Tuesday, August 17, 2010

Bigger and Slower

     Bigger and Slower



     A recent study in Annals of Neurology, a well-respected medical

journal, described an inverse relationship between fat and brain size

in healthy middle aged adults. In other words, the fatter (especially around the abdomen, i.e. visceral fat) the subjects, the smaller smaller their brain. Bigger and slower. This is new. We have known

that obesity, particularly in midlife, is associated with an increased risk

of dementia (memory impairment) and Alzheimer’s disease. Studies have also demonstrated that

different fat compartments carry different metabolic risks, such that abdominal fat

is much more damaging than subcutaneous fat (the fat underneath your skin

throughout your body). So this is another piece of evidence, and a particularly graphic

one, that excess fat can really do us harm. We must ask ourselves why fat, that

supposed inert energy depot, is able to wreak such havoc.



Once again, we must go back in time and look at the environment

that selected for our genetic makeup. One of the most essential factors

in the survival of any organism is the acquisition of food, energy. It would make

sense for an animal to have sophisticated connections between

energy status, metabolic rate regulation (how fast we burn fuel) and reproductive functions.

If a famine is beginning, the animal’s intake decreases, it’s fat stores

dip, and that in turn sends a message that slows metabolism and shuts down

reproductive activity. This would provide the greatest chances of not only that animals own survival,

but also that of its offspring. So it should not surprise us that our fat

stores, the index of external conditions, send commands to every regulatory

system in our body.



THE PROBLEM: We do not live in the environment that formed our genome.

We are adapted to a world that disappeared long ago. We were hunter-gatherers

until the agricultural revolution 10,000 years ago, a tiny tick in time insufficient for

significant genetic adaptation. This was the the first huge shift in our diet, introducing

grains and domesticated meat, and dramatically narrowing the variety of plant foods.

We were much better nourished as hunter-gatherers than farmers. But at least we remained active.

The industrial revolution was the coup de grace. Our diet continued to

distance itself from its origins with ever more processing, and we no longer

had to move to eat.



Cut to the contemporary equivalent of the savannah, your local strip mall. You drive up to

the window and tell some youngster on minimum wage how many calories you want. This is

a far cry from persistence hunting where we chased down game until they died of

heat exhaustion in order to have dinner. (By the way, it suggests that we are

programmed to take a walk, if not a run, before dinner, not after.) The glut of calories

in conjunction with minimal or no physical activity, is incomprehensible to

our genetic makeup. We are getting big and slow. We have become our own

most dangerous predator.

Monday, August 16, 2010

A Hen Is Just An Egg's Way of Making Another Egg

     We like to believe that we consciously make choices, that we control our lives, that we have free will. We subscribe to the concept that there is one external reality that given the physical capacity of sight or hearing in the observer would be perceived by all. But this is not so. For the lawyer, the only thing worse than no eye witnesses, is two, because they will never describe the same set of events. I’d like to look at deception, and especially self-deception, from a Darwinian perspective. When considering this domain through the lens of evolution, we will see that rather than fostering the most accurate perception of things, we are adapted to see things in a way that lends us some advantage. A few examples will make this readily recognizable.



     First one must start with all the marvelous examples of deception that exist in other species. Nature has no love of truth. It’s about winning, which is to say living to reproduce. Some orchids resemble female wasps and thereby attract males that pollinate the plant. Harmless snakes take on the coloring of poisonous ones gaining greater safety. There are literally millions of examples of species taking on superficial characteristics that allow them to be perceived as something they are not when it confers a survival advantage. We are no different. The world is our stage, and yet there is a difference. While the innocuous snake who takes on the coloring of a poisonous one is under no illusions about its identity, we humans believe our P.R.



     Social scientists have provided us with an abundance of data that beautifully illustrate this point. One experiment made use of the fact that when we hear our own voices, our galvanic skin response (GSR, a measure of changes in the conductivity of our skin) is greater than when we hear someone else’s voice. An unanticipated finding was that people, when asked if they hear their own voice, are right less often than their GSR. But the erroneous observations are not random. When subjects have been put through some exercise that lowers their self-esteem, they identify their voice as their own less frequently despite persistently accurate responses by GSR. And correspondingly when they are made to feel greater self-esteem, they claim ownership of not only their productions, but also the voices of others, despite an accurate GSR. In other words, we may be capable of discerning external reality, but what gains consciousness is edited by some automatic function of which we have no awareness, that distorts our perceptions in predictable ways. It's not exactly breaking news, but we consistently overrate things like our skill, generosity, and accomplishment. We perceive our victories as examples of our superiority and our defeats as demonstrations of bad luck. This has been documented with lie detectors, i.e. we believe these distortions and are lying to ourselves.



     So we fool ourselves. But to what end?  The brain’s assignment is not to depict our environment in accurate detail. The brain’s task, that brain that has been selected by a million years of evolution, is to create the greatest chances of reproducing. This often means increasing social status, or appearing more appealing to a potential mate, or more dangerous to an enemy. If this can be accomplished more readily with self-deception, so be it. Language may have evolved simply to be the press agent for other parts of the mind. Back in the 1970’s Robert Tivers suggested that if deceit is fundamental to animal communication, then there must be strong selection to spot deception. Here's the catch. This in turn would select for a significant degree of self-deception, pushing some things out of consciousness, to avoid “by the subtle signs of self-knowledge” the manipulation in play. The best cons believe their own spiel.



Next time, I want to take a look at some of the forms this takes in the contemporary environment.

Sunday, August 15, 2010

Burger With A Side of Lipitor

     You could not make this up. Sure we knew that the fast food industry and pharma were natural partners, but we now have medical researchers joining the kabal, the perfect middle men.  Soon it may be possible to take your burger over to the condiment counter at your favorite fast food joint and grab a packet of lipitor by the ketchup and mustard tubs. They have suggested that such dosing of statins, the medications that reduce cholesterol and cardiovascular disease, could neutralize the risk associated with eating a quarter-pounder with cheese and small shake every day. The researchers suggest that it is unreasonable for individuals to be free to consume fatty food but not have equal access to a statin. I anticipate a right-to-statins movement.

     The idea is presented in the language of this being a natural extension of the right to health care. In order to embrace this thinking it is necessary to overlook some basic ideas such as; maybe an individual should be responsible for what he puts in his mouth, or if the government has the power to subsidize medicating disease caused by self-destructive behaviors why doesn't it have the power to make it either illegal or expensive to do such things, or why should people who take care of themselves pay the same taxes or insurance premiums as those who will be doubling up on the burgers and reaching for the statin pack?

     From a medical perspective, it is important to point out the limitations of this fast food/pharmacy approach. While statins may reduce cholesterol and cardiovascular disease, they do not safeguard against the other consequences of a fast food diet such as obesity, diabetes, hyperetension, and colorectal cancer, to name a few.  

     One other problem with this kind of thinking relates to risk homeostasis, which I've spoken about before. The theory states that when people think a situation is safe, they take greater risk, and vice versa. The example I'd used was when the auto industry introduced disc brakes, a great safety feature, accidents increased. People felt safer and drove more recklessly. This applies to the fast food med counter equally well. If I think you've just undone the risk of eating this burger, give me two of those babies!

     When the medical community is suggesting that if you're going to eat a certain food, you should take this medication so it doesn't make you sick and eventually kill you, maybe we should stop eating that food.

Saturday, August 14, 2010

I've Got Your Back

     Last entry we spoke about getting lost and map bending. Let’s backtrack and take a look at how that gets started, because it is such an insidious process. It’s so subtle that it goes unnoticed until we wake up one day in disbelief and don’t recognize where we are. This can take a million forms, a doctor saying “well now you have officially entered the obese weight range“, or “I‘m afraid your liver can no longer manage the alcohol“ or “that pain in your chest isn’t heart burn, it’s a heart attack”, or a news story revealing that a preservative in your favorite snack has been shown to cause cancer.



     As animals we are highly attuned to danger. Our nervous system has been fine tuned over the last million years to allow us to notice differences from what we anticipated and respond immediately with an elaborate reaction involving heightened alertness, increased heart rate, shunting blood where it will be needed, and adrenaline surges giving us maximum quickness and strength. In fact these things happen before the brain takes the time to send a message to our cortex letting us know what we’ve noticed, i.e. making it conscious. We’re talking milliseconds. That bought us survival. We are also very quick learners. When something seemed dangerous and didn’t cause a problem, we conclude either that it actually isn’t dangerous, or more often, that we have the skill/knowledge/immunity to manage it, and therefore it is not dangerous. The longer we do something unscathed the more convinced we become. Such learning is obviously essential to normal life. We don’t run for safety every thunder storm, or hit the deck every time a car backfires.



     The folks who study this aspect of human behavior call it “risk homeostasis” The premise is simple. We accept a certain amount of risk. This amount is obviously different from individual to individual. If we perceive a situation to have low risk we’re comfortable taking on more risk and vice versa, if it seems more dangerous, we take on less. Seems dead obvious. But the consequences of such thinking lead to some unanticipated consequences. When anti-lock brakes were introduced drivers felt safer and therefore took more risk. Motor vehicle accidents increased with the advent of a powerful safety feature. This is exactly what has happened in modern society generally. We think we are safe. If it’s packaged and on the shelf, it must be ok. We have become phenomenal risk takers because we assume someone’s got our back; the government, the FDA, our affluence, our good behavior, you name it. Obviously, on some level we know this is not true. But no matter how many stories we read or people we know whose luck runs out, we cling to this false belief, we bend the map of our world to make us comfortable. Knowledge, it turns out, is a weak motivator. Look at cigarette smoking. Demonstrating the link between smoking and cancer did not significantly reduce the number of smokers. The two things that most dramatically effected this behavior had nothing to do with health; making it illegal to smoke indoors and taxing the hell out of cigarettes so they were expensive.



     What seems to have real impact on behavior is experience, our own experience, not other unlucky people. That’s why history is destined to repeat itself. To use our own experience as the primary reference obviously is to use an impoverished data set. And as we all know, things that have never happened to us before, happen all the time. The only answer to this dilemma ironically is to regress. We must return to that stage of development where every statement we heard, every explanation, was meet with “Why”. Our curiosity must overpower the constant stream of “accepted truths” that tell us, everything is fine just the way it is.

Thursday, August 12, 2010

Getting Lost

     Last time, in "How Often Should I Exercise", I spoke about our evolution as a species and how we are the product of millions of years of refining an efficient hunting/grazing machine. Your average Homo erectus 2 million years ago, by today's standards, was a stupendously fit animal. He, like the few remaining members of contemporary hunter/gatherer cultures did not suffer from high blood pressure, diabetes, cardiovascular disease, obesity, arthritis or tooth decay. 2 million years later, in the United States, these diseases exist in epidemic proportions despite our modern medical. We spend more than $275 Billion on medications annually, making us the most medicated population in the world, and in the history of this planet. 40% of 18 to 44 year olds are already taking medication daily. Has this translated into longer lives. No. Japan ranks number one in life expectancy but does not make the top 10 in medication use. As the largest consumer of medications in the world, the US ranks 38th in life expectancy, just behind Cuba. You might wonder what types of medications are being taken in such vast quantities. The three most frequently prescribed medication classes are analgesics (pain killers), antidepressants, and antilipidemic/antidiabetic agents like the statins (Lipitor), and things that lower blood sugar. So we have become an overweight, depressed, pain-ridden animal. This bears no resemblance to our ancestors. What happened? How did we get so lost?

     The answer is so simple it is not seen. Scientist who study the behavior of people who get lost (literally, like in the woods or ocean or mountains) can help us understand how we could possibly have gotten so "far off the path."  Laurence Gonzales has written brilliantly about this in "Deep Survival", a must read. Those who get lost in the wilderness rarely backtrack. We'll come back to that idea. Like in any field, you have to start with definitions, and the students of what humans do when they get lost were no different. One definition of lost that got a lot of traction was "the inability to make a mental map match the environment." As we all know, feeling lost is a very uncomfortable state. Having no working mental map is experienced as a loss of self.  So we do some elaborate mental gymnastics to avoid acknowledging being lost. In orienteering lingo this is called "bending the map", trying to make reality mesh with what you want to see. Wilderness expeditions that get into trouble are usually characterized by this phenomenon. The lost party slogs forward convincing themselves that "this must be right" and rarely backtrack after thinking "I'm not seeing what I expected according to my plan, I must be off course." So when you're lost, you're not so much in the wrong location as in a compromised state of mind. And the efforts we make to reassure ourselves that we couldn't be lost take us further into the dark woods.

     So, here we are in 2010, overfed, undernourished and dying of diseases that we have brought upon ourselves, pouring hundreds of billions of dollars into health care for medications when we know what caused the illness and how to prevent it. Sounds lost to me. And there surely has been some serious map-bending. How many of us have normalized or pushed out of consciousness the fact that much of our food is poisonous in the sense that it is not only not nourishing but causes diseases that kill us? We are complacent because we don't realize that we are in the wilderness. We will not be rescued. We must find our way by seeing what's in plain sight but obscured by our wish that it is not so. They say that in the end, everyone who gets lost in the wild dies of confusion. Time to retrace our steps.

How Often Should I Exercise?

     If I had a buck for every time I was asked this question I'd be a rich man. It's a great question and exactly where I'd like to start today because it will begin to frame our conversation about what it means to be fit.

     My response to the question is to pose another; How often do you eat? I don't ask this to suggest that if you're taking in calories you better burn them or they will be stored as fat, although it's true. I ask because it  reminds me of our early life as a species and why Homo erectus didn't need a gym membership. He was moving all the time. And the main motivation to move was to eat. As a hunter gatherer, eating was inseparable from moving. We grazed and chased. And moving is the most important element of exercise. To be sedentary is to be sick. 2 million years of evolution designed us as exquisite movers unlike any other mammal.

     The evolution from Australopithecus to Homo erectus is an interesting story because it describes our birth. And believe it or not, it is all about our ability to move and what that allowed us to eat. Australopithecus was a pea-brained brute (brain 1/3 the size of ours) with a huge jaw to chew tough fruits vegetables and tubers. He stood a diminutive 4 feet tall, but he stood! This was progress and freed up the hands for future tool use. Enter Homo erectus, big brained and biped, long legged and armed with sharp teeth to tear meat. It was the addition of meat to the diet that provided the dramatic increase in calories, fat and protein to fuel the development and maintenance of a big brain. One can't help but wonder how vegans feel about this tidbit.

     Now you might ask, how exactly did he get the meat on his plate? A very reasonable question that created significant trouble for anthropologists for a long time. Remember, there were no fast-food joints and the first spear head dates back to around 20,000 years ago and H. erectus is enjoying his carnage 2 million years ago. To make a long and fascinating story less long, H. erectus practiced what is known as Persistence Hunting whereby he chased down his prey until it collapsed from hypertthermia. Not bad for a biped. The ability not to die in a similar fashion as the prey derives from our cooling system. Unlike the animals that were being chased and had to pant to cool, we sweated. Panting is perfect for sprints and that is what all mammals with coats need to survive, short bursts of extreme speed that require intense oxygen delivery to the muscle. The way this is achieved in these four legged creatures is by yoking the stride to breathing. So for instance, when a lion is galloping along, when its front feet strike the ground its guts slog forward compressing the lungs forcing a full exhalation and when it extends its legs, the guts slog back pulling the diaphragm back sucking in a turbocharged breath of air. This is great in the short-term but not sustainable. The beauty of sweating is that it allows for a disconnection of breathing, cooling and running. This is why, given sufficient distance, a human can outrun a horse, and in fact does, most Octobers in Prescott, Arizona in the 50-mile Man Against Horse Race.

     Now this may have been a long journey but the bottom line is that we were made to move everyday. That is the first and most important message. Your body doesn't care how you do it, but it will reward you if you do. You don't stop moving because you're old. You're old because you stop moving.

How Often Should I Exercise?

     If I had a buck for every time I was asked this question I'd be a rich man. It's a great question and exactly where I'd like to start today because it will begin to frame our conversation about what it means to be fit.

     My response to the question is to pose another; How often do you eat? I don't ask this to suggest that if you're taking in calories you better burn them or they will be stored as fat, although it's true. I ask because it  reminds me of our early life as a species and why Homo erectus didn't need a gym membership. He was moving all the time. And the main motivation to move was to eat. As a hunter gatherer, eating was inseparable from moving. We grazed and chased. And moving is the most important element of exercise. To be sedentary is to be sick. 2 million years of evolution designed us as exquisite movers unlike any other mammal.

     The evolution from Australopithecus to Homo erectus is an interesting story because it describes our birth. And believe it or not, it is all about our ability to move and what that allowed us to eat. Australopithecus was a pea-brained brute (brain 1/3 the size of ours) with a huge jaw to chew tough fruits vegetables and tubers. He stood a diminutive 4 feet tall, but he stood! This was progress and freed up the hands for future tool use. Enter Homo erectus, big brained and biped, long legged and armed with sharp teeth to tear meat. It was the addition of meat to the diet that provided the dramatic increase in calories, fat and protein to fuel the development and maintenance of a big brain. One can't help but wonder how vegans feel about this tidbit.

     Now you might ask, how exactly did he get the meat on his plate? A very reasonable question that created significant trouble for anthropologists for a long time. Remember, there were no fast-food joints and the first spear head dates back to around 20,000 years ago and H. erectus is enjoying his carnage 2 million years ago. To make a long and fascinating story less long, H. erectus practiced what is known as Persistence Hunting whereby he chased down his prey until it collapsed from hypertthermia. Not bad for a biped. The ability not to die in a similar fashion as the prey derives from our cooling system. Unlike the animals that were being chased and had to pant to cool, we sweated. Panting is perfect for sprints and that is what all mammals with coats need to survive, short bursts of extreme speed that require intense oxygen delivery to the muscle. The way this is achieved in these four legged creatures is by yoking the stride to breathing. So for instance, when a lion is galloping along, when its front feet strike the ground its guts slog forward compressing the lungs forcing a full exhalation and when it extends its legs, the guts slog back pulling the diaphragm back sucking in a turbocharged breath of air. This is great in the short-term but not sustainable. The beauty of sweating is that it allows for a disconnection of breathing, cooling and running. This is why, given sufficient distance, a human can outrun a horse, and in fact does, most Octobers in Prescott, Arizona in the 50-mile Man Against Horse Race.

     Now this may have been a long journey but the bottom line is that we were made to move everyday. That is the first and most important message. Your body doesn't care how you do it, but it will reward you if you do. You don't stop moving because you're old. You're old because you stop moving.
   

 

Tuesday, August 10, 2010

How Often Should I Exercise?

     If I had a buck for every time I was asked this question I'd be a rich man. It's a great question and exactly where I'd like to start today because it will begin to frame our conversation about what it means to be fit.

     My response to the question is to pose another; How often do you eat? I don't ask this to suggest that if you're taking in calories you better burn them or they will be stored as fat, although it's true. I ask because it  reminds me of our early life as a species and why Homo erectus didn't need a gym membership. He was moving all the time. And the main motivation to move was to eat. As a hunter gatherer, eating was inseparable from moving. We grazed and chased. And moving is the most important element of exercise. To be sedentary is to be sick. 2 million years of evolution designed us as exquisite movers unlike any other mammal.

     The evolution from Australopithecus to Homo erectus is an interesting story because it describes our birth. And believe it or not, it is all about our ability to move and what that allowed us to eat. Australopithecus was a pea-brained brute (brain 1/3 the size of ours) with a huge jaw to chew tough fruits vegetables and tubers. He stood a diminutive 4 feet tall, but he stood! This was progress and freed up the hands for future tool use. Enter Homo erectus, big brained and biped, long legged and armed with sharp teeth to tear meat. It was the addition of meat to the diet that provided the dramatic increase in calories, fat and protein to fuel the development and maintenance of a big brain. One can't help but wonder how vegans feel about this tidbit.

     Now you might ask, how exactly did he get the meat on his plate? A very reasonable question that created significant trouble for anthropologists for a long time. Remember, there were no fast-food joints and the first spear head dates back to around 20,000 years ago and H. erectus is enjoying his carnage 2 million years ago. To make a long and fascinating story less long, H. erectus practiced what is known as Persistence Hunting whereby he chased down his prey until it collapsed from hypertthermia. Not bad for a biped. The ability not to die in a similar fashion as the prey derives from our cooling system. Unlike the animals that were being chased and had to pant to cool, we sweated. Panting is perfect for sprints and that is what all mammals with coats need to survive, short bursts of extreme speed that require intense oxygen delivery to the muscle. The way this is achieved in these four legged creatures is by yoking the stride to breathing. So for instance, when a lion is galloping along, when its front feet strike the ground its guts slog forward compressing the lungs forcing a full exhalation and when it extends its legs, the guts slog back pulling the diaphragm back sucking in a turbocharged breath of air. This is great in the short-term but not sustainable. The beauty of sweating is that it allows for a disconnection of breathing, cooling and running. This is why, given sufficient distance, a human can outrun a horse, and in fact does, most Octobers in Prescott, Arizona in the 50-mile Man Against Horse Race.

     Now this may have been a long journey but the bottom line is that we were made to move everyday. That is the first and most important message. Your body doesn't care how you do it, but it will reward you if you do. You don't stop moving because you're old. You're old because you stop moving.

Monday, August 9, 2010

What Is Fitness?

     If you ask 10 people what it means to be fit, you will probably get ten different answers. What's particularly striking is this would still be true if you were talking to 10 health professionals, or 10 athletes, or 10 body builders,  or 10 philosophers, or 10 religious leaders. This lack of consensus reflects our times. While great advances have been made in medical science we have more obesity, diabetes, hypertension, and depression than ever before. For the first time in the history of the United States the average life expectancy of our children will probably fall below that of our own. As a culture, we have lost the traditions that created structure and meaning in our lives. Those traditions helped guide everything from a healthy diet to end of life decisions. We are the victims of our success in having created industries that "freed" us from long days of physical labor. What have we done with this "extra" time.

     I propose to explore the question of what fitness in the 21st century might look like in this blog. I'm not suggesting that the answers lie in the past. But there is no question that we've lost our way. Our remarkably evolved bodies are still capable of thriving if treated in a way that makes sense from an evolutionary point of view. This doesn't mean simplistic paleolithic prescriptions. Just the miraculous fact that information can be shared so easily with the internet holds amazing potential for a revolution in the way we live. We must start by questioning everything. For instance, why do we eat 3 meals a day? Why do we eat cereal for breakfast? Why so we eat fast-food? Why do we not sleep well? Why do we feel we don't have enough energy so much of the time? We must begin by looking at how the body works, what it has been adapted to do for thousands and thousands of years, what fuels it prefers, how it changes with age....

     These are just a few of the things I will explore on this blog. I will try to break it down and take small bites that define a situation and provide some practical tips. As a physician I have studied the human condition for almost 30 years and I continue to find it the most exciting topic out there. In order to think about fitness, we need to dabble in evolutionary biology, genetics, anthropology, nutrition, medicine, spirituality, kinesiology, psychology... It's endless. And that's the good news! What study could be more worthwhile. So, join me. Share your thoughts as we begin to explore fitness in the 21st century.