Gun Mathematics

James Holmes went to the movies and shot 142 people. Wade Page entered a Sikh temple and gunned down 9 citizens. 31,513 people were killed by firearms in 2010 in the United States. (1) It remains remarkably easy to obtain firearms in most states.

One man, Richard Reid, boarded flight 63 from Paris to Miami on December 22, 2001 with plastic explosives in his shoe. The fuse failed to ignite. Reid is serving a life sentence in a supermax prison that houses the most dangerous prisoners in the federal system. All airline passengers since Reid’s attempt must remove their shoes so they can be scanned for bombs.  

How do we make sense of the different responses?

To put the question another way, how do we compare the association of shoes with bombs vs. the association of firearms with mortality? What would the equivalent of the new transportation safety regulations be for guns?

Is this simply a matter of the relative impotence of the shoe lobby compared to the gun lobby?

A brief review of the statistics lends some clarity to this uniquely American situation.

Firearms are one of the top 10 causes of death in the US. (1) In a 2003 World Health Organization study, the US was compared to 20 other high-income countries (Australia, Austria, Canada, Czech Republic, Finland, France, Germany, Hungary, Iceland, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Slovenia, Spain, Sweden, Scotland, and the United Kingdom). The US population at that time was 290.8 million and the combined population of the other countries was 563.5 million. There were 29,791 firearm deaths in the US that year and a total of 7,653 firearm deaths in the other 20 countries. (2)

We Americans are not more violent. But American violence is often lethal violence. And there is one reason for this fact; access to guns. We humans are an emotional lot, prone to impulsive behavior. Most violence is impulsive and the consequences limited by what’s at hand.

Another set of statistics helps frame a rational approach to gun legislation. Firearm deaths fall into three categories, suicides, homicides, and accidents. Most people are unaware of the fact that suicides represent the largest category, followed by homicides. (1)

It is fair to say that the majority of individuals who commit suicide are mentally ill or temporarily out of their minds. Most suicide deaths are accomplished with firearms. Between 2003 and 2007, an average of 46 Americans committed suicide with guns each day. (3)

Studies attempting to explain why some regions have higher suicide rates repeatedly find a strong significant positive association between gun ownership and rates of suicide. (4) Simply put, states with more guns have more suicides.

Public health concerns legitimately include gun control.

Similarly, preventable accidents fall under the purview of public health. Many fatal firearm accidents occur in children. In the U.S., children between the ages of 5 and 14 are 11 times more likely to be killed accidentally by a gun compared with the same aged children in other developed countries. (5) If we can perfect the child-proof medicine bottle, we should be able to protect children from guns.

It took one shoe to change the way Americans travel.

What will it take to change our way with guns?  

References

1.     U.S. Department of Health and Human Services, CDC, National Center for Health Statistics, National Vital Statistics Reports Jan 11 2012 Vol.60, 4

2.     Richardson EG, Hemenway D, J Trauma 2011 Jan; 70 (1):283-43

3.     Hemenway D. Amer J Lifestyle Med 2011 5:502

4.     Miller M, Lippman S, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 U.S. states J Trauma. 2007;62:1029-1035

5.     Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003 J Trauma. Doi: 10.1097/TA.

 

 

The New Elixir - A Cup of Joe

The world’s most widely used pick-me-up reduces your risk of neurodegeneration, depression, cancer and cardiovascular disease, and that’s just the beginning of the story.  Yes, I’m talking about that legal, over-the-counter beverage now available every other block. You know, brain juice, brew, liquid energy, morning mud, rocket fuel, wakey juice.
Coffee!

It may even be an ingredient in that fountain of youth we’re still searching for. According to a recent study in the New England Journal of Medicine, coffee lowered all-cause mortality by over 10% after 13 years of follow-up. (1)

Before I summarize the remarkable medicinal properties this plant-based beverage has recently been shown to possess, let me flag the potential negative effects. They are few in number and undoubtedly the positive dwarfs the negative. However if you happen to suffer from one of these conditions, you might want to consult your doctor before changing your coffee consumption.

Coffee can increase blood pressure and intraocular pressure (a potential concern if you have glaucoma), make the anxious more anxious, and worsen tremors and insomnia. (2) There, that’s it. Makes you wonder why it’s gotten such bad press in the past.

While it is true that caffeine transiently increases blood pressure, it appears that when consumed in  coffee, the increase is small and offset by protective effects. For instance, coffee beans are rich in antioxidants that decrease LDL and markers of inflammation (3-8). Inflammation occurs early in the development of cardiovascular disease and is most commonly triggered by a sedentary lifestyle, stress, and processed foods.

Overall coffee appears remarkably heart friendly. It has been shown to substantially decrease the risk for coronary heart disease (4) and as little as 2 cups per day decreases the risk of heart failure. (9)

Recent research has demonstrated coffee’s capacity to protect the brain as well. Investigators found that 1-6 cups per day reduce the risk for stroke by 17% (3) A well designed Swedish study followed female coffee drinkers for an average of 10 years and found a 22%-25% reduction on stroke risk. (11)

Well that’s great you say, but can it help me loose weight? Yes, indeed. By decreasing glucose absorption, coffee can facilitate weight loss, especially when combined with other measures. (15) It also improves glucose metabolism and insulin sensitivity, thereby decreasing one’s risk for Type 2 Diabetes. (12-14)

Coffee also appears to provide protection from a number of cancers through its antimutagenic and antioxidant effects. (16,18) Studies suggest different quantities are necessary to affect different cancers; prostate cancer – 6 cups/day (17), estrogen receptor-negative breast cancer - > 5 cups/day (21), endometrial cancer - > 4 cups/day (16)

When it comes to protecting your brain, studies have shown coffee to be a potent agent. Recent investigation demonstrated a protective effect in subjects with mild cognitive impairment, a condition that usually progresses to dementia. Those who consumed 3-5 cups of coffee per day attained blood caffeine levels of > 1200 ng/ml showed no progression of their condition during the 2 to 4 years of follow-up. (22)

Coffee drinkers also appear to be at lower risk for Parkinson’s disease. Recent research presented at annual meeting of the American Academy of Neurology demonstrated that as little as 3 cups of coffee per day may block the formation of Lewy bodies, an early diagnostic sign of the development of Parkinson disease. (23)

The other remarkable brain benefit relates to mood.
Just last year researchers found that women who consumed 2 to 3 cups of coffee per day lowered their risk for depression by 15% compared to women who drank less than 1 cup per week. And more coffee afforded more protection. Those drinking 4 or more cups per day lowered their risk by 20%. (24) The investigators speculated that this antidepressant effect stemmed from coffee’s antioxidant and anti-inflammatory qualities. (25-27)

If all that isn’t a sufficiently broad spectrum to convince you that coffee might be the most exciting “new” gun in medicine’s armamentarium, the list goes on.

What type of pathology remains? “Can it fight infection?” you ask. Yes, and not just any wimpy intruder. Coffee has also proven itself a potent force against one of the scariest bacteria, methicillin-resistant Staphylococcus aureus, known as MRSA. The mechanism of this effect remains a mystery. However, subjects reduced the likelihood of having MRSA in their nasal airways by almost 50% by drinking coffee regularly, regardless of quantity. (28)

So bottoms up.

For once a simple pleasure is the perfect prescription.

References
1. Freedman ND, Park Y, Abnet CC, et al. Association of coffee drinking with total and cause-specific mortality. N Engl J Med. 2012;366:1891-1904
2. Pasquale L. Program and abstracts of the American Glaucoma Society 22nd Annual Meeting; March 1-4, 2012; New York, New York. Abstracts 23 and 83.
3. Larsson SC, Orsini N. Coffee consumption and risk of stroke: a dose-response meta-analysis of prospective studies. Am J Epidemiol. 2011;174:993-1001.
4. Wu JN, Ho SC, Zhou C, et al. Coffee consumption and risk of coronary heart diseases: a meta-analysis of 21 prospective cohort studies. Int J Cardiol. 2009;137:216-225.
5. Natella F, Nardini M, Belelli F, et al. Coffee drinking induces incorporation of phenolic acids into LDL and increases the resistance of LDL to ex vivo oxidation in humans. Am J Clin Nutr. 2007;86:604-609.
6. Gómez-Ruiz JA, Leake DS, Ames JM. In vitro antioxidant activity of coffee compounds and their metabolites. J Agric Food Chem. 2007;55:6962-6969.
7. Nardini M, D'Aquino M, Tomassi G, et al. Inhibition of human low-density lipoprotein oxidation by caffeic acid and other hydroxycinnamic acid derivatives.  Radic Biol Med. 1995;19:541-552.
8. Montagnana M, Favaloro EJ, Lippi G. Coffee intake and cardiovascular disease: virtue does not take center stage. Semin Thromb Hemost. 2012;38:164-177.
9. Mostofsky E, Rice MS, Levitan EB, Mittleman MA. Habitual coffee consumption and risk of heart failure: a dose response meta-analysis. Circ Heart Fail. 2012;DOI:10.1161/CIRCHEARTFAILURE.112.967299.
10. Larsson SC, Orsini N. Coffee consumption and risk of stroke: a dose-response meta-analysis of prospective studies. Am J Epidemiol. 2011;174:993-1001.
11. Larsson SC, Virtamo J, Wolk A. Coffee consumption and risk of stroke in women. Stroke. 2011;42:908-912.
12. Huxley R, Lee CM, Barzi F, et al. Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Arch Intern Med. 2009;169:2053-2063.
13. Sartorelli DS, Fagherazzi G, Balkau B, et al. Differential effects of coffee on the risk of type 2 diabetes according to meal consumption in a French cohort of women: the E3N/EPIC cohort study. Am J Clin Nutr. 2010;91:1002-112.
14. Floegel A, Pischon T, Bermann MM, et al. Coffee consumption and risk of chronic disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Germany study. Am J Clin Nutr. 2012;95:901-908
15. Vinson JA, Burnham B, Nagendran MV, et al. Randomized double-blind placebo-controlled crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects. Program and abstracts of the 243rd American Chemical Society National Meeting and Exposition; March 25-29, 2012; San Diego, California. Abstract 92.
16. Je Y, Hankison SE, Tworoger SS, et al. A prospective cohort study of coffee consumption and risk of endometrial cancer over a 26-year follow-up. Cancer Epidemiol Biomarkers Prev. 2011;20:1-9.
17. Wilson KM, Kasperzyk JL, Rider JR, et al. Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study. J Natl Cancer Inst. 2011;8;103:876-884.
18. Turati F, Galeone C, La Vecchia C, et al. Coffee and cancers of the upper digestive and respiratory tracts: meta-analyses of observational studies. Ann Oncol. 2011;22:536-544.
19. Galeone C, Tavani A, Pelucchi C, et al. Coffee and tea intake and risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev. 2010;19:1723-1736.
20. Song F, Qureshi AA, Han J. Increased caffeine intake is associated with reduced risk of Basal cell carcinoma of the skin. Cancer Res. 2012;72:3282-3289.
21. Li J, Seibold P, Chang-Claude J, et al. Coffee consumption modifies risk of estrogen-receptor negative breast cancer. Breast Cancer Res. 2011;13:R49.
22. Cao C, Loewenstein DA, Lin X, et al. High blood caffeine levels in MCI linked to lack of progression to dementia. J Alzheimer Dis.           2012;30:559-572.
23. Ross W, Duda J, Abbott R, et al. Association of coffee caffeine consumption with brain Lewy pathology in the Honolulu-Asia Aging Study. Program and abstracts of the 64th Annual Meeting of the American Academy of Neurology; April 21-28, 2012; New Orleans, Louisiana. Abstract #S42.005.
24. Lucas M, Mirzaei F, Pan A, et al. Coffee, caffeine, and risk of depression among women. Arch Intern Med. 2011;171:1571-1578.
25. Pasco JA, Nicholson GC, Williams LJ, et al. Association of high-sensitivity C-reactive protein with de novo major depression. Br J Psychiatry. 2010;197:372-377.
26. Ng F, Berk M, Dean O, Bush AI. Oxidative stress in psychiatric disorders: evidence base and therapeutic implications. Int J Neuropsychopharmacol. 2008;11:851-876.
27. O'Connor A. Coffee drinking linked to less depression in women. New York Times. February 13, 2012. http://well.blogs.nytimes.com/2011/09/26/coffee-drinking-linked-to-less-depression-in-women/ Accessed January 11, 2012.
28. Matheson EM, Mainous AG, Everett CJ, King DE. Tea and coffee consumption and MRSA nasal carriage. Ann Fam Med. 2011;9:299-304.

Run For Your Life, But Not Too Far

Once again, we have a story of "the dose makes the poison." In the fitness world many believe that if running 5 miles is good for you, running 10 might double the benefit. Apparently not.

A recent study presented at the American College of Sports Medicine's annual meeting suggests that shorter distances (less than 20 miles per week) provide a greater mortality benefit. (1) While this is an unexpected finding, the more shocking news is that with increasing distance the reduction in mortality doesn't just level off but actually but reverses.

Dr. Duck-chul Lee led the research, a part of the Aerobics Center Longitudinal Study (ACLS) which includes 52,000 men and women in a retrospective analysis. Subjects entered the study free of cardiovascular disease, EKG abnormalities, diabetes and cancer. They were followed for 15 years.
Running was associated with a 19% lower risk of all-cause mortality compared with individuals who did not run.

Interestingly, how fast you run is important too. Subjects who ran 6 and 7 miles per hour had a significant (21% and 27%) lower risk of all-cause mortality. Those running faster (8 or more miles per hour) had a nonsignificant decrease in risk of all-cause mortality.

The most robust decrease in risk of death was seen in subjects who ran between 10 and 15 miles per week.

How often you run also makes a difference. The benefits of running were lost in those running more than 5 days per week.

While it is possible that some unmeasured variables might have contributed to these findings, the investigators corrected for other known factors such as age, gender, smoking status, blood pressure, and cholesterol levels.

The ACLS study coincides with the publication of a review paper in the Mayo Clinic Proceedings on the possible causes of heart damage seen in participants of long-distance endurance events (marathons, Ironman, long-distance cycling).(2) The review suggests that such activities may cause fibrosis of the heart muscle that can lead to arrhythmias and coronary artery calcification and hardening.

The bottom line is less is more. This data should not be a reason not to run. A regimen of up to 20 miles a week in 2 to 5 sessions at a pace below 8 miles per hour looks best.

So, run for your life, not too far, too fast, too often.  

References

1. Lee DC, Pate RR, Lavie CJ, et al. Running and all-cause mortality risk--is more better? American College of Sports Medicine 2012 Annual Meeting; June 2, 2012; San Francisco, CA. Presentation 3471.
2. O'Keefe JH, Patil HR, Lavie CJ, et al. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc 2012; 87:587-595.

Men, Aging and Bone Loss

Osteoporosis, a weakening of bone that increases the risk for fracture, is usually thought of as a postmenopausal woman's problem. However, about 20% of the 44 million Americans who have osteoporosis or low bone mineral density are men.(1) And men fare less well with this potentially painful and debilitating condition.

30% - 40% of osteoporosis related fractures occur in men.(2) In those cases involving hip fracture, men have a mortality rate two to three times greater than women.(3,4,5) Because this represents a significant public health issue the Endocrine Society recently released a review of the topic with updated practice guidelines.

All adult men should have osteoporosis on their radar as one of the chronic conditions to monitor and take steps to prevent. Here is a brief overview of this condition and summary of the Endocrine Society's recommendations.

The increased risk of fracture due to osteoporosis occurs approximately 10 years later in men than women. Race, ethnicity, location and lifestyle all contribute to one's risk. North American and Northern European men have the highest rates of fracture due to osteoporosis, while Blacks and Asians have the lowest. (6)  Interestingly, the female to male ratio among Caucasians is about 3-4:1 whereas it is around 1:1 in Asians.(7) Smoking, sedentary lifestyle, and excessive alcohol consumption significantly increase risk.

Hormone levels play an important role. There is no question that the anabolic effects of testosterone are beneficial. But relatively recent investigation has demonstrated that estrogen is at least as important in men for healthy bone maintenance.(8)

Recommendations(9)

Who is at risk and should be evaluated?
All men over 70 years of age and 50-69 year olds with a history of delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, chronic obstructive pulmonary disease, glucocorticoid or GnRH agonists, alcohol abuse or smoking.

Lifestyle recommendations include reduced alcohol intake for those men who consume three or more units of alcohol per day. Smoking cessation should also be a priority. They suggest weight-bearing activities for 30-40 minutes per session, three to four times per week. If vitamin D levels prove to be low (<30ng/ml) supplementation is encouraged targeting a blood 25(OH)D level of at least 30ng/ml. Men at risk for osteoporosis should consume 1000-1200 mg of calcium daily. Ideally this should come from dietary sources rather than supplements. A recent study suggests that calcium supplements may increase the risk for heart attack in women. This association has not been observed in men.

These interventions, in conjunction with a variety of medications when necessary, can prevent the progression of osteoporosis, a condition which need not compromise the quality of life.

References
(1) Burge R et al. 2007 Incidence and economic burden of osteoporosis-related fractures in the United States. J Bone Miner Res 22:465-475
(2) Bliue D et al. 2009 Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513-521
(3) Frosen L et al. 1999 Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73-78
(4) Haentjens P et al. 2010 Meta-analysis: excess mortality after hip fracture among older women and men. Ann Int Med 152:380-390
(5) Holt G et al. 2008 Gender differences in epidemiology and outcome after hip fracture: evidence from the Scottish Hip Fracture Audit. J Bone Joint Surg 90B:480-483
(6) Maggi S et al. 1991 Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int 1:232-241
(7) Kanis JA et al. 2002 International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237-1244
(8) Gennari L et al. 2008 Estrogen land fracture risk in men. J Bone Miner Res 23:1548-1551
(9) Watts NB et al. June 2012 Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endo Metab: 97(6):1802-1822

Against All Odds

     

     I was going to call this piece “A Plea For Math Literacy” but thought few titles could better guarantee no one would read it. For most of us, math is our first academic experience of being plain wrong. An incorrect answer in math is never “interesting” the way a response in English or even History class might be. No math teacher ever admiringly uttered the phrase, “Now that’s an different perspective.” I’ll never forget the math teacher who called my answer “not even wrong”. No one likes being wrong, but we turn our backs on math at a cost.

     Math literacy may seem to mix two different systems, the world of numbers and the world of words. Traditionally literacy related to the ability to read and write. But it has grown to encompass the capacity to understand all forms of communication including body language, imagery, or any symbol system relevant to a particular culture.

     We live in a culture where the art of estimation is essential if we hope to understand the wide range of magnitudes and time frames that are tossed around in every day discourse. Whether considering the national debt or your mortgage rate, the population of China or the daily loss of brain cells, an earthquake of 4 or 6 on the Richter scale, the date of the Industrial Revolution or the origin of the universe, you’re lost without some basic math smarts that provide a sense of proportion. 

      Now more than ever, we are flooded with data that could inform our decisions. This is particularly true when it comes to our health. Doctors no longer dictate treatments. In the age of “informed consent” we are presented with the odds of this procedure or medication having “x” benefits and “y” risks. We are expected to make our own decision. (And the complexity of patient decision-making will increase dramatically as the human genome is deciphered.) Yet we rarely use the pertinent data when we make our choices.

     Why do we play the odds rather than calculate them?

     On a fundamental level we seem hard-wired for bad decision-making. We like to presume that we have control over what happens to us. We believe that if we stick to a plan the desired result should occur. If we take "good" care of ourselves (or if we are "good") we will grow old and prosper. But any 10 year high school reunion demolishes these naive assumptions.

     Daily life provides shedloads of examples of just how bad we are at understanding the odds; the popularity of the lottery, casinos, junk food, and cigarettes. Like disagreeable information of any kind, when we don't like the odds we remove them from consciousness. And when we fail to bury disturbing odds we unwittingly seek data that will bind our anxiety. The newspaper we read, the TV shows we follow, the people with whom we socialize, are all chosen to confirm our view of the world, that we're doing the right thing, that we know, that we are secure.

     We are masterful at avoiding the discordant experience of learning something that contradicts our beliefs. And we are equally disturbed when others respond to new information and change their stance. In politics it's pejoratively labeled flip-flopping, a career ender.

     Certainty is seductive. But the reality is that we live in a sea of uncertainty. And yet we are raised (and raise our children) to believe the opposite. Can this change? I think so. While the complexity of the kaleidoscopic forces that drive our choices is overwhelming, there are things we can do in order to encourage better decision-making. And math may be one of the most powerful antidotes to emotionally-based judgements.

     Here's a short list of ideas that could be applied at any stage of development, from kindergarten to think tanks.

     Encourage suspicion of experts and the accepted verities.

     Explore who profits from one set of data versus another.

     Introduce children to probability calculation early in a real-world accessible form using something they find interesting like a favorite player's batting average, or the chances of winning at tic-tac-toe, or the relative risk of getting a filling with and without brushing your teeth.

     Most importantly, we must attempt to get more comfortable with the messy business of ambiguity, complexity and not knowing. If we could delay even briefly that reflexive leap to embrace social or intellectual ready-made conceptions, it could have enormous impact. Like fast-food, these packaged ideas allow some immediate soothing, but provide nothing that nourishes.  In the end they make us sick because in adopting beliefs that are not our own we blind ourselves to what we really think and feel. And without such knowledge, making the right choice is against all odds.

Balancing Acts

     The concept of balance is considered a fundamental quality for the good life. We believe that only a balanced approach can provide the reasonable stance, whether we’re talking about eating, religion, work, sleep, sex or money. Our language reflects this view through such expressions as “an unbalanced individual”,  “a chemical imbalance”, “a balanced economy”.  The unbalanced desire of addiction has spawned every conceivable form from chocoholic to workaholic or shopaholic. And yet for all the lip service balance receives as the prudent path, we worship excess.

     Should we aspire to balanced lives? Certainly not when it comes to love. The very expression “falling in love” speaks to the need for a loss of balance. It is hard to imagine what balanced love looks like, if it looks like love at all.  Don’t we want to believe we would die for someone or some thing? Can we say what amount of love or grief or belief is excessive?

     The notion of balance implies an awareness of what is too little and what is too much. But one can only identify excess by knowing what is enough, something we struggle with (“enough is enough” is as close as we’ve come). We seem much better at identifying excess in others, and we are mesmerized by it.  The righteous indignation and moral superiority that comes with labeling someone else’s excess is made all the more pleasurable for its reassurance. It implicitly suggests that we know our limits, how much is enough and appropriate, that we are in control of our desires.

   We all have some form of excess that feeds our favorite rant, drug addicts, alcoholics, suicide bombers, narcissists, fat people, anorexics, CEO salaries, celebrity orgies, serial killers, faith, atheism.  But the one we find most outrageous or offensive or unreasonable or fascinating, tells us something important.  Show me which excess you can’t abide and I’ll show you who you are.

     How can we understand our relationship with excess? How do we continue to believe that more money or cars or shoes or food or sex will make us happy? Why are we the only animal that can be made ill by our appetites?

     It is precisely because money or cars or shoes or food or sex is not quite what we want that we find ourselves thinking that perhaps more would be satisfying. When we have too much, it is because we have too little of what we need.

 

Sitting Ducks

   

          “Those who think they have not time for bodily exercise will sooner or later have to find time for illness.”

                    Edward Stanley, Earl of Derby 1873

     We continue to deny this idea despite more than a century of data. In the latest contribution to this argument, an Australian group put another nail in the coffin of the couch potato. They demonstrated that the amount of time we spend sitting correlates with all-cause mortality. For those who haven’t been living under a rock, this is not news. However, what puts this study on the map is the finding that the negative effect of prolonged sitting was not significantly reversed by physical activity.

     The fact that modern humans spend so little time out of a chair has given birth to a vital new field, sedentary behavior research. Investigation has revealed that the adverse consequences of prolonged sitting (surely this will become a familiar acronym in the literature – PS, so let’s coin it now) stem from a web of causes including; reduced metabolic function, increased triglycerides and decreased HDL-cholesterol (the good one), decreased insulin sensitivity, and impaired carbohydrate metabolism. These are the usual suspects in any discussion of cardiovascular disease, diabetes or obesity.

     But now the data suggests two important things. First, it seems that physical activity and sedentary behavior act independently through different mechanisms. This would explain why the damage of PS (sitting for 10 hours a day) is not undone by 30 minutes of daily exercise. Secondly, they have found that normal weight is not protective against the  ravishes of PS and in no way means you’re healthy.

     The pioneering work on this issue was done in the early 1950’s by a British researcher, Jeremiah Morris, the man responsible for connecting physical exertion and health. In seeking to determine whether there was an association between the type of work people do and heart disease, he stumbled upon groundbreaking data. Morris combed through the health records of 31,000 bus drivers and conductors in London. The conductors had significantly less heart disease than the drivers. The only variable that consistently distinguished one group from the other was activity level.

     So if this link was appreciated more than 50 years ago, why has so little been done, allowing heart disease to remain the number one killer? The answer is simple. Medicine addresses disease not health. Until you are sick, the medical system has had nothing to offer. We’ve gotten better at treating heart disease but have just begun to seriously consider preventing it. Until people stop thinking about health in terms of doctors and medicines, things will not change. 

     The “progress” afforded by the Industrial Revolution has provided a natural experiment demonstrating the catastrophic effects of sedentary life. If one considers our genetic wiring, perfected over hundreds of thousands of generations, this all makes perfect sense. We were made to move. And our genome has not adapted to this relatively new lifestyle. It turns out we need more than exercise.

      

      So don’t just sit there. Get up and get well.