Type 1

Over the last decade, there's been a bunch of new research around the idea that type 1 diabetes might actually be caused by allergic reaction to food. In short, in certain genetically susceptible individuals, specific foods might be the trigger that kicks off the autoimmune attack on islet cells in the pancreas, the core of the disease.

While that's interesting for discovering ways to prevent new cases of type 1 diabetes in the future, given the very slow regeneration of pancreatic beta cells, researchers long assumed that it didn't really apply to people who are already diabetic. Once those cells were gone, they appeared to be gone for good.

However, a recent set of mouse studies, and a follow-up set of studies with human pancreas biopsies, has shown that intermittent use of the Fast Mimicking Diet led to substantial regeneration of beta cells, even in current type 1 diabetics.

It’s all still preliminary stuff, but it’s certainly suggestive of a route to a cure for current type 1 diabetics, and, even better, a safe and non-invasive one. If you or someone you know has type 1 diabetes, keep an eye on this research going forward. 

[And, while we’re on the subject, if you or someone you know has type 2 (‘adult onset’) diabetes, the news is even better: we already know it can be reversed by lifestyle change.]

It's the Shit

We get asked a lot of questions about gut bacteria these days, and for good reason; over the last decade, research on the importance of the intestinal microbiome for fitness and overall health has exploded. 

Take, for example, one particularly persuasive study, which took fecal bacteria samples from pairs of identical twins in which one twin was lean and one was obese, and transplanted the samples into the intestines of germ-free mice. Lo and behold, the mice with transplanted microbiota from the lean twins stayed lean themselves, while the mice with obese twin microbiota quickly piled on weight. 

Similar microbiota transplants between humans are already being used very successfully to fight deadly infections like C. difficile colitis, and are being researched for conditions ranging from multiple sclerosis to Parkinson’s disease.

Which leads to the obvious question: will poop transplants for weight loss be the next big fitness craze?

In short, we hope not. While we strongly suspect that managing our microbiome will be an important part of health in the decades to come, at the moment, nobody really knows what they’re talking about. Clinical data is still scarce, and possible complications are immense. Even if getting microbiota from your skinniest friend did turn out to be a great diet plan, we still have no idea about all of the other effects of that same bacteria down the line.

And, based on historical record, there’s good reason to be concerned. In the 1950’s, for example, doctors began prescribing transplanted Human Growth Hormone to smaller children deficient in HGH. While the treatment proved effective for spurring growth, it wasn’t until decades later that hundreds of cases of the rare and fatal neurodegenerative Creutzfeldt–Jakob disease (colloquially “mad cow disease”) began to crop up in those HGH recipients. Scientists quickly discovered that prions (the cause of CJD) had inadvertently come along for the ride with the transplanted hormone.

So, in short, the microbiome is something we should be keeping an eye on. 

And it probably would be wise to start doing the common-sense things that research has begun to show as likely to help your microbiome: eat a whole food diet, and include some pre-biotic (raw garlic, onions, etc.) and pro-biotic (pickled stuff, yogurt, etc.) foods; avoid unnecessary antibiotics; get a dog (seriously!); exercise; manage your stress. 

But when it comes to more invasive ideas – whether fecal transplant or even just probiotic supplements (which are currently a bit of a wild west), we’d hold off for now. Whatever the short-term upsides, from our perspective, at least, the long-term unknown risks are just too great.

From Coach Josh: Strength Training for Older Adults

My parents are in their late 60s, but they remain in very good shape. They’re avid travelers, which regularly requires them to walk 10-15 miles in a day, with stairs and hills climbed, bags toted, etc. 

Primarily, they’ve kept fit with ‘cardio’ workouts in their living room, using Leslie Sansone’s solid and much-loved Walk at Home DVDs (or, as my brother calls it, ‘frumping to the oldies.’)

However, recent research has made clear that also focusing on strength training is particularly important as we age. As one recent review paper put it:

Strength-training exercises have the ability to combat weakness and frailty and their debilitating consequences. Done regularly [it] builds muscle strength and muscle mass, and preserves bone density, independence, and vitality with age. In addition, strength training also has the ability to reduce the risk of osteoporosis and the signs and symptoms of numerous chronic diseases such as heart disease, arthritis, and type 2 diabetes, while also improving sleep and reducing depression.

In short, strength training is powerful stuff. And as further research has shown, those benefits are specific to lifting weights; it’s not sufficient to simply maintain a high level of physical activity in general.

So I suggested that my parents also consider hitting the gym once or twice a week. To which my mother replied that they do currently use dumbbells in those Sansone workouts. While that’s great, I clarified that she needed to go to the gym to focus on progressive overload. The health improvements of strength training come from consistently increasing the weight used over time; thus, if you’re using the same ten-pound dumbbells month after month, you’re no longer reaping the same benefits.

To illustrate, here’s an amazing pair of before and after MRI scans showing the increase in leg muscle mass after just twelve weeks of weight training, in a 92-year-old subject. (!!!)

If you want to live longer, healthier, then staying active (in a general, ‘use it or lose it’ sort of way) is hugely important. But adding in weight training, too, is an extremely powerful tool. And, as the scans show, it’s never too late to start.

BHAG

Right now, the US is facing a terrible, relatively new problem: a surge in chronic disease.

One in two Americans suffers from chronic disease (more than half of those from multiple chronic conditions), which is responsible for more than seven out of every ten deaths annually. We spend more than $2.3 Trillion each year (about 12 percent of our GDP) treating chronic disease, and it’s likely only going to get worse going forward, as the rate of chronic disease in kids has more than doubled in the last twenty years.

Our healthcare system wasn’t built to deal with these kinds of chronic conditions. A century ago, our leading causes of death were acute, infectious disease (the top three: tuberculosis, typhoid, and pneumonia), and most other doctor visits were also for acute problems like appendicitis, gall bladder attacks, etc. For those kinds of issues, the medical system is incredibly effective: go see a doctor, get an antibiotic / have surgery, recover. And with new treatments and technologies coming online, we get better and better at acute treatment every year.

But that same system isn’t well-equipped to deal with chronic disease, where doctors’ current tools are largely focused on suppressing symptoms rather than dealing with underlying causes. If you have high cholesterol or high blood pressure, you can get a drug to take (for the rest of your life) to lower them, but rarely a serious look at why either is high in the first place.

Recent research suggests that more than 85% of chronic disease is caused by environmental factors, like diet, behavior (including movement / exercise), and lifestyle. Dealing with the root causes of those chronic diseases, then, involves helping patients build and sustain new patterns and habits over the long-haul.

Given the heavy load we already place on physicians, it’s not reasonable to expect them to accept responsibility for driving that kind of behavioral change, too. The average primary care provider has about 2500 patients on their roster, and sees each for visits lasting on average just 10-12 minutes. That’s enough time to diagnose symptoms, prescribe medication, and then follow up a few weeks later. But while most people will take a course of antibiotics their doctors prescribe, drastically fewer will make wholesale changes to their lifestyle, without substantial ongoing support.

Currently, the fitness industry is failing equally when it comes to providing that kind of support. Indeed, the vast majority of people who start a diet or join a gym today will be no better off (and often worse) a year from now, having seen little results, given up, and returned to their prior behavior. Roughly, the fitness world today is akin to where medicine was in 1850: a lot of new science is emerging, and a slew of potentially helpful tools and technologies are being developed, but it’s yet to coalesce into an effective standard of care.

Which, in short, is what Composite is really about. Our big, hairy, audacious goal is to bring the rigor of medicine into the world of fitness, to try and develop clinically-demonstrable effectiveness in treating the underlying causes of the majority of today’s chronic disease. 

There are a number of other companies, too, living at the intersection of fitness, technology, and medicine, developing new best practices, to whom we look for ideas and inspiration. We strongly believe that, over the next twenty years, we’ll see a whole new fitness industry emerge from those kinds of companies, one that can work hand-in-hand with the existing medical system, to help the US address the problem of chronic disease. And we're hoping that, with the right team, a bit of luck, and a lot hard work, Composite can help drive that change, can become a leader of that pack.

(Physical) Therapist's Couch

The human body is pretty miraculous. It evolved to allow a nearly infinite number of movements: running, climbing, jumping, swinging, and more.

But you mostly use it for one thing: sitting down. You sit in your car or on the subway, you sit all day at your desk, you sit to eat lunch and dinner, and you sit on your couch to binge-watch Netflix at night.

That disjoint – between how your body was evolved to be used, and how you’re actually using it – causes all kinds of problems.

Here’s just one: when you sit, your hip flexors are in a shortened position. And after enough sitting, your body starts to treat that shortened position as the new normal. So when you stand back up, there’s not enough slack in the system. Your hip flexors are permanently tight.

That’s a problem by itself, since so many athletic movements – from running and jumping, to throwing a ball or throwing a punch – depend on generating powerful hip extension. Tight hip flexors oppose that extension, reducing the power you can create. It’s like driving with the parking brake on.

But the secondary effects are even worse. Let us explain:

Perhaps, in the past, you’ve bought beef to cook for dinner, and had to cut off the silver-skin.

Your muscles have silver-skin, too. It’s called fascia. In your body, your muscles cells are held together in bundles, and the fascia is what does the holding together.

In recent years, however, we’ve begun to realize that fascia also connects one bundle to the next, in running lines of tension. As the song says, your hip bone’s connected to your thigh bone. And, similarly, your hip muscle’s connected to your thigh muscle. Which, in turn, is connected to your calves, ankles and feet in one direction, and to your lower back, thoracic spine, shoulders and arms in the other.

In fact, there’s a single run of fascia that extends from your toes, up through your entire body, to your elbows. And your tight hip flexors are right in the middle of that fascia run.

When hip flexors get tight, they take slack out of the middle of the system, creating a game of ‘crack the whip’ that causes problems all the way up and down that chain. Now, your tight hip flexors start causing foot pain, or knee pain, or a bad back, or a tweaky shoulder.

Normalizing the length of your hip flexors, getting slack back in the system, has huge and far-reaching impacts.  It will make you a better athlete, prevent future injuries, and knock out a slew of nagging pains you’ve been living with too long.

Fortunately, you can make big inroads on fixing your hip flexors with just one simple stretch, popularized by Dr. Kelly Starrett. He calls it the ‘couch stretch’, because he and his family do it at night, on the front of their couch while they watch TV.

Here’s a demo, pulled from Composite’s 14-day Jump Start for new clients. (Coach Josh covers similar topics as in this post for the first half of the video; if you just want to see the stretch, hop to about the six-minute mark.)

To recap: 

  1. Get on your hands and knees in front of a wall (or, if you can’t peel yourself away from the tube, the arm of a couch).
  2. Put your right shin flat vertically against the wall; your knee should be wedged into the corner where the wall and floor meet, and your foot should be pointed so that your instep is against the wall.
  3. If you’re not bendy, this may be a stretch already. If you’re more flexible, you can put your left foot flat on the ground.
  4. Squeeze your butt. In particular, squeeze your right glute, the side with the foot that’s against the wall. This will help stabilize your low back, and correctly position your hips.
  5. While still squeezing your butt, try to lift your upper body upright. Think about making your spine long, extending the straight line between the top of your head and your tailbone. You want to get upright by opening at the hip, and not just by arching your low back.
  6. For bonus points, you can eventually work towards reaching both hands overhead, so long as you can do so with tight abs and glutes and with your back long and straight. In the beginning, however, you’ll probably want to use your hands on the floor or on your forward knee, to help push yourself upright. You can also put a box in front of your body, and push up on that.

Now hold that stretch for two minutes. (That’s how long it takes for the Golgi tendon organ receptors to give up, allowing you to reach your full stretch and make lasting change.) Then switch to the other side, and do two minutes on the other leg.

We strongly, strongly suggest timing yourself, as two minutes is waaaaaay longer than most people tend to hold a stretch by default otherwise. (Side note: interestingly, dentists similarly recommend toothbrushing for two minutes. There, too, without using a timer, most people average brushing for only a third of the recommended time. If you like having teeth, consider deploying your two-minute timer next to the sink while brushing, much as you do while Couch Stretching.)

The most common problems to guard against while doing the Couch Stretch:

  1. Your rear knee isn’t against the wall. Even if it means you can’t get your opposite foot up on the ground, keep your rear knee / shin / foot all the way up against the wall. That takes all the slack out of the system, making the stretch much more effective.
  2. Your forward foot is too close in. Take a big step forward with that foot, so that your forward shin is vertical, too.
  3. You’re over-arching your lower back. Hyper-extending your lumbar spine is a very common (and not very good for you) habit in general; it’s even more common in something like the couch stretch, where it’s easier to bend at your low back than to actually stretch the hip flexors you’re gunning for. Think about making your spine tall, and about keeping your low back flat, even if that means you can’t get as far towards upright.
  4. You’re making a ‘pain face’. Effective stretching isn’t a relaxing experience. Done right, the couch stretch is hard work! At the same time, it’s important not to grimace while doing it (more technically called ‘facial fixing’), which actually undercuts the neurological effectiveness of the stretch. Breathe, go to your happy place, and try to keep your face serene. It’s zen and the art of stretching!

That’s it.

Try it daily for the next two weeks; we suspect you’ll be pleasantly surprised by the huge positive impact.

Keep it Moving

If you’re an average, 180-pound person, all the capillaries in your body – the smallest blood vessels, where oxygen and other nutrients are exchanged with cells – can together hold about 3 gallons of blood.

But blood, like water, is heavy. So you evolved into a evolutionary compromise. Your body only contains about 1.5 gallons of blood at a time; much lighter to carry, but only half of what you need to provide for your whole body at once. Fortunately, your body also evolved a smart system of hemodynamics, a combination of forces that sends that blood to capillaries as it’s needed.

At the front end, your heart pushes oxygen- and nutrient-rich blood through your arteries. 

Then the movement of your muscles pulls that blood from your arteries into your capillaries, to feed individual cells. 

In other words, while your heart is circulating blood all the time, the oxygen and nutrients only make it to cells when the muscles around them are moving.

That’s one of the major problems with excessive sitting: without movement, your cells are starving. 

But that’s just one problem. After 30 minutes of sitting, your metabolism slows down by 90%. A few hours in, you’ve got increased blood triglyceride and insulin levels, and reduced (good) HDL cholesterol and lipoprotein lipase (an enzyme that breaks down fat in your body).

So perhaps it shouldn’t be surprising that people who sit more are sicker and fatter than people who don’t. 

What’s more, that’s independent of exercise. Even between people who work out for the same number of hours weekly, a greater number of hours spent sitting each day correlates with an increase in both body mass and all-causes mortality. Studies have tied sitting to huge increases in everything from type 2 diabetes to cardiovascular disease and cancer. 

For example, excess daily sitting increases your risk of lung cancer even more than the second-hand-smoke effects of living with a smoker.

All of which is bad news, because we apparently really love to sit. The average desk worker spends 7-8 hours a day sitting at the office, then comes home to sit down for another 5 hours of daily TV.

Fortunately, the solution is simple: get up frequently and move around.

Research has shown that even short breaks (a couple of minutes) at low intensity (walking to the bathroom, or simply standing up) make a huge difference. One study showed that, the greater the number of breaks taken, the lower the waist circumference and BMI, and the better the blood lipids and glucose tolerance. 

Of course, once you get into the flow of work, it’s easy to forget just how much you’re sitting. That’s why you need some gentle nudges:

First, several fitness trackers can provide regular reminders to move. You can make sure those alerts are set up on your Apple Watch (more info here), Jawbone (see “Idle Alerts” here) or Garmin Vivosmart (info on the “Move Alert” here).

Second, as most people carry a smart-phone at all times, a simple hourly chime app (like Chime for iPhone and Hourly Chime for Android) can be a suitable reminder. When you hear a ‘ding’, stand up for a minute or so. If you’re feeling saucy, you can set those apps for more frequent reminders – say, every 30 minutes. (These are particularly handy in the evening. If you’re watching TV, for example, you can keep watching, just stand up and move a bit for a minute or two while you do.)

Third, since people are most likely to sit for extended periods of time while working on their computers, it’s also worth adding in an even more insistent reminder on-screen. Breaktime for Mac or Rest for Windows will take over your screen at whatever interval your select, reminding you to stand up, shake it out, go the bathroom, grab a water or coffee, or similarly get that mini-dose of movement it takes to get your body back on track.

This one’s an even smaller habit than most – again, it just requires getting up and moving briefly throughout the day. But it’s also one of the most effective you can implement in your life.

Connecting the Dots

  1. All of the blood in your body circulates through your eyes about 8 times an hour.
  2. A cutting edge medical treatment involves extracting patient’s blood, and irradiating it with UV light before reinjecting it, to take advantage of UV’s powerful anti-microbial effects.

So what are the odds that wearing sunglasses all summer long is actually short-circuiting an ingenious aspect of your evolved immune system?

Knock Your Socks Off

As we’ve written about before, the muscles in your feet are extremely important. When they’re engaged, your arch can absorb a huge amount of force, and the muscles further up the kinetic chain – in your legs and hips – work their best, too.

Whereas, when your arch collapses, every step smashes the small muscles and tendons in your feet. Worse, the navicular bone in your heel collapses inward, torquing your shin, and turning off muscles like your glute medius on the side of your hip. It’s a consistent cause of chronic pain in feet, knees, hips, and low-backs. 

That’s why we're long-standing supporters of going barefoot: it allows you to use your feet (and, in turn, your legs) they way they’re meant to work.

Obviously, if you run along city streets (like we do here in NYC), you probably don’t want to go totally barefoot, should instead opt for some minimalist, zero-drop shoes. (I’m a big fan of Inov-8.) And if you’re working out in a commercial gym, even if you take off your shoes, you probably still want to keep on your socks, to avoid picking up infections like MRSA or ringworm from sweaty floors.

But when you’re padding around the house, you’re in the clear. And while you may already be taking off your shoes at the front door, there’s a big difference between going barefoot, and going sock-clad mostly barefoot. 

First, though socks are more forgiving than shoes, they still squeeze your foot, preventing natural toe splay. Second, socks are slippery. Walking depends on friction – between your foot and the ground – to give you something to push against. Imagine walking on ice: with almost no friction between your shoes and the ground, you automatically start to take small, tentative, penguin-like steps, instead of natural human strides. Sure, socks on wood floor (or even carpet) aren’t nearly as slippery as shoes on ice. But they’re still slippery enough to change the way you walk, and to undercut the skill- and muscle-developing point of walking around barefoot in the first place. 

So, in short, make a point to walk around your home without shoes – and without socks. It’s the healthiest thing to do.

Caveman Cardio

In preparation for an upcoming talk, Coach Josh is revising a now five-year-old presentation on “paleo fitness” – what we can learn from our evolutionary ancestors about how to live longer, perform better, and look good naked. 

While our thoughts have shifted just a bit on the final third, the first two sections stand up exceedingly well. So, preemptively, we're posting both of them again here:

Once he finishes revising, we’ll re-record a final installment to complete the trifecta.

Bottle-Full

This time of year, as the weather turns, and people start thinking about having to appear in public in a bathing suit, there’s a sudden uptick in diets and gym trips. With a sense of deadline looming, they tend to jump in full-throttle.

But here’s the bad news: you didn’t get out of shape in six weeks, and you’re probably not going to become a cover model in that amount of time either. We see a lot of people who don’t want to face that reality, cutting their calorie intake in half, hitting the gym seven days a week. And, for about two weeks, it works like a charm. By the third week, they’re overtrained, nursing a summer cold, and entirely burnt out.

Harvey Penick, the legendary golf coach, liked to say, “when I tell you to take an aspirin, please don’t take the whole bottle.” Just because something is helpful doesn’t mean five times as much is five times as helpful. In fact, overdoing it often has entirely negative effects; an aspirin may cure a headache, but a bottle of it will kill you.

So if you want to kick off a summer fitness push, we think that’s a great idea. You can set reasonable goals, make a plan, and see solid results over the span of the next few months. Or you can take the whole bottle, and set off on an unsustainable beach countdown crash approach, which, after a few weeks, will similarly probably be dead.

Additive

When people start getting serious about their fitness, they often start to opt for well-marketed “scientifically designed” food substitutes instead of actual food. They drop simple fish and chicken, for example, in favor of protein drinks and bars.

We've written before about one set of problems that causes, as breaking food down and then reassembling it from its constituent components leaves out all kinds of important micro-nutrients.

But problems exist in the opposite direction, too. A number of ‘harmless’ additives used in those reassembled food products are increasingly turning out to be not so harmless after all.

A study recently published in the journal Nature, for example, demonstrated that two widely-used emulsifiers (carboxymethylcellulose and polysorbate-80) threw off the gut microbiome in mice, sufficient to cause inflammation, colitis, obesity, and metabolic syndrome.

As the researchers conclude, “the broad use of emulsifying agents might be contributing to an increased societal incidence of obesity/metabolic syndrome and other chronic inflammatory diseases.”

The solution? Eat real food instead of food products. It’s the simple, healthy choice.

Earn It

As we blogged about last week, progressive overload is one of the most fundamental principles in fitness: for your body to adapt positively, you need to gradually increase the stress induced by successive workouts. To get stronger, in other words, you need to lift more weight over time.

That’s where barbells come in: they allow you to add load, with more safety and efficiency, than nearly anything else. But just because barbell-based movements are where you probably want to end up doesn’t mean they’re the best place to start. Indeed, starting barbell movements before you have a requisite base of strength is a quick road to disaster. If you can’t generate the stability needed to do a barbell exercise perfectly, your body will compensate with less ideal movement patterns to accommodate the load, putting your joints and muscles at serious risk.

If you look around a commercial gym, you can see all kinds of terrible movements in action: unsafe joint mechanics, limited range of motion, and general wobbly disaster. In almost all of those cases, the root of the problem is the same: people ran before they could walk, adding load to a dysfunctional movement.

If you can’t squat perfectly without weight, adding weight is only going to make things worse.

That’s why, at Composite, we build all of our clients’ movements from the ground up. You need to show us 25 perfect, unbroken squats before we add any load at all. Then you need to build up to 25 perfect, unbroken goblet squats while holding half your bodyweight (60 pounds, say, for a 120 pound woman) before we graduate to the bar.

Similarly, if you can’t do 10 perfect, unbroken pushups – with core stability, and a range of motion from full plank lockout at the top to chest literally touching the floor at the bottom – you have no business bench pressing. We see big guys all the time who frequently bench press 225 pounds, yet who can’t pass the pushup test. And, funny enough, they’re also the same guys who show up with a history of persistent shoulder injury.

And while a lot of people spend time on accessory movements to hit their beach muscles – bicep curls, crunches until the cows come home – they’re equally ineffective for beginners. If you can’t do eight strict pull-ups, put down the E-Z Curl bar. And if you can’t farmer’s walk for 30 second with 1-2x your body weight, then start practicing that instead, as it’s all the core work you need.

Sure, the basics aren’t sexy. But they’re also the fastest, safest, and most effective route to results – and long-term health.

Variable

One of the most fundamental principles in fitness is progressive overload: gradually increasing workout stress over time, so that your body adapts positively to that increase. Perhaps that’s adding five pounds to your squat each time you lift to build strength, or lengthening successive runs to go from a mile to a marathon.

But while overload is easy on paper, it’s far more complicated in real life. Human bodies don’t adapt linearly in even the best of conditions, and progress is even more unpredictable once you factor in life stress, travel, lack of sleep, or a night of heavy drinking and too much dessert. Continuing to overload beyond what your body can keep up with leads to overtraining, which in turn causes illness and injuries, setting progress back.

So as you move forward in training, it’s useful to be able to monitor how well your body is adapting. While there are a number of approaches that work, one of the simplest and most empirically validated is tracking heart-rate variability (or HRV).

We tend to think of our heart as beating in a steady tick-tock. In reality, each beat varies a bit from the last. In fact, a healthy heart has a great deal of variability, whereas increasing regularity (as data from the Framingham study and others have consistently shown) drives increasing risk of heart disease.

Heart-rate variability results from the balance between the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is like the gas in a car, revving our bodies up for increased output, whereas the parasympathetic is like the brakes, bringing us down into rest and relaxation.

When the sympathetic nervous system overwhelms the parasympathetic, your heart-rate variability decreases. And, similarly, when your sympathetic nervous system overwhelms the parasympathetic, you’re on the road to overtraining.

As a result, monitoring heart-rate variability is a great way to simultaneously monitor overtraining.

While, previously, measuring HRV required specialized equipment (whether an EKG or a chest-strapped heart-rate monitor), the brilliant folks behind the app HRV4Training recently developed and clinically validated an approach to measurement using just your smartphone.

The way it works is simple: each morning, right after you wake up, you hold your finger over the phone’s camera lens for one minute. From that, the app determines your HRV for the day, compares the number to your moving averages over the past seven days and two months, and kicks out a simple recommendation: something like “go ahead and train, but limit intensity,” or “if you planned intense training, go for it.”

HRV provides a great window into how you're adapting to the progressive overload of workouts, and it’s a powerful tool in helping to keep you healthy and injury-free, moving forward over the longer haul.

So download HRV4Training, and overload yourself, just the right amount.

PSA: Stop Flip-Flopping

With summer weather upon us, a lot of people are breaking their flip-flops out from the closet.

Our advice is: don’t.

First, if you’re not currently a member of a fraternity, it’s probably not helping your look.

But second, and more importantly, flip-flops are a biomechanical disaster.

Your feet are a beautiful system, designed over thousands of generations of evolution to withstand pounding by forces several times your bodyweight, thousands of times each day. Fundamentally, your foot is a mechanical arch (cf., the arch of your foot), leveraging physics to accept and then dissipate force with ease.

Or, at least, that’s how it’s supposed to work. 

To illustrate, try this: lift your big toe. You’ll notice that, when you do, the arch of your foot pulls taught. The same thing happens when you keep your toe planted, but lift your heel – the way your back foot moves on each step as you walk. That pulling taught is called the Windlass Effect, and it allows you to support your weight using the strength of your fascia, tough connective tissue that surrounds your muscles. The Windlass action tightens up the fascia in your arch (the plantar fascia), as well as fascia in your calves and upper legs, like the IT band. And that fascia is super strong. In fact, you could literally hang a car from your IT band.

But if you’re wearing flip-flops, your big toe does something different: it scrunches in on every step, holding your shoe in place. That prevents the Windlass effect, so instead of pounding your strong fascia, you instead mash the tendons and soft-tissue of your feet, the cartilage and meniscus in your knees, etc., none of which were designed for that job.

So, in short, if you want to avoid plantar fasciitis, knee replacements, etc., stop wearing flip-flops. Sure, you can wear them on the beach / at the pool. But if you’re just walking around in warm weather, try something like a Vans slip-on (timelessly surfer chic), a strappy sandal, or anything else that holds on to your foot without your active effort.

You’ll look better. And you’ll make it to fall with a healthy leg up.

Vera-fied

Last summer, we wrote a series of blog posts about smart approaches to getting some sun. Starting with why sun exposure isn’t really the devil no matter what your mom says about skin cancer, moving on to everything you should know about suntan lotion but probably don’t, covering the use of UV-tracking apps to limit sun exposure to safe amounts, and ending with a pointer to antioxidant fern extract pills that research has shown works like sunscreen from the inside. With warm weather upon us again, all four are still worth the read.

But there’s at least one summer staple that isn’t worth it: aloe vera gel.

Though research on aloe vera for sunburns is surprisingly sparse, almost all the studies (like this one) conclude that aloe is no better than a placebo at reducing the pain or duration of a burn. 

And, indeed, though most clinical studies use carefully titrated medical-grade aloe creams, it turns out that most of the aloe vera gel sold at stores really is just a placebo: as of last year, researchers found that the store brands of aloe vera at Target, CVS, Wal-Mart, and elsewhere didn’t actually contain any aloe vera.

So save your $5 and refrigerator space, and stick with sunburn remedies that actually work: take a cool bath or shower, drink plenty of water, use moisturizer on the burn, and consider taking aspirin or ibuprofen to help reduce redness and pain.

See you at the beach!

Step to It

Like many other coaches, trainers, and health gurus, we’ve long recommended people consider tracking their daily step counts, aiming for at least 10,000 a day. And, indeed, research well supports the benefits of getting 10,000 daily steps; hitting that number results in a nearly 50% drop in all-causes mortality as compared to a sedentary baseline.

Still, the precision of 10,000 is a bit arbitrary. It stems from a Japanese 1960’s public service advertising campaign promoting the first cheaply available electronic pedometers, when “manpo-kei,” or “measure 10,000 steps,” made for an easy, succinct, and catchy slogan. Ever since, 10,000 has stuck as the default pedometer goal. 

Earlier this month, however, the International Journal of Obesity published a great observational study of Scottish postal workers, examining the relationship between walking and metabolic syndrome (a cluster of health conditions that increase the risk of heart disease, stroke, and diabetes). Not surprisingly, the study concluded that “compared with those without metabolic syndrome, participants with metabolic syndrome were significantly less active-fewer steps, shorter stepping duration and longer time sitting.”

But tucked in the paper is a more interesting, and more specific, observation: all of the postmen and women who had no symptoms of metabolic syndrome walked at least 15,000 steps per day.

Obviously, there’s only so much we can glean from a single study. But it does suggest that, while 10,000 may be a great initial goal, it might not be the ideal final stopping point. So if you’re tracking your steps, and already consistently hitting 10k, consider upping that goal by 1,000 more each month, until you reach the 15,000 step point. Considering the huge amount of research backing the benefits of walking in general, wedging in a little more of it certainly couldn’t hurt.

In the Weeds

[Is gluten intolerance really about pesticides?]

As we’ve said before, we're not nutrition dogmatists.  While we think an ancestral-based approach is a good starting point for most people, we also strongly believe that differences in genetics, epigenetics, and microbiome cause different people to react very differently to the same foods.  So it seems a prudent approach to start by paring down to a healthful dietary core, then test the re-addition of new foods to gauge their individualized effects.

Though wheat isn’t a central part of most our own diets, many of our coaches find that we can easily enjoy a bowl of pasta, say, without issue.  But for a number of Composite clients, removing grains has had hugely beneficial health impact.

More than a few of those ‘grain-reactive’ folks, however, have shared with us similar stories: though they feel terrible after eating even organic breads here in the US, while traveling in Italy or France, they decided that the chance to enjoy the local cuisine trumped their usual dietary concerns.  But even after eating relatively large amounts of a food that they couldn’t tolerate at home, often for days at a time, they had no problems while abroad.

We're dubious of claims (at least, health-based ones) against GMO’s, so we’d previously written off those international bread stories as the vagaries of travel - the excitement of being somewhere new, or the masking effects of a circadian rhythm tossed out of whack.

But this week, our lead nutritionist ended up diving down a rabbit-hole of research papers about glyphosate, an herbicide used as a primary ingredient in Monsanto’s hugely popular pesticide Roundup.  Roundup is nearly ubiquitous in the US, where it’s used on 98% of non-organic wheat.  And it travels well enough when airborne that it’s found on more than 50% of US organic wheat, too.

Though Roundup was approved as safe for humans back in the 1970’s, deeper research over the last decade has increasingly indicated that glyphosate - especially when combined with other ‘inert’ ingredients in Roundup - may be an extremely potent mitochondrial disruptor, which in turn can cause a broad array of health issues.

In other words, while people are complex, foods are, too.  And, indeed, over the next few years, we suspect we're going to discover that the rise of 'gluten intolerance' has less to do with an increase in people reacting negatively to wheat, and more to do with people reacting to the specific ways in which wheat is increasingly raised here in the US.

Our approach to large-scale agribusiness has certainly changed the fundamental economics of how we feed the world.  But boy does it seem to come with a lot of second-order costs.

Spring Cleaning

Composite’s approach to health is largely built around habits. That’s because habits, once built, are easy to maintain. They are, by definition, what you do by default.

For most people, energy, willpower, and commitment to a goal wax and wane over time. You have days when you’re psyched up and ready to go, and others when you’re barely dragging through. That’s why we tend to favor building systems – something you can plan out and implement when you’re at your best, to keep you on the rails when you’re at your worst.

One system that we’ve found extremely effective is the Refrigerator Rule: in short, you’re eventually going to eat anything you keep in your refrigerator or cabinets. So you should probably only keep on hand food that passes muster with your best, most psyched-up, goal-committed self.

When we review food journals with clients, we’ll frequently find that they ate crappy afternoon snacks a few times during the past week. At which point, we always ask the same question: did you eat that cookie / candy bar / entire stack of Pringles because you really wanted it, or because it was there? And, about 95% of the time, people tell us they ate that specific unhealthy snack because it was the easy thing to do. 

Life is short, and pleasure is important. If you really want a doughnut, go out and buy one (or three) fresh, and enjoy the hell out of it.

But if you don’t want one badly enough to head to the doughnut shop for it, we’d argue you don’t really want one all that much. You’re just stuffing down the semi-stale Entenmann’s because that’s what’s in your office kitchen.

So, today, on the first day of spring, take a moment and do your health a favor: spring clean the crap – the cookies, candy, chips, crackers, etc. – out of your home and office. Perhaps even go out and pick up some pistachios and walnuts, apples and oranges, beef jerky or string cheese to replace it. 

If you want to eat something less healthful at some point, again, you’re an adult; go buy it and enjoy it. But in the meantime, make fitness easy for yourself. Get rid of the tempting garbage that’s just sitting there, and don’t let your future self make bad choices by default.

Past Perfect

A lot of Composite’s clients follow a Paleo-inspired approach to eating. And, frequently, they ask us about the impact of occasionally adding some specific food – say, full-fat dairy, like cream or cheese – to what they eat.

Not everyone reacts the same to all foods, so we might gauge how a given client reacts to a class of foods through blood panels at a doctor’s office, or at home with the Coca Pulse Test.

But even for people who do show some reactivity, deciding to include a food or not actually requires zooming out a bit. For a change in diet to have meaningful health impact, it needs to be something you can keep up for the long haul. For many people, regularly enjoying something they particularly love makes their new way of eating far more pleasurable, and therefore much easier to sustain. In practice, it’s the difference between eating healthfully, albeit at 90%, for years, versus eating precisely ‘by the book’ for a few months, and then dropping off entirely.

So, as you look at your way of eating, think about the ideal, but also think about what you’ll be able to enjoy and sustain. And remind yourself: in nutrition, the perfect is pretty often the enemy of the very good. 

Acting Shellfish

We get questions from clients on a slew of topics, from exercise programming and injury rehab to sleep management and environmental toxins.  But, more than anything else, we're asked about nutrition.  Over the next couple of weeks, we'll be hitting a handful of posts to address some of the most common nutrition questions we receive.  

First up, staying healthy as a vegan:

As we’ve blogged about before, we're actually totally sympathetic to arguments about the ways in which our food system is unforgivably cruel to animals. For most of our coaches, after weighing a lot of factors, we’ve decided that we feel comfortable eating a diet that includes ethically-raised animals, and ethically-farmed eggs and cheese. But we understand that includes tradeoffs that others aren’t willing to make. If you’re eating a vegan diet for moral reasons, we support that choice.

So, if you’re committed to a vegan diet, what can you do to maximize your health? 

On the plus side, vegans tend to eat a lot of whole foods, which is great. 

On the minus, they’re also frequently deficient in protein, omega-3 fatty acids, vitamins B12 and D, calcium, iron, zinc, and iodine.

Previously, we’ve blogged about some supplements that vegetarians and vegans should strongly consider, to counter those deficiencies.

But it’s B12, in particular, that’s a real issue for vegans. Simply put, while a variety of vegan foods have been held up as good sources of B12 – spirulina, dried nori, barley grass, other seaweeds, raw foods – an avalanche of research has shown that they’re not bioavailable enough for people to actually absorb the vitamin in those foods at meaningful levels. And B12 shots – beyond being a literal pain – use B12 in the form of cyanocobalamin, which steals methyl groups from the body and creates toxic cyanide as it’s processed in the liver.

There is, however, a good alternative: oysters.

We know, we know: oysters are technically animals, and therefore definitely not vegan. But bear with us here.

First, remember that vegans aren’t avoiding animal protein as an end in and of itself. Instead, they’re doing it to inflict the least possible harm to other sentient beings and to the environment.

Fortunately, from an environmental perspective, oysters are actually a net-positive. Farming them doesn’t require bottom-trawling or other destructive forms of fishing; it requires no carbon-emitting supply chain for feed, as the oysters simply eat by filter-feeding plankton in the water around them; and it actually improves the surrounding water quality, through that filter-feeding (enough so that places like NYC have planted oyster beds to help de-pollute their currently toxic waterways).

As for sentience, unlike almost every other animal, oysters don’t feel pain, because they don’t have a central nervous system. As Crook & Walters conclude in a 2011 paper:

[The bivalve] nervous system includes two pairs of nerve cords and three pairs of ganglia. There is no obvious cephalization and the nervous system appears quite simple….to our knowledge there are no published descriptions of behavioral or neurophysiological responses to tissue injury in bivalves.

In other words, oysters have a very simple nervous system, without a brain. Unlike other invertebrates, and even other shellfish, they don’t react to injury (unlike, say, shrimp and lobsters, which groom their antennae after injury), or show the neurotransmitter responses that other animals do when they experience pain.

So eating oysters (and likely mussels, too) doesn’t actually hurt them; they don’t feel it any more than a piece of asparagus does.

A lot of research has shown that the disgust reflex plays a big role in the vegan diet. And I’m sure the idea of eating oysters seems potentially disgusting to a lot of vegans, regardless of the moral, environmental, or health implications.

But as we’ve noted before, the long-term adherence to veganism (and vegetarianism) is terrible – after 18 months, about 85% return to eating meat, which is why the percentage of vegetarians and vegans has held steady at about 5% for the past thirty years. 

According to research, some of them give up due to the social sustainability of the diet – and in our next nutrition post, we're going to talk about behavioral diet sustainability in general. 

But an even larger percentage of vegans (more than 50% of those who give up on the diet) due so either due to declining health, or irresistible food urges (which are often driven by a craving for micronutrients in which people are deficient). And oysters just happen to be a great source of every one of the nutrients in which the vegan diet is deficient (again: protein, omega-3 fatty acids, vitamins B12 and D, calcium, iron, zinc, and iodine), enough so that regularly eating oysters is likely to offset both declining health and animal-food cravings.

So, in short, if you’re a vegan, and you’re worried both about your own vitality and your ability to sustain a way of eating that does the most good for the world in the long-term, consider a happy hour trip to grab some oysters. Strange as it may sound, that’s totally in line with the goals of veganism – not hurting animals or the environment – and it will make you both healthier and more likely to stick with it.