Fitness Focus #6: Keeping Motivated (2012 Year-End)

INTRO
Day after day it's brush your teeth, eat well, exercise, and all of those other "should's." We are constantly in search of motivational devices to keep us going with the exercise piece. We got the hang of the tooth-brushing thing a long time ago, we've systematized the eating well to the point that it is on auto-pilot with virtually no resistance, but the daily exercising element still requires continuous prodding. We look for new activities and new venues to add pizzazz but we also benefit from "reading the numbers." We are always on the look-out for new studies that will tip the balance when the motivation wanes. Here are some of the inspiring observations and findings we learned about in 2012 that helped keep us on track for achieving "exceptionally successful aging":

WHEN IT COMES TO FOOD
"Overeating May Harm Memory"

It's hard to improve on the words used in Dr. Weil's Weekly Bulletin from 2/23/12 entitled "Overeating May Harm Memory" so here is the original text:

The more you eat daily once you reach the age of 70, the higher your risk for memory problems, and possibly Alzheimer's disease. Investigators at the Mayo Clinic came to this conclusion after analyzing data on more than 1,200 seniors in Olmstead County, Minnesota. They found double the risk of memory impairment among the participants who consumed between 2,143 and 6,000 calories per day compared to those whose calorie consumption was lowest - between 600 and 1,525 per day. A third group of participants consumed between 1,526 and 2,142 daily calories and had no added risk of Alzheimer's. The higher risk of memory deficits among the big eaters doesn't prove that overeating causes memory problems but may mean that cutting back on calories could be good for the brain. The study is to be presented in April at the annual meeting of the American Academy of Neurology.

How many more reasons do we need to coax us to do what we know we should do?

"It's OK to eat food"
One of my favorite memories from our extended stay at Joshua Tree this spring was on one of my first hikes made on my slowly recovering leg, which was to a palm oasis. The oasis was fascinating but it was the brief encounter with Katherine that I treasure. Later Bill commented that I'd found my twin.

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The palm oasis where Katherine & I discussed the virtues of food over trail mix.
This woman half my age quickly turned the conversation from our Vibram 5 Fingers to food by asking "What do you eat for trail food?" "We don't" was my initial reply. "We've given up on trail food and just eat food." Katherine immediately began recounting that subtle, nasty feeling some of us get when we eat nuts and chocolate and other quick-to-prepare and quick-to-eat trail food on an empty stomach. "That's why we take the time to eat food for lunch" was my reply.

Katherine's eyes popped out at the sight of our soon-to-be-eaten lunch favorite: our "#4's" of bulgur, black beans, tomatoes, avocados, walnuts and olive oil. A moment later she was writing down the recipe for our concoction. As she wrote she commented that "I tell my friends it's OK to eat food." What a thrill to speak to someone who has also embraced food instead of protein shakes, energy bars, and flavored drinks.

I thought of Katherine the next day after my outrage settled shortly after discovering the only tortillas at the local Walmart that weren't made with lard or trans fats had cellulose in them. "Wood pulp: now the low-carb craze has cornered us into eating wood pulp instead of food" were the words formed from my rage. Online reading that night revealed that my rage was delayed by about 2 years because it was 2 years ago when cellulose in Taco Bell's ingredient list was revealed by the Wall Street Journal. We were overseas at the time and the issue had blown over by the time we returned.

Being fans of the out-of-favor high carb diet, it seemed absolutely absurd that the food processors were stumbling over themselves to make tortillas a low carb food by adding wood pulp to them, but that was the gist of it. A little more reading of the Taco Bell buzz suggested that "fiber is fiber" and wood pulp is a fine way to add bulk to your diet. But I'm sure Katherine would agree "It's not food."

Flitting through articles of decades-old research untainted by the current media frenzy revealed that scientists have wrestled with this "wood pulp as human dietary fiber" issue for almost 100 years. One of these earlier observations resonated with me, which was that highly purified, highly processed fiber, as in wood pulp or cotton, is not metabolized the same way as minimally processed fiber, like wheat bran. In the last few years, that issue--how it's metabolized by the body--has become a key point.

My mind immediately turned to 2 dietary changes we have (unhappily) made based on "how the body metabolizes". One was giving up fruit juice because the natural fructose sugar appears to be metabolized in a liver-injuring way when compared with the same fructose consumed with the fiber in the whole fruit, like drinking OJ vs eating an orange. The other was a study implicating calcium supplements as increasing the risk of cardio-vascular events in post-menopausal women. There went my 10¢ calcium tablets which were replaced by $1.50 in yogurt/day plus 4 lactase tablets. It sounded to me that there was a good chance that highly purified cellulose wasn't worth the risk because the ramifications of an alternate means of processing it by the body was still not clear.

After reading about the metabolic issues related to eating purified cellulose, I changed Katherine's mantra of "It's OK to eat food" to "Eat food, not food additives." I don't think Katherine would mind. And of course, we redoubled our commitment to being careful label readers so we could be careful food eaters.

Foodborne Illnesses
If the threat of diarrhea and vomiting weren't sufficiently motivating to do one's best to avoid food poisoning, more is becoming understood about the potential long-term health effects of having been sick from food-borne diseases. Even folks who only suffered from mild symptoms of food borne bacterial illnesses are at increased risk for a growing list of late-onset health problems including: high blood pressure, heart attack, stroke, aortic aneurysms, diabetes, arthritis, Crohn's disease, ulcerative colitis, urinary tract problems, kidney failure, and damage to the eyes. Knowing of these long-term sequelae is enough to renew our vigilance in washing our produce, being mindful that our shortcuts in the kitchen don't give the bugs the edge, and to continue making strategic choices when eating out. (Maryn McKenna, "Food Poisoning's Hidden Legacy," Scientific American, pp26-7, April 2012.)

MOVEMENT & EXERCISE
Controlling Blood Sugar Spikes
On February 29, 2012 in the online version of the NY Times there was a report on a small study done at the University of Missouri in which the researchers took healthy subjects with regular exercise programs and had them decrease their activity by more than half for 3 days. The individuals ate the same diet for the 3 day test period and the 3 days in which they maintained their regular exercise routine. Amazingly, even being relatively more sedentary for this short amount of time was enough to allow their blood sugar to spike after eating, a spike thought to increase the risk of developing heart disease and Type 2 diabetes. On their regular regime, exercising early in the day would prevent the blood sugar spikes after meals eaten later in the day. ("Why It's So Important to Keep Moving," by Gretchen Reynolds.)

I read this research at a particularly significant time for me, which was when I was recovering from what we termed "Joshua Knee" or knee pain caused by adverse circumstances other than in the knee. I didn't know what the problem was but my knee hurt and several times it punished me with shooting pain. I could barely walk and resigned myself to sort-of-swimming in small pool at the RV park for activity. The best I could muster on most strokes was 1-legged swimming and then later, paddling upright with an Aqua Jogger, neither of which were very robust. But the NY Times article reaffirmed that doing nothing is deadly and my feeble efforts in the pool should help both my general metabolic wellness and my soft tissue recovery. This information helped me feel better about investing time in what felt like a low quality workout as the days rolled into weeks. (And much to my surprise and delight, when I did hit the trails again, I hadn't lost much power or endurance.)

Any Movement Is Better Than None
Two months later the same author, Gretchen Reynolds, presented "Don't Just Sit There" on April 28, 2012 in the NY Times with more compelling research on the importance of activity, any activity. Her take-away from the studies was to get up from sitting every 20 minutes, even if briefly, and to switch to doing some of her sit-down activities in standing, like talking on the phone. The message is clear and consistent: the body was designed to move and its healthiest when it does it often.

Strenuous workouts have their place but her references remind us that the benefits of a big workout can be reduced if followed with hours of too much stillness. So, whether hobbling about with an injury, under the weather with an illness, or doing someone's version of a boot camp workout, what goes on throughout your day matters. Move often, even if briefly and not very far.

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It was cold & damp, but I still got out at daybreak to do my core strength exercises at Yosemite.
Bonus Calorie Burning
For years we've been convinced that dieting alone is a horribly frustrating way to lose weight and that by adding exercise to the equation we lose more weight than the calculations predict. We could feel that there was some magic in the exercise, that it somehow juggled the calorie-counting books in our favor. A study published in Nature this year and summarized in Journal Watch on February 23, 2012 revealed the magic we knew was there.

What the researchers concluded was that exercise triggers muscle cells to produce a particular molecule that reduces insulin resistance by stimulating white fat cells to transition into brown fat cells. That transition is important because the job of white fat cells is to stash away fat whereas the brown fat cells burn it. The upshot is that you win twice with exercise: the exercise burns calories directly plus exercise causes the body to burn additional calories with this white fat-brown fat cell transition. Of course the researchers are hoping to put the chemical identified as being key in this transition into a bottle for weight loss without exercise but we are happy to cheer each other on with "Go out and convert more white fat cells into brown ones." (http://dx.doi.org/10.1038/nature10777.)

"The Exercise Pill"
The interview of Daniel P. Kelly, MD on
Medscape News/Pediatrics series '"Developments to Watch" from 12/27/11 that we didn't read until September 2012 had us talking for days. The focus of Kelly's recent research described in "The Exercise Pill" has been on obesity and type 2 diabetes (formerly "Adult Onset Diabetes") and muscle. Here's a summary of what we found to be the most startling points.
..Obesity and diabetes are now being thought of as a continuum: if you are obese, your tissues are likely beginning to suffer from the early stages of the disease conditions associated with diabetes. These changes induced by obesity also result in damage to the structure and metabolism of muscle tissue in lab mice, changes which are assumed to occur in humans as well.
..Obesity results in decreased activity for the familiar reasons of being uncomfortable, discouraging, and hard to do and some newly identified, more insidious reasons. Muscles in the obese are actually damaged by the excess fat resulting in, among other things, the muscle being less able to burn calories with activity compared to a normal weight individual.
..Obesity causes "lipotoxicity" of the muscle. The new research shows that adipose tissue can only hold so much fat before it starts leaking fatty acids into the blood stream. Some of this leaked fat is deposited in muscle cells, where it stays.
The fat is toxic to the muscle tissue. The toxicity of the fat in the muscle diminishes the normal functioning of the muscle in a number of ways. The presence of the fat decreases the development of slow twitch muscle fiber (fibers needed for endurance) and the number of mitochondria as well as prevents the existing mitochondria from enlarging (which decreases energy output from the muscle). The fat also interferes with the healthy development of blood vessels in muscle. Being obese creates a vicious cycle in which the individual is decreasingly able to effectively exercise because their muscles are being poisoned by fat deposited in the muscles, making it harder and harder to burn calories.
..Studies continue to suggest that exercise buffers individuals from the muscoloskeletal and cognitive declines of aging whereas the progression to diabetes increases the risks of experiencing those declines.
..The disease processes from the lipotoxicity of obesity in skeletal muscle also occur in the heart muscle, damaging it as well.
..Despite the catchy title "The Exercise Pill" there is no such thing in the pipeline. The researchers have genetically engineered some "marathon mice" that love to run but it's a big leap to being able to create the same effects in humans with a pill.

Reading the conclusions of this study reminded me of the popular belief that being obese isn't a problem as along as you don't have ill effects, like diabetes, from the condition. This new research certainly challenges that view by demonstrating that though the overt symptoms
of diabetes may not be present in obese individuals, serious disease changes have likely already begun.

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Barb at Manley Beacon, Death Valley: doing our best to compress morbidity.
Compressing the Morbidity of Aging
"
Mortality" and "morbidity" are companion terms often used by physicians that mean "dead" and "sick enough to wish you were dead", respectively. Well, that's a bit harsh for morbidity, but you get the idea. So when they start talking about "compressing the morbidity of aging," they are referring to shifting the experience of the really nasty conditions of aging from the often long, drawn out process to a short one--a "crash and burn" instead of "sputter, sputter, fizzle". For many of us the focus on wellness isn't to gain more years but to have a higher quality of life in the years we have left and then hope to flame-out quickly rather than linger. And lo and behold, yet another study says that, on average, the length of one's aging-related morbidity is malleable.

A study reported in
Archives of Internal Medicine this year not only demonstrated that "robust midlife cardiovascular fitness is associated with lower cardiovascular-related mortally" but it also "lower(ed) risk for frailty and co-morbidties while improving quality of life in older people." Over the 26 years of the study, the participants at the top 20% of the fitness scale suffered from half as many chronic conditions, like heart disease, diabetes, lung disease, kidney disease, Alzheimer's, and several cancers when compared with the rest of the study group. Willis BL et al., Arch Intern Med 2012 Sep 24; 172:1333.

Your Aching Back

Apparently the increased incidence of low back pain in folks that are overweight or obese has long been known but researchers recently took the issue a step farther and demonstrated that the low back pain was likely due to lumbar disk degeneration. Yet another reason to stay on the battlefield to achieve or maintain a normal weight. (Arthritis Rheum 2012 May; 64:1488).

From An Extreme Perspective
The
NY Times ran a fascinating story on the State of California's innovative program using convicted killers to tend to the exploding population of demented inmates. Their bold program is producing touching results but I also found the general observations by the prison officials on aging equally startling:

While no one has counted cognitively impaired inmates, experts say that prisoners appear more prone to dementia than the general population because they often have more risk factors: limited education, hypertension, diabetes, smoking, depression, substance abuse, even head injuries from fights and other violence.

Many states consider over-50 prisoners elderly, saying they age up to 15 years faster.

Though many of these people have lived life at an extreme edge, it still was stunning to me that factors that are largely lifestyle choices have them functionally aging as much as 15 years faster than the general population. That's yet another strong statement about the vulnerability of our wellness to lifestyle choices and circumstances. (Pam Belluck; "The Vanishing Mind: Life, With Dementia"; NYTimes online edition, 2/25/12.)

SWEET DREAMS (For those whom I haven't already put to sleep.)
My Newest Trick for Grabbing More Zzzz's
While in the final stages of recovering from jet lag in June of 2012 I happened to read a tip for falling back to sleep in the May 2010 edition of body+soul magazine (p36) in which Woodson Merrell, MD described his 'dream remembrance' technique in a "Q&A" article. It's quite simple--when you awaken in the wee hours, fight hard to reconnect with your latest dream and stick with it--that's it. He said that in doing so you will increase your odds of promptly returning to sleep by 50% instead of thrashing about for an hour or 2. I was thrilled, my early results were 100%.

I happened to be taking 1mg of melatonin at bedtime to assist with resetting my clock and that is enough melatonin to make my dreams noticeably more vivid. So, the first 2 nights, recalling my last dream was a snap because they were all set on "150%". Even if I got out of bed to pee, I'd still work at clinging to a snapshot or 2 from my latest dream and allow my mind to focus on nothing but that dream image. In minutes, I be back to sleep with seemingly no effort or lost time.

A night or 2 after discontinuing the melatonin, the vividness had withered and my experience of my dreams was back to being almost nonexistent. But spurred by my previous success, I searched hard for the slightest fragment of a dream, even if it was several awakening back. I quickly learned that even recently archived dreams were good enough. It seemed that ruminating on a image or 2 from a prior dream was equally potent in unlocking the door to the sleeping chamber in my mind and gave the busy and fretty side nothing attractive to latch on to. This technique works so much better for me than counting backwards or focusing on my breathe, and lucky me….I get to practice it every night.

Six months later I'm still a believer in 'dream remembrance' for falling back to sleep. And if I awaken and fail to remember the last dream, I focus on a subject with dream-like qualities, which works just as well.

That's it for our 2012 gee-whizzies; I'll be back with more next year!