Why It’s So Important to Keep Moving

Hoping to learn more about how inactivity affects disease risk, researchers at the University of Missouri recently persuaded a group of healthy, active young adults to stop moving around so much. Scientists have known for some time that sedentary people are at increased risk of developing heart disease and Type 2 diabetes. But they haven’t fully understood why, in part because studying the effects of sedentary behavior isn’t easy. People who are inactive may also be obese, eat poorly or face other lifestyle or metabolic issues that make it impossible to tease out the specific role that inactivity, on its own, plays in ill health.

So, to combat the problem, researchers lately have embraced a novel approach to studying the effects of inactivity. They’ve imposed the condition on people who otherwise would be out happily exercising and moving about, in some cases by sentencing them to bed rest.

But in the current study, which was published this month in Medicine & Science in Sports & Exercise, the scientists created a more realistic version of inactivity by having their volunteers cut the number of steps they took each day by at least half.

They wanted to determine whether this physical languor would affect the body’s ability to control blood sugar levels. “It’s increasingly clear that blood sugar spikes, especially after a meal, are bad for you,” says John P. Thyfault, an associate professor of nutrition and exercise physiology at the University of Missouri, who conducted the study with his graduate student Catherine R. Mikus and others. “Spikes and swings in blood sugar after meals have been linked to the development of heart disease and Type 2 diabetes.”

So the scientists fitted their volunteers with sophisticated glucose monitoring devices, which checked their blood sugar levels continuously throughout the day. They also gave the subjects pedometers and activity-measuring armbands, to track how many steps they took. Finally, they asked the volunteers to keep detailed food diaries.

Then they told them to just live normally for three days, walking and exercising as usual.

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Exercise guidelines from the American Heart Association and other groups recommend that, for health purposes, people accumulate 10,000 steps or more a day, the equivalent of about five miles of walking. Few people do, however. Repeated studies of American adults have shown that a majority take fewer than 5,000 steps per day.

The Missouri volunteers were atypical in that regard. Each exercised 30 minutes or so most days and easily completed more than 10,000 daily steps during the first three days of the experiment. The average was almost 13,000 steps.

During these three days, according to data from their glucose monitors, the volunteers’ blood sugar did not spike after they ate.

But that estimable condition changed during the second portion of the experiment, when the volunteers were told to cut back on activity so that their step counts would fall below 5,000 a day for the next three days. Achieving such indolence was easy enough. The volunteers stopped exercising and, at every opportunity, took the elevator, not the stairs, or had lunch delivered, instead of strolling to a cafe. They became, essentially, typical American adults.

Their average step counts fell to barely 4,300 during the three days, and the volunteers reported that they now “exercised,” on average, about three minutes a day.

Meanwhile, they ate exactly the same meals and snacks as they had in the preceding three days, so that any changes in blood sugar levels would not be a result of eating fattier or sweeter meals than before.

And there were changes. During the three days of inactivity, volunteers’ blood sugar levels spiked significantly after meals, with the peaks increasing by about 26 percent compared with when the volunteers were exercising and moving more. What’s more, the peaks grew slightly with each successive day.

This change in blood sugar control after meals “occurred well before we could see any changes in fitness or adiposity,” or fat buildup, due to the reduced activity, Dr. Thyfault says. So the blood sugar swings would seem to be a result, directly, of the volunteers not moving much.

Which is both distressing and encouraging news. “People immediately think, ‘So what happens if I get hurt or really busy, or for some other reason just can’t work out for awhile?’” Dr. Thyfault says. “The answer seems to be that it shouldn’t be a big problem.” Studies in both humans and animals have found that blood sugar regulation quickly returns to normal once activity resumes.

The spikes during inactivity are natural, after all, even inevitable, given that unused muscles need less fuel and so draw less sugar from the blood.

The condition becomes a serious concern, Dr. Thyfault says, only when inactivity is lingering, when it becomes the body’s default condition. “We hypothesize that, over time, inactivity creates the physiological conditions that produce chronic disease,” like Type 2 diabetes and heart disease, regardless of a person’s weight or diet.

To avoid that fate, he says, keep moving, even if in small doses. “When I’m really busy, I make sure to get up and walk around the office or jog in place every hour or so,” he says. Wear a pedometer if it will nudge you to move more. “You don’t have to run marathons,” he says. “But the evidence is clear that you do need to move.”

Vitamin C related to reduced risk of cardiovascular disease and early death

New research from the University of Copenhagen and Herlev and Gentofte Hospital shows that high vitamin C concentrations in the blood from the intake of fruit and vegetables are associated with a reduced risk of cardiovascular disease and early death.

Fruit and vegetables are healthy. We all know that. And now there is yet another good reason for eating lots of it. New research from the University of Copenhagen shows that the risk of cardiovascular disease and early death falls with a high intake of fruit and vegetables, and that this may be dued to vitamin C.

The study, which has just been published in the well known American Journal of Clinical Nutrition, is based on the Copenhagen General Population Study.

As part of the study, the researchers had access to data about 100,000 Danes and their intake of fruit and vegetables as well as their DNA. "We can see that those with the highest intake of fruit and vegetables have a 15% lower risk of developing cardiovascular disease and a 20% lower risk of early death compared with those who very rarely eat fruit and vegetables. At the same time, we can see that the reduced risk is related to high vitamin C concentrations in the blood from the fruit and vegetables," says Camilla Kobylecki, a medical doctor and PhD student at the Department of Clinical Biochemistry, Herlev and Gentofte Hospital.

Vitamin C from food rather than supplements

Among other things, vitamin C helps build connective tissue which supports and connects different types of tissues and organs in the body. Vitamin C is also a potent antioxidant which protects cells and biological molecules from the damage which causes many diseases, including cardiovascular disease. The human body is not able to produce vitamin C, which means that we must get the vitamin from our diet.

"We know that fruit and vegetables are healthy, but now our research is pinpointing more precisely why this is so. Eating a lot of fruit and vegetables is a natural way of increasing vitamin C blood levels, which in the long term may contribute to reducing the risk of cardiovascular disease and early death. You can get vitamin C supplements, but it is a good idea to get your vitamin C by eating a healthy diet, which will at the same time help you to develop a healthier lifestyle in the long term, for the general benefit of your health," says Boerge Nordestgaard, a clinical professor at the Faculty of Health and Medical Sciences, University of Copenhagen, and a consultant at Herlev and Gentofte Hospital.

The researchers are now continuing their work to determine which other factors, combined with vitamin C, have an impact on cardiovascular disease and death.

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The Paleo diet is absurd, science says

“Our ancestors didn’t eat like this, so we shouldn’t.” This is the main ethos of many modern diets which advise us to exclude a number of recent additions to our plates because they were not part of our distant predecessors diet. There are many different variations on the theme – from all-encompassing “palaeolithic-style” diets to grain-free or gluten-free regimes – which are all generating a massive boom in specialised shops, products and even restaurants.

The general idea is that for most of our millions of years of evolution we were not exposed to grains, milk, yogurt or cheese, refined carbs, legumes, coffee or alcohol. As they only came into existence with farming around 10,000 years ago, our finely-tuned bodies have not been designed to deal with them efficiently.

The belief is that human evolution via survival of the fittest and natural selection is a very slow process and our genes classically take tens of thousands of years to change. This means that these “modern” foods cause various degrees of intolerance or allergic reactions, resulting not only in the modern epidemic of allergies, but also that the toxins lead to inflammation and obesity. So follow our Palaeolithic ancestors we are told, cut out these foods – and your problems are over.

This may sound imminently sensible but as it turns out, the facts on which this idea is based are rubbish. The latest research shows we are not robotic automatons fixed in time but flexible plastic beings adapting to our environments and diets much faster than anyone had realised. A study published in Natureshowed clearly that major changes to our genes can occur in just a thousand years or a few hundred generations.

The researchers looked at the DNA from 101 Bronze Age skeletons across Europe from The Netherlands to Russia for key mutations. These people lived around 3,000 years ago and were busy migrating and spreading their genes. They looked in particular at one key gene (called lactase persistence) that controlled an enzyme conferring the ability to digest milk after the age of three. Around three quarters of modern Europeans have this gene allowing them to digest a glass of milk without feeling sick. Rates of the gene mutation are higher in North Europe (up to 90%) and lower in Southern Europe (around 50%).

It was previously thought this gene mutation started to dominate Europeans around 7,000 to 10,000 years ago at the onset of farming and the use of milk, so the finding that only one in 20 Bronze-age people had it 3,000 years ago was a major shock. It meant that it started later and has spread much faster than we imagined and as a consequence we have adapted to our new food source much more rapidly than the lumbering robots we are portrayed as.

Other genetic evidence of recent changes to our digestive genes comes from a worldwide study of the amylase gene which is key to breaking down starch in carbohydrates. People in areas with starch as a major part of the diet evolved to have multiple copies of the gene to help them digest it better. We found in a collaborative study using our twins that this mutation also strangely protected against obesity, and importantly we think this change only happened in the last few hundred generations.

Other genes key to how we digest food can change even more rapidly. These are the 2m or so genes in the DNA of the trillions of microbes in our gut. Although they are not human genes they are crucial to our health as they control our microbiome which digests our food and produces many of our vitamins and blood metabolites. These bacterial genes in our guts can respond rapidly to changes in our diet, and as they can produce a new generation every 30 minutes, they can evolve very fast indeed.

They also have a secret weapon called horizontal gene transfer which means they can rapidly swap genes between them to mutual advantage, without waiting for natural selection. They use this very effectively to become resistant to new antibiotics and the same process is likely for new foods.

So by all means enjoy eating at going to trendy paleo steak restaurants and decide to lose weight in the short term by going on a gluten-free diet, but don’t be fooled by the evolutionary scientific explanations which are now out of date. Your genes and your microbes are evolving faster than you realise and can cope with the new additions to our diet in the last few thousand years. The caveat is that we need to keep our gut microbes as healthy as possible. But dietary diversity, not exclusions, is the key.

Tim Spector is a Professor of Genetic Epidemiology at King’s College London.

The secrets to a healthy life

hat we choose to eat has a powerful impact on both our internal and external environments. When we realize that something as primal as what we choose to put in our mouths each day makes an important difference in these crises, it empowers us and imbues these choices with meaning. If it’s meaningful, then it’s sustainable—and a meaningful life is a longer life.

For almost four decades, my colleagues and I at the non-profit Preventive Medicine Research Institute and the University of California, San Francisco, have conducted clinical research proving the many benefits of comprehensive lifestyle changes. These include:

• a whole foods, plant-based diet (naturally low in fat and refined carbohydrates);
• stress management techniques (including yoga and meditation);
• moderate exercise (such as walking); and
• social support and community (love and intimacy).

In short—eat well, move more, stress less, and love more.

Many people tend to think of advances in medicine as high-tech and expensive, such as a new drug, laser, or surgical procedure. We often have a hard time believing that something as simple as comprehensive diet and lifestyle changes can make such a powerful difference in our lives—but they often do.

In our research, we have used high-tech, expensive, state-of-the-art scientific measure to prove the power of these simple, low-tech and low-cost interventions. These randomized controlled trials and other studies have been published in the leading peer-reviewed medical and scientific journals.

In addition to preventing many chronic diseases, these comprehensive diet and lifestyle changes can often reverse the progression of these illnesses.

We proved, for the first time, that lifestyle changes alone canreverse the progression of even severe coronary heart disease. There was even reversal after five years than after one year and 2.5 times fewer cardiac events. We also found that these lifestyle changes can reverse type 2 diabetes and may slow, stop, or even reverse the progression of early-stage prostate cancer.

Changing lifestyle actually changes your genes—turning on genes that keep you healthy, and turning off genes that promote heart disease, prostate cancer, breast cancer, and diabetes—over 500 genes in only three months. People often say, “Oh, it’s all in my genes, there’s not much I can do about it.” But there is. Knowing that changing lifestyle changes our genes is often very motivating—not to blame, but to empower. Our genes are a predisposition, but our genes are not our fate.

Our latest research found that these diet and lifestyle changes may even lengthen telomeres, the ends of our chromosomes that control aging. As your telomeres get longer, your life gets longer. This was the first controlled study showing that any intervention may begin to reverse aging on a cellular level by lengthening telomeres. And the more people adhered to these lifestyle recommendations, the longer their telomeres became.

This is a different approach to personalized medicine. It’s not like there was one set of diet and lifestyle recommendations for reversing heart disease, a different one for reversing diabetes, and yet another for changing your genes or lengthening your telomeres. It’s as though your body knows how to personalize the medicine it needs if you give it the right raw materials in your diet and lifestyle.

It’s not all or nothing. In all of our studies, we found that the more people changed their diet and lifestyle, the more they improved and the better they felt—at any age. So, if you indulge yourself one day, just eat healthier the next. If you don’t have time to exercise one day, do a little more the next. If you don’t have time to meditate for an hour, do it for a minute. What matters most is your overall way of eating and living.

These lifestyle changes are part of the most influential trend in medicine today—what is known as “Lifestyle Medicine,” which is lifestyle as treatment as well as prevention.

Health Care Crisis:

There is a convergence of forces that makes this the right idea at the right time. While the limitations of high-tech interventions such as drugs and surgery are becoming increasingly well-documented, the power of diet and lifestyle interventions is also becoming clearer.

More than 86% of the $3 trillion in annual U.S. health care costs (which are really predominantly sick-care costs) are from chronic diseases which can often be prevented and even reversed by making healthier diet and lifestyle choices, at a fraction of the costs—and the only side-effects are good ones.

For example, in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, patients who adhered to healthy dietary principles (low meat consumption and high intake of fruits, vegetables, and whole-grain bread), never smoked, were not overweight, and had at least 30 minutes a day of physical activity had a 78% lower overall risk of developing a chronic disease.

This included a 93% reduced risk of diabetes, an 81% lower risk of heart attacks, a 50% reduction in risk of stroke, and a 36% overall reduction in risk of cancer, compared with participants without these healthy factors.

That’s really mind-boggling. Type 2 diabetes and pre-diabetes are pandemic, already affecting almost one-half of all Americans. United Health Care projected that if current trends continue, annual costs from these will be more than $3.3 trillionover the next decade, which is clearly not sustainable.

And yet the EPIC study showed that type 2 diabetes is completely preventable for at least 93% of people today. We don’t need a new breakthrough; we just need to put into practice what we already know. Also, lowering blood sugar with diet and lifestyle is more effective at preventing premature death and disease than getting it down with diabetes medications.

Likewise, heart and blood vessel disease is still the number-one cause of death in the U.S. Yet at least 90% of heart disease can be prevented—today!—by changing diet and lifestyle. And that’s probably an underestimation.

It’s not just low-fat vs. low-carb. A study found that animal protein dramatically increases the risk of premature death independent of fat and carbs. In a study of over 6,000 people, those aged 50-65 who reported eating diets high in animal protein had a 75% increase in overall mortality, a 400% increase in cancer deaths, and a 500% increase in type 2 diabetes during the following 18 years. In contrast, plant-based proteins were protective.

At the same time that the power of comprehensive lifestyle changes is becoming more well-documented, the limitations of high-tech medicine are becoming clearer.

For example, randomized controlled trials have shown that angioplasties, stents, and coronary bypass surgery do not prolong life or prevent heart attacks in most stable patients. Only 1 out of 49 people with early-stage prostate cancer and PSA levels below 10 may benefit from surgery or radiation; the other 48 may become incontinent, impotent, or both—i.e., maimed in the most personal ways.

Yet when men are diagnosed with prostate cancer, most want to do “something” if the only alternative is to do nothing—watchful waiting or active surveillance. As mentioned earlier, our randomized controlled trial showed that comprehensive diet and lifestyle changes may slow, stop, or even reverse the progression of early-stage prostate cancer, so this may be a third alternative for many men.

Lifestyle medicine is cost effective as well as medically effective. Our research has shown that when comprehensive lifestyle changes are offered as treatment (not just as prevention), significant cost savings occur in the first year because the biological mechanisms that control our health and well-being are so dynamic.

For example, Highmark Blue Cross Blue Shield found that overall health care costs were reduced by 50% in the first year when people with heart disease or risk factors went through our lifestyle program in 24 hospitals and clinics in West Virginia, Pennsylvania, and Nebraska. In patients who spent more than $25,000 on health care in the prior year, costs were reduced 400% in the following year. In another study, Mutual of Omaha found that they saved $30,000 per patient in the first year in those who went through our lifestyle program.

Because of these findings, Medicare began covering my program of lifestyle medicine for reversing heart disease in 2011 when they created a new benefit category. If it’s reimbursable, it’s sustainable. Last year, I began a partnership with Healthways to create a new paradigm of health care based on our work. Already we have trained The Cleveland Clinic, Beth Israel Medical Center, UCLA, and many others. Now that Medicare is covering my program, the other major insurance companies are doing so as well, including Anthem (formerly WellPoint), Aetna, Highmark Blue Cross Blue Shield, and many others.

Environmental Crisis:

Many people are surprised to learn that animal agribusiness generates more greenhouse gases than all forms of transportation combined. The livestock sector generates more greenhouse gas emissions than the entire global transportation chain as measured in carbon dioxide equivalent (18% vs 13.5%). More recent estimates are that these numbers are even higher—that livestock and their byproducts may actually account for more than 50% of annual worldwide greenhouse gas emissions (at least 32.6 billion tons of carbon dioxide per year).

More than half of U.S. grain and nearly 40% of world grain is being fed to livestock rather than being consumed directly by humans. In the United States, more than 8 billion livestock are maintained, which eat about seven times as much grain as is consumed directly by the entire U.S. population. It takes over ten times as much energy and resources to eat a meat-based diet than a plant-based diet.

We have enough food today to feed all 7 billion humans on the planet if more people ate lower on the food chain.

Producing 1 kg of fresh beef requires about 13 kg of grain and 30 kg of forage. This much grain and forage requires a total of 43,000 liters of water.

Governor Jerry Brown recently ordered water restrictions in California. Many people don’t realize that a long shower takes 40 gallons of water but it takes 4,000-18,000 gallons of water to make one 1/3 pound hamburger according to the U.S. Dept. of the Interior.

More than half of U.S. grain and nearly 40% of world grain is being fed to livestock rather than being consumed directly by humans. In the United States, more than 8 billion livestock are maintained, which eat about seven times as much grain as is consumed directly by the entire U.S. population.

So, to the degree we choose to eat a plant-based diet, we free up tremendous amounts of resources that can benefit many others as well as ourselves. I find this very meaningful. And when we can act more compassionately, it helps our hearts as well.

Dean Ornish is founder and president of the Preventive Medicine Research Institute and clinical professor of medicine at the University of California in San Francisco.