Category Archives: Fitness

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

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

 

 

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

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.

Yoga: How to start and sustain a healthy and holistic practice

I’m Kaitlyn, a writer, traveler, and serial exercise dabbler. Over the past three months, I’ve gone from complete yoga novice to nurturing a daily practice. In this seven-part series, I review the best resources, tips, apps, and gear to help even the most stressed-out and stiff-backed desk workers start a healthy, holistic, and life-changing yoga practice.

Here’s are the other posts I’ve written so far in this series:

Too busy to read the whole article? [1800 words, an 8-minute read] Here are the takeaways:

  • This is part 1 of a 7-part series. Follow-up articles will be linked here as they are published.
  • Habits are built through a series of trigger->routine->reward.
  • I test out DoYouYoga’s 30-day video program to see if it can help me build a habit.
  • I like the program, but I don’t like that it doesn’t give me time to meditate, which is very important to me.

Part 1 (of 7): How you can build a yoga habit in 15 minutes a day.

I don’t have any particular qualifications to write about yoga. My lifestyle is unremarkable—I don’t smoke, but I do eat meat and drink alcohol a few times a week. I over-salt my food. I stay up too late, I work too much, and I can’t remember the last time I woke up for the sunrise.

I used to live in Chiang Mai, Thailand, a laid-back city with a yoga scene of international repute. I would drop into a class every now and then, get a rush of endorphins, hug my teacher and pledge to be back in a few days. Then I would get busy and stressed out and forget. When I couldn’t maintain a perfect lifestyle and schedule, I’d get embarrassed and stop trying. This on-and-off cycle lasted for years.

With most fitness routines I get attached to keeping an ideal schedule, but when I can’t keep it up, my enthusiasm wanes. This makes it hard to make a daily practice stick.

Instead of rigorously planning my practice, I needed to make it into a habit. The Habit Loop helped me understand how a habit works—habits are caused by a Trigger, followed by a Routine, and that then leads to a Reward. For example, every morning I wake up (Trigger), make coffee (Routine), and drink it (Reward—both because of the caffeine and the comfort of fulfilling the habit with delicious hot coffee).

I already knew the Reward for doing yoga (it feels amazing). Routine gets more complicated, simply because there are so many kinds of yoga, and so many ways of doing it. We’ll cover some of the variations later on, but since we’re all beginners here, just trust me: it never ends. I realized my fitness plans never quite work because the best way to start a habit that sticks is actually to start very, very small.

Yoga instructor Laurence Gilliot agrees. “If I don’t feel like it, I tell myself ‘Ok, just five minutes.’ Then I start and often I end up doing more than five min. The hardest part is to get yourself onto the mat.”

“The hardest part is to get yourself onto the mat.”

So I definitely needed something short. I needed a quick routine that would help me build the fundamentals and the confidence to move to a longer practice later. Yoga is supposed to be fun and feel good, but like any new skill, there is a learning curve. I didn’t want my daily routine to be so challenging that it left me discouraged or constantly sore—I wanted to see if yoga fit as part of my daily life.

I started with the DoYouYoga 30 Day Yoga Challenge. In this program, instructor Erin Motz leads a different 10-20 minute routine every day, designed to introduce a total beginner to some basics of yoga and let them feel the benefits. You can either sign up for a daily email or find all the videos here or on YouTube. The daily email became my Trigger, and the video my short, achievable Routine.

DoYouYoga

30 days of free videos, via daily emails or download when-you-want

Price: Free

Pros:

  • No-pressure, short intro to yoga, with a motivational 30-day format
  • Easy way to sample some different kinds of yoga and different poses
  • If you’re sore, try a targeted Day to get straight into your problem area
  • After 15 minutes you feel the reward of the practice – and often want to do more

Cons:

  • A 15 minute practice doesn’t have the space to spend much time in any pose
  • Many comments were asking for advice when they found a pose difficult or painful – A teacher will be able to make adjustments if you’re doing something incorrectly and safely push you to go farther, but a video can’t
  • Since they are “bite-size,” the videos often do not make a coherent sequence if you double up, so if you want a longer practice, find a longer video class (more about this next time)

My experience with DoYouYoga’s 30-day challenge

Day 1: Opening up hips and back helps people (like me) who sit a lot. My lower back felt loose and warm with fresh blood flow all day. It’s also interesting to see that one side of your body can be more flexible than the other.

I liked the idea that committing to 15 minutes of practice every day would make it easier to add more time. Everyone can find 15 minutes each day to spare, right?

Day 2: Spending a lot of time in Downward Dog used to be impossible for me—my shoulders would pop out of joint and I would topple to the ground. It looks and feels like I am weak or off-balance, but actually I have an abnormality in my arms. If I hadn’t had a teacher show me how to work around this problem in a live class, I wouldn’t have been able to finish even this short routine, and I would have been totally demoralized.

All video classes have this disadvantage—they cannot accelerate your practice the way a few sessions with a live teacher can, especially if you have an injury or a health problem to work around.

All video classes have this disadvantage—they cannot accelerate your practice the way a few sessions with a live teacher can, especially if you have an injury or a health problem to work around.

Day 3: Focusing on the back and posture was a good counterpoint to days 1&2

It turns out even finding 15 minutes was tough. I would plan to wake up early, but end up sleeping in and then drinking more coffee instead. At night I would decide to meet up with some friends …

Day 4 & 5: I got busy. And the internet was too slow.

How frustrating. Why would I procrastinate about doing yoga? I like doing yoga… right?

The daily reminder email wasn’t helping – if I couldn’t start the video right away, it got buried in my inbox.

I was buying into my old habit again. I got anxious that I wouldn’t be able to do a routine the “right” way or that I wouldn’t be able to keep up the practice. Then I would avoid yoga. I needed to let go of these ideas before I could move forward.

The second time I tried to do Days 4, 5, and 6: The YouTube commentators and I are all surprised at how sore the short yoga-and-Pilates influenced routines make our abs and core. Day 6, focusing on the lower back, is a great relief.

So I gave up on the perfect schedule and squeezed my practice in between work and errands. I wasn’t sure how this would work with a longer daily practice, but I was finally doing yoga every single day, whether first thing in the morning or in the afternoon after hitting a deadline. This really built my confidence.

Pro tip: Instead of doing a routine when I got an email, I left my yoga mat unrolled on the floor where I would see it when I had time to practice.

Day 7: Crow pose always looked impossible and somewhat boggling. A clear explanation of a sequence and which muscles to strengthen made this seem much more achievable. Day 8 also demystifies Wheel pose.

I started to look forward to the daily video, and soon I was spending more time on the mat. I would start with some stretches at first and revisit favorite poses after a video ended. Some days I doubled up or tripled up, and I also stopped feeling guilty if I had to skip a day.

Day 9: More movement and the introduction of more balance poses. I love balance poses, and I really like doing these at home where I can control the length of the pose (and no one sees me fall over!)

Days 10 & 11: Some relaxing stretching through the side body followed by a restorative routine with plenty of time to unwind and quiet down.

I was missing something, though. My favorite thing about yoga is that focusing on your practice naturally quiets your mind down and moves you into a meditation.

Laurence calls yoga a “Meditation in motion” and says, “When I start my practice, I usually still have thoughts flashing through my mind. When I start to focus on my breath and movement, I get into ‘the zone’—I just become the movement. My mind slows down and is concentrated on what’s happening in the present. Stillness comes. If I am struggling with a question or a challenge in my life, in this moment of stillness, the answer arises by itself. This is a magical moment.”

In only 15 minutes I really couldn’t get “in the zone.” Meditation is a major part of the yoga experience, and it’s missing from these 15-minute videos, I think simply due to the short formats.

Pro tip: Consider pausing the video for a few minutes occasionally if you want more quiet space.

Day 12: How embarrassing. I hurried through the hand and arm sequence that looked “easy” and ended up straining my hand. Between that and the intense hip openers on Day 13, I was ready for a recovery day. These were good reminders to keep listening to my body, not my ideal of what I thought I should be doing.

After about two weeks, I’d learned that I could keep up with a regular practice and get excited about getting on the mat each day. I was willing to commit to 15 minutes of practice, and I often did 30-45 minutes once I’d started. I had also built the confidence to start doing longer routines. I was ready for more.

What I learned from 15 minutes a day for 15 days

1) Just start doing it! This isn’t the time to strategize or plan. Go to the videos or sign up for the daily emails. Do one video today, while you are thinking about it.

2) There is no way to “Win” the 30 Day Challenge, so treat the format as a guideline, not a rule. Do two in a day if you want. Pause the videos to stay in a pose longer if you feel like it. Try to stay roughly in sequence (don’t just jump to the end), but you can explore what you are interested in that day. This isn’t how the program is designed, (and, again, I am not a yoga teacher) but I got more out of these videos by using them as a jumping-off point, then listening to what I needed.

3) Conversely, if the 30 Day format is motivational and comfortable for you, stick with it—what do I know?

References

  1. Laurence Gilliot, interview. With six years’ dedicated practice of yoga with a wide variety of styles and gifted teachers, Laurence’s classes are inspired by Anusara, Vinyasa, Restorative yoga, Yin yoga and Ayurveda. Laurence has also studied Buddhist mindfulness meditation on several retreats with Zen-master Thich Nhat Hanh, co-facilitates a weekly meditation group and combines the Eastern practice of Buddhist psychology with the Western practice of Non-Violent Communication to coach both individuals and groups towards more fulfilled and joyful lives.

Erectile Dysfunction (and Function!) in Young Men

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Too busy to read the whole article? [1600 words, a 7-minute read] Here are the key takeaways:

  • Young men think of erectile dysfunction (ED) as an old man’s problem, but the problem is increasing in the young population.
  • Erectile dysfunction, particularly in young men, isn’t just about sex. It’s more likely an indicator of more serious health problems.
  • Worst thing you can do to “fix” your erectile dysfunction: pop pills without a prescription.
  • Best things you can do to fix erectile dysfunction: (1) Start with lifestyle changes (2) Have the guts to talk to your doctor

ED is increasingly becoming a young man’s problem

If my spam folder is any indication, there is an international epidemic of erectile dysfunction the likes of which the world has never seen before.

Not quite, but there is some cause for concern. We’ve known for some time now that long-term ED affects 5% of men at age 40. That figure goes to 15 to 25% of men by age 65.But, what about young men? Young men are suffering from ED at rates higher than previously considered normal. A recent study observed that 1 in 4 patients newly-diagnosed with ED was a young man and almost half of these young men suffered from severe* erectile dysfunction.2

*Severe ED: A patient is incapable of getting and maintaining  an erection to have satisfying sexual intercourse. The less severe cases can still occasionally get it up.

How do I know if I have ED or if it’s just a temporary issue?

I’m sure you’re aware that the main symptom of erectile dysfunction is the inability to achieve and maintain an erection for satisfying sexual intercourse.

There are three main reasons why you might develop ED: (1) physical problems, (2) psychological problems, and (3) problems caused by medication.3

Your doctor should advise you if any medication you’re taking could cause erection issues. So if it’s not medication, then your symptoms are either physical or psychological. Here’s a quick test: if you can get an erection when masturbating or still wake up at full salute, then your troubles are probably psychological.* Temporary contributors to erectile dysfunction include fatigue, stress, and relationship issues, among other causes.

For the purposes of this article, we’ll focus on physical causes of ED, since these may be indicative of more serious and permanent issues.

*The underlying problem may then be stress-related or caused by an over-indulgence with alcohol. Chronic alcoholism can negatively affect hormone metabolism or trigger the onset of a mental condition. One’s mental status can affect erectile function; e.g. anxiety, repeated life stressors (work, relationships), depression or psychosis. That’s as much as we’ll get into that here; leave us a comment a if you’d like to know more about psychological causes of ED.

Why penis health is a good indicator of overall health

There are three main health conditions* that, when affected, can lead to erectile dysfunction: (1) hormonal, (2) vasculogenic, and (3) anatomical.

Simply put, poor penis function can be an indicator of all kinds of other health problems.

Hormone disorders such as hypogandism can cause the body to produce incredibly low levels of testosterone, which in turn could decrease erectile function. But it’s not just sufferers of bona-fide disorders who should be worried about testosterone. There’s a strange endemic in modern society: the testosterone levels in young men are decreasing.4

Testosterone governs your interest in sex, the number of times you’ll want to have sex and the frequency of getting an erection. Suffice it to say, testosterone is a pretty big deal. And testosterone isn’t just about feeling more like a man or growing giant biceps. Testosterone affects a wide range of bodily functions from muscle growth to cardiovascular function.

Vasculogenic problems affect blood flow to the penis. The human penis is populated with a collection of arteries, all of which (except for 1) branch throughout the length of the penis.3 Under normal conditions when it’s time to perform, a man’s brain alerts the nerves in the penis, the arteries dilate (expand), more blood is supplied to the erectile tissue, and the penis becomes engorged with blood.

Think of the ability to get an erection as synonymous with proper blood flow throughout the body. Erection difficulties may therefore be indicators for larger issues with blood flow in general. A fully functional heart and a fully functional penis are a package deal (no pun intended).

Since cardiovascular disease can cause erectile dysfunction, think of ED as a warning sign for possible heart attack—not to be taken lightly.

Coronary artery disease (CAD) is caused by the blockage of the arteries that transport oxygen-rich blood to the heart. A build-up of plaque narrows the passage of the arteries leading to heart problems ranging from chest pain to a full-blown heart attack. CAD is the foremost cause of death for both men and women in the United States. Since cardiovascular disease can cause erectile dysfunction, think of ED as a warning sign for possible heart attack—not to be taken lightly.5,6,7,8

Anatomical disorders of the penis can lead to ED. For example, pudendal nerve entrapment is characterized by reduced or complete loss of penile sensation and experiencing pain when sitting.3 This nerve can be blocked or damaged due to accidents or excessive riding on hard and narrow bicycle seats.

*Neurogenic conditions can also affect penis function. These include spinal cord injuries, stroke, and other ailments affecting brain function. The brain sends signals to the penis when it’s time to perform; if those messages can’t get to the penis, it stays flaccid even if everything else is working. You’ll probably know if you have one of these conditions due to other, more serious symptoms, which is why we’re leaving it out of our discussion of ED.

Erectile function: How to prevent ED and improve penis function

Lets assume you’ve ruled out neurogenic and anatomical disorders as causes for ED. That leaves testosterone levels and vasculogenic (cardiovascular) health.

As it turns out, you can boost testosterone levels while also improving cardiovascular health with the exact same lifestyle changes. The basic prescription? Exercise (with weights!) and watch what you eat. Don’t pop pills.

Don’t fall for the “erectile enhancement” ads. The drug companies would love for us all to believe that our greatest fears and challenges can be solved with a single pill. The truth, however, is that any medication designed to treat ED will have consequences throughout the body, for all the reasons we discussed above. That’s why many men with pre-existing conditions can’t take oral medication. These conditions include heart problems, recent history of stroke, eye problems and kidney disease. On top of that, some medications to treat other conditions interfere with the actions of ED meds.9 Basically, what we’re saying is: consult a doctor before trying any sort of medication or supplement for ED.

Exercise with weights. The exact explanations for why exercise does so much good throughout the body is still a little foggy, but specific research has proven that men who are physically active overall have better erectile function.10 Here’s one particular study of interest: obese men with ED were put on a calorie-restricted diet for two years and were advised to be more physically active. Not only did these men lose quite a lot of weight but the severity of their ED was also decreased.11

Another study showed that exercise alone can help preserve erectile function even if you don’t adhere to a healthy diet.12 The only caveat: if you do eat junk food, you need a higher level of physical activity to maintain erectile function and cardioprotection. Why do we specifically think weight training helps? Because weight lifting can significantly increase testosterone levels while improving cardiovascular health.13

Watch what you eat. As you can probably imagine, obesity has been associated with all sorts of negative effects in the body. Rather than generalizing about obesity, let’s look at specific factors that contribute to ED. People who eat a Western Diet generally consume an excess amount of refined carbohydrates (sugars) and a harmful mix of fats. Chronic high levels of blood glucose (too much sugar in the blood) causes the blood to get thick, which means it becomes much harder for the heart to circulate blood to the extremities. As you might imagine, poor circulation to the penis can mean chronic ED.

There are two main arguments for which fats are worst in the Western Diet. Some research has shown that excess consumption of saturated fats are linked to high cholesterol and high blood pressure, two factors that then lead to heart disease. Others argue that the ratio between Omega-6 polyunsaturated fatty acids (PUFAs) and Omega-3 polyunsaturated fatty acids is more important. Continued, excessive omega-6 PUFA intake has been linked to the development of breast and prostate cancer, inflammation and arthritis.14

Penis, penis penis. Please don’t be afraid to talk about your PENIS.

Listen, guys: if there’s anything you should take from this article it’s that you need to watch out for erectile dysfunction and address it with your doctor if you think it’s an issue.

A line from above bears repeating: proper penis function and proper heart function are a package deal. More than likely, your prescription will simply be some intervals and weights. But, you’ll also be making sure your penis problems aren’t hiding more serious health issues.

Your next action: ask about your erectile health

  • If you’ve been having long-term trouble with erectile function, schedule a visit to a doctor immediately and make sure to get a full physical. ED in young men could be an indicator of more serious cardiovascular or hormonal problems
  • If you’re happy with your ability to get and maintain an erection, still consider a weight-training exercise regimen and watching what you eat to prevent the onset of ED as you get older.

Alright gents, let’s keep it clean in the comments, but I encourage you to talk as much as you want (for once) about your penises.

References

  1. Erectile Dysfunction Basics, WebMD
  2. Capogrosso, P et al. One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man—Worrisome Picture from the Everyday Clinical Practice. Journal of Sexual Medicine, 10: 1833–1841, 2013.
  3. Erectile Dysfunction, Mayo Clinic [last accessed: 23-09-13]
  4. Travison, T.G. et alThe Relative Contributions of Aging, Health, and Lifestyle Factors to Serum Testosterone Decline in Men. JCEM 92:1, 2007.
  5. BMJ-British Medical Journal (2008, October 22). Erectile Dysfunction Gives Early Warning Of A Heart Attack, Warns ExpertScienceDaily.
  6. What is Coronary Artery Disease?, NIH/NHLBI [last accessed: 23-09-13]
  7. Mayo Clinic (2009, February 8). Younger Men With Erectile Dysfunction At Double Risk Of Heart Disease. ScienceDaily. Retrieved August 29, 2013.
  8. Vlachopoulos, CV et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systemic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes 6: 99-109, 2013.
  9. Erectile dysfunction: Viagra and other oral medications. Mayo Clinic.
  10. Joyner, MJ and Green, DJ. Exercise protects the cardiovascular system: effects beyond traditional risk factors. J Physiol 587: 5551-5558, 2009.
  11. Esposito, K et al. Effect of lifestyle changes on erectile dysfunction in obese men. JAMA 291: 2978-2984, 2004.
  12. Hsiao, W et al. Exercise is associated with better erectile function in men under 40 as evaluated by the international index of erectile function. J Sex Med 9: 524-530, 2012.
  13. Fry, A.C. and Lohnes, C.A. Acute testosterone and cortisol responses to high power resistance exercise. Human Physiology, 36:4  pp 457-461, 2010
  14. Omega-6 Fatty Acids. University of Maryland Medical Center [last accessed: 23-09-13]

More reading

  1. Banks, E. et al. Erectile Dysfunction Severity as a Risk Marker for Cardiovascular Disease Hospitalisation and All-Cause Mortality: A Prospective Cohort Study. PLOS medicine, 2013.
  2. La Favor, JD et al. Exercise prevents Western-diet associated erectile dysfunction and coronary artery endothelial dysfunction: response to acute apocynin and sepiapterin treatment. American Journal of Physiological Regul Integr Comp Physiol, 2013.
  3. La Favor, JD et al. Erectile dysfunction precedes coronary artery endothelial dysfunction in rats fed a high-fat, high-sucrose, Western pattern diet. J Sex Med 10: 694-703, 2013.

The Best Free Resources for Yoga

I’m Kaitlyn, a writer, editor, traveller, and serial exercise dabbler. Over the past three months, I’ve gone from complete yoga novice to nurturing a daily practice. In this seven-part series, I review the best resources, tips, apps, and gear to help even the most stressed-out and stiff-backed desk workers start a healthy, holistic, and life-changing yoga practice.

Here’s what I’ve written about so far:

Today, I’ll share the resources I found as I started my first foray into yoga. Some were more helpful than others, but all of them were free.

Too busy to read the whole article? [2300 words, an 11-minute read] Here are the takeaways:

  • There is so much free yoga online.
  • DoYouYoga offers a great 30-day intro to yoga, but I found that the flows were too short for me to get the benefits of meditation.
  • Do Yoga with Me was my favorite resource. It offers a wide range of video lengths and styles and a beginner’s plan.
  • Yoga Journal has shorter videos, but 360 degree video explorations of different poses are incredibly useful.
  • There’s always YouTube, but searching “Beginner’s Yoga” gets overwhelming. I recommend a few videos and share my search technique.
  • If you like to do your research before jumping into things, look up Sun Salutations12 and Vinyasa (breath control). I found these concepts extremely helpful as I sustained my practice.

After two weeks using the 30-Day Yoga Challenge to create my habit, I started checking out other free online yoga. The biggest problem I had with the 30-Day Yoga Challenge was the fact that the short routines didn’t give me enough time to meditate and reflect. I also wanted to build my understanding of yoga, my confidence to keep going, and my physical ability to do the poses.

So I was looking for:

  1. Videos about an hour long. Since many studio classes are about an hour long, this seemed like a good place to start.
  2. Good routines for relaxation.
  3. Good routines for an athletic challenge.
  4. A breakdown of basics to improve my foundation.

I checked out a handful of resources recommended to me by friends who had experience with learning or teaching yoga. These were my favorite resources.

YouTube

Let’s start with the most obvious place to find free yoga videos. YouTube is where I started and it’s how I found DoYouYoga’s 30-day yoga challenge that I tried for, well, about 15 days.

But search YouTube for beginner’s yoga and you’ll find 370,000 results. It’s boggling.

I did find a few good beginner videos:

With that being said, I wouldn’t recommend randomly searching YouTube as a beginner. Instead, try one of the other beginner’s program I write about below, then come back to YouTube when you know what you want.

Example good yoga videos on YouTube:

That’s just a tiny sampling of the videos out there. Obviously, some are better than others—choosing the right video is a combination of being familiar with a particular instructor and knowing the exact type of flow you want.

DoYogaWithMe

I spent about a week with the videos from DoYogawithMe. The site displays each video’s length, average rating, and a few lines of summary before you click through, so it’s easy to quickly find what you want. Reviews from other beginners are under each video, which is helpful with videos like Beginner Basics in Flow which some viewers found very challenging. They also offer donation-based curated routines.

  • Burnout to Bliss is a nicely paced, hour long beginner’s routine. Great transition from the 30 Day Yoga challenge.
  • Seated Whole Body Hatha Yoga Flow is a series of gentle stretches that can become quite powerful and leave long-lasting warmth and looseness in your body. The instructor here goes really deep—you probably won’t be able to, so don’t feel pressure.

Yoga Journal

I spent the next week with Yoga Journal’s video resources. These were harder to choose from, since you have to click through to see video length and there are no reviews. Their routines are generally more technical, more likely to use Sanskrit terms, and more athletically challenging than those on DoYogaWithMe. Plus, most of Yoga Journal’s routines were shorter than an hour, which is less time than I needed to get into a meditative, head-clearing state.

With that being said, I did find a few of their videos useful:

  • The Morning and Evening sequences are short, gentle, and meant to be done twice a day (one in the morning and one in the evening—duh?).
  • Strengthen your Core was the opposite: this athletic, dynamic routine with some arm balance will tire you out. I think it’s best suited for someone who is already in good shape but is looking to try some yoga. For this flow you really need two blocks to put your hands on so you can jump your body through your arms. Blocks can stabilize you in poses where one hand is on the ground, or improve your alignment. Until I got a great set of heavy cork blocks (more about that in a future article), I used a big, heavy book instead.

While it was tough to find the routine I wanted on Yoga Journal, I came back to the site for their invaluable 360-degree video explanations of different poses. I returned to these over and over while learning the basics of a Sun Salutation, the basis for many modern yoga routines.

Learning basic postures (asanas) will quickly make you more comfortable. You’ll pick them up as you go, but if you prefer to study ahead of time, you can use Yoga Journal to learn these poses:

  • Tadasana (Mountain Pose)
  • Urdhva Hastasana (Upward Salute)
  • Uttanasana (Standing Forward Bend)
  • Lunge
  • Plank Pose
  • Chaturanga Dandasana (Four-Limbed Staff Pose)
  • Urdhva Mukha Svanasana (Upward-Facing Dog Pose)
  • Adho Mukha Svanasana (Downward-Facing Dog Pose)

Other sites I looked at

Some yoga teachers host videos on their websites, such as Yoga with Adriene. If you find a teacher you like on another a video site, try Googling their name and seeing if they have a personal site with free videos.

My Free Yoga and Free Yoga Videos both host hundreds of free videos. But they weren’t as easy to navigate as DoYogaWithMe and their videos didn’t feel as curated. These sites have more videos because users can upload their own, of varying quality. I liked sites with more oversight, even if it meant fewer videos to choose from.

Some other websites offer free yoga classes, but these are part of a free trial or restricted to a small portion of all their videos. I’ll talk more about the limited free trials for paid sites in a later article (link will be updated here when it’s posted).

The Limits of Free: Injury and Asking for Help

While doing all of this yoga, my body felt great—until it didn’t. One major downside to practicing from videos vs. learning from a teacher is that it’s easier for a beginner to injure themselves. I was really into my new practice, but I pushed it too hard and had to learn to practice more safely.

I’m naturally flexible, so I tend to like stretchy routines. I realized, though, that I had hurt myself because I was doing too much stretching and not enough strengthening.

I started feeling weird popping noises around my left knee and aching at the base of my neck. With any new exercise, it’s normal to feel some new aches and pains while your muscles adjust.3 When you release tight muscles as you start doing yoga, it impacts your overall posture and muscles in unexpected places across your body, which might make you sore. Since I’m a desk worker, I wasn’t surprised that waking up neglected neck muscles was uncomfortable—they always get sore when I exercise my upper body, and the sensation was familiar.

But, according to instructor Laurence Gilliot,4 any sharp pain means you should slow down and come out of the pose that caused the pain.

My knee stayed sore when I was resting, with sharp pains around my kneecap and the back of the joint. When I couldn’t sleep one night because my knee hurt, I knew something was really wrong. I worried I was feeling a symptom of misalignment—when doing a pose incorrectly and repeatedly harms your body.

Then I asked Laurence about what I was feeling and went to a couple of beginner’s classes. We’ll talk more about classroom lessons next time, but I found that in-person classes were the quickest way to check my alignment and make sure I practiced correctly from the beginning.5

In class, teachers are there to help you. If you are experiencing pain, ask for an adjustment. One caveat: beware that aggressive adjustments from a teacher can sometimes worsen injuries,6 so it’s important to listen to your body and take responsibility for your own safety—more on this next time.

Sustaining the Practice and Next Steps

I’ve often heard that it takes 21 days to cement a new habit (even though some evidence suggests otherwise7). Regardless, at three weeks into my (nearly) daily yoga practice, I felt great. I had more energy and less stress. I was even waking up early to do yoga each morning, and I hate waking up early. I had either stuck the habit or just caught beginner’s enthusiasm—either way, I was happy.

This was also when I began to see—not just feel—changes in my body. It wasn’t dramatic, but I noticed more definition in my arms, shoulders, and legs, which was surprising because I was intentionally leaving the rest of my lifestyle unchanged. While bodyweight exercises and weightlifting have given me much more dramatic results more quickly, the benefit of yoga was that I wasn’t forcing myself through difficult routines and I always finished up feeling energized and relaxed instead of sore.

By the sixth week my practice felt, well, stable. I wasn’t as excited by the novelty of yoga, but it was something I did steadily. I spent more time thinking about what kind of practice I wanted when selecting videos, and I had picked several favorite video I kept going back to. I wasn’t necessarily doing an hour every day, but I usually managed more than 45 minutes five times a week.

And I finally found the peace of mind I was looking for.

I learned to keep my movement attuned to my breath. This is called Vinyasa.8 It was tricky for me, but it’s become one of the most important physical aspects of my yoga practice.

Mindful Vinyasa is a major part of how yoga helps your mind, and provides helps to relieve stress.9 In my opinion, Vinyasa and breathing exercises like Pranayama10 are part of what makes yoga a more holistic practice than just stretching or resistance training alone.

Your Next Action: Try a Few Videos

  • I still think DoYouYoga’s 30-day plan is a good way to get started. Try a few of their videos.
  • Next, head over to DoYogaWithMe and try their Burnout to Bliss or the Morning and Evening sequences.
  • Keep exploring or, if you like structure, sign up for DoYogaWithMe’s beginner program.
  • If you’re not following a curated plan, be sure to vary your routine. We tend to like to do what we are already good at. If you try different routines and styles you’ll find some surprises, and developing strength, flexibility, and balance will keep your body safe.
  • Try some Vinyasa routines. It’s fine if you can’t do it the entire time, but you want to bring your attention back to your breath when your mind wanders. This practice will help you get the most from Yoga.
  • If you have the time and ability, go to a couple of beginner’s classes. Even if you want to do the majority of your practice at home, it’s important to check in occasionally with a teacher so you don’t teach yourself bad habits. We’ll talk more about how to choose a class in my next article.

Notes:

  1. Wikihow, How to do the Sun Salute ↩
  2. The Art of Living, How to Do Surya Namaskar
  3. Eliza Martinez, Sore Muscles After Yoga. azcentral.
  4. Laurence Gilliot, Interview. With six years’ dedicated practice of yoga with a wide variety of styles and gifted teachers, Laurence’s classes are inspired by Anusara, Vinyasa, Restorative yoga, Yin yoga and Ayurveda. Laurence has also studied Buddhist mindfulness meditation on several retreats with Zen-master Thich Nhat Hanh, co-facilitates a weekly meditation group and combines the Eastern practice of Buddhist psychology with the Western practice of Non-Violent Communication to coach both individuals and groups towards more fulfilled and joyful lives.
  5. In addition, Laurence recommended keeping my quads engaged during forward folds to protect my knees, and after reading up I now practice forward folds and some other stretches with a small bend in my knees to protect my hamstrings.
  6. Ivy Markaity, Good Pain vs. Bad Pain? How to Protect Yourself in Yoga Class. HealthCentral
  7. Ben Gardner, Busting the 21 Days Habit Formation MythHealth Chatter: The University College London Health Behaviour Research Blog.
  8. You’ll see some yoga routines described as a “Vinyasa flow,” which means you’re expected to transition between poses according to your breathing.
  9. Alex Korb, Yoga: Changing the Brain’s Stressful Habits. Psychology Today.
  10. Alisa Bauman, Is Yoga Enough to Keep You Fit? Yoga Journal.

Can lifting heavy weights make you bulky? Not if you’re a woman.

woman weight lifting

We combine personal experience, three expert opinions, and a healthy dose of scientific research to explain why most women simply won’t get bulky from lifting weights.

Too busy to read the whole article? [1600 words, a 7-minute read] Here are the takeaways:

  • Women lack the right balance of hormones, testosterone and growth hormone, to put on muscle mass the way men do.
  • When women start lifting, they complain of getting bulky because of a combination of fluid retention, inflammation and plain old “feeling ‘swole”
  • Even if you lift enough to put on some weight, many women [and men] prefer the change in body composition.
  • Supplements. Men and women react very differently to pre-workout supplements. Find out what supplements women can use to booster their performance in the gym.

irst off, let me explain my perspective. I took up competitive weightlifting in my 30s and ended up being pretty good at it—in 2011, I broke the American Powerlifting Association record for the squat in my weight class. I tell you this not to brag, but to explain that I wrote this article not as an outsider, but as someone who has actually lived through the training and science we’ll dive into below. (I also ended up overtraining my way into an ugly injury, but that’s another story for another day — stay tuned.)

When I started training, I never got bulky and I never needed to intentionally increase my mass. In fact, I dropped a pant size or two while I traded some cushy padding for clearly defined muscle. But one woman’s experience does not fact make. So I turned to a couple of experts for their input.  Dr. Krista Scott-Dixon, founder of Stumptuous.com, is the Lean Eating Program Director at Precision Nutrition. And Jerry Handley is a West Virginia University strength coach who works primarily with female athletes.

Women can get bulky, but it’s very difficult

Let’s get right to it. “It is possible for women to get bulky,” Jerry said. “But it is highly improbable. They don’t hit the perfect storm of variables needed.”

How improbable are we talking? “Less than 1/10 of one percent of women are going to hit it,” he said. “It’s going to take a huge amount of consistent long term effort, consistently applying yourself to training – not just recreational [working out]. And it’s going to take a big nutrition push.”

Simply put, women aren’t built the same way as men are and we do not gain muscle mass as easily. According to Jerry, although “the hormonal situation while lifting causes the same triggers in men and women,  men elicit – minimum –  10 times more anabolic hormones than females do, particularly testosterone, which is what actually encourages muscle growth. Even though females can train just as hard and put in the effort to eat, their actual response is much much smaller and slower than a guy’s.”

Or, as Krista put it, “men’s muscles are bathing in a testosterone soup.”

Let’s talk more about those anabolic hormones.* Two things are going on here. Testosterone is stimulated when you lift heavy. What does heavy mean? Jerry defines it as “anything they can do a max of 6 times.” That’s the rep range, according to Jerry, that elicits the highest testosterone. When you “feel the burn,” on the other hand, doing higher volume or spending more time under tension, that’s when you’re stimulating growth hormone. “Women are typically worried about lifting heavy because they think it will make them big but really, while the testosterone will help the muscles repair, it’s not enough to make the muscles much bigger,” Jerry said. “Especially when they’re dieting, lifting heavy can help them retain their muscle mass and retain their strength.”

*Hormones are naturally-occurring chemicals that trigger organs and muscles to perform actions within the body. There are two basic types of hormones involved in normal metabolism: anabolic hormones generally “build up” tissues while catabolic hormones break down tissues for energy. This is a really simplified explanation; we’re working on a full-blown article on hormones and we’ll link it here when it’s ready.

Since few women actually get bulky from lifting heavy, why do so many of us think we do?

Aside from the  very small percentage of women whom Krista called “genetically gifted, hormonally ready easy gainers,”  what’s with all the cries of “I get big!”? Even Jerry sees it with his college athletes. “When it’s the first time they’ve done serious weight training, at least half of them are worried they’ll get bulky,” he said.

Culprit #1: Self Perception

“The first thing to remember,” Krista told me, “is that our self-perception is generally inaccurate. We are all very poor judges of ourselves. I’ve had women swear they were growing giant biceps, and flex for me, and I can’t see anything. But they FEEL like their guns are getting swole. So that’s their reality. The same is true of the FEEL of body composition. Few people truly have the self-awareness and accurate perception to gauge body changes.”

Culprit #2: Fluid retention

Krista explained: “In the early stages of training, you get a lot of inflammation and the muscles draw in glycogen and water. (By way of simplified explanation I say that muscles are “fluffing up” although that is not really what happens; it’s just a handy visual.) The fluid retention and inflammatory process is what causes the stiffness and soreness, same as what happens if you sprain your ankle and it swells up. So, women will train for a couple of weeks and swear they have ‘bulked up’ — and perhaps they have, but it’s not muscle.” And that means it’s not permanent.

Culprit #3: Eating more

“Many women consciously or unconsciously eat more to compensate for an increased training load,” Krista continued. “Some are just hungrier; others deliberately eat more because they think they need it to support their training. More food = more mass… but not always muscle. Most people don’t realize how much body fat they’re actually carrying. I like to show an MRI cross section of an average woman’s thigh to give them the idea. The light/white area is fat; the dark/dense area is muscle. You can see the bone as a circle in the middle.”

Sort of #4: Muscle gain… eventually

“Now, I really do hate to put a figure on it, but we are probably looking at no more than 1-2 lb/month of lean mass gain on average, tops,” Krista told me. “Even 18 year old boys don’t add as much muscle in a short time as some women swear they do.”

Jerry agreed. When you’re new to working out “your system hasn’t learned how to use the muscle fibers enough to create the muscle damage which creates growth. It’s almost completely nervous system,” he explained. “They may look more toned but actual muscle growth is almost impossible in the first few months.”

To sum it all up, “I think what women are often responding to is a different feel rather than an empirical reality,” Krista said. “The body does feel different… it’s just that their interpretation of why that feels different (i.e. the assumption that it’s muscle, and not fluid retention, which is much more probable) is often incorrect. The only way to truly know what’s what is to get regular, accurate body composition measurements. Otherwise it’s just speculation and rampantly imprecise self-perception.”

What actually does happen when women lift heavy?

When Jennifer Hudy‘s boyfriend showed her an article from Nerd Fitness with before and after photos of a girl who lifted, she was heavier in the ‘after’ photo. “She was no longer skinny-fat; she was quite fit,” Jennifer said. “I had never heard of skinny-fat but then realized that was exactly what I was. My build was skinny, but just skinny and nothing more. I envied her body and wanted to look like that!”

Using The New Rules of Lifting for Women program, Jennifer “ended up gaining eight pounds in six months. To see the scale going up was quite intimidating, but since I never had a weight issue it really didn’t bother me too much because I liked the way my body was shaping up.  Not only was my body significantly changing for the better, but my attitude about myself and my self-confidence skyrocketed.”

At the end of the day, lifting weights will change your body. But that’s the whole point, isn’t it?

It feels like a cop-out to say it, but the changes in appearance induced by exercise will be different for each woman. Once again, hormones play a critical role. “Some women with healthy levels of estrogen and progesterone will see body recomposition that reinforces the hourglass shape,” Krista said. On the other hand, “many powerlifters notice that their waist thickens–not from fat, but from the increased mass and density of the spinal erectors, which are powerful spinal support muscles required for a strong deadlift. Many women in upper-body-demanding activities (such as boxing or rowing) may find their bra size changes as their back muscles develop.”

And that’s just what we can see going on. For me, my bone density shot off the charts. Like Jennifer, so did my self confidence. Once you know you can take on a freaking intimidating weight, things that used to worry you seem a lot less scary.

How does lifting heavy compare to low-weight-high-reps?

So I think we’ve made a good case for why lifting heavy weights can help transform a woman’s body without making her get bulky. But, there’s an inherent risk to getting started with weightlifting. Plus, there’s the cost of weights, a coach to correct your form, etc. Is it worth it?

Without going too much down the rabbit hole, there does seem to be some evidence that traditional workout regimens for women actually do more harm than good.

When I asked Jerry about this, he told me “The idea of … doing higher reps and smaller weights [has] pretty much been shown over and over that it’s a crappy idea. It is completely against what the body actually does.” Here’s why: “If you do high volume and cardio and take in lower calories you’re using too much energy [thereby] encouraging your body to break down muscle mass.” And if you’re body isn’t producing the testosterone necessary to put on muscle, any excess calories you intake after a hard workout are more likely to be stored as fat.

We’ll go into loads more details on specific workouts in future articles, but I thought Jerry’s explanation was worth sharing.

Your next action: get started

Here are some ways you can get starting weightlifting for body recomposition. We’ll update this section as we find more resources and as you leave us comments below.