A healthy recess during school can cut down on bullying, improve learning, study finds

New research shows a healthy recess period during the school day can cut down on bullying and strengthen the school climate.

The report from researchers at Mathematica Policy Research and Stanford University compared schools in five cities who used Playworks — a program that uses a full-time coach to work to engage students in safe, healthy play during recess and throughout the day — to similar schools who did not use the program.

Schools that used the Playworks method had less bullying; better recess behavior and readiness for class. Teachers reported quicker transition to learning activities after recess and the students felt safer and more included at recess. Nearly 100 percent of teachers in Playworks said they wanted to use the program again the next school year. (Read more)

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Video systems like Wii Fit not working against child obesity: study

Video games designed to encourage children to exercise don't do anything to prevent obesity, a study has concluded. It found that children either find a way to trick the games "into thinking they are moving around, or they make up for exercise by vegging out more later," reports Maggie Fox for the National Journal.

"It doesn't appear that there's any public-health value to having active video games available in stores — simply having those active video games available on the shelf or at home doesn't automatically lead to increased levels of physical activity in children," said Dr. Tom Baranowski.

Baranowski and his Baylor College of Medicine team studied 78 children, whom they gave the video system Wii to play with. "It's not clear whether those in the study group were more active as a result of the video games but compensated by being less active later, or if they found a way to manipulate the instruments to minimize the amount of physical activity," he said.

Other studies have shown the video systems are beneficial to some age groups, including seniors, Fox reports. The study is published in the journal Pediatrics. (Read more)

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Kentucky ranks next to last, Fifth Congressional District dead last in national healthiness and happiness survey

(Click on images for larger versions)

Kentucky was again next to last among the states in happiness and healthiness of its residents in 2011, ranking above only West Virginia, though precise rankings are uncertain. Eastern Kentucky's Fifth Congressional District ranked at the very bottom of the 436 districts — falling in last place in the categories of life evaluation, emotional health and physical health.

The Gallup-Healthways Well-Being Index is based on a continuing national survey that asks respondents about their overall sense of well-being, physical health, happiness, job satisfaction and other factors related to quality of life.

Of the 190 cities ranked, Lexington was 95th and Louisville 152nd. Kentucky's well-being score was 63.3 out of a possible 100 points. Hawaii again ranked first, at 70.2. West Virginia's score was 62.3. Because there were fewer than 10 points between first and last place, the rankings are not precise.Kentucky ranked lowest in the country in emotional health, which is based on feelings of happiness and sadness. Respondents were also asked about "physical health (chronic health conditions, obesity); lifestyle behaviors (smoking, diet and exercise); emotional health (feelings of happiness, sadness); work environment (relationship with supervisors); basic access (health care, food); and life evaluation (how they rate their lives)," reports Nanci Hellmich of USA Today.

Results were based on telephone interviews conducted between Jan. 2 and Dec. 29, 2011, producing a random sample of 353,492 adults. The margin of sampling error for most states is plus or minus 1 to 2 percentage points, but as high as plus or minus 4 points for states with small populations such as Wyoming, North Dakota, South Dakota, Delaware and Hawaii. (Read more)

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Single best thing we can do for our health is exercise

In an innovative video that draws a complete picture of the answer, Dr. Mike Evans asks the question "What is the single best thing we can do for our health?"

It turns out that whether a person wants to reduce the risk of knee arthritis, dementia, Alzheimer's, diabetes, hip fractures, anxiety, depression, fatigue and low quality of life, the key is exercise.

"The best thing you can do for your health is to spend half an hour being active," said Evans, an associate professor of family medicine and public health at the University of Toronto. "Low fitness was the strongest predictor of death."

The 9-minute video is worth a watch.

Happily, a survey shows more doctors like Evans are telling their patients to get out and exercise. Nearly 33 percent of adults who went to the doctor in the previous year said their doctor told them to be more physically active. In 2000, just 23 percent did, the survey by the Centers for Disease Control and Prevention showed.

The survey found more women were told to do so than men, reports Mike Stobbe of The Associated Press. Of patients with chronic health issues, diabetics were told the most often. Cancer patients were least likely.

The widest margin of increase was in patients ages 85 and older. In 2000, just 15 percent were told by their doctors to exercise. In 2010, nearly 30 percent were. "It's very encouraging that doctors feel people at that age still have time to live and can make their health better," said Pat Barnes, a CDC health statistician who was the lead author of the report. (Read more)

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Michelle Obama announces nationwide contest to fight childhood obesity; $500,000 in prizes

As part of her Let's Move initiative to fight childhood obesity, First Lady Michelle Obama announced a contest today that will give away $500,000 in prizes. The Active Schools Acceleration Project will reward the most "creative, impactful and scalable school-based programs and technological innovations that promote physical activity for children," a press release reads.

"We know there's so much good work going on all across this country to get our kids up and moving every single day," Obama said. "So we want to find the best school programs and technology ideas that increase physical activity for kids — and then help them reach even more children throughout America."

The competition features two categories: school programs and technology innovation. Teachers, schools or entire districts can submit their in-school activity programs, which could include a curriculum, activity, environmental modification, event or other initiative. The technology innovation category can include devices, tracking and measurement systems, software applications, social media, gaming and smart phones that encourage kids to be physically active.

Applications will be accepted through April 2. For more information, click here.

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Don't let food take control of your Valentine's Day!

Trying to avoid, or at least over-indulging in, chocolate and candy on Valentine's Day? Steer clear of making the day about food, experts say.

"Focus on spending quality time with your friends and loved ones," suggests Cristina Harder, a licensed dietician at the Loyola Center for Fitness. "Trying a new activity together is a great way to share time with family and friends."(VirtualChocolate.com photo)

When it comes to eating, cook at home rather than go out to a restaurant, and get some exercise, reports research-reporting service Newswise. In one hour, a person can burn:
• 200 calories walking, ballroom dancing or bowling
• 500 calories playing racquetball
• 600 calories playing tennis

If the celebration just isn't complete with some indulgence, keep track of what it is. Five Hershey's Kisses just have 100 calories, as do 30 plain M&Ms and three Dove dark chocolate hearts. "They will satisfy a sweet tooth without killing a diet," Harder said."If you do over-indulge, just get back on track as soon as you can," Harder added. "A minor dietary mishap is only a bump in the road and should not derail your efforts." (Read more)

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Kentucky ranks 37th, Louisville 33rd in percentage of commuters who bike or walk to work

Kentucky ranks 37th in the nation for its number of commuters who bike or walk to work. Of the 51 largest cities in the county, Louisville ranks 33rd.

These are the findings of the Bicycling and Walking in the United States: 2012 Benchmarking Report, compiled by the Alliance for Biking & Walking. As well as looking at commuter numbers, it also examined how safe those commuters are and where transportation funding is being spent on "alternative means of local travel," reports Jeannine Stein of the Los Angeles Times. (Times photo by Wally Skalij)

Alaska, despite its cold climate, has the highest percentage of commuters who bike or walk to work. Boston has the highest ranking among cities. The lowest are Alabama and Fort Worth, Tex.

Across the country, 12 percent of all trips are on foot (10.5 percent) or by bicycle (1 percent), though from 2000 to 2009, the number of cycling commuters increased by 57 percent. While numbers are growing, safety is a concern. In the 51 largest cities, 12.7 percent of trips are by foot and 1.1 percent are by bicycle, but 26.9 percent of traffic fatalities are pedestrians and 3.1 percent are bicyclists.

Despite the risk, the report makes a connection with biking or walking and health. It points out cycling and walking levels fell 66 percent between 1960 and 2009, while obesity levels increased by 156 percent. The picture was more grim when it came to children. Between 1966 and 2009, the number of children who biked or walked to school fell by 75 percent, while the percentage of obese children rose by 276 percent.

Despite the physical benefits of the activity, states spend just 1.6 percent of their federal transportation dollars on bicycling and walking, amounting to just $2.17 per capita, the report found.

Instead of biking or walking, people are still relying mostly on their cars. The report found 40 percent of trips in the United States in 2009 were shorter than two miles, but Americans used their cars for 87 percent of trips that were 1 to 2 miles in distance. When it came to trips up to 1 mile long, Americans still used their cars 62 percent of the time.

The report was funded by the Centers for Disease Control and Prevention, AARP and Planet Bike.

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What Causes Insulin Resistance? Part VII

In previous posts, I outlined the factors I'm aware of that can contribute to insulin resistance.  In this post, first I'll list the factors, then I'll provide my opinion of effective strategies for preventing and potentially reversing insulin resistance.

The factors

These are the factors I'm aware of that can contribute to insulin resistance, listed in approximate order of importance.  I could be quite wrong about the order-- this is just my best guess. Many of these factors are intertwined with one another. 
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What Causes Insulin Resistance? Part VI

In this post, I'll explore a few miscellaneous factors that can contribute to insulin resistance: smoking, glucocorticoids/stress, cooking temperature, age, genetics and low birth weight.

Smoking

Smoking tobacco acutely and chronically reduces insulin sensitivity (1, 2, 3), possibly via:

1. Increased inflammation
2. Increased circulating free fatty acids (4)

Paradoxically, since smoking also protects against fat gain, in the very long term it may not produce as much insulin resistance as one would otherwise expect.  Diabetes risk is greatly elevated in the three years following smoking cessation (5), and this is likely due to the fat gain that occurs.  This is not a good excuse to keep smoking, because smoking tobacco is one of the most unhealthy things you can possibly do.  But it is a good reason to tighten up your diet and lifestyle after quitting.

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New Year's resolutions: How to stick to them, how to set up a game plan, and even a few you may want to consider making

Research-reporting service Newswise has compiled an extensive New Year's resolutions package, information particularly helpful to newsrooms in search of copy during the week between Christmas and New Year's. Use these items for tips and information that can encourage your readers to live healthier lives. (Illustration by Tara Kaprowy, Kentucky Health News)

Resolutions need a course of action

If you want to achieve your New Year's resolution goals, you need to be detailed about it, said Joshua Klapow, a clinical psychologist at University of Alabama at Birmingham.

If the goal is to lose weight, "You have to outline the days and times you will go to the gym, the menu adjustments you will make and who in your circle can help keep you accountable for these goals," Klapow says. He advises a "gut-check," asking yourself if you really want to commit to the resolution in the first place. "It's better to be honest than to fail.".

Other tips for success include:

• Be realistic about the goal; shoot for success instead of the stars

• Set short-term and long-term goals

• Be open to making adjustments to your resolutions.

Monitoring progress is also important. "Simply keeping a mental track will not cut it," Klapow said. "If you are dieting, write down the foods you eat. If you want to spend less, write down your expenses. This will give you a visual account of what is working and what is not."

An actual record will also establish the "three-day rule," which involves writing down the reasons you stopped if you've missed three days committing to your new habit or routine. It also involves picking a specific re-start date and putting the written record somewhere that can be seen.

It's also important to recognize limitations. "You have to arrange your life for success," Klapow said. "Buying junk food for your family while you are trying to diet is not going to help. If you want to save money, stop carrying credit cards. Control what you can control to make your goals more easily achievable." (Read more)

Use Monday to make resolutions stick

Almost 45 percent of Americans will make a New Year's resolution this year, but studies show many will fall off the wagon within the first week and almost half will break their resolutions within the year.

One trick to stay on track? "Make Monday the day to recommit to your resolution, evaluate progress and set your goals for the coming week," says research-reporting service Newswise.

"We think of Monday as the January of the week," said Sid Lerner, founder and chairman of The Monday Campaigns, a nonprofit initiative in association with Johns Hopkins, Columbia and Syracuse universities. "It's a call to action built into every calendar, giving you 52 chances for success." (Read more)

Secret to resolution success is to make attainable goals

"I think most people make resolutions that they don't achieve for many reasons, often because they seem so overwhelming," said William McCann, director of behavioral science education in Wake Forest Baptist's Medical Center. "So, from a psychological perspective, we should make resolutions that we are sure to be able to follow through on. While it seems counter intuitive, we should lower our expectations because we want to be able to say to ourselves by next Dec. 31st 'I did it.'"

McCann offers a sample list of resolutions:

• "I will eat a little less dried food this year."

• "I will drive a little more slowly this year."

• "I will help others a little more this year."

• "I will interfere in my children's lives a little less this year."

• "I will talk less and listen a little more."

"Doing a little bit is like a seed that might grow," McCann said. "Start little and see what happens in 2012." (Read more)

Resolution Solution: How to meet your goals

A recent study shows committing to a detailed plan to meet one's goal "not only makes it more likely to be done, but also gets it off your mind so you can think about other things." So says E.J. Masicampo, assistant professor at Wake Forest University. "The (plans) that work specify exactly what you are going to do, including when and where you are going to do it."

There are four elements to a good plan:

• It should specify what is the goal and in what situations it should be accomplished.

• The planner should know he or she is in control and the plan is not dependent on what someone else does.

• It should list specific opportunities to meet the goal.

• It should be a goal the planner is motivated to meet.

"You have to picture yourself carrying out your plan," Masicampo said. "That's where the power of the plans lie, in imagining yourself completing the tasks."

For people trying to lose weight, for example, Masicampo said people should make "if, then" plans. "An 'if, then' plan pre-decides how you will act in a given situation," he said. If a person goes to a restaurant, then they should plan to order a salad rather than cheeseburger. "Making a plan is like setting an alarm because you don't have to think about it under the alarm sounds and then you'll act." (Read more)

Ten resolutions to consider

The University of Buffalo offers its annual list of resolutions worth committing to, each of which is based on the research of its faculty:

1. Make returning war veterans feel at home.

2. Floss every day.

3. To lose weight, eat the same foods over and over. Repetition may discourage overeating.

4. Be a humble leader.

5. Talk to your child about bullying.

6. Combat loneliness by reading more fantasy novels.

7. Reflect on things that give life meaning.

8. Set up separate email accounts to avoid getting scammed.

9. Teach math to your toddler.

10. Be nice to nurses.
(Read more)

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The common 'fat gene' can be overcome with a little exercise

Even if they've inherited "the fat gene," people don't have to be overweight if they have a relatively small amount of physical activity, such as walking their dog, a study has found. (Getty Images photo)

The research, published this month in the journal of PLoS Medicine, reviewed dozens of studies about the fat mass and obesity-associated gene, which is very common. "By most estimates, about 65 percent of people of European and African descent and perhaps 44 percent of Asians carry some version of the FTO gene," reports Tara Parker-Pope of The New York Times.

But physical activity, even a small amount, may counter the effects of the gene, reducing reduced the effect of the FTO by 30 percent. "While that still leaves 70 percent of the potentially fat-encouraging effect of the gene intact, the consequences of physical activity on the workings of this single gene seem to be substantial enough to perhaps allow someone who otherwise would become seriously overweight to maintain a normal waistline," Parker-Pope reports.

Scientists are still stumped by how the FTO encourages weight gain, but know the gene is particularly active in the the regions of the brain "that regulate the balance of energy intake and expenditure," said Dr. Lu Qi, assistant professor in the department of nutrition at the Harvard School of Public Health. "The loss of energy balance is the basis of development of obesity."

Physical activity, though, my counteract that. "Biologically, it is possible these two factors, genes and physical activity, may interact in affecting energy balance," Qi said. And exercise might affect how the FTO gene works, influencing "whether it expresses certain proteins or remains quiet," Parker-Pope reports.

Though researchers are being cautiously optimistic, they hope the implications of the findings will be encouraging. "Often people feel that obesity runs in the family or that obesity is in their genes, and therefore feel they have no control over their weight issues," said Dr. Ruth Loos, a program leader at the Institute of Metabolic Science in Cambridge, England. "Our study shows that physical activity plays a role in weight control, even in those who are genetically predisposed." (Read more)

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'Most sedentary' designation sparks Lexingtonians to stand up; Herald-Leader coverage is an example to follow

Lexington's recent designation as the most sedentary city in the country by Men's Health magazine has got its residents talking, exercising and sharing their stories.

First, the city had a tongue-in-cheek Sedentary Parade with stationary floats and non-marching bands. Then, the Lexington Herald-Leader invited readers to share their stories about how they stay active to disprove the designation. The stories were published online Wednesday (with this couch potato illustration).

They include stories of people who have lost weight and run in marathons. It also includes the story of Robert F. Wachs, a 79-year-old man who has walked 4,500 miles in the last four years. "Once a month or so, I walk to downtown Lexington to get a haircut and then walk back to my home. This is a seven-mile round trip," he wrote.

The stories are accompanied by a calendar of upcoming exercise opportunities in the area.

There are also several features under the Stand Up Lexington heading, which include in-depth stories of how Lexingtonians are getting fit. They range from a woman sharing her weight-loss story on her blog to a badly injured trucker who is now participating in an Ironman triathlon. (Photo of Brennan Donahue by H-L's Tom Eblen)

The Herald-Leader has offered a good example for how a newspaper can provide an outlet for readers to share their stories, dispel an unflattering designation and inspire others to get active. Other newspapers across Kentucky could do the same with a variety of health-related topics.

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Four state agencies give employees time to exercise at work

Update, Sept. 2: A new study has shown giving employees time to exercise during their work day could lead to increased productivity, as reported in the Journal of Occupational and Environmental Medicine. The study involved employees at a large public dental health organization in Sweden. On group of employees was required to do 2.5 hours of exercise per week during regular hours. "Another group received the same reduction in work hours, but with no exercise program," research-reporting service Newswise reports. Employees assigned to the exercise program said they felt productive while at work and were absent less often due to illness. (Read more)

Four state agencies allow their employees to take time to exercise as part of their work day, part of an effort to improve morale and productivity. The Department of Financial Institutions, Department of Military Affairs, Department of Veterans Affairs and the Personnel Cabinet have instituted the policies with varying degrees of participation.

"Some workers are limited to 90 minutes of paid exercise per week, while others can exercise up to five hours while on the clock," reports Valarie Honeycutt Spears of the Lexington Herald-Leader. "On any given day, employees can exercise from 30 to 60 minutes, depending on which agency they work for." (Photo of state employee Lisa Clark by H-L's David Perry)

It is unclear how many state employees take advantage of the policies, but officials feels it is cost effective. "A wellness break is just like any other break time," said Crystal Pryor, spokeswoman for the Personnel Cabinet. "The difference is that this break results in reduced absenteeism, increased productivity, higher employee morale and lower health care costs for the Kentucky Employees' Health Plan, the state's self-funded insurance program."

One 2010 Harvard University study showed medical costs fall about $3.27 for every dollar spent on wellness programs. Absentee day expenses drop by $2.73 per dollar spent. Despite the savings, Kentucky is one of the only states to have such exercise policies in place. Montana also does, allowing employees two 15-minutes exercise breaks a day.

"Often these employees are discussing work issues while they are exercising so we really don't see this as cutting back on productivity," said Dick Brown, spokesman for the Department of Financial Institutions. "There are no hard facts around the impact of the program on reduction of sick leave, but certainly that is one of the benefits and trade-offs we hope to see over time." (Read more)

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A Roadmap to Obesity

In this post, I'll explain my current understanding of the factors that promote obesity in humans.  

Heritability

To a large degree, obesity is a heritable condition.  Various studies indicate that roughly two-thirds of the differences in body fatness between individuals is explained by heredity*, although estimates vary greatly (1).  However, we also know that obesity is not genetically determined, because in the US, the obesity rate has more than doubled in the last 30 years, consistent with what has happened to many other cultures (2).  How do we reconcile these two facts?  By understanding that genetic variability determines the degree of susceptibility to obesity-promoting factors.  In other words, in a natural environment with a natural diet, nearly everyone would be relatively lean, but when obesity-promoting factors are introduced, genetic makeup determines how resistant each person will be to fat gain.  As with the diseases of civilization, obesity is caused by a mismatch between our genetic heritage and our current environment.  This idea received experimental support from an interesting recent study (3).

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UK Extension Service launches online challenge to improve physical and financial wellness

The University of Kentucky Cooperative Extension Service has created an online challenge designed to help people improve their health and financial status. The Kentucky Fall 2011 Small Steps to Health and Wealth challenge starts Sept. 4 and runs to Oct. 2.

The free program asks participants to track daily choices they make about nutrition, physical activity and saving money. As they enter data into 10 categories, participants will earn points and see a comparison of their progress to other participants. Top finishers will receive prize packs. The first 150 people to complete the challenge will get a UK water bottle.

"As individuals work toward improving both their health and personal finances, it is important to realize that small changes do make a difference," said Jennifer Hunter, UK assistant extension professor for family financial management in the UK College of Agriculture. "Adopting only one of the 10 recommended daily practices is a step in the right direction."

To register, click here or call a local extension office.

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UK center probes the science of muscles and exercise

Exercise is good for you. But it's not that simple. "Doctors and scientists have a lot of questions about why exercise is so beneficial, how muscles work and the role muscle strength plays in overall health," columnist Tom Eblen writes on the front page of today's Lexington Herald-Leader, and reports that some of those questions are being addressed by the University of Kentucky Center for Muscle Biology, which was created three years ago. "With outside grants of more than $12 million, center researchers are looking at everything from injury prevention in young athletes to rehabilitation for elderly stroke patients," he writes.



"Physical activity and muscle strength seem to contribute to everything from better memory to disease prevention. For example, even moderate exercise can help Type 2 diabetes, which has become epidemic among overweight Kentuckians. Muscles store most of the body's insulin." The center's director, Karyn Karyn Esser, told Eblen, "When you exercise and make muscles work, it creates a separate path for absorbing glucose." (Eblen photo: Caitlyn Kerins demonstrated equipment for measuring muscle control as faculty member Patrick McKeon watched.)

Two researchers are studying how to strengthen diaphragm muscles, which are essential in breathing, "to help patients get off ventilators. It is a huge problem: about 60,000 Americans are on ventilators at any given time, and it costs billions of dollars to care for them," Eblen writes. "The longer most people are on a ventilator, the more likely they are to die." And "muscle weakness is the main culprit in about 70 percent of ventilator patients." Other researchers are investigating why lifting weights can improve memory in the elderly, why certain patients lose muscle strength soon after being hospitalized, how injuries caused by repetitive motion can be avoided, and exactly how massage and ice help repair and strengthen muscles.

Eblen, who took up bicycling at 35 to lose weight and is still an enthusiast in his mid-50s, is writing a lot lately about exercise in response to Lexington's designation by Men's Health magazine as the nation's most sedentary city. And the center's Esther Dupont-Versteegden is even researching inactivity: "We know that people feel better when they exercise regularly, but why is that?" she asked. "What is inactivity doing to people?" (Read more)

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Lexington is most sedentary city in U.S., Men's Health says

Lexington has been ranked as the most sedentary city in the country by Men's Health magazine. Or, to put it more bluntly, the laziest.

"What hurt Lexington most was the actual amount of activity, or exercise, people reported engaging in — any physical activity at all, which was relatively low. And they did have higher rates of deaths from deep vein thrombosis (DVT) as well," said Matt Marion, deputy editor of the magazine.

The rankings were compiled by looking at "how often residents exercise, the number of households that watched 15 hours of cable television a week and bought more than 11 video games a year, and the rate of DVT [deep vein thrombosis], a blood clot in a vein, usually in the leg, which is associated with inactivity," writes Patricia Reaney of Reuters.

Indianapolis and Jackson, Miss., also ranked very low, while Seattle, San Francisco and Oakland, Calif., were high. Southern cities ranked among the lowest on the list, which Marion said is in part due to their warm weather and lifestyle. "In certain cities there is a more laid-back lifestyle," he said. "That's fine, but there is not that same drive you'll see in certain parts of the northeast or California, or the northwest where people get up every morning and run or hit the gym."

The latest issue of Men's Health, with the rankings, hits newsstands Tuesday. (Read more)

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Natural cures looks at the circulation theory

Natural cures are found though the circulation system. The circulatory system of the human anatomy is in many respects a transportation system. Oxygen fixated upon red blood cells in the lungs is transported in the bloodstream to every cell in the body. The wastes eliminated by cells are conveyed through the bloodstream to the excretory system, which excretes the wastes but saves the blood cells for further utilization. Nutrients are also conveyed from the intestine to the cells through the bloodstream.
When circulation of the blood is impeded, the body is besieged by problems. Upon the delay of nutrients or oxygen, cells die from the lack of sustenance. Upon the impediment of blood flow, efficiency of cellular waste eliminanation is greatly reduced, and upon the accumulation of waste matter due to cellular dysfunction, health problems develop.
This would lead some people to conclude that increasing the rate of circulation will decrease  the chances of problems developing inside the body. The method that comes to most peoples minds as appropriate for accelerating the circulation is exercise.

Natural Health Journals – Promoting Health and Happiness through Healthy Living and Natural Medicine.

Natural Cures and Natural Remedies for Disease
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Book Review: The Primal Blueprint

Mark Sisson has been a central figure in the evolutionary health community since he began his weblog Mark's Daily Apple in 2006. He and his staff have been posting daily on his blog ever since. He has also written several other books, edited the Optimum Health newsletter, competed as a high-level endurance athlete, and served on the International Triathlon Union as the anti-doping chairman, all of which you can read about on his biography page. Mark is a practice-what-you-preach kind of guy, and if physical appearance means anything, he's on to something.

In 2009, Mark published his long-awaited book The Primal Blueprint. He self-published the book, which has advantages and disadvantages. The big advantage is that you aren't subject to the sometimes onerous demands of publishers, who attempt to maximize sales at Barnes and Noble. The front cover sports a simple picture of Mark, rather than a sunbaked swimsuit model, and the back cover offers no ridiculous claims of instant beauty and fat loss.

The drawback of self-publishing is it's more difficult to break into a wider market. That's why Mark has asked me to publish my review of his book today. He's trying to push it up in the Amazon.com rankings so that it gets a broader exposure. If you've been thinking about buying Mark's book, now is a good time to do it. If you order it from Amazon.com on March 17th, Mark is offering to sweeten the deal with some freebies on his site Mark's Daily Apple. Full disclosure: I'm not getting anything out of this, I'm simply mentioning it because I was reviewing Mark's book anyway and I thought some readers might enjoy it.

The Primal Blueprint is not a weight loss or diet book, it's a lifestyle program with an evolutionary slant. Mark uses the example of historical and contemporary hunter-gatherers as a model, and attempts to apply those lessons to life in the 21st century. He does it in a way that's empowering accessible to nearly everyone. To illustrate his points, he uses the example of an archetypal hunter-gatherer called Grok, and his 21st century mirror image, the Korg family.

The diet section will be familiar to anyone who has read about "paleolithic"-type diets. He advocates eating meats including organs, seafood, eggs, nuts, abundant vegetables, and fruit. He also suggests avoiding grains, legumes, dairy (although he's not very militant about this one), processed food in general, and reducing carbohydrate to less than 150 grams per day. I like his diet suggestions because they focus on real food. Mark is not a drill sergeant. He tries to create a plan that will be sustainable in the long run, by staying positive and allowing for cheats.

We part ways on the issue of carbohydrate. He suggests that eating more than 150 grams of carbohydrate per day leads to fat gain and disease, whereas I feel that position is untenable in light of what we know of non-industrial cultures (including some relatively high-carbohydrate hunter-gatherers). Although carbohydrate restriction (or at least wheat and sugar restriction) does have its place in treating obesity and metabolic dysfunction in modern populations, ultimately I don't think it's necessary for the prevention of those same problems, and it can even be counterproductive in some cases. Mark does acknowledge that refined carbohydrates are the main culprits.

The book's diet section also recommends nutritional supplements, including a multivitamin/mineral, antioxidant supplement, probiotics, protein powder and fish oil. I'm not a big proponent of supplementation. I'm also a bit of a hypocrite because I do take small doses of fish oil (when I haven't had seafood recently), and vitamin D in wintertime. But I can't get behind protein powders and antioxidant supplements.

Mark's suggestions for exercise, sun exposure, sleep and stress management make good sense to me. In a nutshell: do all three, but keep the exercise varied and don't overdo it. As a former high-level endurance athlete, he has a lot of credibility here. He puts everything in a format that's practical, accessible and empowering.

I think The Primal Blueprint is a useful book for a person who wants to maintain or improve her health. Although we disagree on the issue of carbohydrate, the diet and lifestyle advice is solid and will definitely be a vast improvement over what the average person is doing. The Primal Blueprint is not an academic book, nor does it attempt to be. It doesn't contain many references (although it does contain some), and it won't satisfy someone looking for an in-depth discussion of the scientific literature. However, it's perfect for someone who's getting started and needs guidance, or who simply wants a more comprehensive source than reading blog snippets. It would make a great gift for that family member or friend who's been asking how you stay in such good shape.

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Book Review: S.P.E.E.D.

This book was sent to me by Matt Schoeneberger, who co-authored it with Jeff Thiboutot. Both have master's degrees in exercise science and health promotion. S.P.E.E.D. stands for Sleep, Psychology, Exercise, Environment and Diet. The authors have attempted to create a concise, comprehensive weight loss strategy based on what they feel is the most compelling scientific evidence available. It's subtitled "The Only Weight Loss Book Worth Reading". Despite the subtitle that's impossible to live up to, it was an interesting and well-researched book. It was a very fast read at 205 large-print pages including 32 pages of appendices and index.

I really appreciate the abundant in-text references the authors provided. I have a hard time taking a health and nutrition book seriously that doesn't provide any basis to evaluate its statements. There are already way too many people flapping their lips out there, without providing any outside support for their statements, for me to tolerate that sort of thing. Even well-referenced books can be a pain if the references aren't in the text itself. Schoeneberger and Thiboutot provided appropriate, accessible references for nearly every major statement in the book.

Chapter one, "What is a Healthy Weight", discusses the evidence for an association between body weight and health. They note that both underweight and obesity are associated with poor health outcomes, whereas moderate overweight isn't. While I agree, I continue to maintain that being fairly lean and appropriately muscled (which doesn't necessarily mean muscular) is probably optimal. The reason that people with a body mass index (BMI) considered to be "ideal" aren't healthier on average than people who are moderately overweight may have to do with the fact that many people with an "ideal" BMI are skinny-fat, i.e. have low muscle mass and too much abdominal fat.

Chapter 2, "Sleep", discusses the importance of sleep in weight regulation and overall health. They reference some good studies and I think they make a compelling case that it's important. Chapter 3, "Psychology", details psychological strategies to motivate and plan for effective weight loss.

Chapter 4, "Exercise", provides an exercise plan for weight loss. The main message: do it! I think they give a fair overview of the different categories of exercise and their relative merits, including high-intensity intermittent training (HIIT). However, the exercise regimen they suggest is intense and will probably lead to overtraining in many people. They recommend resistance training major, multi-joint exercises, 1-3 sets to muscular failure 2-4 days a week. I've been at the higher end of that recommendation and it made my joints hurt, plus I was weaker than when I strength trained less frequently. I think the lower end of their recommendation, 1 set of each exercise to failure twice a week, is more than sufficient to meet the goal of maximizing improvements in body composition in most people. My current routine is one brief strength training session and one sprint session per week (in addition to my leisurely cycle commute), which works well for me on a cost-benefit level. However, I was stronger when I was strength training twice a week and never going to muscular failure (a la Pavel Tsatsouline).

Chapter 5, "Environment", is an interesting discussion of different factors that promote excessive calorie intake, such as the setting of the meal, the company or lack thereof, and food presentation. While they support their statements very well with evidence from scientific studies, I do have a lingering doubt about these types of studies: as far as I know, they're all based on short-term interventions. Science would be a lot easier if short-term always translated to long term, but unfortunately that's not the case. For example, studies lasting one or two weeks show that low glycemic index foods cause a reduction in calorie intake and greater feelings of fullness. However, this effect disappears in the long term, and numerous controlled trials show that low glycemic index diets have no effect on food intake, body weight or insulin sensitivity in the long term. I reviewed those studies here.

The body has homeostatic mechanisms (homeostatic = maintains the status quo) that regulate long-term energy balance. Whether short-term changes in calorie intake based on environmental cues would translate into sustained changes that would have a significant impact on body fat, I don't know. For example, if you eat a meal with your extended family at a restaurant that serves massive portions, you might eat twice as much as you would by yourself in your own home. But the question is, will your body factor that huge meal into your subsequent calorie intake and energy expenditure over the following days? The answer is clearly yes, but the degree of compensation is unclear. Since I'm not aware of any trials indicating that changing meal context can actually lead to long-term weight loss, I can't put much faith in this strategy (if you know otherwise, please link to the study in the comments).

Chapter 6, "Diet", is a very brief discussion of what to eat for weight loss. They basically recommend a low-calorie, low-carb diet focused on whole, natural foods. I think low-carbohydrate diets can be useful for some overweight people trying to lose weight, if for no other reason than the fact that they make it easier to control appetite. In addition, a subset of people respond very well to carbohydrate restriction in terms of body composition, health and well-being. The authors emphasize nutrient density, but don't really explain how to achieve it. It would have been nice to see a discussion of a few topics such as organ meats, leafy greens, dairy quality (pastured vs. conventional) and vitamin D. These may not help you lose weight, but they will help keep you healthy, particularly on a calorie-restricted diet. The authors also recommend a few energy bars, powders and supplements that I don't support. They state that they have no financial connection to the manufacturers of the products they recommend.

I'm wary of their recommendation to deliberately restrict calorie intake. Although it will clearly cause fat loss if you restrict calories enough, it's been shown to be ineffective for sustainable, long-term fat loss over and over again. The only exception is the rare person with an iron will who is able to withstand misery indefinitely. I'm going to keep an open mind on this question though. There may be a place for deliberate calorie restriction in the right context. But at this point I'm going to require some pretty solid evidence that it's effective, sustainable, and doesn't have unacceptable side effects.

The book contains a nice bonus, an appendix titled "What is Quality Evidence"? It's a brief discussion of common logical pitfalls when evaluating evidence, and I think many people could benefit from reading it.

Overall, S.P.E.E.D. was a worthwhile read, definitely superior to 95% of fat loss books. With some caveats mentioned above, I think it could be a useful resource for someone interested in fat loss.

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