An Apple A Day

Newly released data, collected over nearly 40 years, indicate that runners live 5-6 years longer than other people.  I like this but also have some doubts. 

I began running as a 12 year old, and after a few more months of surgical recovery, hope to resume this life-long habit. I love it.  My work as medical staff at marathons and as Medical Director of the Santa Rosa Marathon are the confluence of my interests.  Just like this study shows, I am certain that running, and more broadly, being physically active, are crucially important to any person’s health and wellbeing.

Now for the doubts.  Five to six years is a huge difference.  The study has a number of flaws, unfairly visible with close to two generations of hindsight.  Why “unfairly”?  Well, any long-term study will have significant problems.  There is too much we don’t know, including unknown and then unobserved variables.  So, weakness are inevitable.  Too much criticism is also unfair, because of course the reason to do research is to learn what we don’t know. We can’t expect researchers to know what no one knew when they began.  So, my advice is to take these findings with a grain of salt.  Running is great.  However, exercise in any form is great and there are excellent reasons, theoretically, scientifically and understood by those with experience, why other forms of exercise are also essential and sometimes preferable.

As my father died of a heart attack at age 47, can I attribute my 10 additional years (SO FAR) to my running?  Sure, but only in part.  My diet has been excellent, way better than his was, for the last 40 years.  That influence, other elements of my exercise regimen and many other factors for sure play their parts.

 

So, run if you want to run, but exercise, you must.  While you are at it, adding in the other good stuff will help you live better, not just longer.

 

 

I hope that, respecting tradition, you have dedicated yourselves to creating some better health habits in this New Year.  I also hope that you are going about that in a joyful way, understanding that doing the right things will help you enjoy your life more.  Also, pursuing good health habits should be fun, not tedious and just “good for you”.  Sure, sometimes it takes a little while before you start noticing the benefits, so a little discipline is needed to establish your new habits.  Other times, you feel better right away.  Instantaneously or gradually, disease-reducing, longevity-promoting or not, do it because you will feel better. This newsletter is a map, guiding you along the most direct path towards a better life. Change is not just a matter of will-power. Going about it the right way makes it much easier, and markedly increases your chances of success.

I am in an exercise focus right now.  Admittedly, some of that is because of the time I spent during the last month working at the Olympic Marathon Trials and attending a sports nutrition conference, but more importantly, a lot of new data is coming out that is very interesting and will be useful to you. In this blog I will soon post some thoughts about some physical training specifics.  The purpose will be to make your exercise more efficient and more effective.

Making changes

The idea of making changes in the New Year is easy fodder for comedians.  Everyone talks about it, but no one really accomplishes anything.  That’s right and it’s also very wrong.

In the Northern Hemisphere, where most of us live, the New Year roughly marks the return of the sun.  The days start to become longer and warming weather will follow.  Greeting the New Year with hope and new ideas has been the tradition as far back as we can trace human cultural history.  I think this tradition would have died out long ago if every attempt were met by failure.  On the contrary, every day I see patients successfully change their lives for the better, not just at the New Year.  You should be optimistic about making changes.

Change doesn’t happen simply by rolling out of bed on New Year’s Day, although that IS a necessary first step.  To ensure success, you need to develop a plan.

Self-Assessment

The dark, cold months of the year are traditionally a time of reflection, a time of the inner life.  Figuring out where you are is essential to creating a map to get you where you want to be.

I cannot overemphasize how important an honest and thorough self-assessment is when you are trying to make changes.  Your self-assessment must be as objective as you can make it.  An inaccurate assessment inevitably carries the seeds of failure.  If you think you are in better shape than you really are, the training for that April marathon WILL injure you.  You might think you aren’t eating well enough when your lack of exercise or poor stress-management is the bigger issue.

We usually perceive some problems clearly, but others we think are bigger than they really are, while still others are invisible to our own eyes. Trying to sort things out by yourself can be a lot like painting a self portrait without a mirror, or maybe having only a distorted, funhouse mirror to look at.  This is the reason so many people find the help of a professional useful.  A professional can identify problems and solutions you might not recognize or know about.  A professional should have learned from the experience of many patients and can use that accumulated wisdom to guide you.  Seeking the advice of family and friends can also be helpful at times.

Reflection is an inward, ideally a meditative, process.  In keeping with that inwardness we should start from the inside, meditating on who we are and who we want to become.  Following is a list of some areas to consider:

Essential health habits

Drink Enough Water

Exercise Almost Every Day

Eat Well

Take Your Supplements

Avoid The Things That Make You Sick

Get Enough Sleep

Be Involved in Your Community

Have A Healthy Sex Life

Remember That Attitude Is Important

Spirituality/Life purpose

Goal Setting

After you sort out where you are, you can create an image of where you want to be and construct a map to get you there. Deciding that you want to be younger is not going to work anymore than deciding you want to be taller or win the lottery.  Make your goals achievable!  That is the first step in goal setting.

In a more subtle way, deciding that you want to be stronger or thinner or calmer won’t work either.  There is an art to creating goals that will help you achieve success.

Second Step – Goals Must Be Specific

If you set a goal but don’t have a path to follow towards the goal, or you don’t know when you are there, you won’t ever get there.  For example, you decide that you want to lose weight. You then must sort out how you are going to do that and how you are going to measure it.  Let’s say you determined that, for you, the keys to improved health are to increase your activity and change your diet by eating more vegetables and cutting out soda and alcohol.

You could begin by tracking your activity level for a week, either by timing yourself, or better still, wearing a pedometer.  Then, as you set about implementing the changes, you have clear evidence and incentive by simply reading the numbers.

The same applies to your diet.  You could decide that you will eat some vegetables at every meal, including two servings at lunch and dinner with a leafy green salad every night.  You also determine to limit yourself to no more than one alcoholic drink and one soda a week.  All you have to do is look at your plate and into your drinking glass to learn whether you are reaching your goals.

I have a couple of comments about weight loss as a goal.  First, it is not a particularly health oriented goal, so I don’t like it much.  As long as you are sort of close to “normal”, other factors (especially physical fitness) are much more important than the reading on the scale.  There is some evidence that, as long as you are physically fit (i.e., good aerobic capacity and strength), obesity might not be a risk factor for death, disease or feeling poorly.  The scale does not tell you what you are made of, your body composition.  Most people who do a lot of strength training are overweight on the charts, but have low body fat.  Increased levels of body fat are more risky than similar increases in body weight. Many people find that improving their diet and exercise pattern does not change their weight as much as it changes how they feel, their physical capacity and how their clothes fit.  Muscle is denser than fat, so patients usually tell me their clothes are fitting looser even when their weight has not changed significantly.

Third Step – Early Success

To maintain and build on a change we need positive feedback.  If you try to do too much, feel horrible while doing it and feel worse the next day, how likely are you to try it again?

Creating those specific, achievable goals helps you set in motion a positive feedback cycle.  You met your goal.  What you did made you feel better.  You felt good because you met your goal.  You then want to keep it going.  It is vital to let yourself feel good about your accomplishment.  CELEBRATE YOUR SUCCESSES!

Short-term vs Long-term Goals

Tied closely to the concept of early success is the distinction between short and long-term goals.  If you are only going to be satisfied when you have gone all the way from couch potato to triathlete, you are going to be unhappy for a long time and probably never going to become a triathlete.

Short-term goals are the steps on your path.  Long-term goals are the destinations to where the path leads you.  If you think only about the beach, you are going to get lost on the path through the jungle.

Taking Action

Implementing your strategy requires determination, but it also demands gentleness.  Living with a drill sergeant is not going to work, especially if YOU are the drill sergeant. For some patients I need to be a cheerleader, doing everything I can to convince them of the need for change and applauding their positive steps.  For many others, particularly those who are less healthy than they used to be because of age, illness or they just let themselves go, I have to work hard to reign in their over-enthusiasm.

Particularly with exercise, it is very easy to do too much too fast.  The consequence is often an injury, and the time then needed for recovery often sets the patient further back than she/he was to begin with.  You will make the fastest progress by going slow.  When increasing physical activity, I tell all but the youngest, strongest patients to increase EITHER intensity or duration by 10% a week.

The other side of it is that changing several problem areas in your life at the same time can be very good and a highly successful approach.  Diet changes in particular are often most successful when they are dramatic.  You feel better quickly and that experience helps you do more.  As you feel the benefit, your commitment will be stronger and you will have more energy to do more to feel better still.

The greatest wisdom is in simply paying attention to how you feel and adjusting accordingly.

Failure

The road of excess leads to the palace of wisdom – William Blake

Failure is good.  It is good because we have to make mistakes to learn.  When I see a patient who has not implemented my recommendations I always want to know why.  Actually I have to understand why they failed, in order to help them go further.  Problem-solving is an inevitable part of doing anything new.  If I recommend swimming for a patient with back trouble as the best exercise for her condition, but she can’t swim, what is the point?  If a patient has not been using the breathing exercise I recommended because he did not understand it, I need to make it clearer.

The only real mistakes are those that we do not learn from.  Mistakes teach us how to correct our course before we get way off track.  If you haven’t made mistakes, you haven’t been trying.

The recent, very brief hot spell here was good for the souls of Northern California residents who were feeling guilty about how beautiful and temperate our summer has been compared to everyone else’s. I especially loved it as the mild weather helped me train for and achieve a goal I set for myself a couple of months back. Spurred by my daughters’ decision to come home and run the Santa Rosa Half Marathon, I decided to finally settle whether my many joint surgeries had put such running activities beyond my reach. Surprisingly, my strength training, minimalist shoes, and familial inspiration allowed me to complete the race, even bettering my hoped-for pace. Sure, my pace was 50% slower than my last marathon, but I have accepted that 30+ years does change people. (Photo from Santa Rosa Press Democrat)

Far more remarkable is the success of one of you. This patient is a young man with a number of significant health problems. His severe obesity made these problems much worse, and his life was difficult. He recognized the price he was paying and committed himself to doing all he could to make his life better. He began exercising daily. He focused his diet on healthy food, including lots and lots of vegetables. Today he weighs 200 lbs less than he did when he made his decision a year ago. He tells me that the change in how he feels is even more dramatic than the change in his appearance. He inspired his girlfriend to lose 85 pounds. They have married and are now seeking to adopt a little boy whose single mother is homeless and drug-addicted.

While we cannot achieve such dramatic successes every day, each of us has the power to make fundamental changes to better ourselves. I have learned that it all comes down to making the effort, focusing on the process. It is also important to remember that big successes are the inevitable result of comparatively minor daily successes. One day choosing to make one better dietary choice, getting some exercise, keeping yourself from overreacting as you normally would, making time to relax for a few minutes all seem insignificant and trivial. However, doing the right thing today inevitably leads to a better tomorrow. There is much that is out of our control, but taking care of what is in our power can make a very big difference for ourselves and for those around us.

Most of us are social creatures. Other people are very important to our enjoyment of our daily lives. This has important impacts on our health.

Most of the time we think about this because of the difficulties social influences can present. A person who is working to overcome drug or alcohol addiction usually faces pressure from his/her old group, many of whom have the same problem. Sometimes people have to build a new social network in those challenging circumstances.

We often forget that social connections can, and should be, of great help. If your friends and family have good health habits, it can be uncomfortable not to go with the flow. You can also take an active role to better your own health and that of your friends or family.

I see this most often with exercise. Many times I have seen women training to complete their first running race together. Some people join walking groups, tennis clubs or join an athletic team because they then create a regula exercise habit built into their social network. There is social website called Get Up and Move where people challenge friends to be active by posing specific activity challenges for themselves. What better gift could there be for someone you care about than to come together in this way to feel better?