Use it or Lose it

A dentist once said to me: “ Only floss the teeth you want to keep.”

I am now a flossing fiend, but I find this sentiment extends to pretty much every part of our body. It could be restated: “Only pay attention to the body parts/functions you want to keep.” By the way, that is EVERYTHING - strength, endurance, flexibility, bone density, balance, range of motion, cardio….

if you’ve ever had a limb in a cast, then you’ll have experienced muscle loss due to inactivity, or atrophy. Restrengthening the immobilized muscles is essential to regaining function (physical therapy) and if you do it assiduously, it works. Don’t stop by the way, that PT is now preventative maintenance. But what about general inactivity, a sedentary lifestyle, the gym is closed, or one is sick or injured for a while?

Atrophy happens.

Why? Our body is efficient - systems are maintained to only meet the challenges at hand. An active and healthy lifestyle boosts bone density, muscle strength, cardiac capacity, endurance, balance and flexibility. This constructive process is called Anabolism. If a system is not challenged, then maintenance falls back to the bare functional minimum. This process of not renewing tissues, or even actively breaking them down is called Catabolism. (think catastrophe). Another piece of not-so-great news is that the anabolic process slows as we age, so building back after a time of inactivity can be even tougher than a couple of decades prior. Take home message here - never stop challenging yourself, especially with resistance training/you are over 60.

A study done on athletes demonstrated a loss of muscle mass 3 weeks after they stopped working out. Balance decreased after 4 weeks. Cardiac capacity in 2-4 weeks. And not only were functional differences noted, but the ability to metabolize carbs, exchange oxygen, maintain good blood glucose levels and fat storage were all negatively affected. Interestingly, though muscular strength showed some resistance to detraining, it was also slower to come back. Age is a factor - muscle loss due to metabolism slowing with age is called sarcopenia, so we’re all swimming against that tide as well.

So this is all a bit gloomy, but there is good news: atrophy and detraining effects are reversible at all ages.

Here are some ways to stay strong and maintain function;

1) do resistance training/strengthening to your maximum ability at least 2-4 X a week. All ages, all the time. No ifs, ands, or buts.

2) get adequate protein (don’t go nuts because you’ll store the excess as fat) but 1g/kg of body weight is a normal healthy intake. Maybe add a little bit more if you are over 60. If you must take a break (5- 10 d) due to illness or injury, keep your protein intake adequate. It tends to mitigate muscle loss.

3) if you ever had PT, get back to it - it’s prevention for the rest of your life. Make it part of your workout regimen to protect you from the reason you went in the first place.

4) Vary your workouts so that you are challenging all your body systems as frequently as possible. For example, mix and match balance with cardio, resistance training with flexibility etc. (Go heavy and frequent on the resistance training - it’s associated with cognitive, muscular and metabolic maintenance). And keep it consistent over the years. Accumulated breaks negatively impacts your lifetime muscle strength.

Your health-span has the potential to equal your life-span. Pay attention and prioritize your body. Challenge all your systems and don’t stop. Remember the inspiring little phrase: “only floss the teeth you want to keep.”

Intermittent Fasting – A few basics.

To fast is to go without food. We do this every time we go to sleep and then break our fast with the first food we eat that day (breakfast).  Wikipedia defines Intermittant Fasting (IF) as an umbrella term for various diets that cycle between fasting and non-fasting during a defined period. Some folks take a day off food, and then a day on. Some choose to eat only during a restricted period of time during the day over the course of the fast (Time Restricted Feeding). How long you choose to fast is up to you and your metabolism. Some folks have unsteady blood sugar and would need to have a little something  available, others don’t need anything and won’t feel hungry even after 2 days (me – I tried it. I was a little peckish at the end of day 2).

The question of “is it safe?” can be answered easily; YES. It is fine to take some time off eating. We carry hundreds of thousands of calories and store other nutrients in our bodies, so we don’t really need to eat everyday. Early on in our evolution we were not guaranteed daily food, it depended on foraging and hunting success. Food availability changed with the advent of agriculture and food storage. However, it’s a pretty wriggly can of worms involving habits, customs, culture, food addiction and lots of potentially conflicting information. As always, the answer is a qualified  “It depends”, however research is supporting the use of Intermittent Fasting (IF) to maintain body health.  There is something called a metabolic switch - after a certain time following the onset of fasting (12hrs)  the body switches fuel sources and starts to metabolize “fat through fatty acid oxidation and fatty acid-derived ketones, which serve to preserve muscle mass and function. Thus, IF regimens that induce the metabolic switch have the potential to improve body composition…” . But this is not true in all bodies (of course) or for all time courses because everyone metabolizes at different rates. Many studies have show that IF has led to improved insulin and blood glucose levels, lower blood pressure, and sustained weight loss.

If you are going to try Intermittent Fasting (IF) start with simply pushing your breakfast time back and see how you feel. A recommended time frame is 16 : 8, or 16 fasting hours to 8 eating hours. It has been noticed that keeping the 8 eating hours during the daytime has improved outcomes (Circadian rhythm theory) because you are matching your fuel intake to your more active times.

Take away: Intermittent Fasting is an age-old protocol that is gaining more research support and recognition. Adding mindful fasting to nutritious diet choices and movement habits are some of the most sustainably healthy things you can do for yourself.

Electrolytes - what are they?

Remember all the statements about getting adequate “vitamins and minerals”? Electrolytes are the minerals.

‘Electrolytes’ are electrically charged particles known as ions, created when minerals dissolve in water. Minerals in our food (best sources: fruits, vegetables, fresh foods) dissolve into ions in our digestive system fluids. For example, dietary salt (NaCl) will dissolves into Sodium (Na+) and Chloride (Cl-) ions, cross from your small intestine into your bloodstream, and become electrolytes flowing throughout your body.

Basically every body process or enzyme needs an electrolyte component to function. Sodium (Na) is necessary to maintain blood pressure, Iron (Fe) must travel to the bone marrow where hemoglobin is assembled. Calcium (Ca) is required in your bones, nerves and heart; Magnesium (Mg) in your muscles; Sulphur (S) in your immune cells; Iodine (I) in your thyroid; Zinc (Zn) and Selenium (Se) in your brain, and there are many more examples. Some minerals are required in large amounts (measured in milligrams, for ex. Potassium/K) and some only in trace amounts (measured in micrograms, for ex. Copper/Cu). A milligram (mg) is 1000 micrograms (mcg or µg). For a breakdown of daily amounts needed for each mineral, click HERE. Electrolyte levels in the blood are tightly regulated by the kidneys, which excrete any excess in the urine. Levels of electrolytes are indicators of organ function, so an electrolyte measuring outside it’s normal blood or urine level is a red flag and the imbalance deserves investigation.

Imbalances can happen in a number of situations. Electrolytes are lost through our skin when we sweat, when we lose fluid rapidly during an episode of food poisoning/diarrhea/vomiting/colonoscopy prep, or during kidney disease where the electrolyte control center itself is disordered. There are also situations where we are unable to absorb electrolytes appropriately.

Dehydration will also cause electrolyte imbalance, so it behooves us all to make sure we are drinking enough water. Symptoms of dehydration: muscle cramps, fatigue, dizziness, headache, nausea, confusion. If rehydration and electrolyte balance is not regained, symptoms worsen to include seizures and eventually coma. So make sure you have adequate water and nutrition daily to ensure appropriate hydration and electrolytes.

How much is enough water? It varies, but shoot towards 8 cups per day. More is better than less. Remember that age decreases the thirst trigger, so perhaps set a few alarms throughout the day to remind you to drink.

What foods and beverages are the most mineral-rich? Fresh whole unprocessed foods that still have their full complement of nutrients. Different foods will give you different minerals, for example, seaweed is high in iodine, Brazil nuts are high in selenium, cabbage is high in sulphur, etc. The best bet is a varied diet, especially rich in highly colored fruits, leafy green vegetables, seafood, nuts and seeds.

Electrolyte Mixology! Create your own personalized electrolyte beverage (because Gatorade tastes icky):

Mix 1 C of your preferred juice (grape-lime, cranberry, blueberry-lemon, tart cherry, mango, pear…use light-colored white grape or apple juice if managing pre-colonoscopy hydration) with 2 C water* in a quart mason jar. Add 1/2 t of sea salt and 1-2 T of maple syrup or honey to taste. Muddle in some fresh mint or add a few fresh/frozen pieces of fruit, and then store in your fridge. Grab and go - put one in your workout bag for delicious post-workout replenishment! Your homemade mix will be tastier and cheaper than other electrolyte beverages with none of the packaging. Delicous anytime you need an interesting and refreshing mineral-rich beverage - they might become your norm! You could also do some electro-alt-bev-mixology: *Use sparkling water plus the additions above for an alcohol-free treat for the driver or teetotaler in the group.

Exercise and Prevention of Parkinson's Disease

As if one really needed another reason to exercise!

There is evidence that exercise can decrease everyone’s general risk for Parkinson’s Disease (PD), and improve symptoms of those already dealing with it.

Parksinson’s Disease is a usually later onset (60 years +) neurodegenerative process that decreases the number of dopamine-producing cells in the substantia nigra (SN) area of the brain, involved in eye movement, motor planning and reward-seeking activities. Symptoms vary, but can include gait and balance issues, tremors, slowness and stiffness, and some cognitive effects, among other effects.

Wow, sounds a lot like what our society expects “aging” to look like, doesn’t it?

But what if that doesn’t have to be the expectation? There is research that indicates exercise, in fact rather rigorous exercise, can prevent PD onset or even reverse symptoms in PD sufferers. What does rigorous exercise look like? You have to move, and probably faster than your default.

The research indicates that aerobic exercise 3X a week for 30 - 40 minutes at a rate of 70-85% of your maximum heart rate in beats per minute/bpm (220 - your age), or perceived exertion of 14-17 out of 20 (Borg scale on this chart). You have to pay attention to how you are feeling and breathing. Also, it’s not a sprint (that would be 18 or more out of 20). You have to be able to sustain your exertion for 30+ minutes, it’s aerobic exercise, not anaerobic.

Let’s figure out how to manage this.

If one (OK, me) is 52, then my maximum heart rate (MHR) is 220 - 52 = 168bpm. 70 - 85% of my MHR is 117 - 142 bpm. That’s fine if I’m wearing a heart rate monitor or device, or working out on an exercise machine with electrode-handles. If I don’t have an electronic means of measuring, I’ll have to do it the old-fashioned way of taking my heart rate (pulse at neck or wrist) while exercising for 10 seconds and then multiply by 6. I’ll then see if that ballpark number falls between 117 and 142. A bit cumbersome, but doable until I obtain a sense of what 70 - 85% actually feels like. Another way is to use Rating of Perceived Exertion (RPE). The newer modified RPE scale of 20 (“the Borg scale”) allows more precision than the older scale of 10. Feeling or perceiving that like I’m exercising at ‘14 - 17 out of 20’ RPE will correlate to 70 - 85% of my MHR.

It might be a bit unnerving to find out what 70 - 85% actually feels like in your body, and that perhaps you must shift a bit faster to decrease risk factors for Parkinson’s Disease.

Anyway, the upshot - no surprise; MOVE! Move briskly, three times a week for half an hour minimum so your body temperature increases and you are sweating. You should be working hard enough so you are huffing and puffing, and a conversation would be a bit difficult. Use hills and stairs to boost your exertion if you are heading outside. Make a happy music playlist that motivates you to skip and jump and move faster. Take a class that motivates you and gets your heart pumping to 70-85% of you MHR. Huff and puff happily with your classmates.

Challenge yourself with appropriate aerobic intensity, and decrease your risk for not only PD, but pretty much everything else (heart disease, diabetes, stroke, cancer, obesity…) you’ll boost your aerobic capacity and also increase capacity for a healthy and happy lifespan.

The Calf Muscle Pump

We all know that ‘a sedentary lifestyle is bad’, but such a vague statement does not invite meaningful change. It’s more likely to invite the response “well yeah, and so…?”

Lifestyle intervention can happen and compliance improved when we understand the ‘whys and hows of a situation, in this case - sedentariness, or lack of movement. This Food for Thought about the calf muscle pump (also called the “second heart”) is easy to understand and immediately applicable.

Our circulatory system is made up of the heart, arteries and veins (and the lymph system). The heart pumps blood to the arteries sending blood with nutrients and oxygen out to ALL the cells against an entire body’s-worth of vessel resistance. To aid flow, arteries and arterioles (smaller periferal arteries) have embedded pumping mechanisms in their vessel walls. After cargo is discharged in the capillaries, the blood has to get back uphill to the heart. It does so in a venous system - but veins are thin-walled vessels that don’t have their own pumps. How does the body return blood and fluid through passive veins against gravity back to the Vena Cavae in the upper chest?

We have a very cool recirculation system that depends on two important factors: one-way valves in the veins, and muscles in the legs. One-way venous valves are forced open as blood is shunted upwards through the veins, but slam closed if blood falls backwards against the flow. The deep leg veins are embedded in the calf muscles (also in the feet and thighs, but let’s focus on the calves for now). These deep veins are squeezed every time the calves contract, squooshing blood upwards through the valve doors into the next compartment and creating negative pressure to suck blood up from lower or superficial outer veins. Imagine toothpaste being squeezed out of a tube, or for a really forceful visual that brings it home hard, check THIS quick video out! The natural contractions of our muscles return blood (and lymphatic fluid) to the central circulatory system in an elegant and efficient manner, supporting a healthy body and an active lifestyle.

So now we know how it works when all is going as it should. But what happens if it doesn’t?

If the following circulation challenges start to accumulate without intervention or healing, trouble could lie ahead: A sedentary lifestyle (biggie), shuffling gait, long plane flights, pregnancy, prolonged bedrest, wearing high heels (dammit), circulatory problems like congestive heart failure or vein valve failure, and others.

When the calf muscles stop moving as much as they need to due to any combination of the above, blood starts to pool in the lower limb veins. This pooling distends the veins because they are not strong-walled vessels, causing varicose veins, skin discoloration and possibly ulcers, and there are other risks - blood clots could form in stagnant or back-flow of blood known as deep vein thrombosis or DVT. This is why they tell you to move your feet and ankles on the plane, or recommend sexy support socks when you fly. Are you all pointing and flexing your ankles right now? I am! Also I just stood up and am doing heel raises as I type. Unwanted weight gain seems rather innocuous when viewed in the light of some riskier side effects of inactivity.

Keep in mind these are all long-term and worst case scenarios, and yikes - they are alarming. But the good news is that so much is preventable, and we can immediately start to prevent and improve any situation.

1) Stand up right now and do some calf raises for 30 seconds, then stand in a lunge and stretch your calves back out for 30 seconds each. Don’t skip the stretch. If you must sit (plane, non-standing desk work), rotate, point and flex your ankles as far as possible. Make sure you take many movement breaks if you have an office/screen job.

2) Explore different lower heeled (yet still awesome) footwear if you are addicted to high heels. (This is an issue for tango dancers, certainly!) Make sure you stretch and maintain your ankle flexibility and mobility so that the calves and achilles tendons stay long and are able to maximally contract - do not lose your range of motion! “The continuous use of high heels tends to provoke venous hypertension in the lower limbs and may represent a causal factor of venous disease symptoms.” (ref here)

3) Check your gait - don’t shuffle. Use your whole foot when you walk, from heel to toe. There is a foot muscle pump too.

4) Avoid a sedentary lifestyle. This is the biggest intervention. Walk or bike to work, or drive partway and then walk - might save you some parking fees too! Don’t sit for too long (we talked about this…), make time to exercise, change habits and timing to allow for more movement during your day. Get at least 20 minutes in at a time. More is better, so are hills.

Luckily, walking is easy, free, social, and it prevents a lot of health problems. It’s great fun in all weather if you just get the right gear (you’ll always be easy to buy for) and then go take a brisk walk to get those (second) hearts pumping!

Successful weight control and resistance training

What works for long term sustainable weight loss and health for all ages and stages?

Answer: RESISTANCE TRAINING.

TLDR version: The best outcome for sustainable healthy body composition for all ages is resistance training of 20 min sessions, two - three times a week (+ a reasonable food program + aerobic exercise.) Surprise!

So there’s good news and bad news. Let’s get the bad news over with.

The US CDC reports that obesity rates of adults 20-39 years old is 38%, 40-59 years old is 44%, and 60+ years is 41%, and all these numbers are rising! These are costly and unhappy statistics for Americans, since obesity is associated with heart disease, stroke, cancer, type 2 diabetes and other unpleasantness. Inactive folks may see a loss of muscle mass of 5% per year after age 30, which means that things could get pretty dire for sedentary folks by age 60. Inactive seniors are especially at risk for obesity due to age-related loss of muscle mass or sarcopenia. Thank goodness an active lifestyle can reverse this to the point that an older athlete’s skeletal muscle is on par with a younger one’s. Dieting and aerobic exercise alone will decrease weight temporarily, but part of the weight loss includes muscle mass. When the diet stops, the dieter is set back due to less metabolically active tissue, and usually gains all their lost weight back and more. Don’t diet. There’s a better way.

Here’s the good news:

This study (I do recommend clicking and reading the article - it’s very well written) describes a precise and accessible 20 minute resistance training (RT) formula. SO - no more excuses that you don’t have time. Here are the salient points:

1) Resistance Training at 60-70% of your max effort (20 min per session) 2 to 3 X weekly is the key to maintaining metabolically active muscle mass. Here are some free 20 minute sessions you can do at home.

2) Adequate protein consumption to restore and maintain muscle tissue (3 to 4 x 20g increments daily)

3) Stretching either during the work out or immediately afterward helps retain your strength gains by keeping muscular nutrients flowing and maintaining functional muscle length.

4) Reasonable daily food intake proportional to your age and activity level. No unsustainable low calorie dieting because it results in loss of muscle mass, and sets you back once you stop.

5) Aerobic exercise (20 min per session) to maintain cardiovascular performance and complement the resistance training. But it’s not as all-important as the resistance training.

How and why does this work? A resistance training (RT) session at 70% of your maximum effort will shake your muscular system up enough that it will require time and energy to restore and remodel your muscles. Rebuilding your muscles to respond to the imposed demand burns calories (afterburn) and requires building blocks of amino acids, hence the protein consumption recommendation - point #2. This afterburn caloric expenditure during the muscle restoration period can last up to 48 hours after a workout, so give yourself a rest day or two in between RT sessions. You can also stagger sessions, so that you do upper body RT work one day plus 20 minutes of cardio, then lower body RT work the next plus 20 min of cardio.

We are always looking for a quick fix, but there isn’t one really. This is as close as it gets. Do it for 3 months and reassess your health, fat levels, energy, and muscular strength. One more reiteration, because 20 minute sessions seem too good to be true…

• Adopt a moderate and reasonable caloric intake for your age and activity level.

• Do 20 minutes of RT 2 -3 times a week complemented with cardiovascular exercise for another 20 minutes per session. A total of a 40 minute workout 3 x a week is sufficient! You don’t have to dedicate hours to exercise, simply be efficient and work hard during your sessions. If you must choose, pick the RT over the cardio. (But be wary of that, it’s like choosing flossing over brushing - they are both necessary. And cardio is easy to get - just go for a brisk 20 minute walk).

• Eat high quality food that includes 15-20g of protein X 3 times a day plus one more 15-20g after a resistance training session.

A few words on protein:

Most omnivorous folks get enough protein. However, those who are dieting might lose muscle mass, putting themselves in a jeopardized position once they stop. Older adults may have a lower appetite, thus not getting enough protein or overall nutrients. Here are a few ways to boost your protein intake.

20g might be hard to stuff into your current diet! You might have to rethink proportions of protein to carbohydrate - replace low-quality carbs (anything with white or processed flour) with a protein choice instead. Here are some 20g of protein ideas: 1/2 C tuna, 1/3 C canned salmon, 15-20 medium shrimp, 1 C edamame, 6-7 oz tofu, 2 C milk, 3 oz of hard cheese, 6 oz Greek yogurt (Greek style is denser and higher protein than regular), 3 oz meat. Short cuts: a protein shake mix, or some well-vetted protein bars stored in your workout bag. Remember that other plant sources; nuts, beans and legumes are great sources of partial protein, but they must be complemented with grains within 24 hrs to get the full array of amino acids. Make sure you understand this food-combining point so you get all your nutrients. Also, drink adequate water.

Don’t get too crazy about this, just make sure that your meals are well balanced and have enough protein in them, and do resistance training at least 3 x a week to maintain and improve your muscle mass. Sounds a lot like “Eat well and exercise” doesn’t it? Just that the exercise part is more precisely defined.

Luckily, weight is something we can actively (pun intended) do something about. Resistance training boosts and improves lifespan and healthspan. Choose to make this weighty and wonderful decision, and commit to your current and future health.

Brain, Blood, and Boosting Cognition

The link between physical activity and brain health is more important than one might suspect. If you stop reading here, the big takeaway is: start working out with resistance exercises NOW, and never stop. But do keep reading to find out why - this is fascinating stuff.

Cognitive decline, aka the road toward dementia, is on everyone’s mind these days. Words like ‘neuroplasticity’ and ‘synaptogenesis’ are tossed around in the media. (Definitions: the ability to renew nerves and connections, and learn new things.) Good news! Cognitive decline is not an absolute of aging, and there are definitely things we can do to decrease risk factors. As it turns out, it’s more than just sudoku and crossword puzzles alone, although many would like to convince you otherwise and sell you apps and online games. The magic bullet is actually physical activity, specifically resistance training, along with challenging our brain.

First fact; I was surprised to learn that our all-important brain, only gets 15 -20% of our blood flow at rest. This perfusion amount slowly declines after age 20, and women get a slightly better deal than men. FYI, the remainder of organ blood flow is approximately as follows: liver/GI 25%, kidneys 20%, skeletal muscle 15%,and then fat, bones, skin, heart, lungs/the rest, all get about 5% each.

Second fact: A higher BMI (>25) or higher amount of body fat is linked to reduced cognitive functioning and Alzheimers disease at any age, not necessarily over 50.

Both of these fun brain facts point us towards getting more active, and fast. But what is the best kind of activity to do to preserve and rebuild cognitive function? Recent studies have shown that doing resistance training exercises to strengthen our muscles sets up an environment of neuroplasticity, reducing potential loss of executive function. A quote from a University of Sydney Australia professor who has been researching all of this: “…The message is clear: resistance exercise needs to become a standard part of dementia risk-reduction strategies.” Exercise generates beneficial neurochemicals and an environment in the brain to allow new neurons and interconnections to grow, boosting cognitive function and resisting cognitive decline. Daily aerobic exercise increases blood flow throughout the body, irrigating and perfusing the brain tissues with more oxygen and nutrients than it’s usual 15-20% of resting cardiac output. It also increases the amount of BDNF (brain-derived neurotrophic factor) positively affecting the hippocampus, which is involved with memory. Both resistance training and aerobic exercise are associated with adipose tissue reduction and maintenance of a healthy body weight, addressing the second fact of a high BMI’s risk to cognition.

SO… how much training do we have to do, and and how often?

lf you are not doing it yet, add at least two sessions a week of resistance training (at least 20 min) targeting all major muscle groups (legs, arms, trunk) and daily aerobic exercise (at least 20 min). Moderate to vigorous intensity relative to you. A rating of perceived exertion of 5-7 out of 10 has been shown to be effective for frontal lobe and hippocampus maintenance. More is better and consistency is key. Consider it like blood pressure - it varies, and you have to stay aware of it to maintain healthy levels.

Commit to setting yourself up for consistent body/brain training with both resistance and aerobic components to keep all your physical and mental marbles rolling as smoothly as possible in your lifetime.

Caffeine and Energy

Ahh stimulating beverages, how do we love thee? Let us count the ways: tea, coffee, soda, hot chocolate…. these liquids make us feel more alert, and possibly make us more productive, but they can also inhibit sleep and overstimulate us. How do they do this?

Coffee, tea and caffeinated sodas contain identical caffeine molecules, just in different amounts; coffee has more, tea has less, caffeinated soda can be hugely overloaded by processing. Differing physiological effects (coffee ‘buzz’ vs tea ‘energy’ vs Jolt ‘jitters’) are due to a number of elements; caffeine amounts in the original plant, extraction and processing methods (coffee prep results in more concentrated caffeine, soda can be hyperloaded), and also the varying array of co-nutrients present in the plant (or no nutrient effect at all in the case of artificial sodas).

Cacao on the other hand has theobromine, a chemically similar molecule which differs from caffeine by one carbon atom, or a single methyl group ——->

What’s the difference between the coffee/tea/soda caffeine effect vs the cacao theobromine effect? The presence or absence of this one methyl group determines effective penetration of the blood-brain barrier. Caffeine with one more methyl group is better at crossing the blood-brain barrier than theobromine, thus having a greater effect on the brain/central nervous system (CNS). Theobromine with one less methyl group than caffeine, does not penetrate the barrier as quickly or intensely, and has less effect on the CNS though it does stimulates the heart, and relaxes the smooth muscle of blood vessels. Personal sensitivities range, so effects can be unique to each person.

Once caffeine or theobromine is consumed, what is the actual mechanism of stimulation? This is fascinating… As we go through our day, a chemical called adenosine builds up in our brain. Once a certain level is reached, adenosine binds to neural receptors and causes us to feel sleepy. Caffeine and theobromine are similar enough to adenosine to block the receptors, so even though enough adenosine is present, we don’t get the ‘sleepy’ signal and stay alert. Until of course, the caffeine/theobromine is metabolized, which takes about 4-6 hours - then all the adenosine binds, and we crash. Time your stimulant consumption so that the caffeine/theobromine is metabolized by your system long before bedtime. This could be more or less than the 4-6 hr window depending on your genetics, but you probably know by now if you are sensitive or resistant to these stimulants.

Choose wisely; caffeine for a sharper edge, tea for a lighter one, and chocolate for a smoother stimulation. Or maybe cover all your bases and get a mochaccino! (I don’t consider hyper-caffeinated sugar-laden sodas to be a wise choice at all…)

Just give yourself time to calm down before heading to bed.

The image below is a caffeine molecule bike rack in Kendall Square, Cambridge MA -> MIT for the win.

Move More, Sit Less

Type 2 Diabetes (D2) is not a normal aging response - no one needs to resign themselves to D2. Two of the most preventative things you can do is 1) be more active, but also 2) be less inactive overall. What? This statement seems paradoxical, so let’s break it down.

Adding some exercise to your day, though certainly helpful, is not going to counteract all the other times of the day you are sitting. The most emblematic lifestyle would be that of a computer-screen worker who does an intense 30-45 minute peloton or boot camp class every day at lunch, but sits the rest of the time (drives to work, sits in office chair, drives home, sits on couch watching TV, goes to bed).

So, how to approach this?

1) Firstly, know where you stand. Get your blood glucose (short view) and HbA1c (long view) levels checked yearly. Type 2 Diabetes (D2) can creep up asymptomatically until one is in the danger zone, so these markers are helpful indicators. D2 is an insulin resistance issue. Though there is plenty of insulin in the blood to chaperone glucose in to fuel the cells, the problem lies in increasingly deaf insulin receptors on the outside cell wall. Because the insulin receptors cannot ‘hear the doorbell’, more glucose is called for by fuel-starved cells. This scenario increases glucose levels in the blood, and stresses the kidneys who are trying to filter it all out into the urine.

2) Second step, get those blood glucose levels down. The best way to manage too much blood-borne glucose is to burn it off. And not just during that 30 minute boost at lunch. A healthy way to lower blood sugar levels is to train your body to move, or think it’s about to move - it’s like priming the pump. Certainly do your mid-day fitness class, but also find ways to move more through out the day. Get a standing desk. Move every 30 minutes, sit on a stability ball, balance while you are on the phone, park further away from the destination, drive less, put timers on your computer to jog your memory… get creative here, but MOVE MORE OVERALL. (As I type this I notice the irony, and so have stood up from my chair to hold a medium isometric squat position.)

3) Third step, boost your fitness levels and reach a healthy body weight. Aerobic exercise or strength training have been shown to decrease D2 risk, so do both! Intensity and duration correlate with improved insulin sensitivity. And exercise is less expensive than the medication route! One 60 min bout of exercise will reduce your blood glucose by 10 - 20% for up to 24 -48 hrs. So the every-other-day approach works well. What works better is to do something every day, and mix and match a variety of enjoyable activities. The American Heart Association recommends a minimum of 150 minutes a week for basic health. You’ll need to do more if you’re looking to lose weight. Maintaining a healthy weight decreases risk for not only D2, but also other metabolic disorders and many cancers.

4) Decrease sedentary/screen time. Even folks who are very active increase their risk for D2 if they have more than 5 hrs/day of screen time. Do your best to reduce the amount of time you stare at any screen, small or large. Don’t lose the benefit of your activity! And protect your precious non-screen time.

Taking these 4 steps will break a downwards spiral into increased D2 risk. Increasing fitness and decreasing central adiposity has been clinically proven to be twice as effective in reducing D2 risk than medication (Metformin). It may be ‘easier’ initially to just take a pill, but it’s more beneficial long-term to modify the lifestyle, and create sustainable habits that not only decrease your D2 risk, but have other desirable side-effects. Find a dance class, join a hiking club, grab a walking buddy… Boosting your fitness level with enjoyable movement not only decreases risks for illness, but has the upside pills can’t give. Moving more and sitting less is just plain fun, improves your sleep, connects you to others, gives you more energy and creates an overall healthy happy lifestyle!

Part 3 Taking out the carbage - real vs junk carbs.

Next topic of What are you Eating: Carbohydrates. Much-maligned and obfuscated, carbohydrates have many folks twisted up into nutritional knots. This blog discusses what a carb is and isn’t, and how our food sources can end up contaminated with carbage.

A carbohydrate is not a food, but is actually a component of all whole foods. Even meat contains a few carbohydrates (in the form of glycogen.)

The organic chemistry term “carbohydrate” simply means carbon (carbo-), linked to hydrogen and oxygen (-hydrate). A chain of 3 carbons could be acetic acid or vinegar, chains of 5 and 6 carbons could be fructose, glucose and other simple sugars. A pair of linked fructose and glucose molecules is called sucrose. Longer branched chains of carbon are starch (digestible and energy-yielding) or cellulose (indigestible fiber), and the list goes on. Any molecule that ends with the suffix “-ose” is a carbohydrate, or in lay terms, ‘sugar’.

Here’s the difference between whole versus processed carbohydrates (“carbage”).

Whole foods have an ingredient list of one word (“grape”, “corn”) and contain varying amounts and types of carbohydrates plus other macro- and micronutrients. Processed foods are whole foods that go through mechanical and chemical processing, becoming purified towards one particular carbohydrate goal, like starch or fructose. A processed carbohydrate is more energy-dense (higher calorie) and excludes the other nutrients of the plants. Sometimes these nutrients are added back in manufactured combinations (“fortified” cereals. Ah, marketing…) Let’s take the example of a wheat berry, a grain or seed found on a stalk of wheat. Each tiny wheat berry has fat (wheat germ, natural oils), protein (gluten) and carbohydrate (starch and fiber/bran) as well as water, vitamins and minerals. To process wheat berries after harvesting, wheat is dried (to eliminate water), ground and sifted (to eliminate fiber and germ) and then bleached, (destroying any remaining vitamins) to result in white flour containing mostly the purified carbohydrate known as starch. Alternatively, if you eat whole wheat berries (< in this recipe they are cooked like rice) all the nutrients and fiber are retained. The fiber slows the absorption of glucose, reducing blood insulin spikes. Another highly processed dietary carbohydrate example is corn, commonly reduced to high-fructose-corn-syrup (HFCS) - a cheap and easily available sweetener added to sodas and baked goods.

Carbage is a term I use to describe processed and high-calorie low-nutrient insulin-spiking sweet foods and beverages. Any baked good wrapped in cellophane or plastic is an example, and they last much longer than anything found in nature. They do not decay normally, and if bacteria won’t touch it, neither should you. HFCS-contatining soda and “Little Debbie snack cakes” are good examples - apologies to all the Debbies out there. Our tastebuds detect sugar and register instant gratification and pleasure, however such carbage has no nutritional value except empty calories that needlessly boost our insulin levels. We evolved as hunter-gatherers to be drawn to sweet high calorie foods to keep our energy reserves up, but we are now much more sedentary. We don’t burn off the excess energy consumed as highly processed carbage. Carbage feeds the national sugar addiction, which contributes to the obesity, diabetes and heart disease epidemic the US currently faces. But we can make different choices.

We can bypass the sugary processed carbohydrate addiction if we eat real food instead of carbage. Our healthiest bet: unprocessed whole vegetables and fruits obtained directly from a farm or supermarket produce section. These choices give us natural and easily managed levels of carbohydrates along with healthy amounts of water, and all the nutrients. Clean up your diet by choosing real whole foods; Take Out The Carbage, your body will thank you.

Part 2.2 Fats - Triglycerides and Essential Fatty Acids

From the previous blog post, you're familiar with saturated and unsaturated fatty acids. Now we’ll look at how we obtain and use fats (synonyms: fatty acids, triglycerides. lipids), how much we need/don’t need, and why.

Triglycerides (TG): You’ve seen this term on every blood panel your doctor has ever ordered, but what does it mean and why should we care? Fasting blood-borne TG levels higher than 150 mg/dL correlate with increased risk for heart disease, fatty liver disorder, early onset type II diabetes, kidney disorders and pancreatitis (Article). Usually the effects are asymptomatic until something alarming happens and we find a doctor. TG blood screens are recommended yearly to identify high levels before they cause problems.

Triglyceride with 1) Palmitic acid, 2) Oleic acid and 3) Linoleic acids hitched on. Notice different saturation.

We get fats from two different sources: 1) our diet, 2) our liver synthesizes them from other molecules in our bodies including glucose. Yes, when you eat excess sugar, your liver uses it to make fat. (Bummer). In plants and animals, fatty acids tend to travel in threes hitched to a glycerol molecule. The glycerol carrier molecule isn’t choosy about who hooks into those three sites, so one glycerol ‘car’ can have three different fatty acid ‘riders’ varying in length or saturation-style (see image). If only one FA is hooked up, it’s a mono-glyceride, if two, a di-glyceride, and three, a tri-glyceride. This latter form is how fats mostly occur in our bodies. TGs are very large energy-dense molecules, and a lean adult has enough TG stored in them (about 15 kg or 33 pounds) to survive for more than 2 months.

For us to access the energy in dietary fats, our digestive process performs a multi-step process to break TGs down into molecules small enough to cross the intestinal lining.

Feasting: When we eat, 1) we break large fat particles into smaller ones by chewing and stomach churn. 2) most TG disassembly happens in the small intestine where enzymes rip two fatty acids off the glycerol triple-carrier to liberate free fatty acids and mono-glycerides. 3) These smaller molecules are emulsified further by the addition of bile, and are finally able to cross the microvilli membrane into the intestinal cells. 4) Once inside the intestinal cells, the TGs are reassembled into their prior triplet form, and packaged with other goodies like cholesterol and fat-soluble vitamins (A,D,E), into shipping containers called chylomicrons. 5) The chylomicron containers are shipped into the intestinal lymph system and thence into the bloodstream to deliver TGs, vitamins and cholesterol to the tissues. If cells don’t need the energy, excess TGs are instead delivered to our storage units - adipose tissue for later use. Chylomicrons decrease in size as they deliver their load to the periphery and then the empty containers return for recycling in the liver.

Fasting: When we are not eating, 1) “Need Fuel!” signals are released by cells when their energy supplies run low. These signals hit two targets. 2) Our storage units (adipose tissue) react by breaking stored TGs into free fatty acids (mono-glycerides). The mono-glycerides diffuse into the blood, and head off to the cells that need energy, for example, your leg muscle cells if you are going for a walk. 3) The liver responds by constructing new TG’s from the free fatty acids floating in the blood stream plus glucose (we use sugar to make fat!! Bummer again.) 4) The liver packages the TG and some cholesterol and protein into VLDL (very low density lipoprotein) shipping containers and sends them out in the blood. The name very low density means they contain more TG than the accompanying heavier protein and cholesterol. As the traveling VLDL shipping containers drop their TG cargo into energy-requiring cells, they become LDLs, (low density lipoproteins - relatively more protein and cholesterol-laden, see previous post on cholesterol), then IDLs (intermediate density lipoproteins), and then finally HDLs (high density lipoproteins) mostly empty protein vehicles which scavenge cholesterol and return to the liver for recycling and disposal.

TLDR-version: After a meal: blood TG levels spike because chylomicrons are clearing fat from the intestine. Fasting blood TG levels respond to energy requirements via free fatty acids from adipose tissue, and VLDLs from liver.

If the system is working well, TGs disappear into their destinations efficiently, and blood TG levels lower to normal. If the system is consistently overloaded with dietary fats, or confused by lots of sugar-induced insulin, TG blood levels respond by remained elevated and cause trouble in heart and blood vessels, liver, pancreas, kidney and more. How to decrease Triglycerides in your body to optimum levels (less than 150 mg/dL)? There are lots of ways, but the simplest and cheapest are lifestyle choices.

1) Exercise: This burns up extra TG’s floating around and decreases excess levels stored in your adipose tissue.

2) Cooking and eating: Many flavor molecules are fat-soluble which are lost in “fat-free” foods. To makeup for the lack of flavor, processed fat-free foods have sugar added to them to make them more palatable. It’s best to avoid these processed hidden-sugar-laden foods, because type 2 diabetes is risky. Instead, get more creative in the kitchen. Select recipes that are more veggie-forward, discover more pungent and umami-rich ingredients like fermented foods, spices, herbs, mushrooms etc. Instead of frying foods, roast, bake or slow-cook. It’s definitely a life-style change, but one that will benefit your health-span.

3) Drinking and smoking; Decrease alcohol intake and eliminate smoking - both are correlated with increased TGs, metabolic syndrome and morbidity from many causes.

4) Medication or supplementation: Fibrates, Niacin (prescriptions needed) and Essential Fatty Acids somewhat decrease levels of blood TGs.

Essential Fatty Acids (EFA’s) Also called Omega-3s and 6s, these are fats that we get from our diet, most notably fish oils from fish that need insulation in cold water, salmon, sardines, mackerel, steel head trout, cod, (yes, there was a reason for cod liver oil...) as well as flax, walnuts, and leafy green vegetables. The omega nomenclature (biblical reference here, science is not without a sense of humor) tells you how far from the end of the molecule the unsaturated kink is (see the final fatty acid ‘rider’ in the image above). We cannot make these EFA’s in our body and we’ll die without them, hence: essential. They are an important part of cardiac health, vision, inflammation regulation and other important functions. This is why nutritionists are always all over you to eat fatty fish like salmon. If you take the skin off your salmon before you eat it, you are losing much of the oil, so eat the skin! (Salmon skin hint: Grilling makes it even more delicious.) Include these foods in your weekly intake; walnuts, flax, chia seeds, salmon, herring, sardines, oysters, dark leafy greens, pine nuts, Brazil nuts, sunflower seeds/oil, pecans.

Overall takeaway: Balance your fat (triglyeride) intake with lots of healthy food choices, move around to burn off excess energy, eat fish and other delicious foods with EFA’s, and you’ll have solved the fat conundrum, plus you’ll enjoy the wonderful benefits of a healthy heart, liver, pancreas, kidneys and long healthspan.

Part 2.1 Fats - Saturated vs Unsaturated

Fats are a bit of a conundrum for most people. Are they good or bad? What should we avoid? Or include? There is no need to be afraid of fat. it’s just a necessary part of our diet. As with everything, the key is education and moderation.

The word “Fat” has previously been an unkind descriptor for people, and vilifed by media/marketing into a fearful food. Unloading the F-word, I’ll instead refer to dietary “lipids”. In the blood they travel as acids, known as “fatty acids”. Body fat can be more accurately defined as “adipose tissue”.

So what are lipids and why do we need them? Hold on to your hats, we have to do some organic chemistry (relax, you’ll be fine). Organic Chemistry means the chemistry involved with living growing systems - mostly Carbon, Hydrogen, Oxygen, and Nitrogen. An aside: Inorganic Chemistry is chemistry of the inanimate; rocks and minerals, manufacturing of plastics - things that don’t grow on their own.

Lipids are macromolecules made of long chains of carbons strung together with hydrogen atoms sticking out on either side. Imagine a carbon centipede with lots of hydrogen legs. When we eat lipids, the high-energy carbon strings are sequentially broken, giving us energy to move, repair, and generally live our lives. Not only energy sources, lipids are structural and surround every cell of our body as part of the cell membrane. Fatty acids are important for nerve conduction in both the core and peripheral nervous system, and did you know that our brain is made up of 60% fat?

Hopefully after reading all of this, you realize that fats are important components of our diet and bodies, and we simply need to approach them in a calm educated manner.

Saturated/Unsaturated Fat: These are dietary buzzwords, but do you know what they really mean? Have a look at this image. It’s a saturated (left) vs unsaturated (right) lipid - they both exist in nature and our body knows how to digest them.

Think of a sponge saturated with water - It can’t possibly hold any more. Saturation of lipids refers to the number of hydrogens attached to the molecule. If each carbon in the chain has as every possible landing site occupied by hydrogen, it is called “saturated”. These types of lipids mostly come from animal products (exception; fish). Butter, lard, full-fat dairy, tallow, and meat are examples.

Saturated fats are long and straight. They stack together well and protect each other from oxidation (rancidity). This is why saturated fats are so solid and stable at room temperature. Neither butter nor lard need to be refrigerated to stay solid, nor do they go rancid easily at (North America) room temperature.

But if not every landing site on a lipid carbon backbone is occupied by hydrogen and there is space for more, it is unsaturated. Because an unsaturated lipid chain is kinked, they don’t stack straight and solid against each other and so are liquid at room temperature. If there is only one kink in the chain, its a mono-unsaturated fat. If there are more kinks, it’s a poly-unsaturated fat. Unsaturated fats mostly come from plant products, for example olive oil and other vegetable oils, nuts and seeds. Cold-water oily fish also contain many unsaturated fats that are very beneficial to us. (More on these Essential Fatty Acids here.)

There is one last part of the saturation puzzle: Trans Fats.

Trans Fats are created by food processing and capitalism. Vegetable oils (unsaturated) are cheaper to produce than animal fats (saturated), but are less shelf-stable. In order to sell more cheap vegetable oil (palm oil mostly), a way to stabilize them at room temperature had to be found. Enter a chemical process called “hydrogenation” which showers the unsaturated oil with hydrogen to produce a saturated shelf-stable solid. Well OK, points for ingenuity and economy, but this process adds the hydrogen to the opposite side of the carbon chain when compared to the natural version of a saturated fatty acid (see image to the right). Why should we care? Because our body is not familiar with this form of lipid, and the break-down products of trans-fats attack our tissues, notably our cardiovascular system . Denmark banned trans-fats from their food stream back in 2004. The US finally did the same in 2018.

So what’s the takeaway on how to approach dietary fats? Guidelines from the Mayo Clinic and other science-based sources:

#1 Trans-fats. AVOID. They are just not good for you. This includes anything that says “partially-hydrogenated…” on the ingredients label. Pretty much anything in cellophane with a long expiration date, or found at a gas station. And why margarine is still a thing is beyond me. Easy hack: Eat real food - if you avoid processed foods, this problem is eliminated.

#2 Saturated fats. Eat less - aim for 10% of your caloric intake or less. Though our body knows how to handle them, these lipids give us more energy than we probably need, and are associated with higher blood levels of LDL cholesterol. Interesting point: If saturated fat in the diet is replaced with unsaturated fats, risk for heart disease decreases. If saturated fat in the diet is replaced with refined carbohydrates, risk for heart disease increases. Easy hack: choose fewer dietary animal fat sources per day - replace them with plant fats, NOT refined sugar.

#3 Unsaturated fats (both mono and poly-unsaturated fats) are healthier choices. Eat more. Vegetable oils such as olive, sunflower, safflower, and nuts and seeds like peanut, walnut, pine nuts, pumpkin and sesame seeds etc, as well as fatty fish which contain Essential Fatty Acids (EFAs in the next blog) like omega-3s (salmon, herring and sardines.) should all feature in your diet. These fats are associated with lower LDL and improved cardiac outcome. Easy hack: You can generally identify unsaturated fats as liquid at room temperature.

#4 Quantity. All fats are high in calories (9-10 cal/g, an m+m is about a gram of fat). Manage the amount of fat in your diet to about 25-30% of your intake. In a 2000-calorie diet, than means 44 - 77 g of fat. (44 m+m’s? Think about it - that’s not much if you have a sedentary lifestyle). Easy hack: ensure the fats you choose to include are more in the unsaturated (liquid) category. Increase quantity only if you’re burning a lot of energy per day.

Overall, choose mostly vegetable sources, eat real food, and don’t over think it. Less-processed and moderation is the key to healthy diet choices, which should include fats.

What Are You Eating?! Part 1: Macromolecules and micromolecules

A healthy diet includes the appropriate amounts of 6 things:

Carbohydrates, fats, proteins, vitamins, minerals and water. A teenage athlete, a pregnant woman, and a sedentary senior all require exactly the same nutrients, but in different proportions based on their activity level and stage of life.

Macromolecules (fats, carbs, proteins) are called such because they are big polymeric (chains of repeating units) molecules, and we need a large quantity of them, usually daily. They supply energy for all activities and building material for tissue repair. We require constant bodily housekeeping to stay healthy. Micromolecules (vitamins and minerals) are small molecules and we don’t require a large quantity, but they are absolutely essential to our existence. For example, sailors who didn’t get enough vitamin C on ocean voyages suffered from scurvy. Vitamin D insufficiency causes bone fragility, Vitamin E deficiency is associated with neurologic issues, and so on.

Nutrition is a complex scientific field involving molecular biology, physiology, neurology, and chemistry, but still bumps up against the mundane everyday need of preparing and eating food. This interface of ever-evolving science vs shopping for groceries can cause consternation among regular folks who don’t have PhDs in the aforementioned subjects. And it opens the door for money-grabs by those taking advantage of the confusion with fad diets and false supplements. Add in factors like health problems caused by psychological issues, Big-Ag pesticides and pharmaceuticals, food inequity due to social injustice and climate change, dearth of scientific education… and the whole thing starts to get overwhelming. One just starts to flounder with the simple question of “What am I eating?!”

Let’s zoom out a little. The reason for much of the confusion is because nutrition is basically biology, so a lot of answers start with “It depends…”. New discoveries are being made all the time. It seems like the federal nutrition guidelines change every few years. They have to because they are based on ever-new research uncovering more facts. Can you imagine that doctors once told their patients to eat margarine??? Now, the dangers of trans-hydrogenated fats to the cardiac system are well-documented.

An aside: During a recent visit to a health professional, a dear friend with cholesterol issues was asked if they were willing to switch from butter to margarine. I almost fell off my snowshoes when he told me this story. After about 60 seconds of apoplectic sputtering and almost having a cardiac event myself, I regained coherence and wondered aloud about the nutrition education of health professionals. Alas, nutrition is quite neglected in most physician’s education.

I believe that food and movement are the underpinnings of health, and these are some of the few things we can control for our entire lives.

SO. For the next few blogs, I will focus on one nutrient at a time and give a basic overview of what, why and how much we need according to recent research. The hope is to improve your ability to winnow bunk from truth, make better choices, and empower you to ask questions about food/supplements claims, whether they come from advertising, your friend’s friend, or your doctor.

Next week: FATS. Why we need them, what they do in our bodies, best sources, amounts, the bigger picture from the inner workings of the cells, to outer effects of our choices on the environment.

The Parasympathetic Nervous System (PNS) and the Vagus nerve

We hang in a balance between two nervous systems – the sympathetic (Flight or Fight) and the parasympathetic; (rest and digest). The parasympathetic nervous system (PNS) returns our body to calm after a stressful flight or fight response. Many of these responses are mediated through the 10th cranial or Vagus nerve (VN). The word Vagus comes from the Latin word ‘to wander’ and also is the root of the words vagabond, vagrant and vague. The VN wanders downfrom the brain stem (image of what it connects to here) and it’s nerve endings interface with organs and glands in the torso.

The VN ennervates the ear, pharynx,  larynx, back of the tongue, various glands, heart, lungs, esophagus,  stomach,  gallbladder,  pancreas,  small intestine and female reproductive organs. VN connections are the way we register “gut feelings” in the brain. A high ‘Vagal Tone’ (measured by heart rate responsiveness) is associated with increased digestion and ‘body repair and housekeeping’, lower heart rate,  a calmer and positive outlook, vit B12 absorption, boosted social connections, decreased inflammation, decreased anxiety, and increased health (article). It is also a potential new therapy for Rheumatoid Arthritis Inflammation. Performers and students stimulate the VN by deep breathing prior to a high stress show or exam. This accesses the PNS, boosting memory and decreasing stress.

Seeing how activation of this nerve can boost our overall health, how do we increase our Vagal Tone?

We can actively stimulate our VN by doing a few things like 1) deep breathing with long exhales (activates cardiac VN connections) 2) Gargling, laughing and singing or chanting (stimulates the back of the throat where there are some VN sensory nerves)  3) oxytocin-increasing activities (hugging, partner dancing) that boost connection and social networks. Oxytocin affects VN neurons (in mice anyway). So doing things that make you feel good and relaxed increase your Vagal Tone, and therefore your overall health.

Try this simple yet profound activity: find a comfortable position (seated or supine) and close your eyes. Inhale for 4 counts, and exhale for 6 counts. I connect my counting to my heartbeat, which I can sense when I’m sitting still, but however you do it, keep the counting even. Do this for 5 to 10 cycles. Note how you feel before and after the exercise. If you have a blood pressure cuff, taking your blood pressure before and after can be quite revealing.

Anti-inflammatory Turmeric (boosted by fat and black pepper)

Golden turmeric is more than just a spice used in many delicious dishes, (or inadvertent fabric-dye). It has been touted as an excellent anti-inflammatory agent for centuries in traditional medicine practices. Current medical research has found that it decreases risk for all sorts of things including inflammation, arthritis, cancer, and metabolic illness, as well as protection of the average symptom-free person from future medical issues. Nerd out on a comprehensive NIH review article HERE. Turmeric’s therapeutic mechanism involves a component called curcumin, which affects inflammatory pathways and cytokines in the body by bringing them to levels associated with healthy outcomes.

Curcumin by itself isn’t well absorbed in the intestine. Much of it breaks down quickly and is eliminated before it can be used by the body. However, if it is mixed with a small amount of ground black pepper, it becomes about 2000X more bioavailable. The piperin in the black pepper stabilizes curcumin in the intestine, and allows it to be absorbed into the blood stream to deliver it’s anti-inflammatory activity.  More info here. Most curry powder recipes already have the pepper mixed with the turmeric and the other spices.. Turmeric capsules may not have any pepper, and likely no fat either, so you’d have to add some if you are taking just the capsules. Not much pepper is needed; less than a 1/4 t - just a pinch will do.

Curcumin is lipid -soluble, so it’s best to ingest turmeric with fat to boost curcumin’s passage across the gut lining and into the blood stream.

Take home message: take your turmeric with fat and a little black pepper. This is already done for you if your curry powder blend has both turmeric and black pepper in it and you sauté your spices in oil when making your recipe. You can also make your own curry powder blend! An anti-inflammatory DIY might be a spoonful of olive oil with a teaspoon (1g) of tumeric and a grind of black pepper. Turmeric hack: I put 1/4 C of olive oil and 1/2 C of turmeric, and a 1/2 teaspoon of finely ground black pepper in a small jar and mixed it up well. I am taking a small spoonful of it every morning.

I have been experimenting with a delicious Golden Tea or Milk. Whole milk will provide the fat-solubization of the curcumin. Recipe HERE. And a simple chicken curry HERE. (I’d add 2 teaspoons more turmeric, and use brown rice instead of white).

** Turmeric contraindications: pregnancy, gall stones, kidney stones, blood clotting disorders, but these contraindications would be for high turmeric doses; more than 4 g. Lower amounts of turmeric usually consumed in a meal are not problematic. If you are worried, check with your doctor.***

Tags turmeric, curcumin, anti-inflammatory, black pepper, fat-soluble

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Glycemic Index (GI) – what the heck is it?

GI is a number from 0-100 that is assigned to carbohydrate-containing foods to describe their effect on your blood glucose level after eating them. Eating straight glucose gives a GI of 100, whereas a low score means a low effect on your blood sugar. In general, the more processed, fiberless, and sweetened a food is, the higher GI it will have. Here’s a chart and a search engine for the GI of any food. This is important in lowering the risk for, and managing diabetes. Choosing lower GI foods will control the release of carbohydrates (sugar) in to the bloodstream and lessen the deleterious effect of spikes/troughs of damaging seesawing insulin responses.

On the other hand, how much carbohydrate a food actually contains (not only how quickly it is released) is also part of the equation. This is called the glycemic load. Watermelon has a high GI (80), but has so few carbohydrates per serving (5) that it’s unlikely to spike one’s blood sugar too high.

Why do you care? Well, because high GI foods are associated with increased risk of Diabetes, Coronary Artery Disease, Macular Degeneration,Obesity and Cancer.  Yuck. Lower GI foods (>55) are the ones to eat - you know what they are: REAL and FRESH foods; vegetables, fruits, whole grains/complex carbohydrates. Use the method of macronutrient combination in your meals, so that carbohydrates are ingested along with protein and fat. This will slow the rate of carbohydrate release into the bloodstream, smoothing insulin responses, and allowing for sustained energy levels after meals instead of the high-GI-spike-and-crash phenomenon.

Cholesterol levels; Statins and Exercise

Is one better than the other? Are they interchangeable? How do they interact? Is a multiple approach the answer? As with anything to do with biology, the answer is “it’s complex”.

Statins have been one of the most prescribed drugs to lower high cholesterol in the US since their introduction in the early 1990s. Let’s start with understanding cholesterol , why should it be lower in many people, and ways to approach it.

Our livers make a daily genetically-determined amount of cholesterol. It is necessary as a cell membrane stabilizer, a precursor of sex hormones, vitamin D and bile, and as part of the fatty-acid transport system in our blood. Animal foods add a dietary source of cholesterol, but whether dietary cholesterol is actually worrisome has been debated for years (current thoughts -> less problematic, but stay tuned...) We manage cholesterol levels internally with a recycling mechanism that recaptures some, and we also lose some through our gut. The liver uses cholesterol to create bile acids which are secreted into the intestine to facilitate absorption of dietary fats. Some of these bile acids are lost in the feces.

Handy food tips: eating high fiber foods causes more bile to be swept out of the intestine, indirectly lowering your cholesterol. Certain plant foods, (avocado, flax, peanuts) contain phytosterols, which compete with cholesterol for reabsorption sites in the intestine, thus increasing cholesterol elimination. Take home tip: eat higher fiber foods like apples, oats, beans, lentils, leafy greens and consider including avocado, flax and peanuts.

It gets a bit more complicated because you’ll hear about more than one type of cholesterol (total cholesterol reflects the sum of LDL and HDL in lipid profile blood work). Vastly simplified, LDL is a blood-borne vehicle which carries lipids and cholesterol (sloppily) out to the perifery for use in cellular metabolism and repair. The HDL vehicle returns to the liver picking up scraps of cholesterol stuck to the insides of blood vessel walls on the way. Higher HDL levels are good, because it correlates with decreased heart disease risk (you’ll want it high, remember H for high HDL). If one’s levels of LDL creeps up, this is concerning because more cholesterol and fatty acids could get dropped in the blood vessels. Narrowing and hardening of arteries due to plaques, drive up blood pressure and risk of atherosclerotic events such as heart attack and stroke. (So you want it low: remember L for low LDL). Make sure that you know your ratio of HDL to LDL (different for men vs women, but around 3.5 is good). Total cholesterol is a less precise number.

There are a number of tactics to decrease risk of atherosclerosis and improve one’s health span. The simplest one is to go on statins, also known by the following terms: atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin, rosuvastatin (Crestor) and simvastatin (Zocor). Statins are a class of pharmaceuticals that block the creation of cholesterol in the liver, thus decreasing their overall level in the blood. They have been researched to be effective in their short-term goal of cholesterol reduction, but they are a life-long commitment of medication. Many question their side effects (myalgia, or muscle pain for some, low tolerance in others) contraindication in pregnancy, and a possible blinding effect to more overarching issues like poor nutrition or a sedentary lifestyle.

If the simplicity of taking a drug can distract us from making decisions that lead to longer term health, what happens when we choose not to use it any more? What habits are we grooming? Perhaps different lifestyle choices can be used collaboratively with statin drugs, to reduce dependence on Big Pharma and turn our attention back to creating our own healthy lifestyle. Enter: Exercise. Free, no negative side effects and many additional benefits.

Exercise and effects on Cholesterol:

We have a love-hate relationship with exercise (OMG why?!) More on this in another post, but for now let’s look at how exercise affects cholesterol levels. I’ll define exercise here as “movement to increase heart rate and respiration to meet increased activity-induced metabolic demands”.

Mechanisms are a bit murky, but it seems that exercise changes the size of LDL to make them less likely to stick on vessel walls, and increases transportation of LDL to the liver, expediting elimination. A metastudy suggests protective results of exercise are seen when folks exercise for at least 150 min/week, 5 X a week. This is a bare minimum. I suggest at least double that. Sitting is the new smoking - actually, don’t do either, they are both associated with increased risk of atherosclerosis.. (I recognize the irony of sitting to type this, I am looking forward to getting off my butt and going cross country skiing). Also, more intense exercise is more health-protective than moderate intensity, and both aerobic and resistance training are effective modalities in changing cholesterol levels.

“But I don’t have time to exercise…”

Actually, No - you don’t have time to be sick.

Though it’s much easier to take a pill than change your lifestyle and priorities, statins have a long list of inconvenient side effects (common ones are headache, muscle ache, flushing, drowsiness, dizziness, GI upset, rashes, and less common ones include hair loss, inflammation and sexual dysfunction). Plus there’s cost, medical appointments and insurance involved. Increased activity is free, available to everyone, and have very convenient side effects such as improved sleep, muscle tone, mood, bone mass, resilience, immunity, lower weight, blood pressure and stress levels, among many others. Reprioritizing to include more vigorous activity in your life is a choice that will have many long-lasting positive effects on your health.

From where I stand, if you are dealing with a diagnosis of dangerous cholesterol levels, statins are an effective and safe-enough-for-most quick fix. But it’s not the best long-term choice. Updating priorities and habits to add vigorous enjoyable movement to your life will have effects above and beyond cholesterol levels. And this is only one side of the coin - healthy food choices (a few quick tips above) are also very important.

Brainstorm about how to add more enjoyable vigorous playtime to your life to create your own joyful healthy lifestyle, minimize dependance on pharmaceuticals, and enjoy energetic spill-over of all the healthspan benefits statins cannot offer.

A heart-felt commitment: Exercise

Well ‘tis the week of Valentine’s Day, and all it’s hearty associations. Here are some ways to show love to the most important heart in your life - your own.

How does exercise improve our heart health? In so many ways. Here are three biggies.

Cardio means heart, and vascular means vessel. Therefore, the cardiovascular system includes both the heart muscle itself, and all the vessels (arteries, veins and capillaries) through which the blood flows. Exercise affects many things that improve the function of this system of pumps and tubes, and the hormonal milieu in which it works.

We’ll start with the main pumping station - the heart itself. Made of specialized muscle - cardiac muscle - composed of cardiomyocytes (cardio = heart, myo = muscle, cyte = cell), spontaneously generate their own electrical impulses. Heart cells in Petri dish will beat by themselves, and when they grow to touch each other, they beat in synchrony by sharing their electrical waves across their cell membranes. In our own hearts, we have an inner pacemaker poetically called “The Bundle of His” and the “Purkinje fibers”. Go and nerd out on these terms , but for now, I’ll simply say these structures coordinate our cardiomyocytes and keep our heart beating regularly day in, day out until we die (or need an artificial replacement pacemaker). Fibrillation is when our inner pacemaker loses control and all the cardiomyocytes start beating independently. The heart just quivers uselessly, and the owner suffers a heart attack. A defibrillator shocks and resets the inner pacemaker to reorganize synchronicity, keeping the owner alive until the paramedics get there. This is why first aid classes now involve training on an AED or an Automated External Defibrillator.

Strong muscles are more efficient and squeeze more powerfully. By performing aerobic (with air/oxygen) exercise that challenges us past our comfort zone, we forcibly require our cardiac muscle to pump more blood through the lungs and thence to outlying tissues meeting the increased oxygen and nutrient requirements. The heart, like any muscle, will rise to repeated challenges and hypertrophy (become larger). Unchallenged muscles atrophy (become smaller), and cardiac muscle is no different. Cardiac atrophy is not a good idea, so regular exercise is needed to maintain cardiac muscle mass and performance. A general indicator of good heart health is a low resting heart rate (50 - 60 beats per minute), indicative of powerful and efficient cardiac muscle. Take your resting heart rate when you have just woken up and are still lying in bed - here’s how, and here’s a comparison chart. There are exceptions due to medications like beta blockers and various medical conditions.

Take home message #1; perform daily aerobic exercise that challenges your heart muscle to maintain it’s size and efficiency.

The other part of the system are the blood vessels. Arteries move oxygenated and nutrient-filled blood outwards to the peripheral tissues. Capillaries in the tissues are so delicate that O2 and nutrients filter out toward the cells and cellular waste products and CO2 diffuse back in. Veins collect blood with CO2 and waste products and return to the core for purification via lungs, kidneys and liver. Then the whole process starts again. This is a massively simplified overview of course, but you get the idea of circulation.

As with any system of pipes, restriction of flow causes problems, so maintenance of smooth healthy vascular tubing is crucial. Your arteries are muscular (a variety called “smooth muscle”) and complex triple-layered tubes that contract, dilate and secrete slippery substances to keep their inner walls clean. Exercise increases the level of nitric oxide in the arteries, maintaining a flexible and open lumen, thus enhancing blood flow. Aerobic exercise causes the heart to push more blood through the tubes and flushes the system, cleaning the insides of the vessels and reducing risk of build-up. What might build up? Sticky substances like Low Density Lipoproteins (LDL), platelets (clotting factors) and trapped blood cells may collect inside the vessels if they are damaged due to inflammation. Consistent flushing helps keep things flowing. These principles apply especially to the little arteries that feed the heart muscle itself - the coronary arteries. Constriction of the coronary arteries is called Coronary Artery Disease, or CAD and can lead to heart attacks. Exercise decreases this risk.

Take home message #2: daily exercise boosts blood flow by flushing our blood vessels and increases the presence of nitric oxide which keeps vessels open and slippery.

A more general effect of exercise on our system involves stress reduction. Exercise is shown to reduce the amount of stress humans typically perceive. Whether is it’s due to a reorganization of our hormonal response (cortisol/adrenaline) or simply the feeling that we have “done something” (which is mentally relieving) is still up for debate. Our sleep improves when we physically tire our bodies from regular exercise, and sleep is when we repair ourselves to become stronger and more able to face our challenges; mental, physical and emotional. Stress hormones released during negatively stressful situations can depress the nitric oxide in our arteries and increase other inflammatory substances that may rub away at our inner vessel linings to increase the risk of cardiovascular injury and events.

Take home message # 3: daily exercise is a way of inhibiting stress-response chemicals, lowering the risk of damage to our cardiovascular structures.

Make a daily date for 30 - 60 minutes of heart-rate boosting exercise for a long, happy and heart-felt commitment to your cardiovascular system.

Every day is Valentines Day when it comes to your heart!

That's a stretch...

Ahhh, stretching. That thing that feels so good, but no one has time for.

As a Fitness Professional, I’ve witnessed countless times when folks work their butts off in class, sweating and strengthening, and then disappear before the end (citing ‘lack of time’) avoiding the post-workout cool-down and stretch. The last part of the workout is sacrificed by a perception that it is less necessary. (I’d argue that it’s not ‘lack of time’, but ‘lack of time-management’ that’s truly the culprit, but hey…) Hence the second part of my career as Massage Therapist - stretching people back out, after they have contracted themselves into a state of pain and injury. We can get away with the perception that stretching is unnecessary for only so long (usually our 30’s), until our bodies become less elastic and start to give us musculo-skeletal clues that a lifetime of contraction without extension isn’t beneficial. Joint issues, imbalances, uneven tendon and ligament wear and tear, low back pain and more all stem from a lack of elasticity and length in the tissues. Although you’ll probably never be able to put your leg behind your head again like you did when you were 8, boosting your flexibility will make life activities more easy and fluid, enhance balance and increase active range of motion.

What is stretching? For the purpose of this post, I’ll define it as an activity or movement that returns a part of the body to a lengthened and extended resting position. For example after sitting for many hours at a computer our hip flexors (muscles that bring our leg toward our chest) have been held in a shortened position. Because they attach to our anterior lumbar vertebrae, if they are not lengthened back out, we increase the risk of low back pain.

How does it benefit us? More flexible tissues allows our life more lightness and ease. It’s wonderful to have the shoulder mobility to reach backwards for something, or lift our foot up to clamber over a boulder on a hike without worrying about it. Stretching creates more mobility around joint, reducing wear and tear and the risk of injury. Decreased pain and tightness during activities, and increased reach and ability ripples out into our life, reducing our stress levels and boosting our health span.

Why is stretching so uncomfortable? You may be overdoing it. The discomfort comes from pain receptors in the muscle when it is overstretched. Muscles are also attached to tendons and tendons should not stretch, so being aware of how to address stretching correctly and safely is important. Dehydration can also be a factor. (see my previous post).

How do I stretch pleasurably? Warm up a bit first. Think of your muscles like uncooked spaghetti. Cooked spaghetti is much more mobile. Even 5 minutes of movement will increase the metabolism in the muscle and move some blood through. Irrigated and warm tissues are pliable and more willing to accept length. Use the idea of green-, yellow-, and red-flag pain markers. Move yourself slowly into the yellow-flag stretchy-discomfort feeling, and then slow down your breath to access your calming parasympathetic nervous system. Don’t let yourself go into red-flag pain - your muscles will contract to protect themselves. Moving slowly bypasses the muscle spindle reflex - a reflexive contraction in your muscles that protects from damage due to a sudden unexpected lengthening. Hold the stretch for 30 seconds. Stretch after your work out, it’s not so important before.

Hydration: When, Why, Amount? (Now, Because, Lots...)

We are mostly water (60-70%). Water lubricates our joints, makes up most of our blood and cells, regulates our pH, cushions our organs, and provides the aquatic medium in which we function. Going without water even for a half a day can be very uncomfortable, and longer will seriously affect our health. Clean drinking water is a human right, along with food and shelter.

Basic water requirements for adults is over 10 cups a day but that includes the water we get from food (usually about 20%). Our relationship with water can get complicated, and depends on age, size, climate and activity level, among other things. But before you start moaning about how much time during your day you might have to spend looking for a loo, let’s dig a little deeper.

1) If you rarely feel thirsty and your urine is a pale yellow color, you are adequately hydrated. Keep up the good work.

2) Caffeinated beverages count towards your daily water intake, if you are used to it. There is a mild increase in urination (diuresis) noted, but not enough for the average coffee or tea drinker to worry about.

3) If you exercise a lot and sweat, you’re going to need to drink more water to replace your loss. Electrolytes are an optional perk, but since most people don’t push themselves that hard during exercise, plain water is just fine. Prior to exercise pre-hydrate, then hydrate and re-hydrate.

4) Does drinking warmer water hydrate us more? Drinking water of any temperature will hydrate you. Drinking warm water before a meal will 1) pre-fill your stomach, leading to satiety faster. 2) dissolve and transport certain food stuffs along faster in the GI tract. Even hydrophobic things like fats (think peanut butter) will become more fluid. 3) The warm liquid acts as a vasodilator, widening blood vessels in the digestive system and helps increase blood flow and GI activity (A biomechanical description in the words of a gastroenterologist). Both Ayurvedically and in Chinese Medicine, warm water is advised to balance the body systems. Fine - whatever gets you to drink more water works. The idea that drinking hot water boosts metabolism is a myth, however.

5) Thirst can masquerade as hunger. If you have hunger pangs away from meal times, try drinking a glass of water and notice how you feel, it may do the trick. On the other hand, of you are truly hungry, it will be noticeable a few minutes later, so then you’ll know you need fuel. Sometimes drinking a glass of water allows true feelings such as anxiety or boredom to become recognizable. In which case, maybe drink another glass of water, take a breath, and plan to deal with the issues head on.

6) Environment: If you live in a drier climate, you’ll have to hydrate more. A lot more. We exhale 100% water-saturated air, and a low-humidity environment will not give it back when we breathe in. I really noticed this living in Boulder Colorado (mile-high and parched all the time) vs living in Portland Maine (sea level, much more humid). I had to carry a bottle of water with me all the time in Boulder, and my throat would dry out enough to signal me to drink. I still carry the bottle in Portland, and forget that it’s even there (to my hydration detriment).

7) Body constitution: Some people are simply drier (hair, skin). These are the folks who never had acne as a teen, but are now paying for it with dizzy spells and dry skin issues as adults. I’m one of those, and I’m not sure if the acne trade off was worth it, but I now MUST drink more water and use more skin protection. (This segues into…)

8) Aging: We dry out as we age. Our body composition changes to retain less water in our tissues. Our thirst triggers diminish as we age, and there can be competing effects of medications and illnesses (dry mouth, cramps, palpitations). Sometimes dizziness will alert us, sometimes a skin issue. Start drinking more water over the course of the daytime, and less after the sun goes down so you don’t pee all night.

So how to comfortably increase hydration in our lifestyle?

• Timing: Start drinking more water earlier in the day, and taper off after 7 pm so your sleep is not disturbed by trips to the bathroom. Sip smaller amounts during the day instead of plugging down a large amount at once. Set hourly alarms on your phone or computer to remind you to drink a glass of water. Associate a water intake habit to something you already do frequently.

• Keep a refilled water container (glass or bottle) out and visible in your home, for example on a frequently passed counter, and/or workplace, such as on your desk. The visual cue will be a helpful reminder.

• Carry a water bottle with you. Stash them in your vehicle, at your desk, in your workout gear bag. I have water bottles everywhere so I have no excuses.

• Mix it up: try different sorts of teas in the winter, and sparkling waters with light flavors in the summer. I also maintain a large jar of water with mint in the fridge during the summer for a cool drink.

• Be careful of alcohol consumption - definitely dehydrating. You’ll have to drink more water to make up for the loss. That, plus the diuresis caused by the alcohol will keep you up at night!

• Drink a glass of water with meals. Avoid juices, or dilute them. They are mostly sugary water, and the calories are not helpful.

• ‘Empty the bucket’ before you leave the house, or whenever an opportunity presents itself during the day. Even if you don’t need to. (You’ll always need to).