn't enough to improve the metabolic efficiency of the back muscles. The fine print however was far more intriguing.

As it turned out, step count, that is, actual movement and not "just" posture change WAS associated with metabolic improvements in muscle and, when compared to previous studies, standing, like many interventions might have a minimally effective dose. An average 42-minute per day increase for six months in this study wasn't enough, but double that and throw in some professional support on managing discomfort as was the case in this study, and things improved. Of course, this is not the end of the line, there is still more to unravel. Until then, we continue to suggest a strategy that stands on the evidence:

MOVE enough - even if the best you can do right now is get out of your chair more frequently, posture change is good. FUEL clean - lower your dietary inflammatory load by increasing the healthy stuff and decreasing the metabolic stressors like low-quality, sugary/fatty & processed foods. RECOVER fully - keep your system relaxed with enough sleep. Build ENDURE - managing stress plays a bigger role in pain than most realize and last but certainly not least CONNECT - find a few people who have similar goals and band together; social support can help with all of the above.

Lower back pain continues to be common and frustratingly complex for too many Americans. Until we've got the whole mess untangled, go with what you know - a healthier body is a stronger, happier, and more resilient one.

Have a great weekend,
Mike E.