The Science of Great Sleep

Too busy to read the whole article? [4,500 words, a 23-minute read] Here are the key takeaways:

  • Try to sleep 7-8 hours a night.
  • If you sleep better, you’ll be better at regulating emotions, remembering things, working out, and not overeating.
  • To get a better night’s sleep: (1) exercise (2) don’t drink before bed (3) keep your bedroom lights dim (4) avoid gadgets with a screen (5) find a comfortable pillow and (6) try sleeping on your right side.
  • Benadryl and Unisom can help you fall asleep every once in a while, but herbal supplements haven’t been very effective in trials.
  • Artificial dawn alarms can help you feel less sleepy in the morning. But, snoozing any alarm is probably a bad idea.
  • If you didn’t get enough sleep, try a 10-minute nap, a cup of coffee, stretching, or taking a walk.

Tytus Wilson, 27, an entrepreneur in Louisville, Ky estimates he’s spent over $20,000 over the last three years on products to help him track and improve his health. Sleep is a big part of that.

He’s experimented with things like blue light-blocking glasses, a grounding blanket that directs electrons from the earth into the human body, and magnesium supplements to improve his sleep. He’s also tracked the impact of diet, moods and daily steps on his sleep.

He says he realizes some of it sounds ridiculous.“I don’t spend any money on houses, cars and furniture,” he says. “If somebody tells me ‘This will help your sleep.’ I don’t care what it is, I’ll try it and see what happens.”

Wilson is probably an outlier, but sleep is a big concern among millennials. 43%  rated their sleep quality as “fair or poor” in an American Psychological Association poll. We’re more likely than older generations to stress about sleep quality too. 1

Robin Haight, a clinical psychologist in Tyson’s Corner, Va. attributes that stress in part to the internet. “Millennials have more access to information about wellness and health than perhaps older generations had at that same age,” she says. Even at 3 AM—when you’re lying awake in bed, you can go online and find articles citing research that links lack of sleep with things like decreased vaccine effectiveness2 and increased risk for Alzheimer’s Disease.3Haight adds that the increase in research and awareness about sleep can be a good thing, though.

Ever wondered how your sleep compares to everyone else’s? Here’s what a “normal” night’s sleep might look like in healthy 20-somethings:

  • Time to fall asleep: 6.3 minutes
  • Time spent in bed vs. time asleep (sleep efficiency): 6.6 hours to 6.2 hours (94%)
  • Awakenings per hour: 1
  • % of night spent in non-REM sleep: 72.3%
  • % of night spent in REM sleep: 22.2%

reference:4

Is a good night’s sleep really that important?

Here are some of the ways sleeping better makes life more pleasant:

Sleep helps keep you from freaking out about the small stuff. Brain scans taken when sleep-deprived people viewed photos with negative subject matter showed more activation in the amygdala (a part of the brain involved in emotional reaction)5 than in people who’d slept normally. The sleep-deprived people also had a loss of connection between the amygdala and the medial prefrontal cortex, a part of the brain that can help moderate emotional reactions.6,7

To put that in a context that’s closer to real life, people in a study who had their sleep cut by 33% for an entire week reported mental fatigue and emotional instability that worsened over the week.8

Sleep is also good for your memory. A research review cites 35 studies that link inadequate sleep with declines in memory encoding (creating new memories) and memory consolidation (incorporating new memories into long-term memory).  Many of the studies found that people were better able to remember things like a string of letters or solutions to math problems after a night’s sleep.9

Sleep can help you get the most out of your workout. Sleep deprivation can significantly decrease your reaction time, which is important in activities like team sports or weightlifting.10

In another study, players on the Stanford University men’s basketball team improved their shooting accuracy, sprinted faster and reported feeling better overall during games after 5-7 weeks of increased sleep.11

New York-based Hannah Jiang, 23 says sleeping well helps her in her running, biking and other cardio workouts. “If I get the perfect amount [of sleep] like 8 hours and I’m eating well, and I’m working out well, everything is just better. My attitude is better too,” she says.

Sleep can help prevent weight gain. A handful of studies have found an association between shorter sleep hours and obesity. Possible explanations for the correlation: increased calorie intake due to more production of  hunger hormone ghrelin and less production of satiety hormone leptin. Or more available hours in the day to eat. You can’t munch at midnight if you’re not awake. Another explanation: sleep-induced fatigue or reduced ability to regulate body temperature could make working out a lot less appealing.12

In one study, people stayed in a sleep lab for 14 days and were allowed to sleep either 5.5 hours a night or 8.5 hours, the 5.5 hour group ate more snacks, on top of regular meals.13

Beauty sleep might be a real thing. Viewers perceived photos of people who’d slept well as more attractive and healthier looking than photos of the same people who hadn’t slept for a night.14

Now that we’ve established why better sleep is a good idea, let’s talk about the nitty gritty of how to actually sleep better.

Better sleep: What should you do throughout the day?

Make your bed in the morning. Jiang says she tries to as part of her strategy to keep her bedroom uncluttered.  “I try to make [my bedroom] as sort of zen-like as possible—otherwise I find that my mind is all over the place,” she says. “If I have stuff from work that I bring home, I try not to do it in bed because I find that I’m thinking about it.”

She may be on to something. Maybe it’s the old adage that a clean room leads to a clear mind. Or maybe well-made beds just look more inviting. Either way, research shows that people who make their beds every or almost every day are more likely to sleep better at night (though this is at best correlation, not causation).15

Exercise. Remember that better sleep can help you be a better exerciser? It can work the other way too, says Max Hirshkowitz, a professor at Baylor College of Medicine. “If you think of what we call the three pillars of health, which is diet, exercise and sleep, any one of those can improve the others,” he says.

A good reason to step up your workout: in a poll by the National Sleep Foundation, vigorous exercisers (runners, cyclists, swimmers and competitive sports players) reported falling asleep more easily, staying asleep all night, and waking up refreshed more often than people who do less intense workouts. But don’t give up on yoga or walking yet. Moderate and light exercisers said they have better sleep than people who don’t work out at all.

Hirshkowitz, lead advisor on the poll, doesn’t know the reason behind this, but hard workouts may also act as a buffer against bad sleep. Vigorous exercisers reported less impairment in their work, social and sex lives when they didn’t get adequate sleep.16

If you already exercise, but want to try to improve your routine for maximum sleep benefit, Hirshkowitz recommends exercises that improve conditioning as opposed to strength.  “If you’re running, I would say run a little faster, but maybe further to increase conditioning. If you’re doing weights, I would say doing more reps,” he says. He emphasizes building your routine gradually, as injuries can wreck your sleep and undo any benefits.

Cocktails at happy hour and nightcaps might not be a great idea. “Most people kind of believe that [alcohol] helps you sleep and no one’s been able to actually prove that in a lab,” says Eliza Van Reen, a professor of psychiatry and human behavior at Brown University. Her experiments indicate that just one drink can mess with your sleep. Participants who had a vodka tonic around 4 PM17 as well as at 9:30 PM18 had more difficulty getting to sleep than those who had a placebo.

But maybe you remember a time where you’ve had a few drinks and gone to sleep with no trouble. A review of 80 years of research (conducted between the 1920s-2010s) on alcohol and “normal” sleepers found that low (1-2 drinks), moderate (2-4 drinks) and high (4+ drinks) doses of alcohol tended to decrease the time it took to fall asleep. However, moderate and high doses caused a reduction in deeper, restorative REM sleep.19

Get out. Psychologist Robin Haight recommends getting outside for at least 15-20 minutes each day. “Being indoors for the majority of the day can actually interfere with the sleep-wake cycle,” she says. Sunlight exposure jumpstarts the body’s production of melatonin, the hormone most responsible for the regulation of sleep cycles.20

Better sleep: The critical hour before bed

On average, millennials go to bed around 11:58 PM.21 So let’s say it’s 10:58 p.m. Maybe you’re sleepy, maybe you’re not, but you know you should go to bed soon. Now is a good time to turn down the lights.

In dim light, melatonin can start doing its work over an hour earlier than in normal room light.22 How dim should your room be? Researcher Joshua Gooley says you should still be able to read a book, but that the fine print might be difficult. To achieve the ideal pre-sleep lighting level, Gooley recommends using a bedside lamp or putting a dimmer on overhead lights.

After making sure you’ve got sufficiently dim light in the bedroom, pay attention to your bathroom light. If you take a shower at night, or spend any other amount of time in there, bright white light can end that peaceful, sleepy feeling created by a dim bedroom. Warmer, or more yellow light (or a dimmer on the white light) is less jolting.23

Get rid of anything with a screen. The relatively bluer light from computer and tablet screens can interfere with melatonin production more than any other type of light.24There’s no clear answer on how much blue light exposure it takes to suppress melatonin. One study says 5 hours.25 Another says 1-2.26 A general guideline is to avoid bright screens 2-3 hours before bed.27Or, if you absolutely can’t do that, try blue light-blocking glasses or programs that change the color of your screens.

Besides the light factor, there’s the distraction of having a device right by your side that you can use to communicate with anyone, at any time. 67% of 19-29-year-olds say they take their phones to bed.28 Not surprising, right? If anything, that percentage seems a little low.

The most popular use of the cell phone in bed? Texting. Unfortunately, people who text in the hour before bed every night or almost every night are less likely to say they get good sleep, and more likely to be classified as “sleepy” on the Epworth Sleepiness Scale.29

If you absolutely have to take your phone or iPad to bed with you (and I’m guessing you are—habits die hard) turn the brightness down and hold it at least 14 inches away from your face. This reduces the brightness to a level that doesn’t mess with melatonin production as much.30 Airplane mode is probably a good idea too.

Better sleep: Sleep environment (your bed and bedroom) matters

So what exactly is a comfortable bedroom environment? 25-34-year-olds said in a National Sleep Foundation Poll that the top three environmental factors in their are: pillows, bedroom darkness and bedroom temperature, in that order.31

Pillows

If the importance of pillows inspires you to go shopping, be prepared to be overwhelmed. On Amazon alone, there are 11,210 results for “pillow” in the “Health & Personal Care” category.

There’s pretty much no objective way to define a “good” pillow. One study recommended a pillow with an indentation to support the neck for people who tend to sleep on their back or side. 32 Another found that rubber pillows got high marks for general comfort.33 Another said anything but feather pillows.34

To save you some time, (and possibly money by preventing a bad purchase) Nick Robinson, creator of the website Sleep Like the Dead aggregated more than 21,000 consumer reviews from sites like Amazon and Overstock into a table that scores nine types of pillows in 21 categories.35

For example, if you wanted to find a pillow that online reviewers says reduces pain or is good for sleeping on your stomach, the table can point you to a category of pillow (say, a down alternative) and then towards a specific brand.

Darkness

I already wrote about the importance of dimming lights and expelling gadgets from the bedroom. I’ll just add here that if you have problems with light at night (like a streetlamp shining in your window, or some other non-controllable factor) light-blocking curtains are a lifesaver. Insulated thermal panel curtains from Overstock get high scores by reviewers. My personal recommendation: stylish velvet light-blocking curtains from Target.

A light-blocking sleep mask is a cheaper, more portable option. Online reviewers like the Prime Effects sleep mask that has attached earplugs.

Temperature

If you like to sleep with typical blankets, the ideal sleep temperature appears to be between 60.8 and 66.2 degrees at night. If you’re the rare person that sleeps naked with no covers, something like 86-89.6 degrees is better. And if you sleep with just a sheet over yourself, you’ll probably be best off somewhere in between.36

If you sleep with a partner, there’s always a chance that no amount of thermostat adjusting will make you both happy. One interesting option: regulating mattress temperature. The ChiliPad and the Outlast mattress pad both go over your existing mattress and use different technologies to adjust temperature for hot and cold sleepers.

If spending hundreds of dollars on a fancy mattress pad isn’t your idea of a good investment, hot sleepers could consider using a fan for a stream of cool air. And cold sleepers always have the option of more clothing or blankets.

The fastest ways to get to sleep

Now for the main event: falling and staying asleep.

The average amount of time it takes to fall asleep is 6.3 minutes, but anything less than 15 minutes is good.37If you’re still lying awake after that,  here are two interesting techniques I found.

Progressive relaxation. Basically, it’s going through your entire body, from your forehead to your toes, tensing each muscle one-by-one, then releasing that tension.38 There are countless  videos that will guide you through this process. Yoga teacher Jodie Tingle-Willis, says it’s important to find a video with a pleasing voice. “I might like an Australian accent, but it might drive you crazy,” she says.

One study found that progressive relaxation was very effective in helping people with multiple sclerosis get to sleep39 and another found that progressive relaxation can be as effective as Valium in reducing brain activity during a stressful state.40 Unfortunately, I didn’t find any tests of the effectiveness of progressive relaxation for sleep in people who weren’t suffering from chronic conditions.

The “cognitive shuffle.” We’ve all been there: maybe you’re worried about what you have to do tomorrow, or what you did today. All of the sudden, you feel like you’re stuck in an endless loop of thoughts. There’s an app that can help stop that loop—as long as you’re going to take your phone to bed despite some researchers’ advice not to. The idea behind mySleepButton is to take your mind off your worries by guiding you through a series of random images like, “a canoe, playing golf, holding a paper cup.”  (41) 41

Body position is one of the less-discussed aspects of sleep. Joseph De Koninck isa psychology professor at the University of Ottawa researches sleep and dreams. He says that younger adults tend to change position about 30 times per night. When he filmed people for two nights in a sleep lab, he found that “good sleepers,” or people who are normally satisfied with their sleep, changed position less than people who weren’t satisfied.

The good sleeper group also spent more time lying on their right side with their arms and legs both folded. Poor sleepers spent a lot of time on their back.42

Although none of the participants in his study had a sleep disorder, De Koninck says back sleeping is also associated with sleep apnea. If you’re healthy and don’t have any trouble sleeping, De Koninck says there’s no reason to change your sleep position. But if you do want to sleep on your back less, he mentioned devices like the Zzoma—a belt with a pillow attached to the back to make it more comfortable to rest on your side and less comfortable to lay on your back.

Interesting side note: another, more recent study found that right-side sleepers got better scores on the Pittsburgh Sleep Quality Index and had fewer nightmares than left-side sleepers.43

Focus on rest, not sleep. “I always advise people to never look at the alarm clock, never look at the phone. It doesn’t help to know what time it is. It doesn’t help to know how long you’ve been awake. It’s just going to make you stress out,” says Robin Haight. “Just know that your body is resting, even if you aren’t sleeping.”

In one study, participants were challenged to fall asleep as quickly as possible, with a monetary reward attached. But of course the challenge group ended up getting less and worse sleep than the control group, who simply went to sleep with no instructions.44

Sleep supplements. I can’t ignore supplements when writing about sleep. But, this is a HUGE topic. For the sake of not making this article a million words long, I stuck to over-the-counter supplements. This definitely isn’t an exhaustive list, but here are some I ran across, and briefly and what published research says about them:

  • Diphenhydramine, the active ingredient in Benadryl, can work for occasional trouble falling asleep. But its effectiveness wears off pretty quickly with repeated use.45
  • Same with doxylamine, the ingredient in Unisom.46
  • Melatonin supplements might help you fall asleep, but they’re not a surefire shot at a good night’s sleep.47 Oddly, one study found that melatonin found naturally in cherry juice was helpful for sleep.48
  • Valerian, an herb sold in capsule form, doesn’t really do much.49
  • Tryptophan, an amino acid, can be effective.50 Even small amounts can be effective, such as the levels found in foods like turkey and pumpkin seeds.51
  • Finally, a magnesium supplement can be effective if you have a deficiency52 but the effects have mostly been studied in adults over 50.53

My summary: this is only what some of the research says. There’s a lot more out there about all these substances. If you’re interested in one, do some more reading on your own.

Better sleep: how much is enough?

“If you always need an alarm clock to wake up, you’re probably not getting enough sleep.”

Once you’re asleep, how long should you stay there? 6.6 hours in bed is the norm, but that might not be enough. 25-34-year olds say they’d like to get 7.4 hours to function and feel best.54

Elizabeth Klerman, a professor at Harvard Medical School’s Division of Sleep Medicine, who’s studied sleep variation found that when given the opportunity to sleep more hours, people will do it. In one of her studies, people who reported a baseline of 6.1-10.3 hours of sleep per night slept an average of 4.9 hours more when they were allowed to. The participants with a higher baseline of sleep leveled off after a few days, but the people more towards the 6.1 end continued to sleep more hours. (51) Klerman says this suggests that a lot of people are walking around with a sleep debt and they don’t realize it.

Klerman’s advice: “If you always need an alarm clock to wake up, you’re probably not getting enough sleep.”

Waking Up

Oh, hey, it’s been 8 hours. Or 6. Or whatever. It’s time to get up!

Unless you got your magic number of sleep hours, you’re probably feeling groggy and maybe fumbling around as you start your morning routine. That feeling is called sleep inertia. It’s the time between the alarm going off and when you feel fully awake and it can last from a few minutes to a couple hours.55

The only way to not experience this feeling is to wake up naturally, with no alarm clock.56 Of course, if that’s not possible, an artificial dawn light might help. 18-36-year-olds who had trouble waking up at least 4 days a week, said the light helped them feel less sleepy and more active after using the light for 30 minutes before the alarm went off. 57

The Sleep Cycle app is something else you can try to cut down on that feeling of sleep inertia. You set the alarm on it for the time you want to wake up, say 7 a.m. It uses the accelerator on your phone to sense movement during the night. According to the product description, you move differently in every phase of sleep, so Sleep Cycle will use that movement to wake you up when you’re in the lightest phase of sleep at some point between 6:30 and 7.58

I didn’t find any studies that put Sleep Cycle to the test, but Fitbit data analyst Naveen Sinha, 29, says he relies on it. Tytus Wilson has also used the app since 2009. “I noticed that it was good at waking me up in that already restless time. I would just hear the ding and be ready to go,” he says.

Regardless of the type of alarm you use, try not to hit snooze. I didn’t find any peer-reviewed research that specifically says not to, but I did find these two solid arguments:

  • When you hit snooze, your body restarts the sleep cycle, making you more and more sleepy each time your alarm goes off59
  • If you’re snoozing for 20 to 30 minutes anyway, why not set y0ur alarm later and just get solid, uninterrupted sleep?60

So just get out of bed, already! That sounds easy until it’s actually time to do it, right? To really get yourself going in the morning, try one of these highly motivational alarm clocks. One forces you to stand up on your feet, one is a weight that makes you do 30 reps and another connects to your bank account, then makes a donation each time you hit snooze.61

What to do after a bad night’s sleep

Occasionally (well, hopefully occasionally), everyone has a night where they only get a few hours of sleep. Here’s what you can do to survive those sleep-deprived days.

Two obvious solutions are caffeine and naps. But which one works better?  Actually, they’re both about the same, according to one study that compared signs of afternoon sleepiness after a 20-minute nap or two cups of coffee containing 150 mg of caffeine. Measures of sleepiness went down a little, but not really that much. Then again, this study only tested participants who had slept normally the night before.62

After a night of sleep restriction (to 4.7 and 5 hours), two studies found that a 10-minute nap decreased feelings of sleepiness and improved cognitive performance.63 64 Another study showed that 100 mg of caffeine (in pill form) improved performance on a grammatical reasoning test and lessened feelings of sleepiness. Caffeine didn’t beat a placebo on a test of alertness and reaction time.65

If you’re worried about overall caffeine intake, even a placebo might help. Two groups of people in one study each had one cup of decaffeinated coffee. Researchers told one group that their coffee was caffeinated. The group who thought they’d consumed caffeine had quicker reaction times and fewer mistakes on performance tests.66

If you’re going to put your head down on your desk, or against the window of a bus and take that 10-minute nap, the Ostrich Pillow might help you out. It’s sort of like a pillow hood that goes down over your eyes. It allows your forehead or the side of your head to rest on a hard surface, and there are holes at the top for your hands during a desk nap. Another version, the Ostrich Pillow Light, is like a padded sweatband that wraps around your forehead and eyes.

Can’t nap or caffeinate? Try physical movement. Jodie Tingle-Willis, a yoga instructor in Louisville, Ky. recommends a few moves to wake yourself up. “Opening up the chest is really good, so you can take your hands behind you and grab the chair on either side and reach your heart up and forward and take some really nice, deep breaths in and out,” she says. She also recommends a chest-opening side stretch where you leave your left arm by your side, extend your right over your head, and bend to the right.

“A little less conventional is to take off your shoes and actually give yourself a little bit of a foot massage,” says Tingle-Willis. She says pounding gently on the sole of your foot can wake up nerve endings and bring energy into the body.

Michael Bonnet, a professor of neurology at Wright State University School of Medicine, recommends simply getting up and walking around to overcome sleepiness. But, he says the more-sleep deprived you are, the sooner the energizing effect wears off, and the more activity you’ll need.

Your next step: make sleep a priority

Almost every sleep researcher I talked to emphasized the importance of making sleep a priority. Eliza Van Reen, from Brown University emphasizes making a priority of going to bed at a certain time each night and keeping a regular sleep schedule. She says she knows you’ve probably heard that before, and that it’s easier said than done, but it works.

In this article, I didn’t even go into the importance of timing your sleep or understanding circadian rhythms. That stuff matters too, but the fact of the matter is that you probably won’t be successful at harnessing any of those techniques to improve sleep until you decide to make sleep a priority.

And, just like eating less junk food or making a workout pact, committing to sleeping better is not a promise to be made lightly. Getting good sleep is just about the most important step you can do to improving your health, productivity, and well, happiness. While we usually list our specific recommendations at the end of articles, I find it hard to make specific recommendations since sleep is something that everyone knows they need more of, yet we somehow can’t find the will to do it.

So I’ll end with a question.

How will you start sleeping better?

Notes:

  1. American Psychological Association, 2013. Stress in America poll ↩
  2. Huffington Post, 2012. Lack Of Sleep Could Decrease The Potency Of Vaccine: Study ↩
  3. Whiteman, Honor, 2013. Lack of sleep may increase Alzheimer’s risk ↩
  4. Hirschkowitz, Max. (2004) Normal human sleep: an overview. The Medical Clinics of North America, 88(3):551-65. ↩
  5. Wright, Anthony, 2014. Chapter 6: Limbic System: Amygdala, Neuroscience Online. ↩
  6. Carter Lab, University of California, Davis, Cognitive Control. ↩
  7. Walker, Matthew P. (2009) The Role of Sleep in Cognition and Emotion Annals of the New York Academy of Sciences, 1156: 168-197. ↩
  8. Dinges, David F. et. al. (1997) Cumulative Sleepiness, Mood Disturbance, And Psychomotor Vigilance Performance Decrements During A Week Of Sleep Restricted To 4-5 Hours Per Night. Sleep 20: (4) 267-277. ↩
  9. Walker, Matthew P. (2009) The Role of Sleep in Cognition and Emotion Annals of the New York Academy of Sciences, 1156: 168-197. ↩
  10. Taheri, M., Arabameri, E. (2012) The Effect of Sleep Deprivation on Choice Reaction Time and Anaerobic Power of College Student Athletes. Asian Journal of Sports Medicine, 3 (1): 15-20. ↩
  11. Mah, Cheri D. et. (2011) The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players. Sleep, 34 (7) 943-950. ↩
  12. Patel, Sanjay R., Hu, Frank B. (2008) Short sleep duration and weight gain: a systematic review. Sleep, 16: (3) 643-653. ↩
  13. Nedeltcheva, Arlet V. (2009) Sleep curtailment is accompanied by increased intake of calories from snacks. American Journal of Clinical Nutrition, 89: (1) 126-133. ↩
  14. Axelsson, John, et. al. (2010) Beauty sleep: experimental study on the perceived health and attractiveness of sleep deprived people. British Medical Journal, 341: c6614. ↩
  15. National Sleep Foundation, 2012. Bedroom Poll. ↩
  16. National Sleep Foundation, 2013. 2013 Exercise and Sleep. ↩
  17. Van Reen, Eliza, et. al. (2011) Does timing of alcohol administration affect sleep? Sleep, 34(2):195-205. ↩
  18. Van Reen, Eliza, et. al. (2013) Biphasic Effects of Alcohol as a Function of Circadian Phase. Sleep, 36: (1) 137-145. ↩
  19. Ebrahim, I. O., et. al. (2013) Alcohol and sleep I: effects on normal sleep. Alcohol: Clinical and Experimental Research, 37(4):539-49. E463-E472. ↩
  20. Mead, M. Nathaniel. (2008) Benefits of Sunlight: A Bright Spot for Human Health.Environmental Health Perspectives, 116(4): A160-A167. ↩
  21. National Sleep Foundation, 2011. Sleep in America Poll. ↩
  22. Gooley, Joshua J. (2011) Exposure to Room Light before Bedtime Suppresses Melatonin Onset and Shortens Melatonin Duration in Humans. Journal of Endocrinology and Metabolism, 96(3): E463-E472. ↩
  23. Wahnschaffe, Amely, et. al. (2013) Out of the Lab and into the Bathroom: Evening Short-Term Exposure to Conventional Light Suppresses Melatonin and Increases Alertness Perception. International Journal of Molecular Sciences, 14(2): 2573-2589. ↩
  24. Harvard Health Letter, 2012. Blue light has a dark side.  ↩
  25. Cajochen, Christian, et. al. (2011) Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance. Journal of Applied Physiology, 110:1432-1438. ↩
  26. Wood, Brittany, et. al. (2013) Light level and duration of exposure determine the impact of self-luminous tablets on melatonin suppression. Applied Ergonomics, 44(2): 237-240. ↩
  27. Harvard Health Letter, 2012. Blue light has a dark side. ↩
  28. National Sleep Foundation, 2011. Sleep in America Poll. ↩
  29. National Sleep Foundation, 2011. Sleep in America Poll. ↩
  30. Dinges, David F., et. al. (2013) Abstract Supplement. Sleep, Volume 36: 186. ↩
  31. National Sleep Foundation, 2012. Bedroom Poll. ↩
  32. Her, Jin-Gang, et. al. (2014) Development and Comparative Evaluation of New Shapes of Pillows. Journal of Physical Therapy Science, 26 (3): 377-380. ↩
  33. Gordon, S.J.,, et. al. (2009) Pillow use: the behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6):671-8. ↩
  34. Gordon, S.J., Grimmer-Somers, K. (2011) Your Pillow May Not Guarantee a Good Night’s Sleep or Symptom-Free Waking. Physiotherapy Canada,63(2):183-90. ↩
  35. Robinson, Nick, 2014. Sleep Like the Dead. ↩
  36. Onen, L.H., et. al. (1994) [Prevention and treatment of sleep disorders through regulation] of sleeping habits]. La Presse Medicale, 23(10):485-9. ↩
  37. Hirschkowitz, Max. (2004) Normal human sleep: an overview. The Medical Clinics of North America, 88(3):551-65. ↩
  38. American Medical Student Association, 2014. Health Hint: Progressive Muscle Relaxation. ↩
  39. Dayapoglu, Nuray, Mehtap, Tan. (2012) Evaluation of the Effect of Progressive Relaxation Exercises on Fatigue and Sleep Quality in Patients with Multiple Sclerosis. Journal of Alternative and Complementary Medicine, 18(10): 983-987. ↩
  40. Pifarre, P. et. al. (2014) Diazepam and Jacobson’s progressive relaxation show similar attenuating short-term effects on stress-related brain glucose consumption.. European psychiatry, the Journal of the Association of European Psychiatrists, 29 (5). ↩
  41. Beaudoin, Luc P., 2014. My Sleep Button.  ↩
  42. De Koninck, Joseph, et. al. (1983) Sleep Positions in the Young Adult and Their Relationship with the Subjective Quality of Sleep . Sleep, 6(1): 52-59. ↩
  43. Agargun, M.Y. et. al. (2004) Sleeping Position,Dream Emotions,and Subjective Sleep Quality. Sleep and Hypnosis, 6(1): 8-13. ↩
  44. Rasskazova E,, et. al. (2014) High intention to fall asleep causes sleep fragmentation. Journal of Sleep Research, 23(3):295-301. ↩
  45. Vande Griend, J.P., Anderson, S.L.. (2003) Histamine-1 receptor antagonism for treatment of insomnia. Journal of the American Pharmacists Association, 52(6):e210-9. ↩
  46. Medline Plus, 2014. Doxylamine. ↩
  47. Malhrota, Samir, et. al. (2004) The Therapeutic Potential of Melatonin: A Review of the Science. Medscape General Medicine, 6(2): 46. ↩
  48. Howatson, G., et. al. (2012) Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality. European Journal of Nutrition, 51(8):909-16. ↩
  49. Fernandez-San-Martin, M.I., et. al. (2010) Effectiveness of Valerian on insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep Medicine, 11(6):505-11. ↩
  50. Silber, B.Y., Schmitt, J.A. (2010) Effects of tryptophan loading on human cognition, mood, and sleep. Neuroscience and behavioral reviews, 34(3):387-407. ↩
  51. Halson, Shona L. (2014) Sleep in Elite Athletes and Nutritional Interventions to Enhance Sleep. Sports Medicine, 44: 13-23. ↩
  52. Chollet, D. et. al. (2001) Magnesium involvement in sleep: genetic and nutritional models. Behavior Genetics, 31(5):413-25. ↩
  53. Abbasi, B. et. al. (2012) The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences, 17(12):1161-9. ↩
  54. National Sleep Foundation, 2012. Bedroom Poll. ↩
  55. Van De Werken, Maan, et. al. (2010) Effects of artificial dawn on sleep inertia, skin temperature, and the awakening cortisol response. Journal of Sleep Research, 19(3): 425-435. ↩
  56. Ikeda H,,Hayashi M. (2010) The effect of self-awakening from nocturnal sleep on sleep inertia.Biological Psychology, 83(1): 15-9. ↩
  57. Van De Werken, Maan, et. al. (2010) Effects of artificial dawn on sleep inertia, skin temperature, and the awakening cortisol response. Journal of Sleep Research, 19(3): 425-435. ↩
  58. Sleep Cycle, 2014. How it works. ↩
  59. asapSCIENCE, 2013Should You Use The SNOOZE Button?  ↩
  60. Vanderkam, Laura. Why your snooze button is evil. CBS Money Watch, June 21, 2012. ↩
  61. Pavia, Ciara. 21 Alarm Clocks You’d Definitely Want To Wake Up To. Buzzfeed, June 28, 2013. ↩
  62. Horne, James, et. al. (2008) Sleep extension versus nap or coffee, within the context of ‘sleep debt’.. Journal of Sleep Research, 17(4): 432-436. ↩
  63. Brooks, A., Lack, L. (2006) A brief afternoon nap following nocturnal sleep restriction: which nap duration is most recuperative?. Sleep, 29(6):831-40. ↩
  64. Tietzel, A.C., Lack, L.C. (2001) The short-term benefits of brief and long naps following nocturnal sleep restriction. Sleep, 24(3):293-300. ↩
  65. Kohler, Mark, et. al. (2008) The effects of chewing versus caffeine on alertness, cognitive performance and cardiac autonomic activity during sleep deprivation.Journal of Sleep Research, 15(4): 358-368. ↩
  66. Anderson, C. Horne, J.A. (2008) Placebo response to caffeine improves reaction time performance in sleepy people. Human Psychopharmacology, 23(4):333-6.

John Krygiel on Minimalism, Vagabonding, and the Freedom(s) of Less

When I graduated college two years ago, I had lived the “normal” life for 23 years. That is, go to school, get good grades, graduate. But, what comes after that? Oh, right: get a starting-level job, trudge through years of unfulfilling work, indebt myself to material wealth, look back in thirty years and wonder if I had really lived my dreams.

I didn’t want to be “normal” anymore.

The idea of having to pursue a career that would increasingly be on someone else’s terms frustrated me. But, what was I going to do to instead of the normal? After all, I, like most other people I know, live in the real world. How would I make money? How would I pay for all those essentials in life?

You know, essentials like gold iPhones, bottled water from Figi, a TV large enough to see from space, and a financed car with a sound system that can make your ears bleed. What I realized was that all these things are fictional happiness—happiness that rides along the backs of unicorns. You can chase it, but it’s never really there.

So instead of asking myself what essential things I needed, I began to think in terms of what’s most essential about me.

Trading Things for Passions

When I thought hard about myself, I realized that I love music, the outdoors, and writing.

I’m happy to say that right now I’m pursuing all three of these passions. I’ve started my own guitar lesson business, I work for a friend’s solar panel company, and I write at my blog [and now here!-ed].

Do I make a ton of money? Heck, no. But do I need to?

My ultimate dream is and always has been to live a fulfilling life and be able to travel wherever the hell I want, when I want, all while making the world a better place to live. This doesn’t quite align with the typical and safe way of pursuing life, but I’ve always found the words “safe” and “typical” to be boring.

I wanted to live my passions just like Chris Guillebeau a normal guy who has now visited EVERY country in the world.

Or be able to play music like Victor Wooten who is a five-time Grammy Award winner, producer, author, and is widely regarded as one of the best bass players in the world.

I wanted to set out and achieve my own goals on my own terms just as Derek Sivers did when he decided at age 14 he would become a traveling musician. Derek eventually went on to found the world’s largest independent music retailer, CD Baby. He later sold the company for $22 million and much of that money went into a trust that ensures future generations will have access to music education.

Have I met achieved all my dreams? Not yet. But I have realized that my pursuits are much more achievable if I don’t embrace materialism, even if the mainstream says I should.

Today, I own fewer than 300 items and couldn’t be happier with how owning less has led to my personal freedom and the ability to pursue my dreams.

Even though I don’t own many things, I feel rich.

Prioritizing My 300 Things

In my pursuit of renouncing materialism, I came across several bloggers that had written about owning less than 300 things and the idea stuck with me. You see, I grew up in a well-to-do neighborhood where brand-name items were commonplace. Owning several cars, large animals, and fancy electronics was the norm.

Owning fewer than 300 items was unheard of.

Why did I choose to prioritize down to 300? The number itself isn’t set in stone. It just happens to be a challenging number to get to for those pursuing a minimalist way of life. The process was simple and yet will be different for every person. I have my priorities and you have yours. If you want to see what I ended up with, I’ve listed every single item I own at the bottom of this post.

But, first, let me explain how owning just 300 things has afforded me the freedoms to go after my dreams.

Monetary Freedom

The first and probably most obvious personal freedom comes from burning less money on things that are superfluous.

Society has programmed us to become slaves to our things, a term I am using here to include both goods and services.

For example: need a mobile phone? Clearly the ONLY way to have such a device is to sign an agreement that allows you to pay $150 every month so you can have unlimited access to: mindless video feeds, tweets out the ass, selfie pictures to give the world an up-to-the-second update on your whereabouts, and oh yeah, you can make calls if you want.

OR, if you’re looking to save on your cell phone service there are numerous providers that are realizing people are tired of paying an arm and a leg for unnecessary extras for two contractual years. It’s still a small portion of the market, but the contract-free trend is growing.

Your monthly cell phone bill is a great place to start trimming down services you overpay for. Once you begin with something small such as a cell phone bill, it becomes easier to apply this type of thinking to every area of your finances.

But, of course, you have to learn to be happy with the choices you’ve made.

Contentment

When you are discontent, you always want more, more, more. Your desire can never be satisfied. But when you practice contentment, you can say to yourself, ‘Oh yes – I already have everything that I really need.’ ~The Dalai Lama

The Dalai Lama said it best. Power lies in being content with what you already own.

For example, shoes that are tucked away in the closet that you haven’t worn in a year become novel and awesome when you pull them out and wear them again.

This is being content with what you already own.

After getting my belongings down below 300, I learned that contentment comes in simple forms. Not being able to buy new things makes you appreciate instead what you already own. Instead of constantly trying to pursue the next hottest fashion or gadget that offers a buyer’s high for a day or two then wears off, I appreciate what I already own.

Buying and accumulating things can be an addiction just as dangerous as alcohol, drugs, gambling, or porn. Though the activities differ they are all defined by the excessive release of dopamine in our brains.

Being content with the present also relies on understanding and (sometimes) relinquishing the past.

Freedom from the Past

To varying extents, we all harbor feelings related to painful memories from the past. Often, personal possessions are tied to our painful memories. These possessions could be pictures, mementos, clothing we wore, etc. Perhaps we had these things during a breakup, a loss of a friendship, or a death in the family.

By removing these items from storage or even just from plain sight, we let go of the past and free up mental space to work on more positive aspects of our lives in the present.

Having little reminders of an uneasy past serve no purpose but to bring us down. For example, when I purged my belongings, I got rid of some clothes I’ve had since high school. I remember wearing those clothes in high school and not being “cool enough” for friends I had had since elementary school.

I’m not claiming that not wearing Abercrombie & Fitch in high school was the only reason I was no longer “cool enough.” But have you ever seen how the “cool kids” are portrayed on T.V. shows? Rejection due to the fact that I didn’t fit in with a certain culture troubled me for some time.

Getting rid of my high school clothes released me hurtful memories; it felt as if I was cleaning out the cobwebs from my mind.

Organized House, Organized Mind

The last and probably most awesome freedom I have gained from owning less is the fact that I can find my things very easily. I know where everything is and what purpose it serves. This is an extremely liberating feeling, and more important than you might realize.

I don’t have to trip over clothes on the floor. I don’t have to rummage through my closet looking for a tool. I can locate any utensil I need in the kitchen. If you don’t believe me when I say that organization really matters, simply look at how much importance chefs place on mise en place.

The more important thing is that this organization has begun to transfer over to other aspects of my life. For instance, my e-mail inbox is less crowded with useless crap messages. My phone is not overflowing with apps that I never use. My finances are in order and automated. I can locate any file on my computer with ease.

A keen awareness has risen up within me and I can look at any situation/activity and know almost instantly if it will benefit me in the long run or simply be a waste of time. Just as my items are organized and few, my mind is becoming more organized and I can more easily prioritize what I should spend time on.

Getting Down to 300

If you are interested in one or all of the above freedoms, it’s easier than you think to purge down your stuff.

The rules for getting below 300 are not set in stone. You can tailor your own rules accordingly. Here’s how I did it:

  1. Group consumable items together. My consumables included the separate groups of undergarments, foodstuffs, hygiene products, office supplies, and cleaning supplies. By grouping these consumables together, I could more easily compare items with other items in a group.
  2. Apply a simple question to every item you encounter: When is the last time I used this item? If you haven’t used an item in the past month or year, it’s a safe bet that you no longer need it at all.
  3. Evaluate items in every room that are in plain sight. Any items collecting dust?
  4. Move on to closets and storage areas.
  5. Tackle kitchen and bathroom gadgets/cleaners/gizmos. As it turns out, you don’t need that much equipment to cook well, and you hardly need any cleaning supplies at all.
  6. Prioritize your collectibles. Be honest about which collectibles bring you enjoyment vs. which ones simply collect dust. It’s okay to have some guilty pleasures and still be a minimalist!
  7. Take a count of your things and see what your number is. If you are over, it’s time to evaluate your things further using steps 1-6. You will most likely have to challenge yourself to get down to 300.
  8. Sell or donate your discarded items. Craigslist, book and media stores, The Salvation Army, Goodwill, and Facebook all work great to harvest a small fortune or simply afford someone less fortunate to actually use your items.

That’s it in a nutshell. Want more money for things that truly matter? Maybe you desire reaching a state of greater contentment?

Downsize. It will help. Without further ado, here’s:

My list of 300 things

Clothing: 94

Books, Magazine Volumes, Records, CDs, DVDs: 88

Electronics: 9

Furniture & Bathroom: 14

Music & Camping Gear: 25

Wall Décor: 10

Closet & Tools: 13

Kitchen Wares: 35

Miscellaneous: 4

Transportation & Accessories: 4

Consumables:  5 (Undergarments, Food, Hygiene Products, Office & Cleaning Supplies)

Total: 301

dangit! I’m still over. But the point is to get some of your personal freedom back and live a more fulfilling life, remember?

John

How Strong is Strong Enough?

Want to know how strong you are? Pick up any fitness magazine or read an article and you’re bound to find a measuring tool—a chart or benchmark you can use to determine how you stack up.

During my short-lived powerlifting career my focus shrank to pursuit of the numbers that told me how strong I was. A scrap of paper on my fridge reminded me daily (as if I needed reminding) that I would bench press my bodyweight (105), and squat and deadlift 200 pounds before the year was out. Were those things good for me? Would they serve any higher purpose? It didn’t matter. I wanted to be strong, and nothing else could get in the way.

After meeting these improbable goals at the cost of my health (myriad problems still plague me two+ years later) I had to learn to shift gears. But the question—how do I know if I’m strong?—persisted. I wanted a gold standard. To see if there is such a thing, I asked a few people with more experience and smarts than me:

  • Khaled Allen: Holistic health and fitness coach
  • David Dellanave: lifter, coach, and owner of The Movement Minneapolis
  • Dr. Paul McKee: Sports medicine doctor, team physician for University of Louisville football and baseball
  • Sarah Peterson: Personal trainer, yoga instructor and USMC veteran
  • Nick Sarantis: sports performance program coordinator for Baptist Sports Medicine, Louisville
  • Lou Schuler: award-winning journalist, certified strength and conditioning specialist, a contributing editor to Men’s Health magazine, and author or coauthor of many books, including The New Rules of Lifting

And, as if these people had conferred ahead of time, they all confirmed something anyone chasing numbers in a weightroom should consider:

If you’re asking how strong you are, you’re asking the wrong question.

Strength: What is it good for?

People like numbers. We love being able to say “I lost 4 pounds last week,” or “my mile time dropped by 10 seconds.” So I can understand why it can be so addictive to chase heavier weights and faster times.

If you really believe in fitness, shouldn’t you try to lift more weight?

David Dellanave just wants to know if you can get up off the floor. Telling me about a sit and rise test study at Gama Filho University in Rio de Janeiro, David explained that a person’s ability to get up from the floor with no support from their hands was an “incredibly accurate” predictor of mortality.1

As we’ve written before, avoiding an early death should be your most important consideration when making choices about health and fitness.

Dave questions the very notion of being strong, “if … you can squat 800 pounds but you can’t get off the ground without using your hands then maybe you’re not really that strong,” he said.

“if you can squat 800 pounds but you can’t get off the ground without using your hands then maybe you’re not really that strong.”

Nick Sarantis would agree. “You can have a car with a big powerful engine but if you don’t have the ability to shift gears it goes to waste,” he said.

Ok, so experts agree that huge numbers are probably not desirable for most people. But are there baselines that average joes should strive for?

Lou Schuler answered my question with a question. “What does anyone really need, other than a still-undefined baseline amount of physical activity? Nobody needs to be strong enough to squat or deadlift two, three, four times their body weight. … And why would a human ever need to run 26.2 miles in less than three hours?” he asked.

“The barbell was never meant to be an activity in its own right,” explained Khaled Allen. “It was always meant to train you for another activity. It is not something to aspire to. If you simply want to measure force output of a muscle, it’s not particularly useful in the real world because you can’t interact [in the world] by attaching your muscle and contracting.”

Not that Khaled hasn’t fallen into the numbers addiction trap himself. “I got into CrossFit and that was really going after numbers and times,” he said. “I got injured a lot and started exploring other things. I did powerlifting for a while. Then I started thinking ‘what do I really want to be doing here?’ And I wanted to develop enough strength to support … doing what I enjoy … martial arts, Parkour, running. Strength is really important but it’s not the holy grail.”

Too much of a good thing

Just as runners can get “runner’s high,” focusing on a single movement or metric can turn into a meditative practice that imparts positive feelings.

Khaled has a theory. “A lot of people … I think kind of use weightlifting as a refuge,” he said. When he was lifting just for the numbers, “I didn’t have to test what I was doing in the real world. I was interested in Parkour but I thought it was too hard. So I kept going back to the weightroom and would say ‘I’ll just deadlift.’”

While all this makes sense, is it possible that measuring strength has a place, but that we’ve just been doing it wrong? The ultimate strength training metric for many has been the one rep max—the maximum amount of weight you can move for a particular lift a single time with correct form.

“It’s interesting how so many times we use the one rep max as the gold standard for strength yet guys at the NFL Combine do nothing as one rep,” Dr. McKee said. “If it were that simple the NFL would have figured it out a long time ago. Back in the day they did [one rep max bench press] and all it did was tear their shoulders apart.” When it comes to determining how strong someone is, “If the NFL can barely figure it out when they’re trying to decide who to give a $25 million dollar contract to, you can imagine how difficult it is for a layperson going to a public gym working with a trainer making $15 an hour. ”

Simple strength rules of thumb

It seemed like my experts agreed that strength is not easily measured or charted. But could they think of any rules of thumb for basic fitness?

“Every man should be able to do a pull-up.”

When pushed, David cited the pull-up as his benchmark. “Every man should be able to do a pull-up,” he said. “ And every woman should work toward a pullup … I think that almost any woman could [do one] with training. ‘Should’ is a very dangerous word but I think it’s worthwhile to train toward.”

What else? “More so than a squat, I think a double bodyweight deadlift [men], or 1.5 times for women, is completely attainable by anyone, within bounds of reason. It’s the kind of strength that carries over into everything in life. I think you should be able to run a mile in a reasonable time … a nine minute mile, which is slow, but if you can’t do it in one mile, what’s going on?”

Though Khaled isn’t going after numbers in the weightroom anymore, he acknowledges “Strength is important because you need a foundation. Even when people want to become more agile I have them squat and deadlift so they have a baseline of strength,” he said. And that baseline is? “My baseline for transitioning from a foundation into applied movement [is when my client] can do a set of 5 bodyweight deadlifts. And I’m looking for a good squat at three quarters bodyweight.”

After years of research and writing in the field, Lou for one is not playing the numbers game. “Given how little we know about all this, why not tell people to do what they like, but try to do a lot of it?” he said. “For the average person, the ideal level of aerobic fitness is probably a little more than they have now. The ideal amount of strength or muscle mass? A little more. Fat? A little less. Total activity? A little more.”

As with anything in life, exercise poses risk. “Though you can get stronger in the weightroom, you can get hurt in the weightroom,” said Dr. McKee—the physician who tended me through a discectomy, stress fracture, janky knees and even rhabdomyolysis, all while I was trying to get stronger.

How overspecialization can lead to injury

“A lot of trainers and physical therapists talk about the danger of working too hard on your strengths,” Lou said. “Hypermobile women do yoga. Naturally strong guys go into powerlifting. Men and women with naturally high aerobic capacity go into endurance sports. And they all get hurt because they take a natural advantage and train it into something unnatural.”

David sees the results of that. “A lot of my gym members are refugees from something that didn’t work,” he said. “Like they came from CrossFit where they hurt their back, or another modality where they pick up more injuries than PRs.”

Chasing numbers in specialized skills can be especially dangerous. “I see it with people where they get a number stuck in their head and they’re not anywhere close and they’re trying to push their limits. I don’t believe in pushing limits and I know that sounds crazy for a trainer but if you work within your limits, your limits expand,” said David.

“if you work within your limits, your limits expand”

“We’ve all gone through that ‘I’m going to lift as much as I can and that’s all I care about’ phase,” said Nick. “When I’m talking to an athlete, I look at what’s the best way to get better. Not get stronger. The best way to get better is to stay on the field. I had a surgery every year when I played soccer. The amount of training [I missed] was sickening. The only thing you can never get back in life is time.”

“[Working out] is about feeling better,” Nick added. “We live in a society of chronic aches and pains. We’ve got to look at how to prevent this and working out is a great start, but if you’re not doing it right it’s going to do way more harm. The term no pain no gain is crap.”

Is your body even ready for weight?

Nick’s in no hurry to load up a barbell for his clients. Instead, he starts with just bodyweight. “Before we pick up a weight at all, we need to beat the environment that has beaten us down. A two year old has a perfect squat. We lose that ability because of the chair we sit in and car we drive. We’re constantly fighting the environment. The last thing we want to do is load a poor pattern. That would lock it in.”

Until you can “dial in just your body, you do not pass the test, you have no right to pick up a weight,” Nick said. He looks at it joint by joint: ankles, knees, hips, lower back, thoracic spine, scapula, shoulder joint. Are all these functional components adequately mobile? Is there anything a person might hurt by trying to do a squat?

squat

How does he know when someone is ready for weight? “A nice way to measure this is an overhead squat,” he said. “With a PVC pipe, knock out a perfect pattern. Can you sit down pretty darn close to the the ground with your arms perfectly straight up?” An unloaded overhead squat will tell Nick everything he needs to know about ankle and hip mobility, knee stability, core strength, arm and spine mobility and more. “The weakest link is going to come out very quickly.”

Why work out at all?

Bingo: Maybe I’d finally convinced someone to give me a perfect measure of strength. But after talking with these folks, I’m beginning to wonder if it matters. Because while they’d never agree on the golden standard, they did agree on an underlying principle.

Nick’s mantra is “We’re working out to feel better.” For David, “I think the only thing that should matter is where you are right now and what you want to do.”

“No two people are the same,” said Dr. McKee. “You have to compare yourself to yourself.”

Khaled echoed that. “There are so many different kinds of strength … there’s no one standard for what makes a healthy or strong human being. You have to make your own charts. So much of being healthy is about self knowledge. You have to know your own body. That’s the hardest part. The easy part is training.” And, he would remind us, “It’s important to have fun with it. A lot of people start moving in the first place to play and we lose sight of that.”

My friend Sarah Peterson, whom I count among the strongest people I know, shared her wisdom with me. “You’ve gotta do what makes you feel good, even if it’s not instantly gratifying … it helps build your will up to the point that you can be confident in yourself and that can translate into other areas of life. That’s strength to me. I don’t even think about the numbers. I did heavy weightlifting and I liked the way it made me feel empowered but there has to be a respect for yourself that fuels [your workout]. If you feel better when you’re done then you’re doing the right thing.”

Lou wrapped it up for me. “I don’t know if this is a settled issue, but my current best guess is that the pursuit of fitness is what improves us systemically. It’s what improves immunity, reduces chronic disease and aches and pains, and makes people feel better about themselves and more optimistic about life. What you actually achieve? I don’t think it matters.”

Notes:

  1. http://www.ncbi.nlm.nih.gov/pubmed/23242910

The Best “Natural” Sweetener

By now, we’ve all seen the headlines. Sugar is “toxic.”It’s more addictive than cocaine. It may be the real cause behind America’s obesity epidemic.

But it’s one thing to demonize an ingredient and it’s another to make food choices that actually make a difference.

Too busy to read the whole article? [3500 words, a 17-minute read] Here are the takeaways:

  • Many sugars marketed as “raw” or less processed than white sugar have essentially no nutritional benefit.
  • There is also no benefit (and sometimes harm) to products sweetened with “evaporated cane juice,” “cane sugar,” or “dehydrated fruit juice.”
  • Honey shows the most promise of being superior to sugar, but health benefits may depend on the source of the honey.
  • Brown rice syrup also shows some promise, but I couldn’t find nutritional studies comparing it to normal sugar. It does, however, taste really good.

Why is it so hard to get a straight story on sugar? In 2009, Dr. Robert Lustig, a medical doctor and obesity researcher recorded a strongly-worded condemnation of sugar as a toxic drug and one of the main causes of obesity in the United States.

Since then, multiple public controversies have raged, targeting High Fructose Corn Syrup, the size of soft drinks in New York, and serving chocolate milk to children. And as public consciousness of the dangers of sweeteners have grown, so too has the market for alternative sweeteners. Large corporations are desperate to find and bring to market the “miracle” sweetener that can deliver all the taste of sugar without any of its unfortunate consequences.

For the same of clarity, I’m splitting this topic off into two separate articles. This first one focuses on “natural” sweeteners like different types of sugar, honey, and other sweeteners extracted from plants. The second article finds the best nonnutritive substitute for sugar.

Both articles ask two simple questions:

Is any sweetener really “healthy?” Or at least better than refined white sugar?

Let’s cut straight to the point:

The Best Sugar Substitute in Most Cases:

Just use sugar.

<$1 per pound

 

Why am I saying that sugar is the best sugar? Isn’t this sort of obvious? Hear me out.

When looking at sugar substitutes, I considered three factors.

#1: Is it better than sugar, nutritionally? Sugar substitutes can be better than sugar in two major ways: by containing beneficial vitamins and nutrients and by having less negative impact on metabolism. For example, honey contains beneficial vitamins; another example: molasses has significantly less impact on blood sugar than refined sugar does.

#2: Can the substitute actually be substituted for sugar? As it turns out, blackstrap molasses contains many healthy nutrients. It also tastes terrible and makes a miserable substitute for sugar. For something to be a good substitute, it should taste clean and sweet, and not like much of anything else.

#3: Price. Can I actually afford to use this stuff on a regular basis?

With those factors considered, plain old sugar won out. There simply wasn’t a substitute for it that was clearly better in all ways. There are, however, two very good runners up: honey and brown rice syrup, which I’ll discuss a little later. But let’s first dispel some myths about what sugar really is and why premium sugars are a waste of money.

A quick technical primer

Sorry to do this to you guys, but after writing the rest of this article, I thought it’d be helpful to start by explaining a few terms. The word “sugar” actually refers to more than just table sugar. All sugars are a type of carbohydrate. In the context of food, carbohydrates are a form of macronutrient eaten by many as a primary source of energy (the other macronutrients are proteins and fats). They are the primary constituent of flour-based foods such as pasta and bread, as well as of most vegetables.

Chemically, the term carbohydrate is synonymous with “saccharide.” There are four types of saccharides: mono-, di-, oligo-, and poly- saccharides. For our purposes, the term “sugar” refers to monosaccharides and disaccharides only. And that means the term “simple sugar” is essentially saying the same thing as “sugar,” since simple sugars include only mono- and disaccharides.

Monosaccharides are the most basic form of carbohydrates. Whereas we digest polysaccharides and disaccharides into simpler sugars, monosaccharides do not need to be further digested to be used. There are five monosaccharides, the most important of which for our purposes are glucose and fructose.

  • Glucose has many important functions in the body, from providing energy to the muscles to serving in the production of other important compounds, such as protein and vitamin C (asorbic acid). When people talk about “blood sugar,” they really mean “blood glucose”. A healthy level of glucose in the blood keeps the brain and body functioning optimally. Too little glucose can cause an energy crash, while excess glucose can thicken the blood, increasing the risk of heart problems.
  • Fructose is the sweetest naturally-occurring form of sugar and is prevalent in many fruits. Like glucose, fructose is an important enabler of metabolic functions.

Disaccharides are simply two monosaccharides bonded together. Disaccharides must generally be digested before entering the blood stream. Specific enzymes are responsible for the digestion of each disaccharide. The names of these enzymes are easy to remember: simply replace “ose” in the disaccharide with “ase” (sucrose/sucrase, lactose/lactase, etc.) , and you get the name of the enzyme. There are five disaccharides, the most important of which is sucrose.

  • Sucrose is just common table sugar. Chemically, sucrose is one glucose molecule bonded to one fructose molecule. Sucrose digestion is enabled by the enzyme sucrase. Sucrase is secreted by glands in the small intestine, so breakdown of sucrose begins in the small intestine, almost immediately after it passes the stomach. Once sucrose is cleaved into fructose and glucose, these monosaccharides enter the blood stream through the walls of the small intestine. 1

Next, we’ll look at some of the various types of sugar and try to figure out if any are better than normal sugar from a nutrition perspective.

Sugars processed from sugarcane

Most of us know sugar as small white granules, easily stirred into recipes or sprinkled over a plate. Most sugar around the world is made from either sugarcane or sugar beet, but mostly sugarcane. To make sugar, producers crush the sugar plants in large machines to extract their juice. The juice is then boiled to remove water and to promote the crystallization of sugar. Sugar extracted at this point is raw sugar and should have a dark, moist appearance and deep molasses flavor.

However, the term “raw sugar” doesn’t really mean much—many producers claim to produce raw sugar while their actual manufacturing methods vary significantly. The well-known sweetener brand “In The Raw®” clearly explains that its sugar products are actually Turbinado sugar, sugars that have been centrifuged to further dry them and remove plant impurities.2

Both turbinado sugars and Demerera sugars are centrifuged and have a golden, granulated appearance and a slight taste of molasses.

A few sugars are less processed than turbinado and demerera. Muscovado, Rapadura, Panela, and Sucanat Sugars—area all extracted from cane juice without a centrifuge. Either way, they look and taste the most like molasses and will also contain the largest concentration of naturally-occurring vitamins and minerals. Depending on the processing method used, they will also contain more complex carbohydrates than more refined sugars.

These types of sugars are arguably the most “healthy” of sugars, but the ratio of simple sugar to beneficial nutrients is still so high that you might as well think of them as sugar.3 When considering them as a sugar substitute, the negligible health benefits they offer couldn’t offset the increased cost and difference in taste over normal sugar.

Up to this point, I’ve mentioned Molasses, but I haven’t actually explained what it is. When sugar cane juice is boiled and granulated sugar is extracted what remains is molasses. The first processing of molasses typically results in a product with higher sugar content, so high that it is sometimes marketed as “golden cane syrup” rather than as molasses.4 The second and third processing of cane juice results in molasses containing less sugar and more residual vitamins and minerals. The most processed molasses sold in the United States is “blackstrap molasses” and is usually marketed as a health supplement rather than as a sweetener because it has a strong taste.

Although blackstrap molasses could have nutritional benefits as a supplement, it really doesn’t make sense to use it as a direct substitute for sugar. It’d be like comparing apples to apple cider.

The two most well-known sugars on the market are white sugar and brown sugar. To make white sugar, raw sugar that has been centrifuged from cane juice is repeatedly dissolved into water, evaporated, and centrifuged. Each time the sugar runs through this process, more impurities are removed and a more pure sugar results.

Once the sugar is sufficiently cleaned, it is processed with either sulphur dioxide or carbon dioxide to whiten it. Any sugar that is labeled as “unbleached” is simply processed sugar that hasn’t been treated for whitening. Brown sugar, though it might look similar to a raw sugar, is actually just white sugar that has had molasses added back in. Although brown sugar may contain some trace minerals and fiber as a result, like the raw sugars discussed above, the impact will be negligible.

The term organic sugar means relatively little from a nutritional standpoint. USDA organic guidelines don’t allow chemical processing, organic sugar cannot be be treated for whiteness. That, and organic sugar has to come from sugarcane that has been grown in accordance with USDA organic guidelines, which do not allow certain pesticides.

In theory, there should be less risk that pesticides used in the growth of sugar cane would make it into a final sugar product if you buy organic sugar. But, it seems unlikely that pesticides would actually make it into any sugar, given how much sugar is processed. Either way, I haven’t found any studies that further explore the topic.

One final annoyance: labels that boast cane sugar or evaporated cane juice. Both of these are nothing more than plain table sugar. Ideally, evaporated cane juice would be the least processed of all sugars and have a dark, clumpy appearance as shown in the above picture. However, there is no actual regulation of these terms on nutrition labels and many companies use the terms to describe sugar that is for all practical purposes no different from processed white sugar. Remember? Because technically all sugar begins as evaporated cane juice at some point.5

Maybe some companies are legitimately trying to use a better sugar (even though we’ve established it doesn’t really matter), but there’s just no way of knowing for sure.

Corn syrup and high fructose corn syrup (HFCS)

As sugar has developed a bad reputation, many products have sprung up to replace it on supermarket shelves. Here are some of the more well-known.

Let’s start by talking about corn syrup and high fructose corn syrup (HFCS). Corn is high in glucose and when you cook it down and purify its sugar, you end up with a syrup made almost entirely of glucose. In fact, in the United States, all glucose syrup is essentially corn syrup and can be labeled with either name.6 In other countries, glucose syrup might be made from other sources. Glucose syrup makes a poor sweetener by itself; it is less sweet than sucrose while delivering more calories. It’s more often used to give baked goods texture and moisture.

High fructose corn syrup has been widely antagonized in recent years. To make high fructose corn syrup, producers add fructose to glucose syrup to create a product that is approximately 45% glucose and 55% fructose. This syrup has almost the exact same glucose-to-fructose ratio as sucrose. And that, in essence, has been the corn lobby’s argument against the anti-HFCS movement: as far as the body is concerned, HFCS and plain table sugar are functionally equivalent.

Here’s the history:

  • 2004: Researchers link HFCS availability in the U.S. food system to increased obesity7
  • 2007: An expert panel reviews the available literature on HFCS and finds no significant difference compared to sucrose. 8
  • 2008: HFCS and sucrose shown to have essentially identical short-term metabolic effects.9
  • 2009: More researchers fail to identify a reason why HFCS might be worse for health than sucrose.10
  • 2010: Researchers publish an article arguing that rats fed HFCS gain more weight than rats fed an equivalent amount of sucrose. 11
  • 2010: Marion Nestle quickly finds flaws with the rat study and writers stop touting it as conclusive evidence of HFCS’s evils.12

The takeaway? There’s no significant difference between high fructose corn syrup and sucrose. And that’s not just my opinion after reading a few articles. An excellent 2010 article from the Atlantic13 as well as a more recent 2013 analysis of the HFCS debate both came to that same conclusion. In fact, to quote the 2013 study, “the scientific debate related to the initially proposed link between HFCS and the obesity epidemic has been largely settled.”14

“the scientific debate related to the initially proposed link between HFCS and the obesity epidemic has been largely settled”

But with all that being said, that doesn’t mean that HFCS is good for you, it’s just about equally as bad as plain old sugar, which is basically what the corn industry has been saying all along.

Some other syrups, however, claim to actually be healthier than sugar itself.

Sweeteners extracted from other plants

Agave syrup is made from agave plants—the same plants used in the production of tequila. A few years ago, agave syrup started finding room on American store shelves because some science suggested it might be healthier than sucrose. The basic argument goes like this: agave naturally contains a higher percentage of fructose than glucose or sucrose. Since fructose is sweeter than sucrose, you can use less agave nectar (and thus fewer calories) to achieve the same sweetness. On top of that, fructose doesn’t directly affect glucose levels in the blood, which means that it does not register as high on the glycemic index.

Since agave was introduced to the market, most medical professionals have reached agreement that fructose may have worse long-term effects on health than sucrose does alone.1516

One  more problem with agave syrup: marketers would have you believe that agave syrup comes from inside the plant’s leaves, or that it is extracted from nectar. In reality, farmers harvest the thick, woody base of the plants and cook them to convert the complex carbohydrate inulin into fructose.17 Verdict: far from being a healthy alternative to sugar, agave syrup may actually be worse for the body than both sugar and high fructose corn syrup.

For a truly natural sweetener, look no further than honey. Bees actually do make honey from the nectar of flowers. They then use the thick syrup as a form of energy storage, a way to keep the bee colony fed through long winter months when no flowers are in bloom. Honey doesn’t need to be further processed for human consumption; it naturally resists microbial growth and spoilage.

honey

Honey is one of the few sweeteners covered in this article that might actually demonstrate some health benefits. However, those effects vary depending on the type of honey consumed. For example, Acacia honey contains a higher concentration of fructose than other honeys. It therefore has a lower glycemic index than other sweeteners, though higher fructose levels may cause their own problems, as I mentioned while discussing agave, above.

As far as metabolism in general, studies on insulin response and blood sugar comparing honey to sucrose are can be contradicting. 181920 The current general consensus in the medical community, however, seems to be that honey is not significantly better for weight or diabetes management than sucrose. I do think that some of the research looks promising, but it’s not enough to draw any real conclusions. At the very least, though, I didn’t see any studies that showed honey to be worse than sucrose.

Various studies have shown that honey fights oxidation, inflammation, tumor growth, and has overall better impacts on cardiovascular health than an equivalent amount of sucrose.21 But, many of these studies look at relatively large doses of honey—between 50g and 80g per serving (about 3-4 tbsp.) Also, many studies fail to sufficiently describe the sourcing of their honeys. The trace nutrients found in honey can vary depending on the species of bee and the source of nectar used to produce the honey. And since it is most likely these nutrients that are responsible for honey’s health effects, it’s hard to recommend a particular type of honey over others without more research.

Also keep in mind that because honey is a natural product, it can contain trace amounts of toxins and microbes, although the microbes will be inactive. That’s why unpasteurized honey is not recommended for infants.

Verdict? From all I’ve read, it seems that honey is at least a little better than sugar in almost every way and it’s almost always minimally processed. To me, it seems like a no-brainer for everyday use whenever possible. The only downside to honey is that, well, it tastes like honey. While honey does taste awesome, it’s also a distinctive flavor that’s not easily masked by other flavors.

I came across one final caloric sweetener choice when researching this article. Brown rice syrup is made by enzymatically treating the starches found in brown rice to produce simple sugars, then boiling the resulting liquid until it turns into a syrup. The syrup itself is nutty and flavorful and less sweet than an equivalent amount of sucrose syrup. The primary sugars in brown rice syrup are maltose and maltotriose, though the concentration can vary depending on production method used.2223.

Good source of nutrients, great taste, possibly good metabolic impact

Brown Rice Syrup

Price:$11/21 fl. oz.

Metabolically, I wasn’t able to find any studies that tested the effects of brown rice syrup on humans. The good thing, though, is that both maltose and maltotriose fully digest down to glucose, with no fructose at all. But the exact impact on blood sugar and insulin response will depend on how quickly the body can digest maltose and maltotriose, and that’s something I wasn’t able to find.

Compared to table sugar, brown rice syrup is significantly less processed and contains many of the acids, minerals, and complex carbohydrates normally found in brown rice itself.

Unfortunately, toxins carry over into brown rice syrup as well: in 2012, a research team from Dartmouth School in New Hampshire measured high levels of arsenic in brown rice syrup.24 Arsenic is common in rice used for food, but organic brown rice syrup was of particular concern due to its minimal processing. My best advice is to know your sourcing. Popular brand Lundberg releases a detailed archive of resources explaining how they test for arsenic in their rice supply. Hopefully, whatever brand you purchase tests to the same standard.

For now, I can only conclude that this sugar alternative looks promising, but without further testing, that conclusion is tentative.

What does “natural” really mean, anyway?

Contrary to popular belief, the U.S. Food and Drug administration does not regulate the term “natural” when used on food labels. Instead, it “objects” when food producers use the term on anything that includes “added color, artificial flavors, or synthetic substances.”25

By that definition, all of the sweeteners we’ve covered so far are indeed natural, even though enzymes, processing agents, and complex machines are used to transform starchy vegetables into simple sugars.

But, natural does not necessarily mean healthy.

Consider, for example, products sweetened with “nothing but fruit juice.” While fruit juice might sound like a healthy alternative to processed sugar, in fact fruit contains a higher percentage of fructose than normal sucrose does. When you eat fruit in its natural form, the fiber in the fruit’s meat helps to slow down the digestion of simple sugars, which protects your body from metabolic effects. But use a machine to juice the fruit, and you lose much of the fruit’s fiber with it.

In this article, I’ve stuck to sugar alternatives that are clearly derived from plant sources and intentionally left out a few of the lesser-known processed sugar alternatives, such as trehalose and the family of sugar alcohols. I’ll cover those in my article on nonnutritive sweeteners (forthcoming) because, as you’ll see, it makes more sense to compare those products rather than against things like honey and agave.

Do you use a sugar substitute at home? If so, why and how?

Liked this post? Make sure to check out my article on nonnutritive sugar alternatives.

Notes:

  1. eHow, How Sugar is Digested
  2. In The Raw, Frequently Asked Questions, Sugar in the Raw.
  3. Kimball, Katie. Are Sucanat and Rapadura Healthier than Sugar? (August 10, 2011).
  4. Wikipedia, Molasses, accessed 01 May 2014.
  5. McCaffrey, Dee. The Skinny on Evaporated Cane SugarProcessed Free America (3/5/2014)
  6. Leibovitz, David. Why and When to Use (Or Not Use) Corn Syrup. 2009.
  7. George Bray, Samara Nielsen, and Barry Popkin (2004), Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesityAmerican Journal of Clinical Nutrition. 79(4):537-543
  8. Forshee R.A., et al (2007), A critical examination of the evidence relating high fructose corn syrup and weight gain. Crit Rev Food Sci Nutr. 47(6):561-82
  9. Theodore Angelopoulos, et al (2009), The Effect of High-Fructose Corn Syrup Consumption on Triglycerides and Uric AcidJournal of Nutrition. 139(6):1242S-1245S
  10. Moeller S.M., et al (2009), The effects of high fructose syrupJ Am Coll Nutr. 28(6):619-26.
  11. Miriam Bocarsly, et al (2010), High-fructose corn syrup causes characteristics of obesity in rats: Increased body weight, body fat and triglyceride levelsPharmacology Biochemistry and Behavior, 97(1):101-106.
  12. Marion Nestle, HFCS makes rats fat? Food Politics.
  13. James McWilliams, The Evils of Corn Syrup: How Food Writers Got It Wrong. The Atlantic. Sep 21, 2010.
  14. Klurfield, D.M., et al (2013), Lack of evidence for high fructose corn syrup as the cause of the obesity epidemic. Int J Obes (Lond). 37(6): 771–773.
  15. Kathleen Zelman, The Truth About Agave, WebMD
  16. Joseph Mercola, This Sweetener Is Far Worse Than High Fructose Corn Syrup. Huffington Post 
  17. Alfredo Sanchez-Marroquin and P. H. Hope (1953). Agave Juice, Fermentation and Chemical Composition Studies of Some Species. J. Agric. Food Chem., 1 (3), pp 246–249
  18. Shambaugh P., Worthington V., and Herbert J. H. (1990), Differential effects of honey, sucrose, and fructose on blood sugar levelsJournal of Manipulative and Physiological Therapeutics 13(6):322-325
  19. Noori S. Al-Waili. Natural Honey Lowers Plasma Glucose, C-Reactive Protein, Homocysteine, and Blood Lipids in Healthy, Diabetic, and Hyperlipidemic Subjects: Comparison with Dextrose and Sucrose. Journal of Medicinal Food. April 2004, 7(1): 100-107.
  20. Mamdouh Abdulrhman, et al (2011), The glycemic and peak incremental indices of honey, sucrose and glucose in patients with type 1 diabetes mellitus: effects on C-peptide level—a pilot study. Acta Diabetologica. 48(2):89-94. 
  21. Many interesting studies are cited in this review article: Stefan Bogdanov, et al (2008), Honey for Nutrition and Health: A Review. Journal of the American College of Nutrition. 27(6): 677-689. 
  22. Lundberg Family Farms, Rice Syrup FAQs.
  23. Patent US 4876096 A, Nutritional, non-allergenic; liquefaction, saccharification using amylase, glucosidase
  24. Brian Jackson, et al (2012), Arsenic, Organic Foods, and Brown Rice Syrup. Environ Health Perspect. 120(5): 623-626.
  25. U.S. Food and Drug Administration, What is the meaning of ‘natural’ on the label of food?

First Yoga Class

I had planned to spend several months practicing at home before I went into a studio. After a month or so of steady practice with videos, though, I hyperextended my knee and it was hard to keep practicing. I asked for advice from yoga teachers, and found out that I might have saved myself the injury by getting in front of a teacher early on. Luckily, you can learn from my mistake.

Choosing a group class has different challenges from choosing a video class, but it also pays dividends in safety and motivation. This is how to pick the right class and things you can do to make your experience even better.

Too busy to read the whole article? [2,000 words, a 10-minute read] Here are the takeaways:

  • Try a few studios. Ideally you want one that (1) is convenient (2) has a good vibe and (3) has a good range of classes.
  • Keep an open mind and remember that yoga is traditionally a mental and spiritual practice, not just exercise. If you want just exercise, choose a class taught from this perspective.
  • Start with a beginner’s class (or a few), even if you have experience practicing from videos.
  • Try several different teachers until you find someone you connect with, as a teacher and a person. Ideally, you’ll spend some time learning from the same teacher and maintaining this relationship can deepen your practice.
  • Make sure your teacher knows if you have an injury or a health condition, because it might affect the adjustments they offer you.

Going to a group yoga class used to fill me with anxiety. I’m not competitive, exactly, but the idea of being the worst at something and in a room full of people who are all much better at it is intimidating.

“as teachers and as advanced yogis, we love beginners”

Once, another student told me after a class that she was glad I had been next to her so she could see “someone else also having a hard time.” It was reassuring that I wasn’t the only one struggling, but it did underline my fear that, secretly, we were all watching each other.

I used to worry that, not only were the other students better than I was, but even the teacher would be annoyed at dealing with a beginner in her class. I was relieved to hear from Instructor Laurence Gilliot that “As teachers and as advanced yogis, we love beginners and we love the feeling of the beginner’s mind . . . It’s like learning to walk for the first time. We forget how that is. But when we do yoga and especially in the beginning, it’s like a whole world opens. So instead of worrying about ‘Oh I can’t do this thing, and other people are looking at me,’ just really enjoy this newness, …when you get more advanced you will crave this feeling of the beginner’s mind.”

Step 1: get a feel for a few different studios

A good yoga studio is one of the most supportive environments you can find, so it’s worth getting past your nerves to step into a studio.

Before you commit to a studio, try dropping by for an introductory class, or even just walk through the front door and talk with whoever happens to be hanging around. Yoga studios might vary as much as, say, a planet fitness versus a CrossFit gym, but you should get a feel for your options in person, even as a beginner. Instructor Melissa Smith says, “when beginning a yoga practice, think of it as a huge yoga buffet. Sample as many recommended teachers, styles and studios as you can.”

“when beginning a yoga practice, think of it as a huge yoga buffet. Sample as many recommended teachers, styles and studios as you can.”

Here’s what to consider:

#1: Location and price. This might seem like a no-brainer, but the most important part of yoga class is, well, attendance. I wrote about the importance of building a daily habit in my first article on yoga. Signing up with the “best” studio in town doesn’t get you anywhere if you never build up the habit of attending on a regular basis.

#2: Community. A good community and studio can deepen your practice. Or as instructor Rob Williams says “practicing with others is a wonderful part of practice. A part of this process is about engaging in your life and life for most of us would be much emptier without a community.”

Ask yourself:

  • How sociable do you want to be? Do you want to chat with people from your class, or do you want to run in when you have the time, take the class, and then go? For instance, studios with a restaurant or coffee shop attached are often more social, while studios advertising short lunch-hour classes might be more businesslike.
  • Are you interested in learning more about things like meditation, body work, nutrition, or natural health? If you aren’t, and you want to take traditional fitness classes too, you might be better off taking classes at a gym than at a dedicated yoga studio.
  • Are you ok with spirituality? Some teachers only teach asana (the physical postures for exercise), some light candles and open and close a class with chanting, and some reflect on ancient yogic texts and openly discuss spiritual beliefs. Ask yourself if you are comfortable with integrating mediation or spirituality into your class, or if you want a 100% physical practice.

#3: Classes offered. I really think accessibility and community are the most important factors when choosing a studio, but if you want to keep the long-term in mind, make sure to choose a studio that offers a wide range of classes. As your practice grows, you’ll eventually want to try more challenging classes or target parts of your practice you feel are lacking.

What if there are no studios near you? Google Helpouts are a great option. We’ll talk more about this in an upcoming next article, but an 1-on-1 Helpout with a live teacher is the next best thing to an in-person class.In a Helpout you can ask questions, demo postures and ask for adjustments, as well as ask for help developing your own routine. If you have specialized needs, like a serious injury, a private hangout might be better than a large class taught in person, since you’ll have the teacher’s full attention, without the urge to compare yourself to the other people in your class.

What’s with yoga and spirituality, anyway?

You probably wouldn’t be asking yourself this question during a Pilates or a spinning class—yoga is different because it is not solely an exercise methodology. Even though most yoga classes today focus on physical postures, this is actually only one aspect of the tradition of yoga.

In yoga, physical postures, or “Asana” is just one of the 8 Limbs of Yoga. The other limbs encompass a holistic system with roots in Hindu and Buddhist traditions (among others) governing things like ethics and behavior, self-discipline and faith, breathing, awareness, and mediation.

There’s not enough space to go deeply into it here (and I’m not qualified—people can spend a lifetime studying this), but suffice it to say there’s a reason that many yoga teachers don’t stick to just telling you how to stretch. Rather than just exercise, physical asana was historically intended to prepare the body for greater spiritual discipline, growth, and union with the divine. Some further disciplines include breathing exercises, called Pranayama, and meditation practices—hence their inclusion in many classes. Some teachers also reflect on sacred texts like the Yoga Sutras of Patanjali, (a foundational text of yoga), or spiritual teachings from many faiths

This sounds heavy, but even a very spiritually-oriented yoga class is not like a religious meeting or church; instead it’s an environment where people discuss spirituality from this perspective.

Many people do take yoga classes just for exercise, and a teacher should never be pushing their spirituality on you, but if you are uncomfortable with any amount of spirituality in a class, you’ll be missing out on a lot of classes. Light on Yoga by B.K.S. Iyengar is a great resource for more about yoga and spirituality, though it’s not a quick read.

Step 2: Choose a instructor you connect with

Later on we’ll talk about the huge range of yoga styles available to you, but try not to get hung up on that right now. Going to your first class should be about finding a teacher you connect with, regardless of the style they teach.

Melissa advised, “My preference is that you find a teacher that you can meet in person, as opposed to a video. That way the teacher can see your form and offer you adjustments or props that suit your body best . . . . Look for a teacher that speaks to you, challenges you, and offers you a practice that meets you where you are, not where you want to be. And, one that is humble enough to spend time listening and offering you some feedback on your practice.”

Laurence told me, “Go with someone with whom you connect as a person, not only as a teacher. You should like how you feel around them, in their presence, even outside of the class. Because remember that, whatever you practice, whatever teacher you have, if you practice a long time with them, in a way you’ll become a little like them. So be sure you choose a nice person, someone you want to become more like.”

Yoga instructor Garance Clos added, “yoga is an inner journey before being a physical practice, so even for beginners, it’s important to find a  teacher with whom you can be yourself, feel free, safe and comfortable.”

Melissa believes the right teacher is invaluable not just in the class they teach, but in your home practice. She says, “I hope that you also seek out a teacher that will equip you to do a regular practice on your own . . . . I believe mentors and teachers are priceless, but they should give you all you need to carry on to self-study and practice. One day you may grow out of a certain teacher or style and that’s ok. Just be open to what may come. An open heart is the beginning of a life-long practice in wellness through yoga.”

Step 3: Start with a beginner’s class, even if you’re not a beginner

If you’ve been following this series, maybe you’ve already done 30 days of yoga. Or practiced and memorized all the basic poses you need as a beginner.

Should you still be going to beginner’s classes? In my experience, yes.

Just because you have some experience with yoga doesn’t mean you have experience attending a yoga class.

Also, keep in mind that the atmosphere of a group class can make you push yourself harder than you would at home, and being too sore to move the day after a too-tough class is really demotivating.

“Beginning and Intermediate is a blurry line, and I think with intention. No one can tell you what level you’re at, but one can judge a great deal by looking around the class and seeing you feel like you fit in or if you are more lost than others,” Rob told me. “I’d guess one’s first 9-12 classes at least should be beginner’s… 6 would be for an avid athlete who already has advanced body skills and awareness. With all that said, I still go to beginning classes sometimes. One can use the time to work on settling the mind, moving with extreme intention, and maintaining a meditative mindset.”

The best thing you can do for your classroom experience is to come early and introduce yourself to your teacher. It’ll be easier for them to teach you if they know you are a beginner (or you’ve only learned from videos), and they really need to know if you have a health condition or an injury.

One reason your teacher needs to know about any injury or health problem is that they may offer adjustments, which can be anything from placing a hand on your body to remind you to relax to strongly pushing you into a posture. I’ve received very strong adjustments which were actually a bit scary, but which helped me immediately.

Once, though, I showed up late to a class and didn’t tell the teacher that I had a neck problem; then he pushed me into an posture which aggravated it. I had the feeling the adjustment wasn’t going to be good for me, and I didn’t pay attention – but I also don’t think the teacher would have offered the adjustment if he had known that I was hurt. Even though it’s your responsibility to keep yourself safe by listening to your body, your teacher is also there to help, so give them the information they need.

Settle in to your yoga habit

The most important thing when you select a teacher, class, and studio is that you feel comfortable there. A good yoga class is a supportive and inclusive community which gives you space to explore your practice. You should never feel judged about something like your technical abilities, your body, or even your clothes. If you feel uncomfortable for any reason, try a different teacher, class, or studio.

Your Next Action: make a list of convenient studios

  1. Research studios that are accessible: close enough and cheap enough you’re likely to actually go.
  2. Go to a few studios, pick up a schedule, and soak in the vibe.
  3. Try beginner’s classes with a few different teachers. There’s no hurry to commit to one teacher or style; you’ll try new classes throughout your practice.
  4. Show up early to class and talk to your new teacher, especially if you have an injury. Following basic yoga etiquette will make you more comfortable and improve your experience.

After spending some time with a live teacher, you’ll probably feel ready to move forward with your home practice. In the next article I’ll review several subscription services for learning yoga on your own.

Preventive Health for Millennials: An Always-Updated Guide

man

 

It’s true: you’re invincible. You’re barely 25 years old, you’re in great (ok, good) shape, you eat well (most of the time), and you’ve only ever gotten a clean bill of health at the doctor’s office.

You know you’re supposed to be worried about stuff like retirement and healthcare or <shudder> life insurance, but in the back of your head, you know that with modern medicine improving so fast, you’ll easily live to be 100.

And, if you should happen to catch the sniffles or jam a finger, you’re confident that a quick visit to your primary care physician will fix your problems and let you get back to being productive/socializing/rewatching the second season of Mad Men.

Hey—I get it, I’m 27 and that’s how I feel too.

But, part of you wonders: now that you’ve finally got your school debt under control, your career on a decent track, and a social life that’s moving in the right direction, is there anything you could be doing to protect your health?

That’s the same question I asked, and that’s what this guide is all about.

Too busy to read the whole article? [5800 words, a 25-minute read] Here are the takeaways:

  • I worked with a team of researchers to identify the diseases most likely to cause an early death. They are: cancers, heart disease, lung disease, and diabetes.
  • Next, we tried to find the most effective measures you can take as a young, healthy adult to reduce your long-term risk of the most deadly diseases.
  • We found that the most important actions in order of importance were: (1) don’t smoke (2) collect your family history (3) see the doctor every 1-3 years and (4) exercise. Even though most healthcare professionals would say diet is important too, we found it hard to make specific recommendations about nutrition, as existing research is controversial.
  • The one thing most millennials can do right now that will really make a difference in preventive health is talk to their immediate family members about their medical histories. Scroll to the bottom for some useful resources to help you with this.

Preventive Health and The Pareto Principle

If you’re interested in productivity, you’ve probably heard of the Pareto principle, a simple rule of thumb that goes something like this: “80 percent of outcomes are from 20 percent of causes”

“80 percent of outcomes are from 20 percent of causes”

It applies to all aspects of life: “80 percent of work gets done by 20% of employees” or “80 percent of my sales come from 20% of my clients” or “I can get this presentation to an 80% with only 20% the effort”

So does it apply to health and living longer too? Check out this chart:

causes of death 3

…yup, it applies.

The numbers from the Centers for Disease Control (CDC) show that just 15 causes of death (a tiny minority) are responsible for 80% of all deaths in the United States.

And, when we look even more closely at those top 15 causes, we see the same trend appearing again.

Causes of death 4

 

For the purposes of this study, we eliminated non-medical causes of death (accidents, homicides, and suicides). That means that just 4 categories of diseases are responsible for 66% of deaths out of the top 15 causes, almost half of all preventable diseases as a whole.

Methodology

Why are we yammering on about statistics and the Pareto principle? Because when we looked for resources on preventive health, particularly for the millennial demographic, the guidelines were confusing, overwhelming, and at times seemingly arbitrary. So instead, we asked ourselves: “what is the 20% I can do today to give myself 80% of the benefit as I get older?” In the rest of this piece, we explore the top causes of early death* and research the best guidelines for prevention to figure out what behaviors you can start doing today. Do diet and exercise really matter? How much of a role do genetics play? These are the questions we posed. *Why look at figures for deaths before age 75? Don’t most people live longer than that? We looked at causes of death before the age of 751 because statistics on geriatric (old-people) medicine are expected to change considerably in the coming decades as people live longer than ever before.23

We start with the easy stuff.

Lung Disease and Lung Cancer

You could sum this entire section with two simple words: don’t smoke. Here’s why:

  • Lung cancer is the most deadly form of cancer, accounting for about a third of all cancer deaths in people under 75. Between 80% and 90% of all lung cancer deaths are caused by tobacco.4
  • Heart disease is the #2 killer of young people and smoking causes about 20% of heart disease deaths.5
  • Tobacco exposure accounts for 80% of all lower respiratory disease (lung disease) deaths and lung disease is our#3 most deadly disease.6

Oh, and add to these the fact that smoking directly increases risk for many cancers besides lung cancer, and you can conclude that smoking directly causes between 20% and 30% of medically-related deaths under the age of 75. And that’s a conservative estimate.

Of course, it’s not always that easy to quit smoking. It’s very easy to become dependent on or addicted to nicotine. Plus, secondhand smoke has the same negative effects as smoking, if not to quite the same severity.

If you do smoke or are regularly exposed to secondhand smoke, know that you are at significantly higher risk for the most deadly diseases. Be upfront with your doctor about how much you smoke and take special care to follow the other guidelines we’ve summarized for the other deadly diseases, below.

There isn’t much else we can say about prevention for lung disease and lung cancer. Most non-smoking-related cases of chronic respiratory diseases and lung cancer are influenced by genetics. If you have a family history of lung problems or asthmas, you may be at increased risk, especially if you are routinely exposed to smoke. But, even taking family history into account, exposure to smoking is the biggest risk factor here and the best recommendation we can make is: don’t smoke.

Malignant Neoplasms (Cancers)

One in two men and women will be diagnosed with cancer in their lifetimes.

That statistic bears repeating. One in two men and women will be diagnosed with cancer in their lifetimes. It sounds unbelievable but that statistic comes straight from the National Cancer Institute.7

It’s hard to make broad recommendations for avoiding cancer in general because there are so many types and each has its own risk factors. That’s why anytime a product or new study says something like “reduces the risk of cancer” or “helps to prevent cancer” you should be skeptical.

So we started from scratch and looked hard at the published research to find the facts that researchers actually agree on.

Here are the most important takeaways:

  • Smoking greatly increases the risk of multiple types of cancer, not just lung cancer
  • A family history of a particular type of cancer greatly increases your risk of getting it. Depending on the particular type of cancer, and if you know you have a family history genetic testing may be beneficial.
  • Women should definitely get mammograms after age 40.
  • Diet and exercise affect cancer, but causation remains unclear and we can’t make any concrete recommendations.

We looked both at incidence (how often a cancer occurs)8 and mortality rate (how often a patient with a cancer dies from it)9 to identify the cancers you should be most watchful for.*

*Lung cancer, the most deadly type of cancer, is discussed in the previous section.

Colon Cancer (Or why you should be skeptical of all nutrition advice)

Colon cancer is responsible for the majority of cancer deaths after lung cancer. It’s deadly to both men and women.

And the weird thing about colon cancer is this: way more people in developed countries develop colon cancer than do people in less-developed countries. And that’s true regardless of race and socioeconomic factors.

What does that mean? It means that well-off people seem to be making lifestyle choices that increase their risk of colon cancer. What lifestyle choices? Researchers usually single out nutrition as the culprit.

But, here’s why nutrition studies are so hard to believe:

In the early 90’s a group of European nations decided to band together and study the effects of nutrition and lifestyle on the development of cancer.

They developed several key takeaways10 that you’ve probably heard before:

to avoid colon cancer,

  • eat more dairy, fiber, vegetables, and fish, and
  • eat less processed or red meat and drink less alcohol.

While these recommendations might sound reasonable, they don’t tell the full story.

It turns out that the European study, (called the EPIC cohort study), mostly covers ground that had already been addressed by epidemiologists in the past:

  • A 1993 epidemiologic review article on colon cancer concluded that only increased vegetable consumption and leading a non-sedentary lifestyle were supported by the majority of studies.11
  • More recently, professional research service UpToDate concludes that obesity is linked with colon cancer, but that fruit and vegetable consumption have little impact, if any. Fish does seem to reduce risk, but only slightly. No other conclusions could be made because the studies they reviewed were too contradictory.12

Why can’t researchers agree on basic nutrition advice? The answer lies somewhere between research methods, politics, and the adaptability of the human body. We’ll discuss nutrition and nutrition research much more in future articles, but for now, we can’t make any firm recommendations about what to eat and what not to eat based on long-term medical risk factors.

One thing researchers do agree on: people with 1st-degree relatives who had colon cancer are at increased risk.

Breast Cancer

Breast cancer is the most-often occurring cancer in women and is responsible for the most deaths in women after lung cancer.

The most important action you can take to prevent breast cancer is to get routine mammograms every 1-2 years after the age of 40.

Mammogram controversy: In the past few years, there has been some debate around mammograms. The main issue is that the test generates a high rate of false positives (the test says you have breast cancer when you actually don’t), which can result in unnecessary treatment and hardship.1314

The current consensus seems to be that the benefits of getting the mammograms outweigh the downsides; just be aware that your doctor may ask you to come in for a second screening and that a second screening most likely does not mean you have breast cancer—the second screening is used to eliminate those annoying false positives.

And remember, the mammogram recommendation is specifically for women over the age of 40, which isn’t that far off for some millennials. For the rest? You can skip the mammogram for now, unless you know of preexisting factors.

Some women have an elevated risk of breast cancer due to genetics. You’re probably aware of Angelina Jolie’s decision to undergo an elective double mastectomy. The actress made that call because she tested positive for BRCA1, a gene that made her lifetime risk for breast cancer about 87%. Statistically, the presence of either the BRCA1 or BRCA2 genes increases lifetime risk for breast cancer to 65% and 45%, respectively.15

Of course, genetic testing can be expensive and not all women should get tested. The most at-risk women are those of Ashkenazi Jewish descent with relatives who have been diagnosed with breast or ovarian cancer.16

If you are concerned about your risks, the Gail Model pools common genetic factors together with other known contributors to estimate an individual’s risk of getting breast cancer. The best way to use the tool is to try it at home and bring your results in next time you see your doctor to discuss what model says about you.

Prostate Cancer

The prostate is a small gland that is part of the male reproductive system. Prostate cancer is both the most prevalent cancer in men after lung cancer and the number one killer of men after lung cancer.

The risk factors for prostate cancer are pretty straightforward. Prostate cancer rarely occurs in men under 40 and becomes significantly more likely in men older than 60. A family history of prostate cancer increases risk. Diet makes a difference, but exactly how is not clear.17

As most men are probably aware of already, a common way to screen for prostate cancer is the Digital Rectal Exam (DRE), during which a doctor or other healthcare provider to inserts one (gloved and lubricated) finger into the rectum of the patient. From there, they can feel the prostate for lumps or growths—just like a mammogram.

Unfortunately, the DRE is not always effective because (1) many doctors might not know what a diseased prostate feels like and (2) because oftentimes the growth occurs on the side of the prostate toward the interior of the body—where a doctor can’t feel.

There does exist another test. It checks for the marker prostate-specific antigen (PSA) . Unfortunately, some studies have shown that getting your PSA levels checked has no effect on actually reducing mortality.1819 On top of that, PSAs can also be indicative of issues unrelated to prostate cancer, so by screening everybody, you get a lot of false positives and a lot of unnecessary prostate biopsies that may do more harm (complications, infections) than good.

With that being said, many family medicine doctors still do PSA screenings and most insurance companies will still pay for the test, so it appears to remain controversial even between individual primary care providers.

In summary, there simply isn’t a bullet-proof recommendation for prostate screening for most men. What you really need to do is take a look at your family history and bring it up with your doctor if you do have any family history with the disease.

Lymphoma and Leukemia (and Other Cancers of the Blood)

In lymphoma and related cancers, the white blood cells—the very cells normally responsible for fighting infection and disease—become cancerous.

That’s why this family of diseases is often referred to as “hematological neoplasms,”—that’s doctor-speak for “cancers of the blood.”

Since blood travels everywhere in the body, the tumors associated with hematological neoplasms can appear in many places at once, such as in the lymph nodes, bone marrow, or spleen. And since these tumors can be spread all over the body, they’re harder to treat, which means mortality rates are high.

The two main types of hematological neoplasms are leukemia and lymphoma:

Leukemia affects the bone marrow and disrupts production of white blood cells. Children usually develop acute leukemia, while adults are equally susceptible to both chronic and acute forms of leukemia. Only 56% of patients will survive leukemia after 5 years.20

Lymphoma affects lymphocyte production (lymphocytes are a type of white blood cell) . Both types of lymphocytes—bursa-derived (B-cells) and thymus (T-cells)—are affected.

There are two main types of lymphoma. Hodgkin’s lymphoma is characterized by the orderly spread of the disease from lymph node to lymph node, whereas non-Hodgkin’s lymphoma is characterized by the non-systematic spread of the disease. Non-Hodgkin’s lymphoma is more deadly with a five-year survival rate of 69%, compared to Hodgkin’s lymphoma’s survival rate of 85%.21

Unlike other cancers, hematological neoplasms do not appear to be caused by genetics.22 And that means that environmental exposure to chemicals appears to be the primary cause of lymphomas and leukemias.

We’ve done some pretty extensive research on this subject, but frankly there are a great many conflicting opinions about what factors are most dangerous. We’ll follow up here with more information as we get it. For now, it appears that researchers agree that the following exposure can increase your risk of cancer.

  • Exposure to diesel fumes
  • Exposure to ionizing radiation
  • Exposure to hair dyes
  • Exposure to pesticides, specifically:
    • Dichlorodiphenyltrichlorethane (DDT)
    • cis-nonachlor
    • Oxychlordane

References: 2324

Keep in mind that when we talk about “exposure” what we mean is being in contact with these chemicals over the course of 20 years can increase your risk of developing cancer by about 50%. So there’s probably no need to worry if you accidentally get sprayed once with DDT; but, if you use that particular chemical every day for an extended period, you may want to take a look at your risk factors.

Pancreatic, Ovarian/Uterus, Urinary, and Skin Cancers

These other cancers are less deadly and prevalent than the other cancers we’ve discussed, but we felt like they were worth mentioning here.

Although rarely deadly, skin cancer is the most common form of cancer in the U.S. In fact, one in five Americans will develop skin cancer in their lifetime.25 Basal cell carcinoma is the most common form, followed by squamous cell carcinoma. 90% of nonmelanoma skin cancers are associated with UV exposure from the sun.26

Melanomas are more rare but also more serious: 1 in 50 men and women will be diagnosed with melanoma during their lifetimes and the overall 5-year mortality rate is 10%.27 Melanoma is also associated with UV exposure. In a recent study, researchers at Yale found that people who tanned indoors were 69% more likely to develop melanoma.28 The findings were so conclusive that a law in Connecticut banned indoor tanning only months after the findings were reported.

BUT, although the above study stands as a pretty significant condemnation of intentional tanning, don’t think that scientists are saying you have to hide from the sun. The truth is, most Americans don’t get enough sunlight. To avoid skin cancers, simply use sunscreen if you anticipate being outside for an extended period of time.

Pancreatic cancer: though the lifetime risk for men and women is only 1 in 67, the five-year survival rate for pancreatic cancer is a dismal 6%.29 Smoking accounts for 20% of pancreatic cancer cases. Also, people with the BRCA1 mutation (see breast cancer, above) carry about a 116% increased risk of getting the disease.30

There’s also a protein-based screen for pancreatic cancer developed by a 15-year-old that looks promising, but we don’t know when it will be available to the general public.

Ovarian cancer is only the 10th most common cancer among women, but it’s the 5th most deadly. Genetics play the most significant role in predicting ovarian cancer. BRCA1 increases lifetime risk to 39% and BRCA2 increases it to 11%.31 Women with a family history of the disease may want to consider getting tested for these genes.

Uterine cancer affects 1 in 37 women and has an overall 5-year survival rate of 81.5%.32 Like ovarian cancer, there is no known screen; the disease is largely genetic. Oral contraceptives reduce the risk for both ovarian and uterine cancer.33

Bladder cancer is a less common cancer, but it can be dangerous, with an overall 5-year survival rate of 77.9%.34 About 50% of all bladder cancers are attributed to smoking.35 The rest of cases are usually attributed to genetics. If you think you are at high risk (you’re a smoker or have a family history), there are some simple screens you can do. A urinalysis is the simplest method, but you’ll have to ask specifically for a bladder cancer screen, as that test does not come standard. More specific tests exist, such as UroVysion, bladder tumor-associated antigen, immunocyt, and NMP22 bladder check.36 Once again, these tests are only recommended if you know you have a family history of the disease or you’re a smoker.

Conclusions about Cancer

Despite huge strides in medical research and technology, cancer remains a poorly-understood disease. Or rather, a poorly understood family of very different diseases.

Here are the most important takeaways:

  • Smoking greatly increases the risk of multiple types of cancer, not just lung cancer
  • A family history of a particular type of cancer greatly increases your risk of getting it. Depending on the particular type of cancer, and if you know you have a family history genetic testing may be beneficial.
  • Women should definitely get mammograms after age 40.
  • Diet and exercise affect cancer, but causation remains unclear and we can’t make any concrete recommendations.

Heart Disease

Heart disease is most often known for being the most deadly disease in the developed world. The reason it falls behind cancers in our analysis is because we looked only at causes of death in persons aged 75 years or younger.

Takeaways about heart disease:

  • There are all sorts of factors that contribute to your risk of developing heart disease, but the most important markers to track are blood pressure, cholesterol/triglycerides, and bodyfat.
  • You get your blood pressure checked every time you visit the doctor’s office. You can help your doctor out by tracking your own blood pressure over time.
  • Cholesterol/triglyceride numbers should be checked every five years for adults over the age of 20. A high ratio of omega-3 fatty acids to other types of fat can improve your numbers.
  • Bodyfat is usually tracked using something called “Body Mass Index,” but the Body Mass Index was never designed to be used for assessing bodyfat. There are better methods that we discuss.
  • The most important takeaway about heart disease? Make sure to visit your doctor every 1-3 years in your 20s and 30s. They will make sure you get the right tests and can develop an accurate picture of your risk factors.

Most people know heart disease as heart attack—the malfunction and subsequent stopping of the heart that can cause sudden death. In the medical world, heart attacks are separated into categories based on what portions of the heart are failing and how that failure was caused. The term heart disease also covers blood clots that can cause death at the brain or lungs, as well as abnormal heart rhythms (ventricular tachycardia and ventricular fibrillation).

But, regardless of the particular type of heart disease in question, the risk factors are largely the same. You can start taking a look at your risk factors using this online Reynolds Risk Score calculator. Most of the numbers you’ll need you can find on a standard lab test. (For the hs-CRP box, put “2” for middle of the average if you don’t have it available. Bump it up to 3 or higher to see how your risk changes.) Just keep in mind that the calculator only assesses data for people older than 45. This is an educational exercise only.

For a simpler calculator, check out the 10-year CVD risk calculator based on the Framingham Heart Study.

While these calculators can give you a rough idea of where you stand, remember that they are based on epidemiological data and each person’s situation is different. Bring your results in to the doctor’s office if you have concerns about what your numbers say.

Looking at the calculators, it’s pretty clear that there are established markers for assessing risk for heart disease. The major culprits are blood pressure, cholesterol, triglycerides, and body mass index (BMI).* We’ll discuss these more next.

*Note that these levels (BP, cholesterol, triglycerides) are associated with a number of a chronic illnesses in addition to cardiovascular disease. Diabetes, for example, is strongly associated with lower HDL levels, high triglycerides and high blood pressure. So if you are older than 50, have a family history of cardiovascular disease or diabetes, or are overweight, pay very close attention to these measures.

Heart Disease Marker #1: Blood pressure (BP)

Blood pressure refers to the amount of pressure needed to move blood through your veins and arteries. If you have high blood pressure it means your heart is working too hard, and that can contribute to a number of health problems, including heart disease.

The American Heart Association maintains resources for blood pressure monitoring at home. Levels below 120/90 are considered healthy. Blood pressure is a good indicator across many types of people—that is, athletes with a blood pressure of 140/100 carry the same cardiovascular disease risks as non-athletes.

But, more than just looking at the numbers by themselves, it’s important to monitor blood pressure over time. An increase in blood pressure over time could be indicative of development of a chronic disease. And your doctor might not catch the trend, especially if she doesn’t have access to robust electronic medical records. It’s up to you to stay aware of trends in your key markers. If you’ve recently switched primary care providers, try to make your new care provider aware of your historical blood pressure readings.

If you’ve recently switched primary care providers, try to make your new care provider aware of your historical blood pressure readings.

Heart Disease Marker #2: Cholesterol and Triglycerides

Cholesterol is a fat-like substance that serves as an important building block in the body. It is found in all cells of the body and is a precursor to many hormones, as well as vitamin D. It does travel through the bloodstream, but cannot flow freely because it is not water soluble. Instead, it travels in “packages” called high-density lipoproteins (HDL) and low-density lipoproteins (LDL).

A triglyceride is just a fancy way of saying “a fat molecule.” They flow freely through the bloodstream and play an important role in providing energy to the body. However, these molecules can aggregate in the blood vessels and, in conjunction with cholesterol, cause a blockage.

There’s some confusion about which of these indicators (HDL, LDL, triglycerides, or total cholesterol) should be used to assess health and indicate possible disease. In November 2013, the American Heart Association released several new guidelines for measuring cholesterol/triglyceride levels as an indicator for heart attack and stroke as well as the management of lifestyle and diet to manage risk.373839 The full text documents are a bit cumbersome, but the highlights are worth skimming. Note: the AHA itself makes clear that the lifestyle guidelines are “designed for people who need to lower cholesterol and blood pressure,” so although they make specific nutrition statements, we wouldn’t necessarily say they apply to a healthy young adult. See [above] for more thoughts on nutrition research.

Here’s what does matter for our generation: the AHA recommends that all adults over the age of 20 get a fasting lipoprotein test every five years. This blood draw measures HDL, LDL, and triglycerides. Total cholesterol can then be calculated from those numbers.

When you do get this test, your doctor will apply the AHA’s guidelines for calculating risk. Since you can’t really test your own cholesterol, we’ll skip discussing the equations here and simply recommend that you remember to get your cholesterol checked at least every five years.

Heart Disease Marker #3: Body Mass Index (BMI)

BMI is the most commonly used measure for assessing body fat distribution and is calculated like this:

BMI = weight (kg) / height2 (m2). 40

Here’s how physicians use BMI:

underweight <18.5
healthy weight 18.5-24.9
overweight 25-29.9
obese >30

There are two very good reasons why doctors use BMI to estimate body fat: it’s easy and it’s free. But that doesn’t mean it’s effective.

Unfortunately, BMI is a pretty terrible metric when used incorrectly. And for a metric that’s considered the gold standard in obesity research it’s used incorrectly an awful lot.

In fact, the metric was originally developed for population studies and never meant for individual diagnoses. Unfortunately, it’s such an easy metric that doctors started adopting it nonetheless.

At the very least, you can target your own BMI more effectively by factoring in race:

Race Overweight BMI
White 25.0
“American Black” 26.3
Chinese 23.1
Thai 22.1
Ethiopian 20.4
Indonesian 21.8
Polynesian 29.5

Reference: 41

Though, even between same races, BMI can be different depending on what country you came from. Try googling for your particular background if you really want to calculate BMI, but remember that it’s really not a great metric of health.

Better methods to measure bodyfat

Here’s the obvious, but underpublicized truth: BMI is simply a poor estimate for body fat. If you’re any sort of athlete, you probably know what I’m talking about. Every year at the doctor’s office, your doctor inevitably blushes when he tells you that “according to his measurements” you fall in the overweight BMI category—you know, despite your 6-pack and the fact that your blood markers are all perfect.

There are many better ways to measure body fat, and if it’s not practical to do it in the doctor’s office, you can always do it yourself and bring in your results. Personally, I use a combination of the U.S. Navy taping method and the Jackson skin caliper algorithm. Simply looking at comparison photos of people at various body fat levels can also provide a quick guess. A recent study found that skinfold thickness was 10% more accurate than BMI in assessing body fat. 42

Diabetes

Diabetes may not be a leading cause of death, but it does have significant impacts on quality of life, on everything from energy levels, to being able to eat certain foods, to possibly losing a limb due to poor blood flow.

Once again, regular light exercise and having a healthy body weight can drastically reduce your risk for diabetes. With that being said, causation remains uncertain. 434445

But whereas we normally find it difficult to make specific recommendations about diet, with diabetes, we can safely say that excess sugar consumption likely contributes to poor insulin regulation. The worst culprits are processed sweets, such as sodas, fruit juices, and candy. Next comes highly processed grains like pre-cooked white rice, white bread, and corn-derived processed foods. Finally, even some less processed starches, like pasta and potatoes could make an impact, but the buffering effects of fiber might also mitigate the insulin response.

Besides diet and exercise, diabetes is marked by a resistance to insulin and the best marker for insulin, is blood glucose levels. Here is a sense of scale for glucose levels:

  • Normal: <100 mg/dl
  • Pre-diabetes: 100-126 mg/dl
  • Diabetes: ≥126 mg/dl

Source: 46

You can get your blood glucose levels checked through a standard blood draw at the doctor’s office. We would not recommend monitoring blood glucose at home unless you are pre-diabetes or already have diabetes and must monitor glucose on orders from your doctor.

Although high BMI, high blood pressure, and high triglyceride levels all increase your risk for developing diabetes, the best thing you can do today watch your simple sugar intake and commit to regular light exercise.

Conclusions and Next Actions

Let’s review. In this article, we started off by asking the question: what preventive health actions can millennials take today to improve their lives for the long term? Remember: the tagline of this blog is “teaching 25-year-olds to survive the next 75 years.”

Our approach was to identify the diseases most likely to cause an early death and identify the specific actions we can take today to reduce our risk factors for those diseases.
Here’s what we found out about the actions we can take:

Smoking. Smoking drastically increases your risk of both lung cancer and lung disease. On top of that, smoking increases your risk of developing several of the most deadly cancers, heart disease, and diabetes. Taking all that into account, smoking can be directly correlated to 20-30% of all preventable early deaths.

Family History. In our research, we repeatedly found that a family history of a disease increased your own risk of disease. Since the other preventive often talked about didn’t pan out as cut and dry as we expected (see below), we want to emphasize here the importance of collecting a thorough family history. Skip below for resources and help on this.

Tests given at the doctor’s office. Healthy young adults should visit a primary care provider once every 1 to 3 years. The doctor will check your blood pressure during every visit and will get you a cholesterol test once every 5 years. These will help assess your risk for heart disease. If you’re concerned about diabetes, you can ask for a glucose test as well. Mammograms are recommended for women over 40 and men can have their prostates checked, though the effectiveness of known prostate cancer screening techniques are currently in question.

Exercise. Exercise has clearly been shown to reduce the risk of heart disease and may be correlated to other major diseases as well. Specifically, researchers recommend about 40 minutes of light exercise (defined as a minimum of brisk walking) 3 to 4 times a week for optimal benefits. At this point, we can’t make recommendations about other exercise regimens for preventive health, such as weightlifting or more intense exercise.

Genetics. The vast majority of healthy young adults probably don’t need a genetic test. The one exception are women of Ashkenazi Jewish decent. If you have a significant family history of a disesase, genetic testing may also be useful, but you should start with collecting a family history, then ask your doctor about genetics.

Nutrition. Nutrition is the most divisive topic we researched for this article. The research on nutrition mostly deals with colon cancer, heart disease, and diabetes. The only two recommendations we can make are to (1) increase the ratio of omega-3 fatty acids to other types of dietary fat, this improves triglyceride levels, which are related to heart disease; it also reduces the risk of colon cancer. (Fatty acids can also help maximize your performance in the gym.) And, (2) limit the intake of simple sugars such as candy and soda (this helps prevent diabetes). We looked at all sorts of other nutrition studies and there simply weren’t other specific recommendations we could make for young, healthy adults.

Your next action: collect your family history

  • Of all the preventive measures you can take, the most important action you can take right now in terms of both simplicity and effectiveness is to get in touch with your immediate family and get them to answer a few questions about family history.
  • We found two pretty simple resources to help you gather a family history. The Surgeon General of the United States created a Family Health History Initiative that allows users to store and track family health information online.

Travis Whitfill, Jennifer Petrea, Stefanie S., and Neliswa Nhlbatsi contributed research to this article.

Travis is a graduate student at Yale University studying chronic disease epidemiology. Jennifer is a registered nurse (BSN) and currently as the Health & Fitness Outreach Coordinator at Vitality Medical Wellness Institute. Stefanie is a PhD Candidate in Molecular Biology. Neli is an MSc(Med) student at the University of the Witwatersrand in Johannesburg, South Africa.

[Top image: Tuna Akçay]

Notes:

  1. Preliminary Mortality File – CDC
  2. The 2030 Problem: Caring for Aging Baby Boomers, Health Services Research
  3. Geriatrics for the 3rd millennium, Wien Klin Wochenschr
  4. Smoking – National Cancer Institute
  5. Smoking and Heart Disease – WebMD
  6. Chronic lower respiratory disease – West Virginia Health Statistics Center
  7. Cancer of All Sites – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  8. CDC’s data on cancer incidence
  9. CDC’s data on cancer mortality.[and here’s the pdf]
  10. Key Findings – EPIC Project
  11. Potter, J., et alColon Cancer: A Review of the Epidemiology, Epidemiologic Reviews 15(2).
  12. UpToDate is a paid subscription service that reviews recent medical journals to provide physicians and other subscribers with concise, useful research.
  13. Mammogram Fact Sheet from NIH’s National Cancer Institute
  14. Free PubMed Article: Mammography screening. Benefits, Harms, and Informed Choice.
  15. Hereditary Breast Ovarian Cancer Syndrome (BRCA1/BRCA2) – Stanford Cancer Institute
  16. ABC News Health Blog: Should You Get BRCA Testing?
  17. Prostate Cancer – Causes, Incidence, and Risk Factors – National Library of Medicine
  18. Mortality results from a randomized prostate-cancer screening trial – New England Journal of Medicine
  19. Prostate-Specific Antigen (PSA) Test – National Cancer Institute
  20. Lymphoma Incidence and Mortality – Surveillance Epidemiology and End Results, National Cancer Institute
  21. Lymphoma Incidence and Mortality – Surveillance Epidemiology and End Results, National Cancer Institute
  22. Bhatia, S. and Robison, L., Epidemiology of leukemia and lymphoma, Current Opinion in Hematology, 1999
  23. Occupational exposures and non-Hodgkin’s lymphoma: Canadian case-control studyEnvironmental Health, 2008.
  24. A Prospective Study of Organochlorines in Adipose Tissue and Risk of Non-Hodgkin LymphomaEnvironmental Health Perspectives, 2012 
  25. Sun exposure, sun protection, and vitamin D. JAMA
  26. Prevention and early detection strategies for melanoma and skin cancer. Current status. Arch Dermatol, 1996.
  27. SEER Fact sheets: Melanoma of the Skin – Surveillance, Epidemiology, and End Results Program, National Cancer Institute.
  28. Some Melanoma Survivors Still Use Tanning Beds, Skip Sunscreen – American Association for Cancer Research
  29. Cancer of the Pancreas – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  30. Cancer Incidence in BRCA1 Mutation CarriersJournal of the National Cancer Institute
  31. Hereditary Breast Ovarian Cancer Syndrome (BRCA1 / BRCA2) – Stanford Cancer Institute
  32. Cancer of the Corpus and Uterus – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  33. Uterine Cancer Prevention– Centers for Disease Control
  34. SEER Stat Fact Sheets: Bladder Cancer – Surveillance, Epidemiology, and End Results Program, National Cancer Institute
  35. Cigarette smoking implicated in half of bladder cancers in women – National Cancer Institute
  36. Can bladder cancer be found early? – American Cancer Society
  37. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
  38. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk
  39. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk
  40. for those of us not used to metric calculations, use BMI = (4.89) weight (lbs) / height2 (feet2) or BMI = (704.55) weight (lbs) / height2 (inches2)
  41. Body mass index and percent body fat: a meta analysis among different ethnic groupsInt J Obes Relat Metab Disord, 1998
  42. Can weight-related health risk be more accurately assessed by BMI, or by gender specific calculations of Percentage Body Fatness?, Medical Hypotheses, 2012
  43. Diagnosing Diabetes and Learning About Prediabetes – American Diabetes Association
  44. Prevent Diabetes – Centers for Disease Control
  45. Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes, Journal of Epidemiology and Community Health, 2005
  46. Diagnosing Diabetes and Learning About Prediabetes – American Diabetes Association

 

 

Lymphoma Products

On the relationship between organochlorines and human cancer risk (Sources: Breast Cancer Research and Treatment 2002, Breast Cancer Research 2005). Risk of Non-Hodgkin’s lymphoma (NHL) associated with contemporary hair dye use varies by genetic polymorphisms; particularly, immunological genes, DNA repair genes, and genes involved in the metabolism of environmental exposures may influence individual susceptibility for NHL.

Below is a table with common genetic variants that modulate risk for lymphoma when exposed to benzenes and ogranochlorenes:

Table 1.

Gene

SNP

Ref

Gene

SNP

Ref

Immune-related genes

TNF

rs1800629

[1-3]

IL-1RN

rs2637988

[4]

IL-6

rs1800795

[2]

IL-6

rs1800797

[2]

IL-4

rs2243248

[2, 5]

DEFB126

rs6054706

[6]

IL-5

rs2069812

[5]

ICAM1

rs2304240

[7]

IL-10

rs1800890

[2, 5]

IL-10

rs1800896

[2, 5]

IL-10RA

rs9610

[1]

MASP2

rs12711521

[6]

IL12A

rs582054

[2]

PTGDR

rs708486

[7]

IL15RA

rs2296135

[2]

Genes that metabolize NHL-relevant environmental exposures

AHR

rs17722841

[8]

GSTM3

rs1799735

[9]

CYP1A1

rs1048943

[9]

GSTP1

rs1695

[9, 10]

CYP1B1

rs1056836

[9]

MPO

rs2333227

[11]

DNA Repair Genes

BRCA1

rs16941

[12]

NBS

rs1805794

[13]

BRCA2

rs144848

[13]

WRN

rs1346044

[12]

ERCC2

rs1618536

[14]

XRCC3

rs3212024

[14]

ERCC2

rs2070831

[14]

XRCC3

rs3212038

[14]

ERCC5

rs17655

[12]

XRCC3

rs3212090

[14]

MGMT

rs12917

[13]

References

1.         Bi, X., et al., Genetic polymorphisms in IL10RA and TNF modify the association between blood transfusion and risk of non-Hodgkin lymphoma. Am J Hematol, 2012. 87(8): p. 766-9.

2.         Deng, Q., et al., Occupational solvent exposure, genetic variation in immune genes, and the risk for non-Hodgkin lymphoma. Eur J Cancer Prev, 2013. 22(1): p. 77-82.

3.         Skibola, C.F., et al., Tumor necrosis factor (TNF) and lymphotoxin-alpha (LTA) polymorphisms and risk of non-Hodgkin lymphoma in the InterLymph Consortium. Am J Epidemiol, 2010. 171(3): p. 267-76.

4..         Hosgood, H.D., 3rd, et al., A pooled analysis of three studies evaluating genetic variation in innate immunity genes and non-Hodgkin lymphoma risk. Br J Haematol, 2011. 152(6): p. 721-6.

5.         Lan, Q., et al., Cytokine polymorphisms in the Th1/Th2 pathway and susceptibility to non-Hodgkin lymphoma. Blood, 2006. 107(10): p. 4101-8.

6.         Hu, W., et al., Polymorphisms in pattern-recognition genes in the innate immunity system and risk of non-Hodgkin lymphoma. Environ Mol Mutagen, 2013. 54(1): p. 72-7.

7.         Shen, M., et al., Polymorphisms in integrin genes and lymphoma risk. Leuk Res, 2011. 35(7): p. 968-70.

8.         Ng, C.H., et al., Interaction between organochlorines and the AHR gene, and risk of non-Hodgkin lymphoma. Cancer Causes Control, 2010. 21(1): p. 11-22.

9.       Kilfoy, B.A., et al., Genetic polymorphisms in glutathione S-transferases and cytochrome P450s, tobacco smoking, and risk of non-Hodgkin lymphoma. Am J Hematol, 2009. 84(5): p. 279-82.

10.       Soucek, P., et al., Genetic polymorphisms of biotransformation enzymes in patients with Hodgkin’s and non-Hodgkin’s lymphomas. Int Arch Occup Environ Health, 2002. 75 Suppl: p. S86-92.

11.       Farawela, H., et al., The association between hepatitis C virus infection, genetic polymorphisms of oxidative stress genes and B-cell non-Hodgkin’s lymphoma risk in Egypt. Infect Genet Evol, 2012. 12(6): p. 1189-94.

12.       Shen, M., et al., Polymorphisms in DNA repair genes and risk of non-Hodgkin lymphoma among women in Connecticut. Hum Genet, 2006. 119(6): p. 659-68.

13.       Jiao, J., et al., Occupational solvent exposure, genetic variation of DNA repair genes, and the risk of non-Hodgkin’s lymphoma. Eur J Cancer Prev, 2012. 21(6): p. 580-4.

14.       Smedby, K.E., et al., Variation in DNA repair genes ERCC2, XRCC1, and XRCC3 and risk of follicular lymphoma. Cancer Epidemiol Biomarkers Prev, 2006. 15(2): p. 258-65.

Bottom line:

The studies indicate that, in general, exposure to one or more of the chemicals mentioned will increase your risk by about 50% if you are exposed to them for at least 20 years (not accounting for genetic risk). And if you have any one of the genetic variants (you are very unlikely to have more than one), and you are exposed to these chemicals, your risk is increased generally by 200% compared to normal genotype and unexposed people. The average occurrence of one of these genotypes is about 1 in 1,000.

So, chances are you are probably safe, but it wouldn’t hurt to avoid occupational exposure to these chemicals or using dangerous hair products. If you really want to make sure, you can test your genome to see if you have any of these SNPs.

Live to 100 With the 80-20 Rule

man

 

It’s true: you’re invincible. You’re barely 25 years old, you’re in great (ok, good) shape, you eat well (most of the time), and you’ve only ever gotten a clean bill of health at doctor’s office.

You know you’re supposed to be worried about stuff like retirement and healthcare or <shudder> life insurance, but in the back of your head, you know that with modern medicine improving so fast, you’ll easily live to be 100.

And, if you should happen to catch the sniffles or jam a finger, you’re confident a quick visit to your primary care physician will fix your problems and let you get back to being productive/socializing/rewatching the second season of Mad Men.

Hey – I get it, I’m 26 and that’s how I feel too.

But, part of you wonders: now that you’ve finally got your school debt under control, your career on a decent track, and a social life that’s moving in the right direction, is there anything you could be doing to protect your health?

The short answer is yes, and it’s way easier and much more effective than you’d probably guess. To find out how, read on.

The Rule of Thumb

If you’re interested in productivity, you’ve probably heard of the Pareto principle, a simple rule of thumb that goes something like this:

“80 percent of outcomes are from 20 percent of causes”

It applies to all aspects of life: “80 percent of work gets done by 20% of employees” or “80 percent of my sales come from 20% of my clients” or “I can get this presentation to an 80% with only 20% the effort”

So does it apply to health and living longer too? Check out this chart:

causes of death

…yup, it applies.

The numbers from the Centers for Disease Control (CDC) show that just 15 causes of death are responsible for 80% of all deaths in the United States.

Let’s take a closer look. After eliminating non-medical causes of death (accidents, homicides, and suicides) we see that 4 categories of diseases are responsible for 66% of deaths out of the top 15 causes.

Here’s the chart:

causes of death 2

Um… So What?

[explanation, quick summary]

 A note on methodology. We specifically looked at causes of death before the age of 75 because statistics about geriatric medicine are expected to change considerably in the coming decades as people live longer than ever before.1,2

Here’s what changes: while heart disease beats out cancer as an overall cause of death, cancer actually edges it out in the under-75 population. We used 2010 data. Since specifics change from year to year, we ballparked statistics where appropriate.

1 Health Services Research
2 Wien Klin Wochenschr

Lung Disease and Lung Cancer

You could sum this entire section with two simple words: don’t smoke.

Here’s why:

Oh, and add to these the fact that smoking directly increases risk for many cancers besides lung cancer, and you can conclude that smoking directly causes between 20% and 30% of medically-related deaths under the age of 75. And that’s a conservative estimate.

Of course, it’s not always that simple. It’s very easy to become dependent on or addicted to nicotine. Plus, secondhand smoke has the same negative effects as smoking, if not to quite the same severity.

If you do smoke or are regularly exposed to secondhand smoke, know that you are at significantly higher risk for the most deadly diseases. Which means it’s even more important for you to keep a close eye on blood pressure, weight, and lung capacity in order to catch health problems at an early stage.

*Most non-smoking-related cases of chronic respiratory diseases and lung cancer are influenced by genetics. If you have a family history of lung problems or asthmas, you may be at increased risk, especially if you are routinely exposed to smoke.

Cancer

One in two men and women will be diagnosed with cancer in their lifetimes.

That statistic bears repeating. One in two men and women will be diagnosed with cancer in their lifetimes. It sounds unbelievable but that statistic comes straight from the National Cancer Institute.

It’s hard to make broad recommendations for avoiding cancer in general because there are so many types and each has its own risk factors. That’s why anytime a product or new study says something like “reduces the risk of cancer” or “helps to prevent cancer” you should be skeptical.

So we’ve done the legwork for you.

We looked both at incidence (how often a cancer occurs)3 and mortality rate (how often a patient with a cancer dies from it)4 to identify the cancers you should be most watchful for.*

*Lung cancer, the most deadly type of cancer, is discussed in the previous section.
3 CDC’s data on cancer incidence
4 CDC’s data on cancer mortality. [pdf]

Colon Cancer
(Or why you should be skeptical of all nutrition advice)

Colon cancer is responsible for the majority of cancer deaths after lung cancer. It’s deadly to both men and women.

Here’s the weird thing about colon cancer: way more people in developed contries contract colon cancer than do people in less-developed countries. And that’s true regardless of race and socioeconomic factors.

What does that mean? It means that well-off people are making lifestyle choices that increase their risk of colon cancer.

What lifestyle choices? Researchers usually single out nutrition as the culprit.

But, here’s why nutrition studies are so hard to believe:

In the early 90′s a group of European nations decided to band together and study the effects of nutrition and lifestyle on the development of cancer.

They developed several key takeaways that you’ve probably heard before: to avoid colon cancer,

  • eat more dairy, fiber, vegetables, and fish, and
  • eat less processed or red meat and drink less alcohol.

While these recommendations might sound reasonable, they don’t tell the full story.

It turns out that the European study, (called the EPIC cohort study), mostly covers ground that had already been addressed by epidemiologists in the past.

  • A 1993 epidemiologic review article on colon cancer concluded that only increased vegetable consumption and leading a non-sedentary lifestyle were supported by the majority of studies.
  • More recently, [UpToDate] concludes that obesity is linked with colon cancer, but that fruit and vegetable consumption have little impact, if any. Fish does seem to reduce risk, but only slightly. No other conclusions can be made because the data are just too contradictory.

Why can’t researchers agree on basic nutrition advice? The answer lies somewhere between research methods, politics, and the adaptability of the human body.

We’ll discuss nutrition and nutrition research much more in future articles, but for now, remember to treat any nutrition advice with a healthy dose of skepticism.

[people with 1st-degree relatives who had colon cancer are at increased risk: uptodate.]

Breast Cancer

Breast cancer is the most-often occurring cancer in women and is responsible for the most deaths in women after lung cancer.

The most important action you can take to prevent breast cancer is to get routine mammograms every 1-2 years after the age of 40.

Controversy

In the past few years, there has been some debate around mammograms. The main issue is that the test generates a high rate of false positives (the test says you have breast cancer when you actually don’t), which can result in unnecessary treatment and hardship.5,6

The current consensus seems to be that the benefits of getting the mammograms outweigh the downsides; just be aware that your doctor may ask you to come in for a second screening and that a second screening most likely does not mean you have breast cancer–the second screening is used to eliminate those annoying false positives.

Some women have an elevated risk of breast cancer due to genetics.

You’re probably aware of Angelina Jolie’s decision to undergo an elective double mastectomy. The actress made that call because she tested positive for BRCA1, a gene that made her lifetime risk for breast cancer about 87%. Statistically, the presence of either the BRCA1 or BRCA2 genes increase lifetime risk for breast cancer to 65% and 45%, respectively.7

Of course, genetic testing can be expensive and not all women should get tested. The most at-risk women are those of Ashkenazi Jewish descent with relatives who have been diagnosed with breast or ovarian cancer.8

If you are concerned about your risks, the Gail Model pools common genetic factors together with other known contributors to estimate an individual’s risk of getting breast cancer. The best way to use the tool is to try it at home and bring your results in next time you see your doctor to discuss what model says about you.

5 Mammogram Fact Sheet from NIH’s National Cancer Institute
6 Free PubMed Article: Mammography screening. Benefits, Harms, and Informed Choice.
7 Stanford Cancer Institute
8 ABC News Health Blog: Should You Get BRCA Testing?

Prostate Cancer

The prostate is a small gland that is part of the male reproductive system. Prostate cancer is both the most prevalent cancer in men after lung cancer and the number one killer of men after lung cancer.

The risk factors for prostate cancer are pretty straightforward. Prostate cancer rarely occurs in men under 40 and becomes significantly more likely in men older than 60. A family history of prostate cancer increases risk. Diet makes a difference, but exactly how is not clear.9

And that’s about all you can do for prostate cancer–besides, you know, get your prostate checked. There is a marker call prostate-specific antigen (PSA) that’s elevated in patients with prostate cancer. But, studies have shown that getting your PSA levels checked has no effect on actually reducing mortality.10,11

Charlene says:
Most PSAs increase with age (and can also increase with prostate/bladder infection I think), so by screening everybody, you get a lot of false positives and a lot of unnecessary prostate biopsies that may do more harm (complications, infections) than good. Some family medicine docs still do PSAs, so I think it’s still pretty controversial even between individual primary care providers. I think testing should definitely be done for people with high risk and I would be ok with testing a patient feels strongly about getting the test. Plus, most insurance companies will still pay for the test.

9 National Library of Medicine, Prostate Cancer – Causes, Incidence, and Risk Factors
10 New England Journal of Medicine, Mortality results from a randomized prostate-cancer screening trial
11 National Cancer Institute, Prostate-Specific Antigen (PSA) Test

Lymphoma and Leukemia
-and Other Cancers of the Blood

[How dangerous?] [Why are we talking about it?]

In lymphoma and related cancers, the white blood cells–the very cells normally responsible for fighting infection and disease–become cancerous.

That’s why this family of diseases is often referred to as “hematological neoplasms,”–that’s doctor-speak for “cancers of the blood.”

Since blood travels everywhere in the body, the tumors associated with hematological neoplasms can appear in many places at once, such as in the lymph nodes, bone marrow, or spleen.

And since these tumors aren’t localized, they’re harder to treat, which means mortality rates are high.

The two main types of hematological neoplasms are leukemia and lymphoma:

Leukemia affects the bone marrow and disrupts production of white blood cells. Children usually develop acute leukemia, while adults are equally susceptible to both chronic and acute forms of leukemia. Only 56% of patients will survive leukemia after 5 years.12

Lymphoma affects lymphocyte production (lymphocytes are a type of white blood cell) . Both types of lymphocytes–bursa-derived (B-cells) and thymus (T-cells)–are affected.

There are two main types of lymphoma. Hodgkin’s lymphoma is characterized by the orderly spread of the disease from lymph node to lymph node, whereas non-Hodgkin’s lymphoma is characterized by the non-systematic spread of the disease. Non-Hodgkin’s lymphoma is more deadly with a five-year survival rate of 69%, compared to Hodgkin’s lymphoma’s survival rate of 85%.13

Unlike other cancers, hematological neoplasms do not appear to be caused by genetics.14 And that means that environmental exposure to chemicals appears to be the primary cause of lymphomas and leukemias.

Here are the specific substances you should avoid:

  • Exposure to diesel fumes
  • Exposure to ionizing radiation
  • Exposure to hair dyes
  • Exposure to pesticides, specifically:
    • Dichlorodiphenyltrichlorethane (DDT)
    • cis-nonachlor
    • Oxychlordane

References: 15, 16

And by exposure, we mean that being in contact with these chemicals over the course of 20 years can increase your risk of developing cancer by about 50%.

[The research on hematological neoplasms is still developing and the subject of some debate, but here’s the bottom line: although this class of cancers is rare, they are very deadly and should be avoided if possible.]

12 Surveillance Epidemiology and End Results (SEER), Leukemia Incidence and Mortality
13 SEER, Lymphoma Incidence and Mortality
14 Current Opinion in Hematology 1999
15 Environmental Health 2008, Occupational exposures and non-Hodgkin’s lymphoma: Canadian case-control study
16 Environmental Health Perspectives 2012, A Prospective Study of Organochlorines in Adipose Tissue and Risk of Non-Hodgkin Lymphoma

Dishonorable Mentions
Pancreatic, Ovarian/Uterus, Urinary, and Skin Cancers

Although rarely deadly, skin cancer is the most common form of cancer in the U.S. In fact, one in five Americans will develop skin cancer in their lifetime.22 Basal cell carcinoma is the most common form, followed by squamous cell carcinoma. 90% of nonmelanoma skin cancers are associated with UV exposure from the sun.23

Melanomas are more rare but also more serious: 1 in 50 men and women will be diagnosed with melanoma during their lifetimes and the overall 5-year mortality rate is 10%.24 Melanoma is also associated with UV exposure. In a recent study, researchers at Yale found that people who tanned indoors were 69% more likely to develop melanoma. The findings were so conclusive that a law in Connecticut banned indoor tanning only months after the findings were reported.

BUT, although the above study stands as a pretty significant condemnation of intentional tanning, don’t think that scientists are saying you have to hide from the sun. The truth is, most Americans don’t get enough sunlight. To avoid skin cancers, simply  use sunscreen if you anticipate being outside for an extended period of time.

Pancreatic cancer: though the lifetime risk for men and women is only 1 in 67, the five-year survival rate for pancreatic cancer is a dismal 6%.17 Smoking accounts for 20% of pancreatic cancer cases. Also, people with the BRCA1 mutation (see breast cancer, above) carry about a 116% increased risk of getting the disease.18

There’s also a protein-based screen for pancreatic cancer developed by a 15-year-old that looks promising, but we don’t know when it will be available to the general public.

Ovarian cancer is only the 10th most common cancer among women, but it’s the 5th most deadly. Genetics play the most significant role in predicting ovarian cancer. BRCA1 increases lifetime risk to 39% and BRCA2 increases it to 11%.19 Women with a family history of the disease may want to consider getting tested for these genes.

Uterine cancer affects 1 in 37 women and has an overall 5-year survival rate of 81.5%.20  Like ovarian cancer, there is no known screen; the disease is largely genetic. Oral contraceptives reduce the risk for both ovarian and uterine cancer.21

Bladder cancer is a less common cancer, but it can be dangerous, with an overall 5-year survival rate of 77.9%.25 About 50% of all bladder cancers are attributed to smoking.26 The rest of cases are usually attributed to genetics. If you think you are at high risk (you’re a smoker or have a family history), there are some simple screens you can do. A urinalysis is the simplest method, but you’ll have to ask specifically for a bladder cancer screen, as that test does not come standard. More specific tests exist, such as UroVysion, bladder tumor-associated antigen, immunocyt, and NMP22 bladder check.27 Once again, these tests are only recommended if you know you have a family history of the disease or you’re a smoker.

17 SEER, Cancer of the Pancreas.
18 Journal of the National Cancer Institute, Cancer Incidence in BRCA1 Mutation Carriers.
19 Stanford Cancer Institute, Hereditary Breast Ovarian Cancer Syndrome (BRCA1 / BRCA2).
20 SEER, Cancer of the Corpus and Uterus.
21 CDC, Uterine Cancer Prevention.
22 JAMA
23 Link http://www.ncbi.nlm.nih.gov/pubmed/8629848
24 (SEER)
25 (Source: SEER)
26 (Source: NCI)
27 (ACS)

Conclusions about Cancer

Despite huge strides in medical research and technology, cancer remains a poorly-understood disease. Or rather, a poorly understood family of very different diseases.

Here are the most important takeaways:

  • Smoking greatly increases the risk of multiple types of cancer, not just lung cancer
  • A family history of a particular type of cancer greatly increases your risk of getting it. Depending on the particular type of cancer, genetic testing can give you a better picture of your risk.
  • It’s still questionable whether men should have their prostates checked after age 40, but women should definitely get mammograms after age 40.
  • Diet and exercise affect cancer, but causation remains unclear.

Heart Disease

Heart disease is most often known for being the most deadly disease in the developed world.  The reason it falls behind cancers in our analysis is because we looked only at causes of death in persons aged 75 years or younger.

Either way you look at it, the numbers are alarming, especially when you consider that the two best ways to prevent heart disease are through the proper management of diet and lifestyle.

Most people know heart disease as heart attack – the malfunction and subsequent stopping of the heart that can cause sudden death. In the medical world, heart attacks are separated into categories based on what portions of the heart are failing and how that failure was caused.  The term heart disease also covers blood clots that can cause death at the brain or lungs, as well as abnormal heart rhythms (ventricular tachycardia and ventricular fibrillation).

Regardless of the particular type of heart disease in question, the risk factors are largely the same. You can start taking a look at your risk factors for using this online Reynolds Risk Score calculator. Most of the numbers you’ll need you can find on a standard lab test. (For the hs-CRP box, put “2” for middle of the average if you don’t have it available. Bump it up to 3 or higher to see how your risk changes. And keep in mind that the calculator only assesses data for people older than 45.)

For a simpler calculator, check out the 10-year CVD risk calculator based on the [Framingham study].

While these calculators can give you a rough idea of where you stand, remember that they are based on epidemiological data and each person’s situation is different.  Bring your results in to the doctor’s office if you have concerns about what your numbers say.

Looking at the calculators, it’s pretty clear that there are established markers for assessing risk for heart disease. The major culprits are blood pressure, cholesterol, triglycerides, and body mass index (BMI).

Blood pressure (BP)

BP is an indicator of heart health and should be monitored a little more closely with increased age. The American Heart Association has a good website for blood pressure monitoring at home. Levels below 120/90 are healthy.[JNC # 7 or # 8] It is important to monitor blood pressure over time. An increase in blood pressure over time could be indicative of development of a chronic disease.

Blood pressure is a good indicator across many types of people—that is, athletes with a BP of 140/100 carry the same cardiovascular disease risks as non-athletes.

Blood pressure should not be confused with pulse. Pulse is one measure that is always assessed at the doctor’s office, but is not a strong indicator of health, unless it’s combined with body temperature, respiratory rate, and blood pressure.

Cholesterol

Cholesterol is a fat-like substance that is a precursor to many hormones and vitamin D. It is in the bloodstream, but cannot travel freely because it is not water soluble. Thus, it travels in “packages” in the bloodstream. These molecular packages are called high-density lipoproteins (HDL) and low-density lipoproteins (LDL). Perhaps counter-intuitively, higher HDL levels are healthier and lower LDL levels are better. LDL levels should be below 100 mg/dL,  HDL levels should be above 60 mg/dL, and total cholesterol levels should be below 200 mg/dL (American Heart Association). If you have certain diseases, such as diabetes, these recommended levels become more stringent.

There’s some confusion about which of these indicators should be used to assess health and indicate possible disease. HDL levels alone? LDL levels? Total cholesterol? A ratio of these? Well, a holistic consideration is warranted when measuring all three of these. A recent study suggests that the best indicator for overall health and risk for cardiovascular disease is the ratio of non-HDL:HDL ratio (Source: Eur J Prev Cardio). I recommend using this measure as opposed to total cholesterol and LDL levels [why?]. But note that this contradicts American Heart Association’s official recommendation of using absolute levels of total cholesterol and HDL.

Triglycerides

A triglyceride is comprised of a glyceride molecule attached to three fatty acid chains, and can be found circulating freely in the blood stream. Since these molecules can aggregate in blood vessels, the goal is to keep these levels as low as possible, below 150 mg/dL. These levels can be kept down with a healthy diet and by eating good ratios of fats (olive oil, for example).

[recommended cholesterol and triglycerides also depend on other risk factors, such as diabetes]

Body Mass Index (BMI)

BMI is the most commonly used measure for assessing body fat distribution and is calculated like this:

BMI = weight (kg) / height2 (m2).

For Americans:

BMI = (4.89) weight (lbs) / height2 (feet2)

BMI = (704.55) weight (lbs) / height2 (inches2)

underweight <18.5
healthy weight 18.5-24.9
overweight 25-29.9
obese >30

There are two very good reasons why doctors use BMI to estimate body fat: it’s easy and it’s free.

Unfortunately, BMI is also pretty terrible metric when used incorrectly. And for a metric that’s considered the gold standard in obesity research it’s used incorrectly an awful lot.

To create BMI tables, epidemiologists[] took a cross section of Americans in the 19[]’s and associated BMI with measured body fat. Of course, people in the 19[]’s were generally processed-food-eating, car-driving, desk-working [Caucasians].  So if you don’t live sort of life (or don’t want to live that life), BMI might kind of suck for you.

In fact, BMI is different for different races:

Race Overweight BMI
White 25.0
Black 26.3
Chinese 23.1
Thai 22.1
Ethiopian 20.4
Indonesian 21.8
Polynesian 29.5

(Source: Int J Obes Relat Metab Disord).

And even between same races, BMI can be different depending on what country you came from [].

[Here is a calculator for BMI from the NIH.]

How to really measure body fat

Here’s the obvious, but underpublicized truth: BMI is simply a poor estimate for body fat.  If you’re any sort of athlete, you probably know what I’m talking about. Every year at the doctor’s office, your doctor inevitably blushes when he tells you that “according to his measurements” you fall in the overweight BMI category – you know, despite your 6-pack and the fact that your blood markers are all perfect.

There are many better ways to measure body fat, and if it’s not practical to do it in the doctor’s office, you can always do it yourself and bring in your results. Personally, we use a combination of the U.S. Navy taping method and the Jackson skin caliper algorithm[]. Simply looking at comparison photos of people at various body fat levels can also provide a quick guess[]. A recent study found that skinfold thickness was 10% more accurate than BMI in assessing body fat. (Source: Medical Hypotheses).

[what’s the conversion for BMI to body fat?]

What do we mean when we say “diet and exercise”

[walking 30 minutes a day? raising heart rate?][google:10,000 steps a day]

*Note that these levels (BP, cholesterol, triglycerides) are associated with a number of a chronic illnesses in addition to cardiovascular disease. Diabetes, for example, is strongly associated with lower HDL levels, high TGs and high blood pressure. So if you are older than 50, have a family history of cardiovascular disease or diabetes, or are overweight, pay very close attention to these measures.

Diabetes

Diabetes may not be a leading cause of death, but it does have significant impacts on quality of life, on everything from energy levels, to being able to eat certain foods, to possibly losing a limb due to poor blood flow.

Once again, regular light exercise and having a healthy body weight can drastically reduce your risk for diabetes.  With that being said, causation remains uncertain. [Sources: ADA, CDC, JECH]

But whereas we normally find it difficult to make specific recommendations about diet, with diabetes, we can safely say that excess sugar consumption likely contributes to poor insulin regulation. The worst culprits are processed sweets, such as sodas, fruit juices, and candy. Next comes highly processed grains like pre-cooked white rice, white bread, and corn-derived processed foods. Finally, even some less processed starches, like pasta and potatoes could make an impact, but the buffering effects of fiber might also mitigate the insulin response.

Besides diet and exercise, diabetes is marked by a resistance to insulin and the best marker for insulin, is blood glucose levels. Here is a sense of the scale of glucose levels:

  • Normal: <100 mg/dl
  • Pre-diabetes: 100-126 mg/dl
  •     Diabetes: ≥126  mg/dl

(Source: American Diabetes Association [ADA]).

You get your blood glucose levels checked every time you have blood drawn [no, it depends on what labs are ordered]. That’s one reason it’s important to fast before a blood draw: blood glucose levels are affected by food intake [2nd part is true, but the only lab that usually needs to be done fasting is cholesterol].  We would not recommend monitoring blood glucose at home unless you are pre-diabetes or already have diabetes and must monitor glucose on orders from your doctor.

Although high BMI, high blood pressure, and high triglyceride levels all increase your risk for developing diabetes, the best intervention is to develop a plan of action to improve diet and lifestyle, not monitor glucose.

About the Author

Kevin Liu…

Contributors

Travis Whitfill contributed research to this article. Travis is currently a graduate student at Yale University studying chronic disease epidemiology. He can be contacted at travis.whitfill@yale.edu.

References

Top image by Tuna Akçay

Stop “aspiring” to cook; just start cooking

How many of you own or know a non-photographer friend who owns a nice DSLR camera? Ok, great. Now, those of you with your hands raised, how many of you can explain the terms ISO, focal length, or crop factor? How many of you have successfully used that fancy DSLR in anything other than “auto” mode?

Hmm. I see a lot of hands going down.

Gadgets are supposed to make our lives easier and better, which is why we spoon out our hard-earned dollars on fancy cameras: We imagine that if we only owned better gear, our pictures would instantly improve. But, they don’t.

Ready for the secret of how to take better pictures? Take a lot of pictures.

So, what does this have to do with cooking?

Mom did not own kitchen gadgets.

My mom is amazing (hi mom). No, but seriously, she has three master’s degrees, heads up a multi-million dollar research budget at work, and she still manages to be the best cook I know.

But did my mom own a kitchen full of widgets designed to make her cooking better? A $300 le creuset dutch oven to pair with her $800 DSLR?

Heck, no.

Mom uses cheap knives from the Asian market, a nonstick pan that may actually have been nonstick at some point, and a rolling pin that I’m pretty sure she brought with her from China. 25 years ago.

So, if mom can make do with just the basic implements, why do we young people feel the need to drool over the latest kitchen “accessory?”

If the wedding registries I’ve doled out for in the last few years are any indication, we 20-somethings feel culinarily incomplete without at a minimum: a 5-qt kitchenaid stand mixer, a 14-piece set of All-Clad tri-ply cookware, and a professional knife set (Shun and Henckels are both acceptable. Just make sure to get forged. Why, you ask? What are you, a caveman??)

Wow, all of that cool equipment sounds awesome, and your kitchen looks damn sexy! So are you going to cook me up a nice sole meuniere with a side of mushroom risotto, topped with a chiffonade of fresh basil?

Whhaa–? Why not?

I don’t have the time or energy to cook

Ohhh, I see.

Don’t worry, I understand. You’re a very busy young professional, and you are much too busy/stressed/tired to cook for yourself.

Besides, you ran the numbers one time and it actually makes more financial sense to order takeout than to waste your valuable time (worth at least $30/hour) standing in front of the stove.

And all those terrific pots and pans you own from Williams-Sonoma?

Well, they’re there, you know, in case one day you get around to cooking for yourself. Just in case.

PEOPLE.

We all keep bucket lists with items like “sail Everest” or “climb the Atlantic Ocean” (just stay with me here), but do you really want to look down at that list when you’re 85 and realize you’ve never cooked a decent meal in your life?

Cooking is like walking; it is a defining characteristic of humanity

Without getting all anthropological on you, cooking is arguably the one aspect of human evolution that allowed homo sapiens to separate himself from the rest of the animal kingdom.

If you don’t cook at least one dish, from scratch, in your life; then I submit you have lost a key part of the human experience.

Maybe you’ll never cook again after that one dish, but trust me, even creating one dish will be worth it.

A few basic tools are worth buying

Ok, enough preaching.

How do you get started in the kitchen? If you already own the laundry list of gear I went through above, it’s easy enough to get started. Most grocery stores sell pre-packaged raw ingredients that come with a recipe card.

Fantastic startups like Plated will even deliver the ingredients of a gourmet meal straight to your door.

If you don’t own the basics, they won’t set you back as much as you think:

One of the most highly rated knives online is just $40. And if you already own a chef’s knife, make sure to get a solid $8 knife sharpener.

I like a nice large plastic cutting board. Though some people prefer a smaller one. Whatever your preference, the real important thing to buy is a cheap roll of cabinet liner to put under your cutting board—it makes your cheap plastic board feel like an expensive heavy wooden one by sticking the board to the top of your counter.

And here’s where I’ll go against the recommendations of many food blogs out there and say that for the beginner cook, your best best is a 10” nonstick pan. Sure, you shouldn’t be searing steaks at blazing heats in a nonstick, but you can still get a decent crust in a nonstick and you run a lot lower chance of ending up with half your dinner stuck to the bottom of a skillet—a very serious risk for the beginner cook.

And finally, skip the spatula, and just grab a pair of these OXO Good Grups tongs with nylon tips. They are the ultimate multitasker in the kitchen.*

So what’s our total bill? Around $150. And that’s if you buy everything I just listed.

Now stop reading this post and go cook something.

*actually, chopsticks are the ultimate multitasker in the kitchen, but not everyone is good with those

Does Your Daily Multivitamin do More Harm than Good?

vitamins

We originally wanted to write an article about which multivitamins are best for healthy young people. But as we dug deeper into the topic, our research showed that a daily multivitamin is almost never beneficial and might even be harmful.

Too busy to read the whole article? [2000 words, a 9-minute read] Here are the takeaways:

  • The medical community agrees that healthy people do not need multivitamins.
  • Studies of multivitamin supplementation show increased risk of some diseases in those who take them.
  • The Medical literature has documented specific downsides to supplementing with Vitamins A and E, and calcium.
  • You probably don’t need a multivitamin; if you have symptoms related to malnutrition, consult a doctor.

If you’re anything like me, taking vitamins was a part of your daily childhood routine. Though, in truth, I cared more about which flavor Flintstone chewable I got than about what that mystery Barney/Fred/Wilma actually had in it.

As I outgrew my beloved Flintstones chewies, my vitamin usage dwindled and stopped through high school and college. But, by the time I made it into graduate school, I started getting paranoid about my health and wondered if I should begin taking vitamin supplements again.

As a Ph.D student in Molecular Biology, I’m no stranger to doing in-depth research, so I started researching vitamin supplements to determine which ones were worth prying open my (very) tight wallet for.

I was surprised by what I found. You see, nutrition research can often be a contentious field, with experts and researchers going back and forth on what’s really “good for you.” Which is why I was so surprised that peer-reviewed, placebo-controlled scientific studies have consistently shown that vitamin supplements are not only unable to prevent disease, but in fact may increase your risk of cardiovascular disease, cancer, and mortality.

In fact, the evidence is so concrete that in a public statement, the National Institutes of Health (NIH)1 said, “present evidence is insufficient to recommend either for or against the use of [multivitamins/minerals] by the American public to prevent chronic disease”.

 “present evidence is insufficient to recommend either for or against the use of [multivitamins/minerals] by the American public to prevent chronic disease”.

Regan Bailey—a nutritional epidemiologist in the Office of Dietary Supplements at the NIH—futher elaborated, “people have very strong beliefs about these products and I don’t know where they are getting their information… It’s not from the doctors. The majority of scientific data available do not support the role of dietary supplements for improving health or preventing of disease”.2

And yet, half of Americans take vitamin supplements today. Half. Besides the obvious role of marketing, why do so many of us allow ourselves to believe that vitamins are good for us with zero proof? Have we become a society that believes we can correct an unhealthy lifestyle with a daily pill?

Why we need vitamins and the downside of getting too much

We’re using the term “vitamin” here to refer to the organic compounds needed for your body’s proper function. For example, “vitamin A” is actually a group of organic fat-soluble compounds used in the eyes to maintain good vision. But we’re really also talking about minerals and inorganic compounds like calcium or potassium that serve similar necessary functions in the body.

There’s no denying that prolonged deficiency of certain vitamins can lead to illness and disease. The real question, though, is whether vitamin supplements are necessary for healthy individuals.

In the United States, if you eat a diet full of fruits, vegetables, and whole grains, you are most likely getting your full daily value of essential vitamins and minerals. And even if you eat a terrible diet, many types of processed foods are fortified with vitamins and minerals.

If you are taking a vitamin supplement in addition to eating well and consuming some fortified foods, you may be ingesting multiple fold over your recommended daily value (DV) of certain vitamins.

Multivitamins as a drug: an analogy

To visualize the downside of overdosing on vitamins, let’s consider an analogy.

Would you take a powerful antibiotic every day “just in case”?

Well, sure you would, if you lived in an area infested with malaria. In such a situation, you might take a daily dose of the anti-malarial antibiotic doxycycline. But, would you want to take doxycycline in a malaria-free region? Probably not, unless you’re a fan of daily nausea, headaches, and let’s just say…digestive discomfort.

What happens when you apply that same benefit vs. side effects analysis to your daily multivitamin?

If you knew you were at risk for a vitamin deficiency due to a poor diet or a preexisting medical condition, then you would perhaps consider supplementing to address that deficiency. But, if you were otherwise healthy and didn’t suspect a vitamin deficiency? The downsides of multivitamins could easily outweigh the benefits.

Multivitamins often contain 100% or more of your daily recommended value of Vitamin A, Vitamin C, iron, and calcium. Unless you aren’t consuming any nutritional food at all, you simply don’t need these supplements.

The downsides of supplementing with multivitamins

A very popular 2004 meta-analysis study from the University of Copenhagen examined the ability for antioxidant supplements (Vitamins A, C, E, and beta-carotene) to prevent gastrointestinal cancer in over 170,000 individuals. Their results found that these supplements were not only unable to prevent cancer, but actually significantly increased overall mortality by 6 percent.3

Another study by the same authors three years later found that in over 232,000 patients treated with another antioxidant supplement (Vitamins A, E, and beta-carotene) mortality rates were again significantly higher than in patients who received no supplement.4

Lastly, a 2011 study of over 38,000 older women found that women who used multivitamin supplements had increased mortality rates compared to women who did not use them.5 The fact that three separate studies with over 440,000 total participants show there is a significant increase in mortality associated with multivitamin supplement use should concern anyone who pops these pills daily.

Additionally, a 2007 study showed that multivitamin supplements (Vitamin C, E, beta-carotene, selenium, and zinc) increased the risk of skin cancer in women.6

Learn how we interpret and evaluate studies, and how you can too.

While it appears that multivitamin supplements may have alarming effects, can single vitamin supplements have deleterious effects, as well?

The downsides of supplementing with Vitamin A/beta-carotene

Vitamin A is a fat soluble nutrient that can be obtained either through animal sources or through fruit and vegetable sources as “pro-Vitamin A” (most commonly beta-carotene). The body then converts pro-Vitain A into Vitamin A through digestion. They’re basically the same thing from a practical standpoint.

Vitamin A is found in bright yellow and orange fruit and vegetable sources such as sweet potatoes (1 cup = 380% DV), butternut squash (1 cup = 300% DV) and carrots (1 medium = 200% DV). It can also be found in dark leafy vegetables such as kale (1 cup = 130% DV), spinach (1 cup = 50% DV) and broccoli (1 cup = 10% DV). Fortified sources, like most breakfast cereals, contain ~10% DV.

Unfortunately, beta-carotene (pro-Vitamin A) has been shown to increase the incidence of lung cancer in two separate studies. In a 1994 study, it was found that beta-carotene supplementation increased the incidence of lung cancer in male smokers by 18 percent.7 In 1996 the Beta-Carotene and Retinol Efficacy Trial (CARET) tested the combination of supplemental beta-carotene and Vitamin A in men and women who were at high risk of developing lung cancer due to asbestos exposure or an extensive smoking history, respectively. This study found that with supplementation there 28 percent more lung cancers developed and 17 percent more deaths occurred than those in the control. In fact, that study was discontinued 21 months early due to the obvious danger of this supplement combination in this patient demographic.8

The downsides of supplementing with Vitamin E

Vitamin E is a fat-soluble nutrient that can be found in wheat germ (1 tbsp = 100% DV), various nuts and seeds (1 serving = ~35% DV), as well as dark leafy vegetables and seed/vegetable oils. You can also obtain this vitamin through fortified sources like cereals (1 serving = ~40% DV). While it appears there are more limited sources of Vitamin E, studies with its supplementation have been shown to be concerning.

A 2005 study found that Vitamin E supplements had no effect on preventing cancer or cardiovascular disease, but actually increased the risk of heart failure.9 A separate study that same year found that in over 135,000 patients, supplemental Vitamin E was significantly correlated to increased mortality rates. The authors even went as far as to conclude that Vitamin E supplementation should be avoided.10 Lastly, a 2011 study in over 35,000 men reported that Vitamin E supplementation significantly increased the risk of prostate cancer.11

The downsides of supplementing with Calcium

Nearly every multivitamin supplement contains calcium and calcium supplements are highly recommended to women. The CDC has reported that 10% of women over 50 are afflicted with osteoporosis of the hip and so increasing calcium intake has become a concern for many women as they age. Great natural sources of calcium include yogurt (1 cup = 20-45% DV), dairy milk (1 cup = 30% DV) and tofu (1/2 cup = 45% DV). Some types of fish and various vegetables also contain calcium. Fortified sources such as soy or almond milk (1 cup = 50% DV) and cereals (1 serving = 25-100% DV) are easy ways to increase your intake.

Calcium supplements can be found not only in tablet form, but in tasty chocolate and caramel chewable form, as well. So can these supplements help protect your bones as you age? Not only have some studies shown that increased calcium intake does not protect you from bone loss, but can also increase your risk of cardiovascular disease. A 2007 study found that not only were calcium supplements unable to protect women or men from hip fracture, but that they actually put patients at increased risk for fracture.12 Results from four separate studies looking at the relationship between calcium supplementation and cardiovascular disease (CVD) indicate that calcium supplements are associated with higher CVD-related deaths.13,14,15,16

Conclusion: Treat vitamins and supplements with the same care you would treat any other drug

It’s just so easy to think of vitamins as a “nutritional insurance plan” and so many people take them that everyone thinks they must do something good, or at least do no harm. But, would you take a tylenol every day just because it didn’t make you feel worse?

Doctors are catching on to the research and starting to advise against vitamin supplementation.

With that being said, remember that I specifically researched the effects of vitamin supplementation on healthy adults, aged 25-35. Although I didn’t see any studies in the course of my research that specifically said children or seniors benefit from a daily multivitamin, I also didn’t look at those age groups in depth.

Also, just like any drug, vitamins can and should be prescribed for special cases. If you’re pregnant, your obstetrician/gynecologist will probably advise you to supplement with folic acid and if your doctor suspects you have a vitamin deficiency due to poor diet or a particular physiological problem, she might also advise you to supplement.

But for the rest of us? I simply could not find any real benefits to taking vitamins and there appear to be some pretty significant risks to healthy individuals or to those at risk for cancer or heart disease.

Your next action: stop taking multivitamins

  • As long as you are eating a diverse and healthy diet, it appears the “necessity” for vitamin supplements is unfounded. If you believe you are deficient in certain vitamins, increasing your consumption of natural sources is unarguably the best way to resolve the issue.
  • If you have more serious symptoms, consult a doctor. If they think you may have a deficiency, they may recommend a blood draw for nutritional screening or refer you to a licensed nutritionist or registered dietitian.

References:

  1. http://www.ncbi.nlm.nih.gov/pubmed/17332802
  2. http://consumer.healthday.com/cancer-information-5/mis-cancer-news-102/with-benefits-unproven-why-do-millions-of-americans-take-multivitamins-673173.html
  3. Bjelakovic, et al. (2004) “Antioxidant supplements for prevention of gastrointestinal cancers: a systematic review and meta-analysis.” Lancet: 364(9441), 1219-28.
  4. Bjelakovic, et al. (2007) “Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis.” JAMA: 297(8), 842-57.
  5. Mursu, et al. (2011) “Dietary supplements and mortality rate in older women: the Iowa Women’s Health Study.” Arch Intern Med: 171(18), 1625-33.
  6. Hercberg, et al. (2007) “Antioxidant supplementation increases the risk of skin cancers in women but not in men.” J Nutr: 137(9), 2098-105
  7. [No authors listed]. (1994) “The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group.” N Engl J Med: 330(15), 1029-35.
  8. Omenn, et al. (1996) “Risk Factors for Lung Cancer and for Intervention Effects in CARET, the Beta-Carotene and Retinol Efficacy Trial” JNCI J Natl Cancer Inst: 88(21), 1550-1559
  9. Lonn, et al. (2005) “Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial.” JAMA: 293(11), 1338-47.
  10. Miller, et al. (2005) “Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality.” Ann Intern Med: 142(1), 37-46.
  11. Klein, et al. (2011) “Vitamin E and the Risk of Prostate Cancer: The Selenium and Vitamin E Cancer Prevention Trial (SELECT).” JAMA: 306(14), 1549-1556.
  12. Bischoff-Ferrari, et al. (2007) “Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials.” Am J Clin Nutr: 86(6), 1780-1790.
  13. Michaëlsson, et al. (2013) “Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study.” BMJ: 346, f228
  14. Xiao, et al. (2013) “Dietary and Supplemental Calcium Intake and Cardiovascular Disease MortalityThe National Institutes of Health–AARP Diet and Health Study.” JAMA Intern Med.: 173(8), 639-646.
  15. Bolland, et al. (2010) “Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.” BMJ: 341, c3691
  16. Kuanrong, et al. (2012) “Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg)” Heart: 98, 920-925.