August 28

In a busy life, there's never really enough time. An entire subgenre of self-help suggests that life would be better if we said "no" more often. Easier said than done. For those who prefer physics, the theory of relativity says that the faster we move, the slower time passes. Perhaps this is why seconds can feel like minutes in an emergency situation - our brain is moving so fast the world slows down, as explained here. However, if we widen our gaze from the moment or even the day to our entire lifetime, new research suggests another very clear way to slow time: by investing between 6.5 and 8 hours in RECOVER every day. Yes, we're talking about sleep this week and some new updates on how much we need and how best to protect what we have. 

The story starts with Dr. Junhao Wen, an assistant professor at Columbia University's medical school. Combining expertise in advanced data science with a personal concern about the health effects of being a "light sleeper," Dr. Wen and his team tested more than 20 models of tissue and organ aging (called aging clocks) against the sleep habits of 500,000 people. What he and his team found confirmed what we know about sleep: first, there's a sweet spot for adults, which they found to be between 6.4 and 7.8 hours each night to restore and recover; second, both insufficient and excessive sleep can indicate risk—not too hot, not too cold, just right. Zooming further in, the team also found that certain organs and systems are more closely linked than others.

While long sleep was associated with a narrower group of risks, including breathing and digestive disorders like COPD, asthma, gastritis and GERD, short sleep was more broadly negative. Like the chicken-and-egg problem, we don't know for sure whether poor sleep is a symptom, a cause, or both. However, the data clearly showed that regularly getting less than 6.5 hours was associated with all the risks above plus others, including high blood pressure, heart disease, obesity, type 2 diabetes, and mental health disorders like anxiety and depression. So what can be done if we regularly fall on the edges or even outside this optimal range?  The short answer is: work on it. Sleep habits can be influenced by repetition.

The longer answer is to explore it more deeply; finding the approach that fits your pattern is key. For example, one study published in February showed that for sedentary individuals, releasing pent-up energy through high-intensity exercise, when combined with efforts to improve sleep habits, was more effective than either approach alone. Of course, we shouldn't expect the same result for individuals who do heavy, fatiguing work all day. A recent review of interventions for industrial workers showed that lower-intensity efforts promoting relaxation and freedom of movement, such as yoga, had a better impact—similar to a structured cool-down after a hard workout. This may be particularly important during the summer, as heat exposure can make it even more challenging to fully rest and recover as described here.

Finally, from chamomile tea to functional foods, a long and ever-growing list of nutrients may positively impact sleep. This extensive review from May dives into the evidence on many nutrients we are often asked about. While there are pros and cons to consuming well-studied supplements like Melatonin and Magnesium, which warrant caution, adding kiwifruit and tart cherry to the menu (also well-studied) might be worth a look. In more specialized groups such as older adults with poor sleep and mild cognitive impairment, adding Vitamin D is showing promise, and a single dose of creatine (although perhaps too heavy to be practical) appears to ward off the brain lag associated with acute sleep deprivation; however, these options would be best discussed with a professional before proceeding.

The not-so-great news is that burning the candle at both ends objectively ages us faster at every cell in the body. The better news is that what we've known from previous years still holds: how we MOVE, FUEL, and ready our relaxation runway before bed all impact whether we can expect to RECOVER and be ready for tomorrow. Prioritize, protect, and prime it - you'll be glad you did.

Have a great weekend,

Mike E.

August 14

It started a few weeks ago as these things often do on our team. Someone brought up a study they had recently read, and others began to chime in, expanding on the subject and revealing some very intriguing ideas. This time, the discussion centered on breathing and the potential positive health impacts associated with deliberately training ourselves to breathe differently. It's not a new topic; we've covered it before, but as (un)luck would have it, a few days later in a rugby match I took a hard shot to the ribs which made deep breathing painful for a day or two. Then, less than a week later, as if the universe was listening and totally unrelated to my sore ribs, I received a text from a colleague (not affiliated with our team) connecting me to a physician in the space who was developing a product targeting the pulmonary (lung) side of endurance exercise and wanted to bounce some ideas off a willing ear. It was an interesting conversation, and although I ultimately felt I wasn't the best fit for him (and referred him to a different member of our team), it definitely got my wheels turning. Then, as if the internet was listening (ok, it is), by this time last week I started seeing ads for breathing apps for athletes with claims so significant that I felt compelled to step down the rabbit hole. So here we are.

The idea that deliberately working on breathing techniques can improve health is not new. In fact, according to one wildly popular voice, it is among the oldest health practices known. The general gist for modern humans is that we tend to run a little hot. Our normal breathing rate of 12-20 breaths per minute, double or triple the 6 breaths per minute most often advocated to reduce stress and improve resilience—a rate referred to as "coherent breathing"—suggests we may be letting our breathing apparatus become flabby by relying on rapid, shallow upper-chest breathing instead of relaxing, deeper "in through the nose" belly breathing. This habit might lead to a low tolerance for carbon dioxide, an indicator potentially worth a closer look. You can test this by taking a deep breath in through your nose and timing a full and slow exhale as described here. While slightly surprising given my current and heavily aerobic exercise load, my very pedestrian 34 seconds suggests it could use some work; maybe my social media "big brother", lurking as it may, was right this time. However, the jury is still out on the best way to do so.

While a stable research base supports the benefits of calming our nervous systems by controlling our breathing—and some version of 6 breaths per minute is extremely common across many cultures and used in many protocols—at least one rigorous, randomized, and placebo-controlled study published in 2023 showed that the rate itself may not matter as much as the intentional practice of stabilizing it. Subjects who performed controlled breathing exercises at 6 breaths per minute had about the same (significant) improvement as those tasked with the placebo rate of 12 controlled breaths per minute over the same 4-week period. While structured, even breaths (matched inhale and exhale) with no pauses are the consensus favorite for slowing us down, adding a breath hold (or other technique) to garner very specific effects associated with brief increases in carbon dioxide concentration is an emerging area of interest.

Take, for example, the study that started the conversation. It showed that brief increases in carbon dioxide benefited a group suffering from Parkinson's Disease by helping their bodies clear byproducts from the brain. Another suggested that a similar protocol might help the body fight cancer. In athletics, a few rounds of breath holding prior to training significantly improved Oxygen uptake and allowed trained athletes to exercise longer before showing signs of exhaustion. Another study, which asked trained athletes to sprint after exhaling (and then hold their breath during the sprint), also showed improved fatigue resistance. A recent review of the literature on the topic concluded that while the findings are plausible and promising, they are not definitive; more research is needed. With this in mind, after reviewing hundreds of studies, at least one researcher advocates implementing a 5-5-2 method: a 5-second inhale, 5-second exhale followed by a 2-second hold, especially for those in high-stress professions like emergency responders.

Breathing is a curious one. It is both automatic when we're not thinking about it and under our control when we are. There are very few physiological levers that set off a cascade of reactions as fast as consciously altered breathing. While there is still plenty to learn, and the best technique will almost definitely depend on our goals - one size never really fits all - becoming aware of our current patterns and working to expand, quite literally, our capacities through breathwork is about as easy as it gets. Hold here; I'll let you know how those time-to-exhaustion protocols go in a few weeks.

Have a great weekend,

Mike E.

July 31

A decade or so ago, FUEL as a lever against movement-related pain was one of the many "crazy ideas" we rambled on about.  Like so many fundamental shifts in the narrative, this idea was met initially with resistance, which wasn't a huge surprise. In a world rooted in the tradition that mechanics mattered most, the idea that eating healthy foods, especially fruits and veggies, could meaningfully impact physical function (and pain) seemed too far-fetched for many. It was such a hot topic back then that in 2018 I was asked to take part in an "Oxford Style" debate as part of a large conference of physical therapists in Orlando. I still have the trophy presented to the winning captain - a stuffed Mickey Mouse of course. Since that time, and with significant help from an ever-growing mountain of evidence, the idea has become well accepted, if not commonplace. 

Over the years we've discussed this connection. Whether it's the multiple randomized controlled trials showing that blueberry consumption positively impacts knee pain as reviewed here earlier this year or the inverse relationship between fiber and knee osteoarthritis - a 27% decreased risk in those who consumed the most as discussed here last year, the idea that what we eat makes a significant difference in joint health without the negative side-effects common with other treatments is so simple it's compelling. Of course, in our estimation, this was never an "either/or" story; rather, like so many other lifestyle factors, we viewed each as an important layer in the theme of "both/and." Lowering the inflammatory load via FUEL could open a window of opportunity, allowing a strong enough dose of MOVE to achieve the benefits of better mobility and strength without irritating an already cranky joint. How else can we make sense of an umbrella review, published in March of this year, which showed that fruit and vegetable consumption correlated with improvements in walking speed - a functional measure of lower body health that is intimately tied with longevity? Of course, for those who really want to leverage the system's self-healing capacity, layering in a few tactics to improve sleep, especially in cases when poorer sleep coincides with increased pain (as explained here), achieves all three critical legs of the stool. However, in the spirit of efficiency, I suppose it's only natural to wonder which factor is most effective - a question that hasn't been explored until now.

To tease out the answer, researchers from the University of Nottingham in the UK randomly assigned 117 individuals with knee pain from osteoarthritis to one of four groups for 6 weeks: the FUEL group received a 20 gram daily fiber supplement (inulin, aka "prebiotic"), the second (MOVE group) received an online 15 minute exercise prescription developed by a physiotherapist, the third received both MOVE & FUEL protocols; and the last received a placebo. The least surprising finding was, "it worked". Both the MOVE and FUEL groups (separately and combined) improved meaningfully compared to the placebo group; their pain was reduced. However, the important nuance is that below the surface the "why" was fundamentally different; the comparison was not in fact "apples to apples". In addition to reduced overall pain, those who performed the exercise protocol showed signs of improved function - they could get up and moving out of a chair faster (TUG test) and demonstrated better lower body power (30-second sit-to-stand test). Those who consumed the fiber supplement benefitted via a different pathway. They also had reduced overall pain; however, theirs was related to sensitivity - irritated tissues calmed down. Additionally, they showed improvements in blood markers associated with beneficial changes in gut health (SCFA and naturally occurring GLP-1), which have been linked to nervous system efficiency via the gut-brain and possibly the gut-muscle axes. This finding helps explain why those who consumed fiber also improved their grip strength. 

Unfortunately, there weren't enough subjects in the study to reliably understand if the "both/and" protocol was greater than the sum of its parts (synergistic). However, one conclusion seems certain enough to me: While we may feel it most in the heavily used moving parts (knees, shoulders, lower back) - and can even see the "wear and tear" there at the end of the line - arthritis is a complex, whole-system condition, so all inputs, indirect as they may seem, matter. The lifestyle formula for joint pain is simple: ditch the "or". MOVE to stimulate growth AND choose FUEL that provides the building blocks without adding inflammatory gas to the fire AND protect the time needed to RECOVER (especially sleep). Repeat.

We're a third of the way through Summer. Start now, and those achy joints could be feeling better by Fall.

Have a great weekend,

Mike E.

July 17

By now it seems almost everyone understands that the bacterial makeup of our gut plays a major role in determining our health. What we eat (and drink), how well we sleep, whether we exercise and how much stress we carry all impact the concentration and types of bacteria, and therefore the influence they exert.

A flood of research on the topic has emerged over the last 5 years. A Google Scholar search for "Gut Microbiome" yields 20,000 citations from this year, but that number grows more than tenfold if we start the search 5 years back. During the same time a smaller—though no less significant—swell of research (a little over half the size) has been forming related to the impact of another microbiome: the one inside our mouth. Since this time last year the bacterial make-up in our mouths has been linked with breast cancer, stroke risk, and, just this week, inflammation and heart valve risk. Interestingly, how we alter that microbiome has also been in the research news.

In addition to a trend away from harsh mouthwashes that kill both good and bad bacteria, as published in March 2025, one animal study showed that exercise had a significant inflammation-lowering effect in and around the mouth which was further improved with Omega 3 supplementation. Another study from last month showed that a healthy, primarily plant-based and low-calorie diet (Fast Mimicking Diet) used along with traditional treatment for gum disease, not only improved the local impact in the mouth but also lowered whole-body inflammation suggesting oral hygiene may start with what's on the menu. This week, in a counterintuitive twist it seems how we order our food matters and those who choose greens before carbs might unlock a new performance edge.

A few weeks back we reviewed this study which showed that dietary nitrate, a powerful nutrient abundant in plant sources, can powerfully impact cardiovascular efficiency (including lowering blood pressure in as little as two weeks). While this study used beets as the source, we know that other plants also pack a punch this way. However since the oral biome loses key bacteria as we age, the impact was greatest for older adults, as regularly drinking beetroot juice appeared to help rebuild the biome - what we feed grows. This week, however, another way to maximize this reaction surfaced and oddly enough, Hubba Bubba (yes, the bubble gum) seemed to be the catalyst.

In a London lab, researchers theorized that the same, not-so-wonderful, pH-lowering (acidity) effect that makes sugar enemy number 1 in cavity prevention might also actually prime the biome to absorb more dietary nitrate. It turns out their theory held. When subjects were randomly assigned to either the Hubba Bubba (sugar) group or the Wrigley's Extra (sugar-free) group, the sugar-containing gum group showed a lower mouth pH, increased nitrite levels in the mouth (+45%) and in the bloodstream (+25%), and a 2-3 point drop in blood pressure. The sugar-free gum group did not experience these effects. However, caveat emptor (buyer beware), given the study's very small size (14 people) and the potential harms of chewing sugary gum, the researchers quickly pointed out that this was only a proof of concept and not intended as advice. 

The senior author had this to say: "We are certainly not suggesting that people should start chewing sugary gum regularly. Frequent sugar consumption is harmful for dental health and is also detrimental to cardiometabolic health when consumed in excess. Instead, our findings provide a proof of concept that we may be able to improve how the body processes dietary nitrate, and future research should focus on developing tooth-friendly, metabolically sound approaches that achieve the same effect. Because dietary nitrate is already a recognized sports supplement, there is potential to optimize how athletes use it. If we can enhance nitrate conversion, we may be able to improve the physiological benefits that athletes obtain from nitrate-rich foods."

There's a lot more to learn about how we can optimize the beneficial health and performance promoting effects of food. A healthy oral biome is key—it loves leafy greens and other Summer garden treats. In the meantime we'll be keeping an eye out for more from this research team.

Have a great weekend,

Mike E.

June 26

When is "the hill"? You know, the figurative image of peak human performance and the onset of inevitable decline we all face once we are "over the hill". It's a question I like to use, especially in a group, to illustrate that although packaging aging this way is convenient, it is also inaccurate.

In truth, and staying with the analogy, after a decade or so in the mountains - our mid 20's to mid 30's for physical capacity and structure, for example - most people navigate up and down various foothills, experiencing numerous peaks and valleys as they progress through middle age and toward retirement. In fact, some capabilities like "crystallized intelligence" (making sense of things), which differs significantly from raw processing power (computation), might not peak until midlife or even later, according to some findings. Yet, even these findings don't really challenge the fundamental idea: that we should expect a peak followed by decline - whether it looks like a smooth downgrade or a general trend. Of course, there are individual cases that say otherwise.

This fascinating article from August of last year claims, for example, that a strong neuroscience foundation - the crossroads of adaptation due to neuroplasticity over time and refined recovery methods - explains why superstars like Novak Djokovic and LeBron James seem to have gotten better with age. However, it's far simpler to conclude that these same capacities aren't really available to mere mortals like us. Therefore, we often view these athletes as outliers or anomalies rather than disciplined investors maximizing returns through time and effort.  New research from a team at Yale University, however, provides evidence that getting better with age is more common than we think. 

Published in March of this year, this study showed that almost half of the more than 11,000 participants - aged 65 and older - improved in at least one of the measured areas over the next decade. Thirty-two percent improved on cognitive measures, and twenty-eight percent improved on physical measures. This suggests a sizable percentage, as much as 15%, improved in both areas. However, when the researchers tried to determine why some individuals improved while others didn't, the results were striking.

The team found that individuals with positive beliefs about aging at the study's start tended to perform better over time. This finding aligns with Stereotype Embodiment theory, which the current study's lead author described first in 2009. The theory suggests we grow toward what we believe and see in the world around us; aging is a social construct heavily influenced by our environment. This might explain Harvard's classic 1979 "counterclockwise" experiment by Ellen Langer, which literally turned back the clock on aging in its participants by placing them in a 5-day time-capsule environment. 

Of course, the big takeaway message, which applies at any age, is the most important learning of all - our beliefs drive our behaviors and ultimately our results. The stories we tell ourselves - our "narrative" if you prefer trendy terms - heavily influence and often become our reality. 

So the next time things feel stiff rolling out of bed or a body part protests after a long day of repetitive effort, ask yourself whether it's truly a sign of "getting old" as the world often suggests, or if it's actually the feeling of getting stronger, which an athlete would expect after a hard day of training. Believe it, the choice is ours.

Have a great weekend,

Mike E.

June 12

Six months ago, in the first blog of 2026, I mentioned this study, which discussed critical lifestyle factors from a survey of 16,000 individuals across 29 different countries. The authors identified 3 common factors that, if implemented consistently, could strongly impact future health. 2 of the 3 were as expected: improved resiliency, the skills needed to ENDURE moments of distress, and increased total MOVE minutes closer to guidelines. However, the third factor - how often a person ate home-cooked meals - was a refreshing surprise. Whether due to the benefit of CONNECTING with others around the table to discuss the day or the potential for significantly improved FUEL quality from fresh ingredients, a home-cooked meal can pack many positives into each serving. New evidence suggests it might even help with a very modern problem impacting us all. 

We first encountered the idea of dwindling attention spans a few years ago when we learned about the work of informatics researcher Gloria Mark. She showed, among other things, that over 20 years, average human attention—measured by the time spent on one task before switching to another in a digital environment (like a computer screen)—dropped from 2.5 minutes to just 47 seconds. The implications, of course, are concerning. 

For example, in 2023, findings published in the Journal of the American Medical Association showed that high doses of screen switching—such as near-constant checking of social media by adolescents—caused changes in brain development as measured on MRI. At the time, experts suggested it was primarily an environmental problem; therefore, organizing our space and time to allow deep engagement could help. New research, however, suggests that organizing our menu also matters.

The punchline seems to be that diets rich in fresh ingredients—partly because they are packed with healthy nutrients and partly because they displace ultra-processed foods (UPF)—might help us maintain our attention span in a highly distracting world. Late in 2025, a team studying the impact of UPF consumption patterns in adults found that high intake was associated with a poorer attention span and increased dementia risk even in those who ate an otherwise healthy diet. Reducing UPF appeared to be the answer. 

This conclusion also aligns with a 2025 study that tracked the risk of type 2 diabetes in over 200,000 Americans for 40 years. The study found that consuming minimally processed potatoes had a largely neutral effect on disease progression; however, when processed into French fries, the risk increased by 20%. Then, in January, a study of 653 adolescents showed that in the developing brain, it might be "both, and". Greater adherence to a healthy Mediterranean diet was associated with more favorable brain functioning, while heavy exposure to ultra-processed food at the other extreme was associated with a negative profile. This 2026 review of the existing evidence concluded the same: UPF consumption was generally negative for brain health, and minimally processed foods were protective. 

You may not have realized it when planting, but whether in pots, a tower, raised beds, or a traditional fenced-in patch, if you're tending a garden this year, you've got focus FUEL on the vine; turn it into a home-cooked meal and savor it.

Have a great weekend,

Mike E.

May 29

As I scanned this week's headlines looking for patterns worth relaying, only 2 really stood out: (1) the letter B was everywhere, and although the stories weren't directly related, (2) they all had important enough implications to be shared. So here goes:

Beets and Beans for Blood Pressure: Two new studies making headlines this week reiterated points we've discussed many times before. First, eating plants, especially those known to be high in dietary nitrates like beets (but also leafy greens and others), can powerfully impact the cardiovascular system. While we've known for a while that beetroot juice can improve endurance performance by making it easier to pump blood throughout the body, new research suggests it might also meaningfully lower blood pressure in older adults in as little as 2 weeks. The interesting twist here is that it didn't have much of an impact on younger adults. The secret to this may be in the saliva - it appears that we tend to lose key bacteria in our mouth as we age, and drinking beetroot juice may help restore it. For those who don't find beetroot juice super palatable (the flavor is admittedly a bit "earthy"), beans, along with legumes and lentils, may be the answer. In a review of 10 different studies, researchers found that individuals who ate up to 170 grams of legumes (about 1.5 servings) or 80 grams of soy (about 1 serving) daily lowered their risk of hypertension by nearly 30%. 

A closer look at Beta-Blockers: For decades, this medication—taken by millions globally to slow down heart rate and relax smooth muscle—has been standard treatment after someone suffers a heart attack. According to two studies, originally published last year but making headlines this week, it may be time to rethink things. For men who've had mild heart attacks (where the heart muscle retains its ability to push out blood effectively), beta-blockers did not have a meaningful impact on future risk. For women, another study outlined that higher doses of the medication actually increased risk, effectively worsening the condition. With any luck, these new findings will prompt productive conversations with cardiologists as they examine the standard of care. 

When supplementing B12, remember Goldilocks: The last "B" making the news this week was B12, a vitamin known for its role in helping produce red blood cells, maintaining nervous system function, and critically assisting cells in copying their DNA during replication. When cells are healthy, this last role is highly beneficial, so having enough B12 is critical for our health. In fact, supplementation or even injections may be recommended for individuals who may not get enough through their diet, such as those who eat an exclusively plant-based diet or those who've had bariatric surgery. One new study even showed that lower B12 levels were associated with reductions in brain function as age increases, which might lead us to believe more is better. Recent research, however, suggests caution because a link between high doses of B12 and cancer risk has emerged. As it turns out, B12 appears to encourage replication of ALL cells, not only healthy ones. Therefore, heavy supplementation may not be ideal in cases where unhealthy cells, such as precancerous cells, are present in higher concentrations. Not too little, not too much, just right.

That's all for now. Maybe next time we'll cover the health benefits supplied by those other bees—the ones in the hive. 

Until then, have a great weekend,
Mike E.

May 15

For many, April 26th might have seemed like any other day. For marathon fans, it was an epic performance - the kind that ushers in a whole new chapter in human achievement. On a near perfect day for racing in London last month, Sabastian Sawe from Kenya defended his 2025 course title, set a new world record and became the first person ever to officially break the 2 hour mark for the full marathon (26.2 miles) on a record-eligible course. To put some numbers to it, his average pace was an absolutely blistering 4 minutes and 33 seconds per mile (13.16 mph) for 1 hour, 59 minutes and 30 seconds - something most humans would struggle to do on a bike.

Experts suggest that the combination of perfect conditions, world-class physiology and the Evo 3 - an engineering marvel designed by Adidas as a "super-shoe" for this exact purpose - is what put him over the top (and perhaps explained why Ethiopia's Tigst Assefa, wearing the same shoes lowered her own world record to 2:15:41 in the women's race on the same day). However, another factor, mostly overlooked until recently, is buried in the details. It is a variable that holds great promise as we ready for the summer heat and muster the endurance required to "race" toward our limits.

"Durability" is a long-standing concept that has only recently been formally defined and studied for its power to predict athletic performance. As a concept it's essentially what we might expect: the ability of an athlete to resist performance losses as an event nears its later stages. However, until recently, there didn't seem to be much of a pattern. For marathoners, race predictions were traditionally based on three variables: the athlete's "engine" size (VO2Max), their "movement efficiency" (minimal wasted energy) and their "fuel economy" (ability to utilize fuel at the highest possible speed).  However, around 2021 as researchers tried to understand why the two-hour marathon remained elusive, they realized there was wide variation even among the best racers: some degraded significantly, while others seemed to improve as the day progressed. For example, Sawe ran his fastest two 5K (3.1 mile) segments beginning at mile 20, when most marathoners are "hitting the wall". The second half of his race was actually faster than the first half, known as "a negative split" - suggesting, much like we might describe a highly durable truck, that he was "overbuilt" for the task from his heart to his shoes. While most people aren't looking to break marathon records, this same physiological durability can be a major asset during the summer heat, when the workday can feel like it lasts 26.2 hours.

According to this 2025 article, training our bodies for greater resilience is possible. It requires emphasizing total exposure over time, consistency, controlled overload and microbursts at peak intensity. Let's break each of those down.

1. In some workplaces, long-term exposure is at times referred to as "old person strength": the idea that a person with many years of experience who may have only average strength in absolute measures, is remarkably strong while performing a given task because they are perfectly adapted to it, honed over many years of doing so. Athletes who have logged greater training volumes over long periods tend to have more durability. Runners from Kenya like Sawe for example are known to average +/-25 miles per day (100-150 miles per week) for years in preparation.

2. Training consistency is no surprise. Like adding layers of varnish coat by coat to protect a wood surface, or adding to a retirement account week by week to build a nest egg, showing up day in and day out to train builds the physiological reserves needed to perform under withering conditions.

3. Controlled overload can be likened to "game simulation". The idea is to create brief exposures to expected conditions to mimic what an athlete might face and allow the body to rise to the challenge. For at marathoner, this might involve harder efforts, at or even above the predicted race-pace near the end of a workout to mimic the fatiguing conditions of a race's later stages. In the Summer workplace, this might involve deliberate heat exposure at safe doses known to stimulate heat acclimation - 75-80 degrees for increasing time intervals - to prepare for long periods of truly hot days. To be clear, prolonged exposure to max intensity (e.g., over 90 degrees), especially without prior acclimation (as weather forecasts predict next week) is a bad idea. There is no shortcut for Durability. It cannot be rushed and acute over-exposure causes harm.

4. When training for durability, intensity deserves great respect. As shown in this 2026 review of studies on cyclists, high intensity efforts degraded durability more than lower intensity efforts, even when prolonged. While bursts of peak intensity help elite athletes build extra top-end capacity, it is critical to do so without delaying recovery timelines. Therefore, these efforts should be brief enough to stimulate but never exhaust. For an athlete this might include activities that train strength, power or explosiveness such as heavy resistance training or plyometrics. For consistent gym-goers and according to this study performing strength exercises at 5 sets of 4 reps with 2 minutes of rest between might be the sweet spot for soft-tissue durability. For those not currently going to the gym consistently, this might mean adding a short round of body weight exercises to the day's routine or trying to "power up" the hilly sections of an evening walk. For those closer to the sedentary end of the spectrum, stair-snacks, fast walking at lunch or taking the plunge into pickle ball can all make a difference.

For some regions of the country next week will be a preview. With any luck, it will serve as a reminder that the annual 100 day endurance race we call "Summer" is on the horizon. There's enough time to be ready if we start adding durability now. Let us know if you need a training plan.

Have a great weekend,

Mike E.

May 1

Last week, we discussed the pace of change in the modern world and recognized that our ability to adapt is one key to future health. I ended the blog by acknowledging that stepping beyond comfort, seeking challenges, and even embracing discomfort might be important tactics to keep our edge. Then, right on cue and as if the cosmos were listening, a new large-scale and long-term study published in the British Medical Journal popped onto my radar and reinforced the idea. 

Let's start with a recap of what we know:

(1) Physical activity has proven to be one of our best tactics for lowering the risk of injuries and diseases we face.

(2) While getting the proper dosage matters, the benefit is not linear; most of the benefit occurs early on in the session, and more is not always better, meaning there is a sweet spot. Most research suggests that between 7,000-10,000 steps per day or 150 minutes per week at moderate intensity is the sweet-spot for the general population.

(3) Concentrating physical activity - either by increasing intensity to decrease total time required (e.g., 75 minutes of vigorous activity) or by compressing it into a shorter window (e.g., the weekend warrior effect) - is effective and may even add extra benefits in some cases.

(4) Since longer-term adaptation takes time, consistency is key.

Which brings us to the next open question: Is there a "best" way to MOVE? 

This was the essential question that a multinational research team with contributors from Harvard's school of public health set out to answer when they pooled two large datasets - the Nurses' Health Study and the Health Professionals Follow-up Study - into one massive dataset. Combined, the data included the physical activity habits of more than 100,000 people for over 30 years, totaling 2.4 million person-years. What they found was both more of the same and a new twist on the idea.

First, and literally more of the same, the team found that to lower our risk of major diseases like heart disease, cancer, and respiratory diseases, we need to move more. After statistically scrubbing other lifestyle factors associated with being active- such as being less likely to smoke, more likely to eat healthier diets, more likely to drink alcohol, and more likely to maintain strong social connections - the most active group benefited across almost all activity types. Compared to individuals in the lowest category of physical activity, those who recorded the most weekly activity enjoyed risk reductions of 17% from walking, 15% from tennis or squash, 14% from rowing or calisthenics, 13% from weight training, resistance exercise, or running, 11% from jogging, 10% from climbing stairs, and 4% from cycling.  In fact, swimming was the only activity whose participation level showed no significant difference between groups; the risk remained about the same whether someone swam a little or a lot. 

Interestingly, mixing things up appeared to provide an even stronger benefit than doing more of the same. After adjusting for total physical activity levels, participants in the group with the most variety had a 19% lower risk of dying during the study period compared with those in the group with the lowest variety; this reduction ranged from 13% to 41% depending on the disease studied.

As it turns out, the best way to MOVE is all of the above, as often as you get the opportunity. Run, jump, lift, carry, row, ride, or walk - whatever you can make work for you today will ultimately work for future-you, too.

Have a great weekend,

Mike E.

Apr 17

According to my smartwatch, I hadn't fully recovered from my last workout when I started my run on Tuesday. I assumed this was why my legs felt heavy and stiff. Thankfully, things began to loosen up after half a mile. Feeling a bit more like myself, I glanced at the screen and found my pace was slow and steady, just as intended; however, my heart rate was 15-20 beats higher than typical. With the temperature approaching 85 degrees in mid-April, and my heat acclimation estimated at 3%, this all made perfect sense... If only it were summer. The physiological effect of heat is one of the most predictable risks our clients face each year, so we always make a special point to review it, along with recent trends and findings, as the summer months approach. Although April is supposed to be solidly "Spring," temperatures approaching 90 degrees in several of our clients' territories this week suggest 2026 might have other plans.

At the highest level, three key points regarding our ability to work or perform athletically in the heat are worth reinforcing. (a) Heat increases cardiovascular demand, leading to early fatigue, (b) full adaptation requires about 2 weeks of repeated exposure, and (c) effective mitigation strategies are a critical bridge while our bodies adapt. Let's break down each of these points further.

First, as we point out every year, "heat stress is heart stress". This cannot be overstated. As the body temperature rises, our hearts pump faster to circulate blood closer to the surface, prompting us to sweat and allowing heat to radiate more easily into the environment. This explains the heart rate increase I saw during my run, which is the expected response in the heat for healthy individuals not on heart rate-stabilizing medications (e.g., beta blockers). While an elegant solution to the immediate heat problem, the trade-off is that it is also energy-intensive, shortening our fatigue and therefore risk timeline. Next, while adaptation induces a variety of positive physiological changes that improve performance in hot conditions, it requires 10 days to 2 weeks of steady exposure at temperatures high enough to create an adequate demand, at or above 75 degrees F, according to most sources. This time of year can be especially tricky in that regard because fluctuating temperatures make the physiological "ask" unclear.  Therefore, slowing down, taking breaks, staying hydrated, using cooling strategies to maintain core temperature, and prioritizing sleep are all critical to staying healthy and mitigating risk. Simply put, if we respect the process and acclimate safely, we stand to benefit. Recent studies of elite athletes suggest that training in the heat or even just repeatedly sitting in a hot bath can improve physical performance. In some cases, this improvement is comparable to training at altitude, a well-known and widely studied tactic.

While important, none of this is new or wildly different from best practices used for years. The classic plan for most individuals who must perform in the heat, whether wildland firefighters or special warfare trainees, is very similar to those used in athletics: closely monitor and actively manage risks until acclimatization (acclimation under real-world conditions rather than in a controlled setting) takes place. This must all be done while acknowledging that body size and sex differences can significantly impact the time required for heat adaptation; larger bodies may take longer to adapt.

So what can we do now to prepare for the dog days on the horizon? Start early and use the early-season fluctuations to our advantage. Lower temperature days can act as built-in recovery days, allowing for a longer readiness ramp-up before the steady heat arrives. This recent study showed that a longer acclimatization period produced better results in cognitive performance, reducing the likelihood of critical errors for those who leverage it. Consistent with other protocols, such as the one used by the Indian Military, both training variables (like duration and intensity) and situational variables (such as uniform type and PPE) can be adjusted upward during the two-week protocol to more closely mimic real-world conditions and maximize the effort's benefit.

Whether it's the best cooling strategies or the proper use of sunscreen according to leading dermatologists, there is, of course, so much more to this topic. However, this week's hot shot arrived early enough to give us all a head start; now it's up to us to use it. Get out there and start getting ready, Summer will be here in a blink...

Have a great weekend,

Mike E.

Apr 3

On January 9th, we identified a key theme for 2026. It started with the intriguing idea that physiological energy flow - our ability to efficiently harness and transform energy, such as from the food we eat, into our actions - was at the very heart of human health. Summarizing some of this paper, we discussed 3 connected systems: the energy apparatus (metabolic system), the communication apparatus (nervous system, hormones, etc.), and the physical apparatus (cells, tissues, and organs), and how each requires resistance to stay strong. Two new studies published this week suggest that the right kind of resistance, even in very small doses, should be a priority.

The first study confirms the critical nature of the "physical structure" in supporting a healthy energy apparatus, particularly our growing realization that muscle is important not only for movement but also for metabolism. While decades of study have focused on the "bad" of excess body fat, far less has looked at the other side of the coin: the "good" of adequate muscle mass. Thankfully, this is changing. When a team from Brazil studied a dataset of over 5,000 adults older than 50 for 14 years, they found both factors mattered, but when it came to the risk of dying during the study, one of the two carried more weight.

Individuals with both excess belly fat (central adiposity) and low muscle mass had a shockingly high, 83% increased risk of dying during the study compared to individuals with neither risk factor. However, when the team reviewed the trajectory of individuals with only one of the two risks, things became even clearer. Those who had low muscle mass alone (no excess belly fat) still had a 40% increased risk of dying during the study period, while those with the opposite profile, excess belly fat alone (but adequate muscle mass), had a statistically insignificant 9% increase in risk. Muscle, as it turns out, mattered more, which requires resistance. 

The second was a more global review of physical activity patterns at the population level, but it confirmed something equally important: the resistance needed to keep our energy flowing well can be found almost anywhere, and the effective dose is incredibly small. In a population of nearly 100,000 individuals wearing activity trackers, the risk of developing 8 different diseases was significantly lower for those who engaged in higher intensity physical activity - the body's reaction to resistance - compared to those who did not, even when total physical activity was the same. 

Specifically, the research team found that when as little as 4% of total physical activity minutes, as little as a few minutes per day, were performed at higher intensities, the risk dropped between 29% and 61%. Interestingly, the intensity-driven effect was especially pronounced for the immune and inflammatory diseases studied (e.g., arthritis). Major cardiovascular events, atrial fibrillation, chronic respiratory disease, and dementia all followed a similar pattern, though to a lesser extent. The remaining diseases studied responded more evenly; intensity still outperformed, but only slightly.

Start small and be realistic. Not everyone is ready to turn this dial up. However, for those who are or can get there over the course of time, whether you prefer moving weights, hammering hills on a bike, or lugging a backpack to inspiring views, relishing resistance may be your best next step. 

Have a great weekend,

Mike E.

Mar 20

Every few months, a cool new study on how coffee impacts health surfaces. Since September 2024, when we authored our first blog dedicated to the global morning favorite, the storyline has been mostly positive: drinking 2-3 cups of coffee daily appears to offer health benefits. This week, we found two additional large studies that reinforce the claim, but first, a bit about the ripple effects of parent stress on children's health. 

As we've discussed many times before, in small doses, stress can stimulate growth when managed well or resolved quickly. In the longer term, however, it can fester, wear us down, and lead to poorer health choices. For example, in 2022, a research team showed that diets tend to suffer during times of stress, priming a downward health spiral as psychological (mind) effects broaden to physiological (body) effects as well. One of the trickiest parts, however, is that stress is also "contagious". Research confirms that witnessing someone experience a stressful moment can cause us to feel agitated as well. 

While this is especially true for those high in empathy (measure your EQ here), it stands to reason that the spillover potential is also high in close relationships, such as those between parent and child. Two studies published earlier this week support this idea. The first showed that adults who experienced harsh economic stress during childhood—enough that it impacted their family's ability to provide healthy food—had definitive signs of malnutrition later in life: stunted growth and poorer body composition. The second brought slightly better news: that while a parent's stress doesn't need to reach such an extreme level to affect their child, healthy management can keep the negative effects in check. While stressed-out parents correlated with poorer nutritional outcomes in children, adding mindfulness training was enough to neutralize the risk. This, indirectly, brings us to coffee and how it might be a longer lever than we realize. 

We've discussed the physiological benefits of coffee consumption before. Coffee drinkers who consume two to three cups per day benefit from its high antioxidant content and known anti-inflammatory properties. The effect appears to apply to a variety of diseases, including Parkinson's disease, lung cancer, and, according to another new study, if we skip the sugar, cardiovascular health. However, where things really get interesting is in the brain. A massive new study tracking dementia and cognitive decline in over 130,000 people for more than 40 years showed an 18% risk reduction for those who regularly drank coffee (or tea). Caffeine appeared to play a key role, as decaf coffee drinkers did not experience the same benefit.

Although the jury is out on whether coffee also positively impacts psychological stress, some studies suggest it can. Using the time it takes to savor a morning cup wisely—such as to organize the day or process feelings—can significantly benefit not only personal health risk but also the risks of those close enough to “catch” our stress when things bubble over. It's a great one to ponder over a cup.

Have a great weekend,
Mike E.

Mar 6

It seems simple - movement is fundamental to human health, so we should all probably MOVE often enough and vigorously enough to benefit. However, the upfront expenditure (time, effort, and energy) with no guarantee that the results will match the vision can create inertia that is hard to overcome. Whether the recommended dose (typically 30-60 minutes per day) feels too big or the grip of all-or-nothing thinking takes hold, the barriers can feel insurmountable. This is presumably a primary reason research on exercise dosing - whether small micro-doses, which we occasionally refer to as "snacks," or various combinations of duration and intensity - has become so common.   

One of the more exciting themes to emerge is the value gained for "weekend warriors", those folks who cram an entire week's worth of physical activity into one or two days. We started paying closer attention around April 2023, when we reviewed this study on healthy step counts, which showed a significant risk-lowering benefit even when participants achieved 8,000 steps per day only 1-2 times per week. Then, 18 months later, we discussed this study, which showed significant benefit across 200 different diseases, almost as much as those who exercised steadily five to seven times per week. In April 2025, the theme returned, as we discussed a paper that showed weekend warriors, provided they didn't ramp up too fast, actually performed slightly better from a health perspective than those who chose a more distributed movement pattern. Now, in 2026, the theme is really gaining traction with 3 new studies all published in January showing great benefit.

(1) The first looked at conditions of the spine, joints, and bones. Researchers showed that physical activity significantly lowered risk, regardless of whether it was evenly distributed throughout the week or heavily concentrated (defined as accruing more than 50% of activity minutes in 2 days or less). Subjects who met movement guidelines were less likely to have arthritis, degenerative spinal conditions, and osteoporosis-related events, regardless of the pattern they adopted. 

(2) Then, using the same criteria, another study examined the impact of the weekend warrior pattern on sarcopenia, the abnormal muscle loss associated with age or immobility. As it turned out, the weekend warriors not only did better than the inactive group but also significantly better than the group that got their exercise in a more steady, predictable pattern. The study authors concluded that weekend warriors tended toward more high-intensity activity, while those with a more regular daily pattern stayed at a more moderate intensity. 

(3) Lastly, in a study considering the likelihood and impact of stroke in a large sample of people living with high blood pressure (stroke's number 1 risk factor), researchers found that those who accrued enough physical activity minutes to meet guidelines (75 high intensity minutes or 150 moderate intensity minutes) had a lower risk of dying during the study period - about 30% lower; a finding that wasn't super surprising. The punchline was that physical activity lowered risk by about the same amount, whether the minutes were achieved in a routine (daily) pattern or the concentrated, weekend warrior pattern.

The baseline fact remains: moving well - with minimal restrictions or limitations - often enough (about 1.5% of our time each week), can significantly lower our future risk of injury, illness, or disease. Whether we choose 81 seconds every waking hour, block off 21.6 minutes per day, or use almost any other combination, when we achieve 2.52 hours per week - even if it's all compressed into Saturday - we are far more likely to thrive.

Have a great weekend,

Mike E.

Feb 20

Sometimes we have to dig deep to find an interesting new wrinkle or twist in our ongoing story of "future thriving in present hands". This week was different; a rare scenario where each of the 5 ELEMENTS: MOVE, FUEL, RECOVER, ENDURE, CONNECT was represented in the health headlines, sometimes stand-alone, other times stacked together.

First up, in an ELEMENT stack that we've seen before: MOVE + CONNECT in order to ENDURE, a new study, given its size and scope, brought things to a whole new level. A massive "umbrella review" of 63 studies dove into exercise's impact on mental health (specifically depression and anxiety) and showed, again, that it may be our most consistent and powerful lever to help manage the conditions, precursors, and associated risks. With reductions in symptoms similar or better than what might be expected with medication and psychological interventions generalized as "talk therapies", the authors concluded that exercise prescription should be among the first treatments prescribed. The fine print suggested that aerobic exercise was the most powerful mode and that exercise done with others in a group was particularly potent, but all exercise types worked, especially when tailored to an individual's needs. The authors were quoted as saying "exercise effectively reduced depression and anxiety symptoms across all age groups, comparable with, or exceeding, traditional pharmacological or psychological interventions. Group and supervised formats gave the most substantial benefits.". Powerful stuff.

Next, under the header of FUEL, a trio of studies helped drive home the fundamentals that we so often talk about. The first was another enormous study which tracked the diets of nearly 200,000 individuals over decades (more than 5M "person years" in total) in hopes of settling the "Low carb" vs. "Low fat" debate. Ironically, as the Harvard research team found out, the answer was neither and both...because when it came to diet's role in future health, it was more than macros that mattered, with food quality proving most important. Individuals who consistently consumed diets made up of high-quality foods with an emphasis on whole plants, whether low-fat or low-carb, were far more likely to avoid heart disease. Unfortunately, individuals who consumed lower-quality foods didn't enjoy the same benefit. The editor of the Journal of the American College of Cardiology, where the study was published, made it very clear: "Whether a diet is lower in carbohydrates or fat, emphasizing plant-based foods, whole grains, and healthy fats is associated with better cardiovascular outcomes." To make the good news even better, in a first report-out on recent Nordic nutrition recommendations, which attempted to account for both human health and planetary health, foods similar to those above appear to yield a win-win, including a 23% lower risk of dying in those who adhered most closely. The final study in the FUEL category this week may explain why. 

When a research team compared 3 dietary approaches, each known to lower inflammation, it was a combination of probiotics (healthy bacteria) and fiber (a prebiotic that feeds those healthy bacteria) that did best. Specifically fermented kefir mixed with diverse fiber outperformed omega-3 supplementation and fiber alone. To be clear, all three were effective, but the combination worked best at lowering markers of inflammation...just not right before bedtime.

The last study of the week, under the header of RECOVER, reinforced a habit we hold in high regard and talk about any time we can - going to bed empty. This time, it was work done at Northwestern University's medical school that showed that cutting off consumption at least 3 hours before bedtime significantly improved sleep restfulness. As evidenced by improvements in blood pressure (3.5%) and resting heart rate (5%), each a critical marker of whether we are "revved up" or "well recovered", those who shut down earlier did better. The lead of the study said: "Timing our fasting window to work with the body's natural wake-sleep rhythms can improve the coordination between the heart, metabolism, and sleep, all of which work together to protect cardiovascular health." 

There's no single perfect formula that works for everyone, but there definitely is a pattern that appears to work for most. If you're not leveraging the ELEMENTS as an investment in the future, it's a great time to start.

Have a great weekend,

Mike E.

Feb 6

It started with a knock on the door last Thursday evening. It wasn't late, but we weren't expecting anyone, so it was strange. With a firm grip on one of the two dogs, I opened the door to a person I'd never seen before, looking a little stricken. "Hi," I said, to which she responded, "I think your chimney is on fire..."

And then, somewhere shortly after "um, what?" and "ok, thanks", I closed the door and said "call 911" to my wife, who was nearby holding the other dog as we quickly sprang into action. Within seconds, I was dousing the wood in the fireplace, and she was talking to the dispatcher. Our son, a volunteer at the local fire department (who still gets the text alerts while away at school), immediately started calling, wondering what was going on, and within minutes, we were trying to make sense of a situation that now included lots of flashing lights in the driveway. Fair to say, things were stressful there for a bit.

Although I would've much rather had the uneventful and relatively quiet evening it was shaping up to be, it was a great reminder of exactly how much can (and has to) happen in the seconds between alarm bells going off in the brain and us resolving whatever is causing them, and the benefit we gain when the cycle is completed without major harm. In a world of ever-present chronic stressors - the kind we generally try to avoid - it's easy to forget how positive and even critical the acute stress response is for survival and ultimate thriving. It's an idea that a year or so ago a global research team wrote about, detailing how the immediate release of hormones and the resulting changes in the nervous system not only allow us to focus and react, but can, with an adequate recovery phase, kick start learning and growth...the upside of stress we've often talked about, which is not only for bodily health (stronger after the stress of exercise), but also brain health and mental health, as the authors make clear.

The keys then are both in the challenge and the dosage - having enough of the right stuff to stimulate the positive cascade, but not so much that we cannot adequately recover; a physiological example of "growth from adversity" (various stoics) or for those who like Nietzsche  "what does not kill me makes me stronger", in biology terms, hormesis. 

Last week, I mentioned a study on the keto diet, which can serve as a good example. While it showed mostly negative effects over the long term from the strain of "running on back-up fuel" (ketones being evidence that the body is burning predominantly fat for energy instead of blood sugar), the same may not be true with a smaller dose, such as in the shorter term. This 2026 study of studies showed a strong association between a ketogenic protocol and reduced depressive symptoms, while intermittent fasting, a similar short-term stress on the metabolic apparatus, appears to stimulate health benefits when done with moderate calorie reduction, as shown in this trial. The effect shows up in other areas as well. 

Last year, hot tubs were highlighted for their ability to raise core temperature, another "good in small doses" stress for general health, and in high-level athletes, finding methods to more precisely dose training stress to unleash full potential has gone from an idea in 2021 to a recommended practice in the present moment. There is even one new theory that suggests that the ability to heal from minor burns sustained while handling fire, a uniquely human experience that started a million or so years ago, may be one of the main drivers of our adaptation and evolution as a species. For us, thankfully, we didn't have to test that theory. 

Despite a scary hour or so, all signs point to a false alarm. The local FD didn't find anything at the scene, and earlier this week (on further inspection), the chimney was given a clean bill of health. No harm, no foul, and definitely better safe than sorry. Try as we might to avoid stressors that set off our physiological alarms...we are happy they're working well when we need them...which is far more likely if we keep them well maintained on days we don't. Spoiler, this too has roots in a healthy lifestyle.

Have a great weekend,
Mike E.

Jan 23

It probably seems a little "off" to still be talking about New Year's resolutions with the end of January coming up quickly. It's definitely not the first time I've been called a little "off" :), but I'd much rather we think of the last 3 weeks as building a case that took some time but is worthy of action...which means now is that time.

In case you missed it, in week 1, we jumped on 3 themes identified by a large group that could act as resolutions (MOVE more, ENDURE better, and invest time and energy into home-cooked meals) and then explored some of the possibilities that could compound the effect. Growing the food that supplies the meals to increase the nutrient density seemed especially good. Then in week 2, we tried to find the root "why" that made these 3 endeavors particularly good ones. We came up with "energy management", specifically the transformation and transportation of energy through our cells, as something all 3 resolutions could help with. Then in week 3, we dove a bit deeper to show how energy and the apparatus that allows us to keep it flowing well, touch a variety of areas that might not otherwise seem connected, including: sleep health, cancer, and emotional distress. There are, of course, many, many more, but now it's time to add the final bits and (hopefully) answer what the best next steps are if we are ready to repair, restore, or bolster our health by improving the energy apparatus and its function.

The short answer, which no one, including me, prefers is of course, "it depends". Where we are starting plays a major role in what action to take, which means assessing before proceeding. 

Let's start zoomed out: For anyone at the edge of or beyond the preventative end of the spectrum - whether diagnosed with a condition that includes fatigue as a central component (e.g., post-infection syndromes) or not diagnosed necessarily but always feeling tired, run down physically, and/or emotionally drained or regularly irritable - the best step 1 is to involve professionals. Start with a consultation with one of the members of our team to dive a little deeper or seek out another trusted health professional to have the conversation with. Getting another brain on complex problems increases the odds of finding direction.

For those who might fit within the "at-risk" category, doing some version of a functional self-assessment might be a great step. Generally speaking, growing (but not necessarily limiting) fatigue, sleep disturbance, a few persistent pounds from the holidays, or possibly biomarker changes like increased blood sugar, triglycerides, or blood pressure - would all be signs. Day to day, I often use the walking test described a couple of weeks back (walk briskly but not hard for 5-15 minutes and ask yourself if you feel better, worse, or the same afterward). If I'm more tired, I chalk it up to being truly drained and focus on RECOVER, while if I'm more energized, I consider ways to challenge the system a bit. Of course this same approach could be done by considering energy levels after a meal (and identifying foods that energize and foods that drain), or, perhaps most classically assessing how well rested we feel first thing in the morning after experimenting with sleep hygiene tactics to ease the transition to good sleep. Using heart rate or blood pressure data to make it more precise is probably even better. Bottom line, for the at-risk group, I often recommend experimenting - test, try something, and retest - to find the formula that gets the results you're looking for. There are SO many little things that can have an impact. HERE is an AI-generated list of 100 that might inspire.

Last, for those who are already well on their way to solid baseline health, gaining momentum or closer to the performance end of the spectrum, now may be the time to start thinking about how to challenge the energy apparatus to maintain or improve its adaptability. While certainly not perfect, I really like simple calculators like those offered HERE as a fun assessment. Changing different variables on the biological age or metabolic age calculators, for example, can be a great help in deciding which is the "best right" area to focus on. I was impressed by how much losing a few pounds or adding another day of exercising per week could do. It makes sense, of course. Since aerobic fitness is a large part of what drives the energy system, as reviewed here, the treadmill or indoor rower should probably be a prominent feature in many energy management plans for folks at this level...it definitely will be in mine. However, those in this bucket should also never forget the cautionary tale of attempting to "outrun a bad diet" or the near futility of burning the candle at both ends by diminishing the "regenerative window" of sleep.

For me personally, 2 of the 3 original resolution ideas fit particularly well - MOVE more, which will include a refocus on aerobic training this year as one of the most well-proven ways to improve energy apparatus and investing more time and energy into making home-cooked meals more nutrient-dense (in the garden) and more frequent (on the table). 

I hope you, too, have found something that has or, with work, will energize you this year. Now we start.

Have a great weekend,

Mike E.

Jan 9

With the holiday season whirlwind in the rearview for most of us and the new year solidly here, the 2026 blank slate is already starting to accumulate markings. While we're still very much at the start, the next few weeks are a critical time for anyone who is seeking growth and change this year. Moving from the "fun part" of generating ideas and a vision of what's possible to the part that actually gets the results, the day-to-day execution of habits that work, is where many can lose energy...which, interestingly, may actually be the root we've been looking for.

I did some traveling this week, which usually means books or podcasts or both. This time, feeling exceptionally proud of myself that I was able to stave off my near compulsion to buy a book every time I get through airport security, I finished the one I had with me and got a few podcasts in, too. I stumbled onto a discussion with Martin Picard, a Columbia University professor in the department of Neurology who, in addition to other areas, is an expert on mitochondria, the small bits of our cells known to play a large role in energy production and cellular communication. He was promoting his forthcoming book and the fundamental ideas that drove him to write it. 

Although WAY oversimplified when compared to this 2025 paper, which provides more detail, the idea that really caught my attention was how he defined health. He suggested that we might be best to think of "health" as the natural state we experience when our energy systems (the metabolic pathway) and communication systems (nervous system, hormones, etc) are working well within a physical structure that has integrity (cells, tissues, and organs). Or, in the podcast version, health is a state in which energy flows effectively through the body, influencing how we think, feel, and age...a state that almost always entails fighting through resistance to achieve it.

15 minutes of walking after a long day of sitting is a perfect example. There is resistance, which might be physical, psychological, or both. Despite feeling exhausted because of NOT expending energy (sitting), we tend to want to sit because we feel tired. An object at rest tends to stay at rest, perhaps. Yet, for those who can overcome this inertia and get themselves moving, there is often a point when we feel energized from doing so. The mental fog lifts, and we feel less tired. 

Of course, less tired from expending energy makes no sense...unless the "tired" we were feeling wasn't the fatigue of energy depletion but the fatigue of energy stagnation...an energy log-jam in the normal production and use schedule. As a bonus, we might also feel less distressed, which is a simple explanation of why exercise is such a powerful lever for both anxiety (high energy) and depression (low energy). It might also explain why we sleep better when we are adequately (but not overly) drained of energy, which we can call "good tired", and why exercise is therefore a critical aspect of the energy management plan for anyone, but especially those who don't expend enough during the day.

It's a lens that helps us to understand a lot of what we see and one that I will continue to explore in the weeks to come, but for now, let's leave it at the main points: (1) there is increasing evidence that energy production and transformation is one of the major roots of health. (2) This is far more than "metabolism". 

The foods we consume and the environments in which they grow, the efficiency with which we can transform the stored energy in those foods into the kind that drives our physiology (ATP, etc), and all of the great other benefits we gain when it's flowing smoothly results in something that looks a lot like the thriving most people hope for. 

It's not easy. There is resistance. However, like a spring or a rubber band, we may be most powerful when we are storing just the right amount, not too little and not too much...so let it flow. 

More to come.

Have a great weekend,
Mike E.

Dec 26

It's been almost a full year since we shared our plan for 2025. We were going in with an eye toward 3 significant health themes that we thought would be worth watching closely. Broadly, they fit into the categories of "building reserve capacity", "improving metabolic health with emphasis on gut health", and "the power of the people" - keeping up with the latest on how those around us influence our energy, motivation, and ultimately health. 

We started with a focus on metabolic health by stepping into the experience of wearing a continuous glucose monitor for 30 days. My wife, Lindsay, and I acted as the guinea pigs and tracked the results from a variety of small changes known to have an impact on blood sugar spikes; one of the physiological reactions that, if left unchecked, can be a precursor to metabolic health decline. We drank vinegar water and monitored the impact of exercise. We saw how fatty foods threw us off for hours, even while sleeping, and got a much better sense of how it "felt" to be spiking and crashing (spoiler...TIRED). We found that some of the tactics were good enough to keep and others that fit better as temporary. For Lindsay, shifting her breakfast routine to include more protein has stuck, and for me, short exercise bursts immediately prior-to or following meals have become a more regular part of my pattern. Perhaps not surprisingly, neither of us stuck with the vinegar water...but we liked the results of the entire effort enough to plan on a second round after the holidays.

By mid February, it was time to set the glucose experiment down and pick up the topic of building and maintaining "reserves". These are the extras, the capacity that we have but don't need all too often, and a bit like the shoulder of life's highway, act as a margin that we can rely on to provide the space and time we need to reassess and course-correct before a close call becomes a catastrophe. We know it as one of the most important themes we track, and so we cover it often and hope to be comprehensive. While there was plenty to reaffirm the tried-and-true, like aerobic fitness, strength, and power (which we hit on a combined 13 times this year), we also discovered a few new wrinkles that we will certainly be keeping a closer eye on. "Gait Speed Reserve" (the difference between our top-end walking speed and our typical walking speed), which we discussed in July, is super intriguing. As a predictor of both future physical and cognitive abilities, there is a strong case for maintaining our top gear. When we overlay the massive (5X) benefit gained by fast-walkers compared to slow-walkers, which we touched on in August, and the impressive benefits of doing so in bursts of activity that last at least 15 minutes (as reported on at the end of October), the case for MOVE continues to be strong and getting stronger. 

For those who might struggle to find the right physical activity formula, all hope is certainly not lost. 2025 also provided a heaping helping of FUEL research for those who feel they are best to focus on their plate. In fact, the ever-growing mountain of evidence that connects a healthy diet to the body's ability to thrive was featured more than any other topic this year, 15 times, eclipsing physical activity by 2. However, when it comes to building reserves and maximizing the margins, 2025 might have been the year of the combo-platter, with some really fascinating studies showing the cumulative power of combining ELEMENTS emerging this year. Whether it was the "DO HEALTH" study, which we reported on in March, or the two Sleep, Physical Activity & Nutrition (SPAN) studies (here and here), which we reported on in August, the power of combining was certainly clear. And while we might never know exactly why there is such a compounding effect, we are finding more and more evidence that these are not stand-alone domains but parts of a whole, each interrelated with the next. 

By Fall, the volume of evidence on the wide-reaching impact of the "big 3" (MOVE, FUEL, RECOVER) on just about every mind and body injury, illness, and disease risk we face ensured they would be the most prominent again. But among the more fascinating evidence of the year were studies that shed light on the third theme - the power of and between people - and findings that cannot be overlooked. It turned out that "little things" which might seem easy to ignore, like word choice as mentioned at the end of November or the incredible health benefits that come with strong relationships (mentioned just 2 weeks ago), dramatically increase our odds of living a full and meaningful life...it's not all CONNECT, but it is definitely all connected.

On behalf of the entire team, thanks for another great year. We can't wait to see what 2026 brings us to learn and share.

Have a great weekend and wonderful holidays,
Mike E.

Dec 12

Here's a quiz for you: When it comes to predicting future health, what are the 5 most important health metrics or measurements you can think of?

If you guessed things like blood pressure or cholesterol, body weight or waist circumference, well done, they're all important...and I would imagine you're not alone. If you guessed cardio-respiratory fitness, grip strength, or lower extremity power, I'd be impressed and pleasantly surprised, as they are all critically important. However, if you guessed your 5 closest friends and how long those relationships have been intact, I'd be absolutely shocked...and you'd be right.

Of the 5 ELEMENTS we talk about, CONNECT is the one that's easiest to overlook. It can feel a little fuzzy or somehow soft because it doesn't require a blood sample or a white lab coat to understand it. Yet, it underpins one of the most fundamental truths of human health - that we are all social creatures with a biology that has been honed over thousands (if not hundreds of thousands) of years to favor operating in small bonded packs. 

In 2010, for example, a study of 148 different studies on the connection between social relationships and the risk of dying in more than 300,000 people in total concluded that those who had the strongest social relationships had a 50% greater likelihood of survival than those who did not; a huge benefit. For perspective, that's 15% better than nutrition and 30% better than physical activity, which are (of course) major levers. Not surprisingly, findings like this have prompted a major uptick in research and have helped us get closer to an understanding of why.

In March of this year, one expert made a strong case that the effect is largely due to the stress-reducing effects of strong relationships, including feeling secure, valued, and cared for. The author goes on to suggest that the magic number of close friends for humans might be 5 and provides several interesting ideas to support the theory. However, for those who like hard, measurable evidence, things got even more interesting in October when a team from Cornell University showed clear physiological differences in those who had a deep well of CONNECT, when compared to those who did not.

By plotting the "biological age" which uses changes in genes associated with aging as well as inflammation and stress markers in a group of more than 2000 individuals at or near midlife as compared to a social connection score across familial, religious, emotional, and community domains referred to as "Cumulative Social Advantage" (CSA), the team was able to show a significant difference. Those with higher CSA scores had slower aging and lower inflammation compared to those who did not. And, much like the compounding interest of a retirement account, the effect got significantly stronger the longer the connection was sustained.

The lead author of the study had this to say: "What's striking is the cumulative effect -- these social resources build on each other over time. It's not just about having friends today; it's about how your social connections have grown and deepened throughout your life. That accumulation shapes your health trajectory in measurable ways. People with richer, more sustained social connections literally age more slowly at the cellular level. Aging well means both staying healthy and staying connected -- they're inseparable."

It's a great time of year to reach out to someone you haven't heard from in a while or recognize those friends or family who are always there for you, no matter what. They are having a bigger impact on our health than we may realize.

Have a great weekend,
Mike E.

Nov 28

We've all experienced the emotional power of certain words. Whether the negative bite of a sarcastic comment that hits too close to home or the positive boost we feel when someone we care about recognizes a job well done, something is amazing about how certain strings of letters can prime our actions and shape our behaviors. 

According to a research team from Virginia Tech, it starts with brain chemistry. In January, they found that certain words had the power to kickstart a wave of chemicals known to influence our mental health, regulate our emotions, and prompt us to act. They were the first to show that neurotransmitters like dopamine, serotonin, and norepinephrine are released in varying parts of the brain and in differing concentrations depending on the words used and whether they were positive, negative, or neutral (aka "valence"). While the list of tested words wasn't readily available, it did make me wonder if expressions of gratitude, something known to impact on the brain as discussed here, made the list. If so, it may further explain why the annual ritual that many of us participated in yesterday can be so much more than turkey and stuffing...

It's easy to think of "thank you" as a simple and often superficial gesture of politeness, something we might teach our kids to do by the age of 2 or 3 years. However, as has become popularized over the last several years, there's more to it than that. Inwardly, feelings of gratitude can impact a wide variety of personal health metrics and precursors. Interestingly, this 2020 review of research found even improved sleep quality made the list of benefits...but it doesn't have to end there.

A new review published in July suggested passing it on, that is, the moments when we allow our inward appreciation to overflow into a genuine outward expression toward someone deserving a "thanks", acting as a critical communication signal, greasing the cogs of trust between humans. Originally referred to as the "find-remind-bind" theory in 2012, expressions of thanks help us to identify the right people to connect with, keep them (and their positive traits) front of mind, and further solidify the strength of those relationships. They go on to say that when used in socially oriented settings like the workplace, outward expressions of gratitude not only benefit the members of the exchange but also those who witness the act, increasing the odds of positive contagion (social cascade) by priming others to join in (collective emergence). However, there is some fine print. The authors of the review point out that while gratitude as a practice can be powerful, gratitude as a "program" could be something closer to a tightrope walk. If it feels forced, fake, or otherwise phony, it's likely to backfire. 

In a world where chaos and calamity sell, there's never a bad time to have a moment to reflect, reset, and ready...in this case, for the final push of 2025. We hope you had the chance to do so and were able to both give and receive the brain boost that comes with expressed positivity. But just in case one more wouldn't hurt...on behalf of our entire team - thank you - we could never complete our mission without every single individual who strives to live a stronger and happier life. We hope you'll pass it on.

Have a great weekend,
Mike E.

Nov 14

When setting out to write this blog each week, I typically try to find a unifying theme worth relaying to clients, customers, staff, and friends. It starts with a headline that is interesting enough to dive into a little deeper and often sends me down the rabbit hole of review in hopes of determining whether the case is as strong as the headline claims. This week, however, things were a bit different. Instead of one generalizable headline, there were 3 that were interesting enough to share but perhaps applicable to a narrower few. Here they are in no particular order:

Coffee for Conduction - because it is a fan favorite (and because I love a good cup of coffee), we are always on the lookout for research that helps us answer whether coffee is "good for us". As we've mentioned plenty of times before, the general consensus leans "yes" when the dosage falls in a reasonable range and at a time of day unlikely to impact sleep. However, for some groups, such as those with heart rhythm disorders like atrial fibrillation (a-fib), things aren't quite as simple. Even though for at least 10 years observational studies have suggested a slight decrease in the risk of developing the condition for coffee drinkers, not everyone is convinced. This week, the case got even stronger as a randomized controlled trial showed that in a study of individuals who were treated for a-fib, those who consumed 1 cup per day had a 39% decreased risk of recurrence.

Rest for Runners - the second headline worth knowing about seemed intuitive, maybe to the point of obvious at first. Simply put, a research team showed that runners who trained on inadequate or low-quality sleep had a significantly higher risk of injury when compared to well-rested peers. OK, no surprise there. However, where things get interesting is the degree to which the risk was increased. Poorer sleepers - which was defined as low quality, low quantity, or trouble falling (and/or staying) asleep - had a whopping 78% increased risk of sustaining an injury in the 12-month assessment period as compared to peers who were steadier sleepers. Now, to be fair, this was not a super rigorous study, so we can't draw firm conclusions - but it lends support to the idea that recovery definitely matters, especially in those who are pushing themselves physically at work or at play.

More on Movement for Knee Pain - in something of an addendum to our October 24th blog on managing knee pain, a new study out this week added Tai Chi to the list. In a randomized controlled trial, individuals who participated in an unsupervised Tai Chi protocol had significantly greater relief of pain and increased function than participants who received education alone and not by a small margin. Compared to those who got an education alone, 55% more individuals in the movement-based intervention achieved clinically significant pain relief, and 38% more achieved clinically significant functional improvement

So there you have it - MOVE more, RECOVER well, and if you like the stuff, enjoy that cup of coffee...it's probably good for you, even your heart.

Have a great weekend,
Mike E.

Oct 31

Movement is a powerful health elixir. This is not new news. In one way or another, it's a song we have been singing for a very long time. Thankfully, it is also a message that many of the people we interface with understand, agree with, and, if our most recent client survey is accurate, are leveraging. We were excited to see that approximately 45% of respondents were in the low risk category for this ELEMENT, which is nearly double the average for American adults, where only 24% meet the full standard. However, we also know there is still work to be done as 35% of our respondents remained at high risk...they just haven't been able to turn the knowledge into action, which, of course, drives the results. Thankfully, we have a growing pile of research that provides strategies to bridge the gap.

One of the most critical bits to understand is that dosing matters. How often we move (Frequency), how hard we go about it (Intensity), how long (Time), and the mode we choose (Type) will all have an impact on our results...and therefore how close to achieving our goals we get. Exercise every day (F) at maximum effort (I) for hours (T) doing the exact same thing (T), like wind sprints, 7 days per week, and the combination is likely to produce such an overload that we could easily become injured. On the other extreme, sitting in a chair barely moving our thumbs enough to scroll, even for hours every day, is probably not enough to stimulate a healthy response. The good news is, just about everything in between, whether it be short bursts at higher intensities (aka "fitness snacks") or long slow walks, can be beneficial. The even better news, as new findings from a global research team showed this week, the greatest benefit, when dosing is dialed in, can be gained by those who are having a hard time getting the ball rolling.

More than "I" Alone

While so many studies have focused on intensity and there is fantastic research showing many great benefits of trading intensity for time (the stairwell is our friend!), this time, researchers wanted to understand if, at the lower end of the intensity spectrum, the tradeoff would still produce a benefit. They started by mapping the physical activity patterns of more than 30,000 generally healthy adults, but either had low levels of daily activity (5000-8000 steps per day) or were considered sedentary (defined as < 5000 steps per day). They then monitored health trajectories for the next several years to understand the connection between each pattern and the likelihood of developing heart disease or, worse yet, dying during follow-up. After nearly 8 years, the results were in, and the trade-off, in this case for slightly longer duration (Time), even at reasonably low effort (Intensity), worked.
 

Even though all movement patterns produced some benefit, individuals who got most of their steps in longer blocks (at least 10 minutes of continuous movement) were far less likely to die (about 1/5th as likely) as those who got their movement in bouts lasting less than 5 minutes, with the best result noted when activity bouts lasted longer than 15 minutes. The same basic trend was true for the development of heart disease. The group who got their steps in 15-minute blocks (or more) were more than 67% less likely to develop the disease as compared to those who achieved their movement in 5-minute blocks or less.

The takeaway on this one is simple enough: All movement matters and just about any "dose" can provide health benefits. While short bouts at higher intensities can do great things, even for individuals not quite ready for HIIT, carving out 15 minutes might just "FITT".

Let us know if we can help.

Happy Halloween - Have a great weekend,
Mike E.

Oct 17

Pain is a universal human experience and, at the most basic biological level, a critical warning system that lets us know when it's best to "stop everything" to avoid danger. Yet, as we've learned in greater detail over the last few decades, it isn't just a "local" danger radar, like the temperature sensors activated when we touch a hot stove, but rather, a finely tuned brain-integrated system which uses our past experiences to help predict our current and future risk. Unfortunately, there are times when our memory doesn't quite fade like it should and the system gets stuck in the "on" position, allowing our brain to send continuous full volume pain warnings long after healing has taken place or, as in cases of phantom limb pain (the experience of pain in a limb that has been amputated), the local signal has been turned off.

This can be just as confusing and frustrating as it sounds. While the initial pain might have been turned on locally with the onset of injury, it ultimately "lives" in the activated circuits of our brain. Therefore, what we experience as very real pain, often at the site of an old injury long after healing and even without any active harm present, is more likely to be a stuck brain switch. Referred to as persistent pain and impacting as many as 50 million Americans, this type of overreaction by our warning system can become a major impact on quality of life.

The good news is, as experts have helped us transition from dismissing something that we don't understand ("it's not real") to searching in the right places ("because it lives in the brain, it is both a mind and body phenomenon"), we have learned a ton. For example, while we know it is more likely to occur in individuals who experience chronic stress at a young age (especially those with adverse childhood experiences), we also know that lifestyle and health habits play an important role. For example, there is a known association between metabolic disease and persistent pain (possibly related to inflammation), and the emerging evidence shows that improving health factors can lower the odds of persistent pain. 

For example, in one study from earlier this year, individuals with knee pain who maintained a healthy lifestyle were significantly less likely to experience chronic pain than less health-focused counterparts over the two-year study period. Similarly, in a 2025 randomized trial, back pain sufferers who improved their health habits showed a greater recovery than those who performed more traditional (guideline-based) care without an emphasis on lifestyle habits. Now, in a very interesting development last week, we may be closer to understanding why.

As published in the journal Nature, a UPENN neuroscientist who had personally observed that being really hungry dampened chronic pain, found the root of this phenomenon. As it turns out, a bundle of nerves in the brain stem that plays an important role in driving the chronic pain experience also relates to other key survival circuits such as thirst and fear. The team went on to find a specific signaling molecule called Neuropeptide Y (NPY), which helps the brain juggle these competing needs and override pain in the face of more critical needs. 

“It’s like the brain has this built-in override switch. If you’re starving or facing a predator, you can’t afford to be overwhelmed by lingering pain. Neurons activated by these other threats release NPY, and NPY quiets the pain signal so that other survival needs take precedence”.

 While there's still plenty of work to be done to develop a treatment for this overactive circuit, the team has made it clear that they hope for more than a pill. “We’ve shown that this circuit is flexible; it can be dialed up or down, so the future isn’t just about designing a pill. It’s also about asking how behavior, training, and lifestyle can change the way these neurons encode pain”.

Pain that lasts for more than 90 days can be frustrating and confusing. The good news is, it doesn't always have to be. Reach out if we can help.

Have a great weekend,
Mike E.

Oct 3

Maybe you, too, grew up hearing the term "brain food". In our house, it usually referred to eating fish, which, whether consumed whole (e.g., low rates of depression per average pound consumed) or as a part (e.g., Omega 3 fatty acids and their connection to brain health and recovery), sometimes needed a little nudge at dinner time. There are of course others, many that we've talked about previously, and some outlined here, however, since then, the proof of the essential idea, that there are foods that are uniquely "good" for our brain and others that are not-so-good, has grown exponentially, which is getting us far closer to understanding why and how fast changes can start. 

First, in a series of studies, a research team from Purdue University demonstrated that the accumulation of fat in the brain disabled certain immune functions, which appear to be at the root of Alzheimer's disease. This represents a major shift in thinking away from "plaque" (b-Amyloid) as the root problem and toward viewing it as something closer to a contributing factor linked to inflammation that has been shown to drive a variety of brain diseases and disorders. 

 Lending support to this idea, another study published last week showed a clear connection between ultra processed food (UPF) consumption and whole-body inflammation in a large sample of Americans as measured by C-reactive protein. Individuals with a diet in which half or more of their calories came from UPF had significantly more inflammation, as much as double, when compared to those who consumed less than 40% of their calories this way.

However, perhaps the most show-stopping finding, also released last week, showed exactly how quickly this can all begin — at least in mice. Researchers from the University of North Carolina Medical School found that when they fed mice junk food, a diet that "resembles typical Western-style junk food rich in saturated fat -- like cheeseburgers and fries", there was evidence that critical brain structures, especially those related to memory, were negatively altered in as little as four days. Whoa. 

 Notably, the team found evidence that this dose of junky fat and the way the brain attempted to deal with it, which included altering the ability to access blood sugar, further connected the dots between metabolic efficiency (how well the body converts food into energy) and brain health. When they rebalanced blood sugar, brain activity showed signs of normalizing. While mouse models don't always translate perfectly to human models, this one, especially in light of growing evidence that suggests a connection between creatine supplementation (an important cellular energy component) and markers of future brain health, is worth keeping an eye on.

There's certainly more to come on this one, but for now, if, like many, you too are keeping future brain health front of mind, a spinach salad with avocado and/or salmon might be a great choice.

Have a great weekend,
Mike E.

Sep 19

I can't even remember the first time I heard the phrase. As a regular in physical therapy and orthopedic clinics - a quip often used by clinicians to describe the risk of crossing the line into "sedentary" - it is so commonplace that I just assumed the credit belonged to some legendary doctor somewhere. As I dove further in, I found that "if you rest, you rust" was actually attributed to a famous actress who, in addition to a massively productive career, also played an important role in the movement for healthy movement. I learned that Helen Hayes was not only the first female actress to win the "grand slam of American show business" (the Emmy, Grammy, Oscar, and Tony) as part of an 82-year career which started in childhood, she also became a major philanthropic force in the domain of rehabilitation. The hospital in West Haverstraw, NY, where she focused her energies, eventually became her namesake. Research this year has backed her up - we humans are built to MOVE and should do so often if we want to stay vibrant. Here are a few that I thought were particularly cool:

Pain & Injury

First, in February, a group compared the impact of traditional exercise and "exergaming", that is, video games which incorporate whole body movements, on chronic low back pain. Both approaches made a positive impact, and neither was definitively superior to the other, suggesting just about any movement can work to help those suffering longer-term back pain (typically defined as >90 days) feel better. Whether you prefer movement for its own sake or movement that feels more like fun and games, it all counts. Then, in the same journal (a study we mentioned a few months back), another team showed that when it came to pain severity, this time in older adults across 28 different countries, movement was the most important lifestyle factor for predicting severe pain. It showed a much stronger association than even well-known drivers like smoking, poor sleep, and poor diet. Those who reported low and very low rates of physical activity had more than 4X the odds of developing severe pain than those who were highly active. A few months later, in June, as reported in the Journal of the American Medical Association, the work of a team in Norway helped to quantify how much movement, in this case, total walking minutes, is required to prevent low back pain from becoming chronic in the first place. The answer was 100 total minutes per day with higher intensities, such as a faster pace, only slightly better than slow-paced walking. While some benefits began around 80 minutes, the greatest benefit appeared at 100 or more, where an additional 23% risk reduction was achieved. 

Illness & Disease

The story got even better last month when, in a huge new review of 57 studies that aimed to determine the "dosage" (in steps) of movement required to get meaningful risk reduction across a variety of diseases, the number 7,000 kept coming up. When researchers pooled the data and reanalyzed, they found that compared to a low-activity group (2,000 steps or less per day), individuals who got at least 7,000 steps daily had a significantly lower risk of getting (and/or dying from) a host of the most common diseases during the study period. In addition to a 47% decreased risk of dying from any cause (which ranged from 37% to 47% for cancer and cardiovascular disease respectively), those who averaged 7,000 steps per day also had a 38% lower risk of developing dementia, a 28% lower risk of falls, a 25% lower risk of developing cardiovascular disease, a 22% lower risk of experiencing depressive symptoms, a 14% lower risk of being diagnosed with diabetes type 2 and a 6% lower risk of being diagnosed with cancer. A powerful benefit from 1 simple habit.

Very few people work for 82 years or live to be 93, but if we can find a way to incorporate her first quote into our lives and minimize the rust with movement, we might be able to prove that she was also right when she said, "age is not important...unless you're a cheese." :)

Have a great weekend,
Mike E.

Sep 5

If you're an athlete, engaged sports fan, or have followed any of our communications, you've likely heard the term "load management" in one way or another. It's a simple concept - when we overload the body, it's more likely to bark back (or break down) - but until relatively recently, there wasn't really a common language around the idea or a reliable way of measuring it, and therefore it was more intuitive theory than hard science. Then, in the 20-teens, a researcher named Tim Gabbett planted his flag on the concept with some very interesting data, which helped spur a consensus statement and, in the process, something close to a revolution in the training and competition space. The talk of measuring physiological loads, primarily in athletics, became far more commonplace and started to ripple into conversations where injury and illness prevention in other athlete types (e.g., industrial, tactical, etc) was the goal. Fast forward 10 or more years since the idea first entered the conversation, and, like many trends, it has experienced backlash, revisitation, and refinement.

So how does it work?

The basic premise is reasonably simple. Whether high tech, through the use of wearables or monitors which might capture data like continuous heart rate to predict intensity, or low tech, such as a 0-10 "rating" of perceived exertion after a training session multiplied by the total time spent training, a training load can be calculated. For example, if yesterday's exercise session was rated a 7 out of 10 effort level for 30 minutes, it would score 210 "load points" (7 x 30). If we then compared that total to the rolling 1-week and 4-week averages for the same athlete, we would know, relative to both a short-term and long-term baseline, how hard that athlete had pushed. We could do the same thing for the intensity of a workday or training operation. 

Gabbett's research showed that if an athlete pushed significantly beyond their baseline average, such as more than a 30% increase in a week, their risk of injury went up. On the other hand, since the only way to reliably improve physical capacity (strength, power, etc) is to actually overload the system, so it can bounce back stronger, finding the sweet spot which allows for maximum gain with reasonable risk, has become a major focus for other research teams and coaches who have picked up the trail. 

One athlete type that is particularly attuned to this fine balance is runners. They are not only notorious for overloading (and therefore experiencing a high rate of injury), but they also tend to like gadgets, which means between their training device (usually a watch) and the app it pairs with, they have access to lots of training data. Knowing this, a research team from Australia sponsored by Garmin recruited more than 5,000 runners to analyze their training data and injury histories in hopes of determining with a greater level of understanding "how much is too much?". What they found, as reported late last week, is something worth knowing: in runners (and possibly other athletes who repeat movements in high volume), a single session overload (compared to baseline) presented significantly more risk than the same overload if it increased gradually over days or weeks and not by a small margin. Specifically, if a run was more than 10% longer than the longest recorded in the previous 30 days, the risk was 50-64% higher. If the spike was very high, such as double or more the longest session recorded in the previous 30 days, the risk more than doubled by 2.28X (228% increase). 

While we can't assume the change in risk is the same for those who are experiencing non-running-related spikes, such as seasonal workloads or intensive environmental conditions in tactical or industrial athletes, the principle makes sense - pushing ourselves beyond what we are used to all at once adds significant risk.

Humans can do amazing things. Our systems adapt to almost any stress we throw at them and get stronger most of the time...just not all at once. It's said that the original interpretation of the famous two-word inscription on the temple of Apollo, which reads "know thyself," was something close to "know your limits"...for the runners and all of us who grind out lots of repetitive motion at work, home, or play, perhaps that really means "know thy baseline".

Have a great weekend,
Mike E.

Aug 22

Most everyone believes that movement matters. That is, we humans are built to MOVE, should do so often and with reasonable intensity in order to prevent and reverse disease. Of course, as we always like to point out, it doesn't end there. We think clearly, feel better, and even get more out of social interactions when we are on the MOVE. However, when we explore the details of healthy and efficient movement, such as what it "should" look like, things get fuzzier. 

On one side of the spectrum, somewhere in the weeds, is a group that sees movement through a lens of mechanical precision; let's call them "the engineers". On the other end, zoomed way out as if hovering far above the weeds, lives a second group, which sees movement as an entirely unique expression, heavily influenced by our personal experience of the world; let's call them "the artists". The engineers tend to argue that there is a "right" way to move, something that is efficient, can be taught, and should be replicated by all, in order to minimize risk and promote thriving. The artists, while acknowledging the clear advantages of leveraging our, well, levers, as well as our fulcrum and pulley (aka musculoskeletal) system, point to the almost countless variations in even the highest performing humans as evidence that there really isn't a standard. As is usually the case, it's a bit more nuanced than either extreme, and we now have stronger proof. What started a decade or so ago with a team of biomechanists (i.e. "the engineers") who were studying one of the fundamental human movements - gait (that is, walking) and common changes associated with knee arthritis, has grown into a simple and powerful alternative for those who might want to stave off a surgical correction or replacement.

To provide context and in a wild oversimplification in hopes to save words, the inside (medial) portion of the knee, where the round thigh-bone (femur) sits on the flat-ish shin-bone (tibia), is a major load-bearing structure when we walk. The combination of compression and the requirement to bend under that load in order to walk makes the area susceptible to wear, especially in those with reduced leg strength or elevated body weight. While staying strong, reasonably limber, fueling for health, getting good sleep, and a variety of other health behaviors can significantly lower our odds of developing arthritis, even when a genetic risk is on board, the engineers theorized that improving the way a person moves could also help.

In the late twenty-teens the idea was put to the test. One group of researchers found that when individuals with knee arthritis were trained to "toe out" while walking, their biomechanics improved. Around the same time, a different group at Stanford's Performance Lab found that a more personalized change, having individuals either "toe in" or "toe out" based on their unique mechanics, produced better results. They found that a personalized approach more consistently lowered the pinch force on the inner side of the joint. The results were so promising that they expanded the study and, in 2022, reported continued positive results, some of which were discussed in a 10-minute video here. As it turns out, and as published last week, even under the most rigorous testing conditions (a randomized controlled trial), 6 weekly sessions to retrain participants to move differently, in a way that complemented their unique mechanics ("gait retraining"), resulted in not only pain reductions on par with those expected from medication but also a clear improvement in cartilage health on MRI over time.

 Said another way, both the engineers and the artists were right. Like a function-fingerprint, if you look close enough, our movement is uniquely ours. There is no "one perfect pattern" that works best for every human. However, exactly how we interface with the world through our movement can be optimized to lower risk, improve health, and ultimately maximize performance. If you think you could benefit from improving the way you move, let us know. We are happy to help.

Have a great weekend,
Mike E.

Aug 8

We dropped our youngest off at college this week. Although by the third repetition, it'd be reasonable to assume the process would be more routine and easier this time (that was, in fact, the hope), it certainly didn't feel easy.  Always a bit of an adventurer, Andrew's choice was the furthest from home and will start in a rigorous military environment. To complicate things, always fairly independent, he's probably the least likely to call home and tell us how everything is going. Combine all of this with the fact that those in charge describe this place as "the road less traveled" and even the locals referred to it as "in the middle of nowhere,"  and maybe it's no surprise that good sleep has been a little more elusive than usual this week. The upside, of course, is that it made deciding which avenue of health to explore for the blog a lot easier. :)

As an unapologetic sleep-geek, along with my Garmin, which, similar to their new sleep-focused product, calculates a daily sleep score, our usual go-to sleep hygiene tactics are already well-integrated in my life. However, for those who might be just starting or ready to take a second look, let's start with a wildly unscientific self-assessment of those key areas we know matter to set the stage:

Bedtime - My bedtime is as close to set-in-stone as it gets (25 of 25 points).

Long Runway - I try to ramp down a few hours before that time, first by stopping calorie intake (hours prior) and then by leaning on a cup of Sleepy-Time tea to reinforce my "habit loop". (20 of 25 points)

Environment - My bedroom is set up for something about as close to hibernation as possible with generous use of blackout shades and a temperature that is cool but not cold (25 of 25 points).

Physical & Mental Readiness - although not typically as part of a bedtime routine, my heavy reliance on to-do lists to stay organized (a known tactic to help swirling minds before bed) combined with the fact I usually cram enough into any given day to be physically tired, ensures that I am ready when my head hits the pillow (20 of 25 points).

Total = 90%

So what could possibly be left?

One recent study that caught my eye was on the use of Creatine, a supplement which is gaining attention for brain benefits, along with its more well-known benefits associated with physical training. The 2024 study showed that a single dose of creatine could combat the brain fog of sleep deprivation. While I wouldn't say I'm sleep deprived (yet), it's certainly one I'll keep looking at.

However, more recently, and as reported last month, certain exercise modes might be particularly beneficial for those who struggle with sleeplessness. When the research team reviewed the randomized controlled trials on the subject, they found that of the 13 different intervention types tested, exercise was most effective. In particular, yoga and Tai Chi had the greatest number of benefits (including reducing the time required to fall asleep by 25-30 minutes each), while moderate intensity rhythmic aerobic exercise (like walking and jogging) showed improvements in the general severity of sleeplessness.

While I suspect my bout of insomnia may be temporary and things will settle in now that I'm both back in my normal timezone and got a text that things were going reasonably well (especially now that he knows about the fire ants, oof!), sleep can be challenging at times. If you find yourself struggling and need some ideas or a place to start, reach out anytime. 

Have a great weekend,
Mike E.

July 25

If we work at something long enough, despite how distant the horizon, there's an occasional breakthrough to celebrate. A month ago it felt a little bit like that when the American Heart Association released a "scientific statement" which critically reviewed one of the oldest, most obvious, and yet still wildly polarizing concepts in health care - that since food quality has the power to restore health, professionals (including physicians) should prescribe it like a medication. While this seems like common sense to many who agree with the fundamentals of the idea, not everyone does. Whether the lack of formal training health professionals receive in the area of nutritional science, or the claim that eating healthy is inconvenient or costly compared to the "ease" of medication or even questions related to effectiveness, getting to a point where "food is medicine" has been a slog. However, over the last 5 years, things have begun to shift, and the idea is gaining steam. A growing number of people are realizing that trading the convenience of cheap ingredients enhanced with ultra-processed flavor profiles now for a hefty quality of life cost in the future is not a good bet, and since the microbes in our gut (microbiome) play an oversized role, they are worth learning to take care of.

Making sense of exactly how the many-trillion microbes on board actually drive our health is no small task. However, an exponential growth of studies in this area has helped. Before 2010 for example there were hundreds and even thousands of references on the topic depending on how far you go back, but in the last 15 years there have been hundreds OF thousands...and more than a quarter million since 2020, bringing far more clarity to the picture; and with it, a few themes that have become reasonably well established:

(1) Healthy bacteria feed on fiber and fermented plants, so consuming a wide variety and volume daily helps grow the population of "good guys". On the other hand, bacteria implicated in disease prefer an industrialized diet, heavy in sugar and highly processed, so limiting these whenever possible can help keep their population in check.

 (2) It's not only food that matters - other lifestyle factors like physical activity, sleep, and stress management can also play an important role and often have a bidirectional relationship with the microbes - they both drive each other.

(3) Supplementing or replacing colonies in order to restore health is an interesting but still mostly experimental idea, so our best chance to reset things may be to restore our diet to one which mimics a pattern far more common before the industrialization of food...a theory which was tested in Canadian adults.

 Researchers recruited and randomly assigned 30 people to consume a diet which they called the NiMe Diet (short for non-industrialized microbiome restore), an eating pattern of times gone by for most of the world. Typical of "ancestral" diets, this one was primarily plant-based, contained no dairy or wheat, and was low in process, which means it was low in sugar (as measured by glycemic index) and high in fiber. From a macronutrient perspective, it was 60% carbohydrate, 15% protein, and 25% fat, and the menu featured foods like beans, sweet potato, rice, cucumber, and cabbage as well as foods which were known to feed the particular bacteria they were hoping to grow, such as Jerusalem artichokes, peas, and onions. 

Following the intervention, their deep-dive analysis of participants' health showed impressive changes in only 3 weeks. The findings, published earlier this year, showed that participants had a significant change in the makeup of their microbiome, including growth of a particular bacteria found in tribes that still eat this way, like those in rural Papua New Guinea. They also had meaningful clinical changes, including significant reductions in cholesterol, blood sugar, and body weight, which paralleled a significant drop in health risk.

It seems less likely that the "Father of Western Medicine" is the one who said it, but whoever gets the credit for "let food be thy medicine and medicine thy food"...the data says they're right. I hope your garden is growing as fast as my lawn and you're benefiting greatly from feeding those microbes.

Have a great weekend,
Mike E.

July 11

Under the heading of "practice what you preach", I've been focusing on increasing my total exercise volume lately. Since I'd much prefer to be outdoors, I've found my way to a local rail-trail for a few jogging miles more regularly. While "easy and enjoyable" is not my typical default which is less surprising given new research on the links between personality type and exercise preference I suppose, on Tuesday I was reminded of how powerful an equalizer the heat & humidity of July can be; after two 15-ish minutes of jogging separated by a bout of walking, I was fried. My legs felt like they were made of lead, and I really just wanted to lie down, pretty clear signs that I had overloaded and possibly strained my system more than intended. 

Maybe this sounds like a bad thing. It certainly can be if not given the respect it deserves, but doesn't have to be. In fact, despite hype phrases like "you need to shock your system" that make it sound scarier than need be, unlocking the adaptations that make us stronger and healthier is, at its root, a conversation about controlled overstress. The better we are at staying on the right side of the fine line that separates "functional overreaching" (the good and stimulating stress)  and "over training" (the excessive overload which delays recovery or sets us up for injury), the more we can leverage the power of our physiology - we get stronger through stress. For most of us, that means if we dial in strategies that help us RECOVER, we can get stronger this summer.

Of course, this isn't exclusive to athletics, and it doesn't have to be all at once. Recent studies, such as this one and this one, have shown that allostatic overload, the more technical term for the accumulation of strain, is connected to overuse injuries and physical performance decline in tough environments like Officer Candidate School (OCS) with the US Marine Corps. Although the blood markers and survey data collected may not be practical in our daily lives, and three of the other five proven markers would require a blood draw, newer technology can provide a close approximation. Whether using a smartwatch or an app on the phone, most of us can easily and routinely measure heart rate and heart rate variability (HRV) if we want to. These two data points, which don't fluctuate all that much if measured in a true resting state (shown here) and therefore can tell us when our "engine is idling a bit high", have been effective in quantifying overload in higher stress occupational scenarios. For me, after the jog, those same data points suggested it might be the perfect opportunity to test a new recovery framework that had recently caught my eye - the 4Rs of Sports Nutrition: Rehydrate, Refuel, Repair, and Recuperate. 

It's a relatively simple idea - by accounting for current body mass and activity profile along with the symptoms I was feeling, I could leverage the latest in sports nutrition and focus on replacing the nutrients needed to bounce back quickly and fully. With the help of the web tool that accompanied the article, I was able to generate a plan for the next 24 hours. In truth, I didn't follow it to the letter, but instead used it as a guideline to help me be a bit more deliberate than I might typically be. I rehydrated more aggressively than usual and worked to make sure my next meal had the amount of carbohydrates and protein needed to restore quickly. The results were promising. While restless sleep or other signs of extended stress are not uncommon, the night after a heavy physical load, I slept like a log, my resting heart rate returned to within 2 beats of my baseline, and my overnight HRV was within my normal range...a good first test.

 The heat and humidity are likely here for another couple of months...that could mean risk , or it could mean more opportunities to test the 4Rs. Give it a try, and I'll let you know how it goes on my end.

Have a great weekend,
Mike E.

June 27

The list of "important things we should probably do for our health" is almost endless. Some of them are big foundational things that never seem to change (ELEMENTS). Others, like coffee consumption, are generally positive and seem to be gaining steam - for example, 3 new studies say it supports healthy aging in women, improves heart risk when taken "without", and may even flip a cellular stress switch. Yet others, like consuming seed oils (which have attracted a LOT of attention recently), are still probably in the "need more info" stage. Research from April, which said seed oils are a negative for cancer risk...in contrast to a recent talk at a nutrition conference earlier this month, which suggested they are possibly good for metabolic risk, only complicates things...stay tuned on that one.

However, in an otherwise busy life, trying to keep track of, or even more daunting, actually "execute" on the whole list is probably impossible. Ranking, prioritizing, and honing, therefore, is one of the most important things we can do in deciding where to place our limited (and possibly dwindling) attention. If we asked the American Heart Association which are the critical bits, they might suggest their Essential-8: be more active, quit tobacco usage, get better sleep, manage weight, cholesterol, blood sugar, and blood pressure. Research from this year, which shows better biological aging in those who do, appears to confirm the claim. If you ask us, we think those 8 (and a few others, perhaps) can be trimmed to 5 major headers: Move, Fuel, Recover, Endure, and Connect. But what if you had to pick just 1? Which is the most powerful?

It's a fun exercise, but context matters. The "most powerful to what end?". For example, when AHA number 4 (manage weight) is the priority, perhaps the old fitness idiom "you can't outrun a bad diet" applies. If so, Fuel might be the best starting point. For those who are trying to protect future brain health, a fascinating new theory that blends biology and physics suggests that our brain works best on the brink of chaos, which is primed while we sleep. If that's the goal, Recover (via sleep) should be near the top of the list. However, for the populations we often serve, those groups who push themselves physically as part of everyday life, often in stressful environments, which can leave bodies hurting, the answer may be Move.

This 2022 study showed for example that stress levels experienced by professional firefighters were cut in half when exercise was a regular part of their routine; a reduction of about 16% per 1 hour of exercise added per week and more recently, this small study (March 2025) showed moderate aerobic activity had a significant and positive impact on sleep quality. However, one of the more intriguing recent studies on the topic was completed by a team in Chile and published in January of this year. It showed overwhelmingly, in a population of nearly 30,000 older adults, that low physical activity loads increased the odds of experiencing severe pain. While all the usual culprits increased the odds of experiencing severe pain later in life - smoking by 21%, poor diet by 78% and poor sleep by 81% - physical activity was far and away the heaviest hitter, increasing the odds by a multiple of 4.35 (i.e., 435% increase). And, if this study on individuals with back pain is on the right, getting these loads in nature might be even better.

It's never a bad time to get moving. Start slow, keep it fun, and respect the heat.

Have a great weekend,
Mike E.

June 13

If you subscribe to the notion that "smarter is better than "harder", you probably love the idea of a shortcut. Truth be told, you're not alone - effort takes energy, which we humans try to conserve. While the thinking part of our brain understands for example that regular physical activity has the power to add years to our life AND life to our years, the part of our brain that controls our action is wired to stay put and opt-out, and so we often do. Brain-scan studies like this one from 2021 confirm this imbalance, providing support for the "Theory of Effort Minimization in Physical Activity", a fancy way of saying that it is neurologically more natural to sit on the couch than get up from it. Coupled with our equally powerful problem-solving circuits, we find ourselves on a quest to have it both ways - to get the benefit without all that pesky effort - a drive which has produced many innovations...as well as some unfortunate fallout. Whether it's moving walkways and e-scooters everywhere which make it easier to get around but also lower the odds we will hit a healthy number of steps per day (+/- 7K for most people) or any other number of conveniences, we have to make choices every day on when efficiency goes bad.

Dietary conveniences follow a similar pattern. Messaging on supplementation can feel like a game of chutes and ladders. Taking multivitamins, protein, omega 3s, vitamin D, or others can be an easier way to meet recommended daily units, however, the research on their health value is far from conclusive. While our thinking brain knows that getting enough healthy greens in our diet the old-fashioned way (by eating them!) is probably the way to go, the convenience of having something similar in a powder appeals to enough of us to generate $70 Million in sales each year...we're just not sure if it actually works.  On the other side of the spectrum given the known risks associated with consuming diets heavy in animal proteins and the generally positive story related to creatine supplementation which might help fill their gap, one might assume this switch would be well underway. A recent small study even showed it could improve our ability to think clearly when we are sleep deprived, an interesting gap-filler despite not making up for a good night's sleep. Of course, things get even more complicated as new threats emerge.

The trifecta of safe, effective, and convenient is becoming increasingly difficult to find.

The growing body of research on microplastics and their negative impact on health, for example, has certainly gotten me wondering about ways to limit exposure. Coffee consumption, which is generally in the "healthy" column (and something I look forward to each morning), could get murky if the way we prepare it needs to be drastically changed. While filtering coffee makes a major difference in limiting cholesterol-raising compounds that come along for the ride when coffee is brewed unfiltered, the trade-off of a steaming cup of plastics depending on what the filter is made of may need deeper consideration. Of course, unfiltered coffee steeped through a convenient tiny plastic cup might be especially problematic.

In a world where "time is money" and "no free lunch" can both be true, we are always trading something. With any luck it doesn't have to be our future health.

Have a great weekend,
Mike E.

May 30

Recovery is at the heart of prevention and health promotion this time of year. It's an easy time to get over-stressed, overdone, and maybe even run down to the point of injury or illness. Since, on one side of the (load) balance, work and life demands are often not under our full control, it tends to be the recovery side where we can gain the most ground. With that in mind, we are always on the lookout for ways to tip the scales. This week, a team in Switzerland opened a rabbit hole to a whole new idea, and it starts with the lining of our arteries.

Inside the muscular pipes known as our arteries are a layer of cells called the endothelium. This thin layer of specialized cells plays an oversized role in our health, acting as both a physical barrier between the arterial wall and the bloodstream, and is also critical in regulating blood flow, controlling some of our inflammatory responses, and repairing the vessels from the day-to-day wear of a busy life. Their ability to recover and repair is directly related to how and when our vessels begin to age. When the endothelial cells can no longer replicate but are still active, called senescence, the entire system slows down. It stands to reason then, that if we could influence this cellular switch, we might be able to keep our systems healthier for longer...and a research team in Switzerland may have just solved the puzzle.

They found that as our bodies break down certain foods they leave a key byproduct (aka metabolite) that in a high enough concentration, flips the cellular switch to prompt cardiovascular system aging. Determining how to counteract this byproduct, which accumulates over time and is related to the consumption of foods high in phenylalanine, such as red meat, dairy, and certain artificial sweeteners, could act as a fountain of youth. While the initial experiments used antibiotics to kill off the gut bacteria which produces the negative byproduct, they also found that adding in another more positive metabolite (acetate) can restore and rejuvenate the aging cells. While the concentration of good bacteria and therefore the capacity to rejuvenate seems to get lower with age, the researchers believe that diets rich in fiber and foods with antioxidant and anti-inflammatory properties could boost the body's own "fountain of youth", something they have begun testing.

This may explain why another recent study showed that a garlic supplement was linked to improved cardiovascular endurance in recreational athletes and a third study showed that curcumin helped control cellular stress before and after exercise.

We may not be able to limit the stress and strain we face this time of year, but we may be able to recover better and therefore age a little slower...and it starts in the gut.

Have a great weekend,
Mike E.