Older Bolder Life

Stronger | Leaner | Sharper | Longer - From Older Bolder Fitness

fitness

Inquiring Minds Want to Know: Older Bolder Links, Reads, Recipes, and More 7 September 2019

By

This one’s been making the rounds over the past week – can a pharmacological cocktail reset a human’s biological clock? Read two lay news reports (here and here), and note the formal report of the very small study is not available online at Aging Cell (via Wiley) as of this morning.

A low carb (not very actually) diet trial for firefighters made ‘em healthier.
An argument for early day time restricted feeding.

A fairly stunning statin critique from European Scientist.
And thinking about conventional medicine getting their hackles up, how about this low carb community critique via MedScape (free account required).

Living closer to nature makes you happier, and longer-lived.
Speaking of life span, sleep disordered breathing ages you faster. (Free MedScape account required).

Exercise makes sex better.
A decent review a very common cause (and a poorly understood one at that) of mechanical low back pain.

Thought provoking podcast featuring Dr. William Davis.
Is there a higher hemorrhagic stroke risk for vegans? (The study is here.)

Food, Glorious Food

Does music make cheese age better?

One of the most impressively wrong portrayals of healthy eating you’ll read.

1015 Onion Marinated Skirt Steak
Grill Roasted and Marinated Red Peppers

Health and Fitness Expectations After 40: Can I Live Absolutely Pain Free?

By

During my twenty-five plus years in medicine, most of that focused on the conservative (non-surgical) management of musculoskeletal injuries (roughly 70% spine-focused) and trauma, I had the pleasure of interacting with an astoundingly varied assortment of patients presenting with a host of aches, pains, and pathologies. No day was ever quite the same, and there was (and is) always something new to learn every day.

My principle task was of course helping figure out what the heck was the main problem at hand (diagnosis), because frankly it’s impossible to articulate an effective and cogent treatment plan unless you really understand the underlying issue(s). Only then could an effective treatment plan be customized to optimally fit a patient’s needs; that process typically also involved laying out a list of best choices in terms of treatment options and potential outcomes.

I believed then, and still do adamantly today, that a caregiver’s most critical tasks are making an accurate assessment of the issues at hand (there’s that diagnosis issue again) AND educating their patient (or client if you will) about a host of things – the problem itself, options to make things better, consequences of not dealing with the problem, and finally – managing expectations about recovery and the future.

Though it took several years to really appreciate all the moving parts in play here, over the long haul one of the more challenging aspects of that entire process was managing expectations patients brought to our relationship – the most challenging of all was the expectation that there was some magic pill, potion, therapy, surgery, or other treatment that could and would make them “pain free”.

The Pain Free Life After 40: Myth or Reality?

No doubt some will disagree, but after spending the better part of four decades studying human physiology, focused both on response to injury and normal degeneration (let’s call it wear and tear), along with ways to mitigate the problem(s) and improve function using a variety of approaches – I’m convinced it’s nigh on impossible to live an active, healthy lifestyle and NOT experience a host of aches and pains along the way, particularly for those of us who have invested four decades or more living our lives.

My rationale is pretty simple, and of course is colored in part by my own personal experience.

First, no matter if you come from the intelligent design or the evolution camp, there’s no question that the human body we see wandering the earth today experiences wear and tear changes along the way. This is of course common sense, something that we see all around us, and feel ourselves, just about every day, and yet several interesting points apply.

The longevity of the human body is critically impacted by how you care for it along the way. There are a host of great examples, but here’s the easiest one – living for years overweight increases joint loading (think hips, knees, ankles/feet, and spine) and accelerates degenerative changes in vital joint structures.

Or how about that combination ACL/MCL tear on the high school sports field or the ski slope (actually pick your major joint here – the other common example I see over and over again is a shoulder/AC joint/rotator cuff problem that starts at a very young age) that almost always leads to accelerated degenerative joint changes down the road.

Even some of the fitness activities that we all laud and encourage – jogging, running, cycling at a high level, hours spent in the pool swimming, some would even include CrossFit here – stress joints and other parts of the musculoskeletal system mechanically and probably do, at some level, indeed accelerate inevitable wear and tear.

We continue to do those fitness activities because the myriad benefits far outweigh the wear and tear we’re inducing, however there’s still a wear and tear component to the process.

Those changes wear and tear changes accumulate over the months and years, and now and again will inflame and generate what we all perceive as aches and pains. Don’t forget that typical age-related muscle and strength losses happen too, impacting joint support and mechanics; throw in a sedentary lifestyle and even worse overall physical conditioning, and joint changes worsen even more – and so do the inflammatory-driven aches and pains.

So Being Absolutely Pain Free After 40 Is Indeed a Myth?

What I suggested to patients for years and now for coaching clients is simply this – I think it’s virtually impossible to be absolutely free of aches and pains after 40 living an active and functional lifestyle.

Perhaps even more importantly, I’d argue that there are some “aches and pains” that are unquestionable a good thing; probably the best example is DOMS (delayed onset muscle soreness) after a new workout or pushing your game a little.

Wear and tear of the human body (sometimes referred to as the degenerative cascade) just happens; part of your musculoskeletal longevity might be genetically influenced, but the most critical impacts are related to how well you care for yourself over the long haul.

There’s no question whatsoever than you can dramatically influence inflammation levels in your body via diet (we’ll be looking at detail in inflammatory impacts from diet in a several post series shortly). Moving closer to whatever you consider your ideal body weight will have dramatic impacts as well, as will rebuilding (or working hard to maintain) practical levels of functional conditioning – getting into, and staying, in “fighting trim” will itself invoke some soreness and aches along the way.

Your body has amazing recuperative powers.

Is it theoretically possible to live a pain free life? Sure it is, it’s just not very probable.

Instead, embrace the occasional joint tweak, morning stiffness, and sore muscle group – it’s going to happen again and again. And relish those days when everything feels pretty good, modify on the days that it doesn’t, and just keep moving.

Health and Fitness Expectations after 40: Managing the Timeline Game

By

Last week I introduced a series to come focusing on managing expectations, in particular expectations that those of us working to maximize our health and fitness after our 40th birthdays create for ourselves.

Given what we know about athletic performance, I’m thinking here of the old rule of thumb that your VO2max (think of VO2max as a measure of your body’s ability to utilize oxygen) declines by about 10% every decade post age 30, we probably should really be talking about expectations we create for ourselves post age thirty. (And this old study shows that the traditional 10% per decade decline doesn’t hold true for fit people actively exercising, even in their 7th decade).

And of course, the absolute crux of the timeline expectation game is damned simple – the time it’s going to take you to get from your starting point to your fitness, or weight, or metabolic health target depends on a host of factors unique to you, and critically where – relative to your targets – you’re starting from.

An Embarrassing Example from my Own Experience

When I first made the decision now just about three years ago to do what ever it might take to reclaim my health and fitness, I was a physical and metabolic disaster. In a full blow metabolic syndrome (I could have been a poster boy), I had just finished a round of treatment for renal cancer, had developed an idiopathic thrombocytopenia (low platelet count), weighed 412 pounds, and had so many aches and pains I could hardly walk through a store without the aid of a cart, and on the worst days, needed help tying my shoes.

A mentor helped me take the first steps in terms of revamping my diet and beginning at the most basic level in terms of rebuilding my fitness, and drilled into me the importance of setting attainable and rational short and intermediate term goals (incentives, and success, are huge helps). He also challenged me to set “reach for the stars”, seemingly at the time almost crazy goals as well; we can talk about structuring goals in detail sometime in detail – the psychology is fascinating – for sake of this story let’s just say I did set some seemingly unreachable long term goals (most of which I’ve now surpassed at the almost two year mark).

My mentor, wise friend that he is, hammered into me week after week that part of the process is indeed expecting life to get better (fitness to improve, weight to drop, etc), but he cautioned every single time that trying to pair my fitness and weight loss goals with a timeline I’d pulled out of thin air was a fool’s errand. He (correctly) harped on the principle that our expectations (especially when it comes to timelines) need to be tempered and tied to our reality unfolding day by day.

For Every Year a Couch Potato a Month in Recovery?

My mentor repetitively hounded me with another rule of thumb that he swears he learned from Dr. Phil Maffetone (I’ve yet to find it expressly stated on his site or any of his books), basically saying that after 40 (arguably 30 or 35 as well), for every year you’ve spent not exercising and overweight, you’ll spend at least a month of consistent fitness and healthy eating to reverse and overcome the damage and deconditioning done on your way back to a healthy baseline.

To be perfectly honest, I despise most rule of thumb discussions in health and fitness in general, as there’s simply too much variability in human physiology and experience to make them conform meaningfully to an individual’s reality.

That said, I’ve used this principle in advising clients and patients for years now – for every year a couch potato you’ll spend a month eating healthy and exercising consistently to restore a healthy baseline – and I’ll be damned if it doesn’t ring ring true more often than not. And note I’m talking about a healthy baseline here – becoming a masters cyclist or runner might take a little longer.

The Bottom Line: Play to Win the Long Game

In particular for those of us over 40, restoring optimal health and fitness after a period of…let’s say any time living with less than optimal nutrition and shunning exercise…is going to be a long game; accepting that reality will make the process immensely more rewarding, enjoyable, and sustainable.

Amazingly I still have people contact me for help in “easily dropping 50 pounds in three months”; most of the time we don’t mesh and work together – unrealistic expectations at the start are a huge hurdle to overcome. (Can somebody drop 50 pounds in three months? While possible, it’s sure as hell not probable, but it depends on where you’re starting from and how you want to get there; I dropped 50 pounds in four months myself at one point in my journey. )

By 40, most of us have accumulated at least a few dings and bruises, we don’t recover as quickly from aggressive workouts or injury, we often have very demanding work and family responsibilities, and we’ve often accumulated some damned harmful and deeply ingrained habits too. These things won’t prevent you from coming back, but they’ll impact your approach, and the timeline.

Have a long way to go to rebuild your health and fitness? It can be done; embrace the longer journey, savor the victories along the way, and build a lifestyle to take you into later years, remaining active, vital, and engaged.

Health and Fitness After 40: Managing the Expectation Game

By

The Cambridge Dictionary defines the word expectation in several ways, and there’s a slight twist when comparing the US vs. the British definitions…

US: the feeling or belief that something will or should happen

UK: the feeling that good things are going to happen in the future; the feeling of expecting something to happen, what you believe or hope will happen in the future

At the risk of sounding a little too old school, I’d venture that – when it comes to personal health, wellness, and fitness – many of us have allowed the impatient, “I want it right now, dammit” tone dominating society now to impact how we view our own approach to, and our progress in, an effort to up our game and live healthier.

The longer I actively practiced medicine the more convinced I became that, for a variety of reasons we’ll talk about over the next several weeks, most of us have expectations regarding health, fitness, and function that are hugely divergent from our own personal realities, and if you’re not a thoughtful steward of expectations – lousy results often follow, many times leading to failure and disaster.

Here’s an example of what I’m talking about. During the last fifteen or so years in practice, I focused on the conservative management of spine disease and injury. Most of the patients I treated were older than thirty-five, overweight – some massively, poorly conditioned, sedentary or close to it, consumed some variation of the Standard American Diet, and many engaged in some other high risk health behavior, smoking and recreational drug use being the most common.

Most of the patients I treated stepped into my office with the expectation that, with some wave of the technological magic wand helped by some pharmacologic sorcery, their pain would somehow be resolved with minimal effort otherwise on their part.

Managing these expectations was in reality perhaps my biggest challenge in the medical game; it required patient, consistent, endless education, helping people understand what was wrong, why it happened, how recovery and restoration of function actually happens, and what the potentials were down the road for improvement and gains.

You can guess how the story unfolded; a minority really dug in, listened, learned, made life and activity changes, and genuinely improved. A bigger group went through the motions, did the minimum to quiet the problem at hand, and resumed their destructive lifestyle to return with another back pain crisis a few months down the road. Another minority refused to engage, and went off seeking the holy grail of a no-effort recovery, usually unhappy, bitter, and disparaging on the way out the door.

Health and Fitness After 40: Managing the Expectation Game

Over the next few weeks we’re going to tackle some of the expectations those of us over 40 (you could argue over 30 for most in America today) have regarding our own personal health, wellness, and fitness; of course we all want to be more fit, closer to our best weight, sharper, more engaged and energetic, and live as long as a highly functional – and happy – human as we possibly can.

Before your expectations derail your progress on your journey, let’s spend some time looking in more detail at some common areas where our expectations can quickly breed frustration. We’ll start with a fairly candid look at weight loss expectations next week, followed by a number of other topics in the weeks to come.

A Nifty Counter to Genetic Programming Skeptics Flew Overhead This Morning

By

The past few weeks I’ve been overflown on my early morning walks by both small and large flocks of geese headed south. We live in a small community north of the DFW metroplex, surrounded by pasture and farmland, and the flocks are resting overnight before flying out about sunrise. The biggest V formation had already passed when it dawned on me to grab a pic this morning…

Why geese here today?

I have a physician acquaintance from long ago who’s recently resurfaced and taken me to task for aligning with much of the ancestral health world in what I’ve shared here on the Older Bolder Life.

Rounding out the story, he’s a no-nonsense internist who happens to spend over half his time working with a bariatric surgery team managing the oft expansive metabolic dysfunction that can sometimes occur post these procedures. We’ve not interacted in some time, and while I’d not define our past interactions as being those of close friends, we were involved in a community service project together years ago.

He’s particularly offended by those of us in the ancestral health and wellness circle who dare to suggest that consuming the Standard American Diet (SAD) and living what for most is a sedentary lifestyle runs counter to our inborn, encoded genetic programing, leading to development of a host of metabolic disorders and functional impairment (insulin resistance, metabolic syndrome, T2DM, fatty liver are just a few that come to mind).

His argument appears to focus upon the fact that, at least from where he sits today, human evolution has been for the most part static for generations now, and that disease and metabolic dysfunction today, despite being damned prevalent, is primarily due to behavioral features that (in his view) most people simply can’t overcome; he goes on to argue that one’s “genetic program is simply the cards you were dealt” to play at your birth, and that the concept of using food and nutritional elements to “manipulate” genes is absurd.

He’s also gone on to suggest that man’s innate higher level cognitive abilities give us the power to override the (faulty) genetic programming we’re born with, at least most anyway, and he’s even suggested that the natural world around us offers very few concrete examples of deeply encoded genetic information that impacts the behaviors of creatures around us.

My acquaintance is dead wrong of course, and on a number of points.

The Canada geese honking their way overhead this morning are a beautiful example of deeply embedded programing that compels them to make their annual fall migration south, often covering thousands of miles, around the same time every year.

And, of course, there’s now decades of hard evidence supporting the fact that our genome appears to be encoded to thrive on a food plan that’s quite different from the SAD; my own experience (now having lost nearly 200 pounds!) is a prime example. The challenge of course is finding the optimal food/nutrition and activity/fitness plans to suit your particular physiology and activity demands, though it can be done, and it’s much simpler than you’d think.

(Postscript: My former colleague reluctantly admitted that he’s 70 pounds above his ideal weight range, is on statins, is insulin resistant and teetering on the edge of a formal diagnosis of T2DM, though he insists he’s “fit but fat”.)

Inquiring Minds Want to Know: Older Bolder Links, Reads, Recipes, and More 10 August 2019

By

Fitness At Any Age: Thoughts From the Week

Much has been written of late covering quarterback Tom Brady’s 19th NFL season which officially started last week; while I’m not necessarily a fan of his TB12 methodology and program being a fit for most mere mortals over 40, Men’s Health recently published a nicely done interview piece on his pre-season training program.

4 laws of muscle; great reminder about the importance of protein (and protein signaling).

Nice piece from Sisson on microworkouts.

91-year old woman breaks age world record in 400 meters.

89-year old deadlifts 405 – twice!

An Eclectic Collection of Other Older Bolder Topics of Interest

5 ways to conquer an impossible task.

Elevated fasting glucose levels raise pancreatic cancer risk. (I lost a good friend years ago to pancreatic cancer – improvements in diagnosis and care have transpired since then, but dammit, what a bad actor that disease can be…)

People with T2DM lowered hepatic fat and improved glucose tolerance on a LCHP food plan in only 6 weeks.

Speaking of protein above, higher protein in seniors may help combat osteoporosis too.

Food, Glorious Food

From vegetarian to butcher.

Should you be thinking about sesame seeds as an allergen? The study…

Countries eating more butter are happier? (Beware the correlation v. causation issue)

Scapegoating red meat? (A chef friend who sent this over had some interesting commentary, more to come in a post…)

Our Recipes from the Week
Sweet Potato Hashbrown Cheeseburger Pie
Libby’s Verde Cashew Wonder Sauce
Easy Romesco Sauce

Reclaiming Health and Fitness After 40: Five Quick Thoughts

By

A couple of weeks ago I had a chance to reconnect with a friend from residency days back in Salt Lake City in the mid-80s; we were residency mates there in the University of Utah hospital system before he headed back home to San Diego to set up his practice and later found his own company.

My friend had something of an unusual story; he was a gifted mechanical engineer who later went into medicine with a goal of designing adaptive equipment for people with profound neuromuscular disease and injury. He was a delight, one of those rare hyper-intelligent and inquisitive people we all (rarely) have occasion to meet, and was an uber-fit skier, distance runner, and surfer.

Without boring you with details, through a mutual connection in England, he’d heard of my recent health transformation, and ended up calling to chat one afternoon. We covered a lot of ground in an hour, but he was particularly interested in what I’d done to reclaim my health and lessons I’d learned along the way. He shared that he had an adult “child” in her mid 40s who desperately needed a lifestyle and fitness change, and he was at the end of his rope trying to encourage her to start. He shared, among other things, that she felt she was “too far gone” to ever make a meaningful impact.

Thinking about it on the fly as we talked, I offered him five quick thoughts about reclaiming health and fitness after 40 gleaned from my own experience.

It’s Never Too Late to Start

I am profoundly and utterly convinced that it’s never too late to jump in with both feet, start moving physically, and reshape one’s approach to nutrition. At 57 I did just that, and started from a point of metabolic and physical disaster – 412 pounds, unable to tie my own shoes some days, with so many aches, pains, and symptoms I’m embarrassed to list them all. Now, just a bit over three years later, I’ve lost nearly 200 pounds and 20+ inches at my waist, am more fit than ever, and am even training for sprint competition in Senior track and field events upcoming.

Clearly your mileage may vary, but I have clients now in their 80s who’ve made similar changes and reshaped their approach to life. It’s never too late.

Reclaiming Health and Fitness After 40 Is a Long Game

Expectations can be an interesting beast to tame, at least for most of us. We’re an impatient society, and often fall prey to tall tales and crazy promises to shed improbably amounts of excess weight and gain extraordinary levels of fitness over very short time frames (30 days wonders) by following some magic diet, taking a wonder supplement, or copying the routine of a sculpted gym barbie with an Instagram following.

Attaining optimal health, fitness, and wellness at any age is a long game, most often measured in months if not years, but particularly for those of us north of 40. It’s a lot more enjoyable journey if you embrace the long view, and don’t sweat the day to day and week to week stuff.

Reclaiming Health and Fitness After 40 Might Take Baby Steps, But Take ‘Em

Talking with my friend, we agreed that life in today’s world, at least for the majority, is astoundingly sedentary. Many sit all day at work, commute sitting, come home and eat a poorly composed meal, and then sit on the couch for the next four hours before tossing and turning at night and starting it all over again.

Thoughtfully incorporating movement into the day can make a world of difference when starting from fitness ground zero; we’ve all heard the suggestions (park at a distance and walk in, get up and walk 10 minutes every two hours, etc), and these steps are easy to incorporate into one’s day. I’m a HUGE fan of walking outdoors, still do it daily to start my day myself, even on sprint training days, and just about every one on the planet can do it with minimal investment in time and equipment.

Baby steps turn into meaningful fitness routines over time.

Reclaiming Health and Fitness After 40: Embrace the Aches and Modify

One of the things I learned with my 30+ years in medicine is that the human body, despite its astoundingly complex design, function, and capacity to repair itself, is nonetheless designed to wear and tear over time. It’s inevitable, though manifests differently and at unique times for all of us.

The point: we all have our various aches and pains, joints that have been injured or have advanced markers of degeneration (read wear and tear); some days you’re going to be more sore and achy than others. Accept that reality, and modify, modify, modify exercise and fitness to accommodate your function on a given day. Remembering that you’re playing a long game makes this strategy more sensible too.

Personally I’ve been astounded at what a difference rebuilding functional strength has made in my own “aches and pains” related to prior orthopedic injuries, and just general activity and functional tolerance. Of course, that’s in part related to the last point…

Personally Optimizing Nutrition Makes Life So Much Better

Finally, I suggested my friend gently remind his daughter that there is a far, far better way to fuel the human machine than via the SAD (standard American diet). The point I tried to convey was simple from our perspective – the food we eat now is so much tastier, interesting, and flavorful than any we’ve consumed over the years, AND is so much healthier – less inflammatory (there’s that aches and pains concept again), less atherogenic, and more physiologically sensible given the science that has evolved over the past twenty years.

Personally I think for almost everyone walking on the planet, metabolic flexibility is the holy grail of nutrition – not being in ketosis or rigidly adhering to some arbitrary set of dietary rules. There is no one size fits all nutrition plan. Metabolic flexibility is key for anyone at any age, but perhaps even more meaningful for those of over 40, busy with all that life has to offer.

The challenge, of course, is to find the nutrition plan that resonates with your own particular physiology and metabolism, and make the tweaks and adjustments that work for you. It can be done, and again, it’s never too late to start.

Enjoyed the call JS, best of luck with your daughter and I’m happy to help any way I can.

My Newest Travel Workout: The Three Card Flip (or Deal Me Three) Workout

By

About a month ago a friend, who happens to travel what seems like endlessly for his work, shared with me a workout hack his wife had stumbled across at her gym – the Three Card Flip Workout, though my buddy and his wife called it the Deal Me 3 Workout.

That said, low and behold the same concept surfaced last week in GQ’s Level Up email newsletter (worth a subscribe if you don’t read it already); from the newsletter –

…I’ve been thinking about that idea in a different context recently: exercise. Specifically in reference to my favorite workout hack, something I’ve (very creatively) coined the Three-Card Flip. Pull three playing cards from a deck—the first is the number of push-ups that you’ll do; the second card is the number of bodyweight squats (or lunges, for variety); the third is the number of leg lifts. (Jack, queen, king = 11, 12, 13; Ace = 1…or 14, if you’re a hardo.) Do it all the way through the deck—17 times, in total—and about 20 minutes later you’ll have done 360-plus push-ups, bodyweight squats/lunges, and leg lifts in total. The Three-Card Flip is my go-to on days when I don’t have time to do a longer workout—and it usually leaves me with a similar post-exercise high. (Highly recommend if you’re traveling and you don’t know what your schedule might look like, or if you’ll have access to a gym.)…

I’ve used this a few times now on the road, and even on a day when I need a shorter, intense, HIIT additional workout to meet my targets during a lighter day when weather or schedule intervened.

I’ve been incorporating simple body weight movements for each of the three, typically some combination of pushups, pull-ups, squats, lunges, toe raises, or squat-toe raise combo moves and trying to get through the “deck of exercise” in something close to 20-minutes or less.

Customize to suit your fitness level and capacity, and keep on dealing…