I am so doomed

As the sunshine gets hotter on the Mid North Coast of NSW, Australia, we get more and more paranoid about it. I got a first hand experience of this paranoia this Monday morning when I showed up at work with my forearms pink from getting mildly burned (gasp!) while walking this weekend. Getting burned is something I diligently try to avoid but hey, it happens. Expecting a lecture on sun safety and attempting to avoid one, I wore a high neck top but my bare arms still showed the tell-tale signs of my weekend indiscretions. The practice nurse took one look, threw her hands in the air, did the tsk tsk tsk, demonstrated the sun damage on her legs while hysterically enumerating my future ails. My raised eyebrow did nothing to quell the outpouring of the well-wishing criticism: “These young people think they are invincible… Skin cancer… How could you… A smart doctor…”

Eventually we switched to the topic of her weekend which was marked by a birthday celebration. The nurse proudly announced that she “ate too much and drank too much” and is feeling decidedly sick this morning. It took all my willpower NOT to point out that a weekend of junk food and alcohol probably carries a higher risk burden to your health than a weekend of walking out in nature, even if accompanied by mild sunburn.

This incident really drives home how we see melanoma. We zero in on one risk factor (“it’s the Sun, stupid!”) and ignore all others. However, we seem to be a lot better at understanding that for other cancers a variety of genetic and environmental influences is at play.

Somehow I don’t think I will ever see this conversation:

- I had a lovely dinner last night: a delicious lamb roast and a glass of red wine.
– Oh my god, you should not have done that. Don’t you know that alcohol gives you breast cancer?
– But I just had one glass with dinner.
– Yeah, but alcohol is a risk factor for developing breast cancer.
– But surely, a risk factor is not the same thing as the cause.
– It totally is. It pretty much means that if you have alcohol you are a reckless ignorant individual willingly putting yourself in harm’s way.
– But I am aware of the risks and benefits of red wine consumption and I am also an adult. I think I can estimate my own risk and make a rational decision.
– No you can’t. Let me show you post mastectomy images to horrify you even further. These women had been thoughtless like you, exposing themselves to alcohol when they were young. And that’s how they got cancer.
– But aren’t there other risk factors?
– Don’t be ridiculous.
– Do I even know you?
– …..

Pretty sure somebody will get punch out in this scenario. But somehow it’s ok for total strangers to share their unasked opinion when it comes to melanoma. If you want to replicate this experience I recommend that you paint yourself red and then go to work, go shopping, go to a café or see your family. And note every time you get told off for your recklessness and your upcoming demise.

double-facepalm1

UVA vs UVB

Following on from my previous post on the inanity of anti-sun public health campaigns, I wanted to discuss a few aspects of sunlight itself and pathophysiology of melanoma.

Here is the story so far:

- the relationship between sunlight and melanoma is complicated. Genes matter (your family history), your phenotype (skin and eye colour) can be a risk factor, but the environment also seems to play a large role.

- there is no linear relationship between exposure and melanoma. Zero exposure over a lifetime will probably guarantee no melanoma (I’ll leave it up to you if you would like to spend your life hidden inside because let’s face it, what could possibly go wrong?) But beyond that, the picture is sketchy. Less exposure does not mean less melanoma. Chronic UV exposure has been repeatedly shown to be protective.

- in spite of widespread and very successful health campaigns which focus on one single risk factor (sunlight) the incidence of melanoma is rising.

- while it is tempting to reduce exposure to minimum in an attempt to mitigate risk, the lack of sun exposure is a significant problem on its own. I won’t go into too much detail here, but vitamin D deficiency (which is estimated to affect 1/3 of Australians)  is only a part of the picture.

Sunlight is frequently referred to as some homogenous substance in the same way that all fat is apparently the same because each gram contains the same number of calories. However, just like lauric acid (a medium chain saturated fat) is processed in your body completely differently from palmitic (long chain saturated) or DHA (long chain omega-3), different wavelengths of solar spectrum have varying effects on our physiology.

UV radiation is only a part of solar spectrum, with wavelengths between those of X-rays and visible light. Its unique effect on biological systems stems from the ability of the photon  to break chemical bonds. UVR is further divided into UVA (the longest wavelength at 400 – 315 nm), UVB (315 – 280 nm) and UVC (280 – 100 nm). While the shorter wavelengths of UVC and UVB are most damaging to biological entities like human cells, they are also filtered by our ozone layer. In normal run of things UVC is completely blocked with none of it reaching the Earth’s surface. UVB is blocked partially with the rate of absorption proportional to the length the photon travels through the ozone layer. If you got a little lost in the last sentence here is the gist. If the sun was directly over your head and the sun rays were falling at 90 degrees to the surface of the Earth (this is considered Solar Zenith Angle of zero), photons would have to travel the shortest distance through the ozone layer and more UVB radiation would reach the surface. If the direction of the radiation is at 45 degrees to the surface, more ozone is encountered on the way and less UVB gets to the surface.

Ok, with maths out of the way let’s get to the nitty gritty of what is different between UVA and UVB.

skin penetrationWhile UVB is a stronger partner being able to cause direct damage to DNA, it is also the one that has less penetration. In fact, very little is able to penetrate down to the basal cell layer where melanocytes live.

UVAWhat is this “photoprotection” I am talking about? Amazingly enough, after millions of years under that yellow orb our bodies did not wait for the invention of sunscreens. Instead, we have evolved multiple ways to protect ourselves. Locally in the skin, there are two major mechanisms of photoprotection.

  1. Skin thickening. Sounds too simple to be effective but it does in fact work, especially in preventing UVB penetration. This effect is mediated most strongly by UVB itself and manifests in thickening of stratum corneum.
  2. Melanin production. Melanin is a substance produced by the melanocytes in the basal cell layer. It absorb UVR as it passes through the skin and prevents further damage. It is an excellent defender against both UVA and UVB rays. The initial DNA signal is required for the initiation of melanin production. Here is where the differences between UVA and UVB are most striking. Even though the tan produced by UVA and UVB looks identical, its origins are different. UVA does not increase total content of melanin in the skin, it just releases pre-made melanin from the melanocytes and oxidises it. UVB, on the other hand, stimulates melanin production.

So if you predominantly expose your skin to UVA rather than UVB you may be getting sun damage without the benefit of innate skin protection.

UVB used to get a lot of bad rap. And who could blame the scientists doing in vitro experiments and seeing DNA molecules unravel, the sequence misread, uncontrolled proliferation initiated – all in response to UVB. In fact, we have done everything we could to eliminate our exposure to UVB rays full stop. SPF rating of sunscreen applies to its ability to prevent erythema, aka burn. Therefore it reflects how much UVB it can block (UVB being the erythematogenic partner).

UVA remained under the radar for a while. Solariums used to be advertised as “safer than the sun” because UVA was predominantly used. Now UVA is coming more under suspicion for being the culprit behind melanoma. How to tease out which is which? For starters, scientists like to use some poor animals to prove their theories.

It is hard to believe but we haven’t got very decent animal models of melanoma. Well, there is this fish which got melanoma after being irradiated with UVA.

…an alternate action spectrum that is more heavily weighted to the longer wavelengths, including UVA and visible light, has been found in the platyfish-swordtail hybryd model of melanoma, which suggests that UVA is a much more potent inducer of melanoma, relative to UVB, than it is of tanning. The relevance of this animal model to human melanoma is uncertain but cannot be completely discounted because of its particular characteristics and phylogenetic distance; development of mammalian models will be particularly informative in this regard.
Weinstock (1996) Controversies in the Role of Sunlight in the Pathogenesis of Cutaneous Melanoma. Photochemistry and Photobiology, 63(4) 407

And there is this knockout mouse which got melanoma after being irradiated with UVB. http://www.nature.com/jidsp/journal/v10/n2/full/5640184a.html

These data show that in this albino mouse model UVB is responsible for the induction of melanoma, whereas UVA is ineffective even at doses considered physiologically relevant.
Ha L. et al (2005) Animal Models of Melanoma. Journal of Investigative Dermatology Symposium Proceedings, 10, 86–88;

Go figure. I would not be relying on the evidence from a fish and a GMO mouse as yet. Give me some humans. Well, actually, you can infer some information on which wavelength initiated melanoma by looking at what mutations are associated with this cancer in humans. As you remember (scroll up to the graphic if you don’t), UVB causes CPD and 6-PP product formation. UVA is the initiator of free radical formation. After going through the known signature mutations in humans, Lund et al concluded:

Thus it can be seen that, although not yet incontrovertible, the available evidence points away from pyrimidine dimer formation by UVB and toward oxidative stress damage caused by longer wavelengths [UVA].
L.P. Lund, G.S. Timmins (2007) Melanoma, long wavelength ultraviolet and sunscreens: Controversies and potential resolutions. Pharmacology & Therapeutics, 114: 198–207 (my square brackets)

The As have it?

Another crucial component to add to the mix is Vitamin D. Without going to far into this massive topic, I will just mention that it is one of our main immunomodulators, both preventing DNA damage and initiating repair and/or apoptosis (programmed cell death) when necessary. Its active form, 1.25(OH)2D, is protective against UVR-induced photocarcinogenesis. In diagnosed melanoma, Vitamin D levels and pre-cancer skin exposure are predictive of survival. Not forgetting that UVA does not lead to vitamin D synthesis. In fact, it can break it down when it is attached to the vitamin D receptor (VDR). You need UVB in order to synthesise Vitamin D in your skin.

So here you go. When it comes to sunlight, things are not always what they seem. Focusing our full attention to blocking ALL sunlight to protect ourselves, we may have unwittingly increased our UVA to UVB ratio.

UVA and UVB imbalance is a neat hypothesis. It resolves some of the apparent paradoxes relating to sunlight and melanoma, the paradoxes that conventional wisdom desperately tries to ignore.

To summarise: what are the effects of receiving too much UVA and not enough UVB?

  • Reduced propensity to sunburn
  • Reduced melanin production – > reduced photoprotection
  • Reduced Vitamin D production
  • Increased Vitamin D breakdown

And how to you ensure you upset this balance in favour of UVA?

  1. Wear sunscreen that predominantly filters UVB
  2. Consequently stay out in the sun too long because your sunscreen prevents you from burning so you continue to receive UVA without a burning signal to get your ass in the shade
  3. Go out in the sun early in the morning and late in the afternoon and avoid midday hours (when you actually get some UVB exposure)
  4. Get a “safe tan” in the solarium
  5. Stay indoors and get all your sunlight through the window (UVA gets through the glass, UVB doesn’t).

Sounds like something we have been doing for the last 30 years.

So do we still think that there is not such thing as safe tan? Or that sunscreens will save us all?

 

Shonky pseudoscience by NZ Herald

bang_headOccasionally I read stuff that makes me angry. Really angry. Moronic popular media pseudoscientific articles “debunking”, “educating” and “linking nutrient x with disease z” normally fall into this category. The award for the popular media article with the dumbest headline and the most questionable content of the month goes to NZ Herald article “Researchers write off benefits of vitamin D“.

Researchers who have debunked one of the claimed benefits of vitamin D capsules are sceptical of the links that have been made to a much wider range of medical conditions.

Auckland University physician Professor Ian Reid and colleagues concluded after studying 23 trials that most healthy adults need not take vitamin D supplements for the prevention of the bone-weakening condition osteoporosis.

Let’s start with the headline. The researchers DID NOT “write off the benefits of vitamin D”! The article relates to vitamin D SUPPLEMENTATION. Unfortunately we use the term “vitamin D” interchangeably with the pro-hormone 25(OH)D that we synthesise in our own bodies and with the white pill that you can take orally to supplement your serum levels of this. Still, shouting out “there are no benefits to vitamin D” is extremely stupid and deceptive. All vertebrates have to synthesise vitamin D to survive, and have been doing so for over 350 million years.

I have not got access to the actual study (only the abstract) so I will reserve the judgement on the paper. Let’s have a deeper look into this NZ article instead (it may very well be that it doesn’t fully reflect the authors’ conclusions).

Love this sentence:

Use is said to be very high among patients of GPs in wealthier areas.

That, I assume, either implies that GP are trying to scam their more affluent patients into buying a totally unnecessary supplement, or that health-conscious and gullible wealthy worried-well are using vitamin D in addition to their chiropractic appointments, yoga retreats, and other voodoo. Both are pretty insulting implications.

They have become something of a cure-all – or prevent-all – with low blood levels having been linked to multiple sclerosis, winter colds, heart disease, cancer, mental illness and numerous other medical conditions. Professor Reid has found reports of links to 53 conditions.

‘When you get 53 different diseases associated with low vitamin D levels and when those diseases are incredibly disparate … it’s pretty hard to see a common biological explanation for those associations except the fact that people don’t go outside and lie around in the sun [when they are sick].’

Hmmm. 53 “incredibly disparate” conditions linked to low vitamin D levels. That does sound rather suss. That’s, like, this is miracle vitamin, or something. What could possibly all these conditions have in common???

Erm. I assume Professor Reid has heard of inflammation. And I hope that Professor Reid is familiar with the extensive body of research looking at vitamin D as much more than just a “bone-building vitamin” but a powerful immunomodulator. Its method of action is so broad that vitamin D receptor (VDR) is expressed by the cells in most organs of the body: intestines, bone, kidney, skin, brain, heart, breast, parathyroid glands and gonads.

This from the Scandinavian Journal of Clinical and Laboratory Investigation (Reichrath et al, Hope and challenge: The importance of ultraviolet (UV) radiation for cutaneous Vitamin D synthesis and skin cancer, 2012)

Of high importance was the discovery that in contrast to earlier assumptions, skin, prostate, colon, breast, and many other human tissues not only express the vitamin D receptor (VDR) but also express the key enzyme (vitamin D-1 α OHase, CYP27B1) to convert 25(OH)D to its biologically active form, 1,25(OH) 2 D [1,2,6]. This active vitamin D metabolite is considered as an not exclusively calciotropic hormone, but additionally as a locally produced potent secosteroid hormone regulating various cellular functions including cell growth and differentiation.

Cell growth and differentiation: that may have something to do with all those cancers, huh?

 

No, there is no plausible biological explanation at all.

 

Not sure why Professor Reid mentions any of these conditions at all since his paper actually only looked at the effect of vitamin D supplementation and the risk of osteoporosis. I am going to take a stab in the dark and say that osteoporosis is a multifactorial disease. From the abstract it transpires that 10 of the studies analysed use such piddly doses of vitamin D as 800IU. I wonder why they even bothered. For the populations in question the typical doses of 600IU to 1000IU of cholecalciferol barely going to maintain their levels, let alone increase them significantly. Compare this to 10,000IU your body can potentially synthesise from 30 minutes of direct sunlight.

Most healthy adults in New Zealand got enough vitamin D from the sun, said Professor Reid.

Riiiight. This may indeed be the case in sunny tropical New Zealand but here in Australia we have a few issues with vitamin D deficiency.

Research by Deakin University found that one third of Australians is now vitamin D deficient. The authors of this 2009 paper were quite alarmed by this fact, seeing it as a “major health problem worldwide”:

Low levels of vitamin D can contribute to a number of serious, potentially life-threatening, conditions such as softened bones; diseases that cause progressive muscle weakness leading to an increased risk of falls, osteoporosis, cardiovascular disease, certain types of cancer and type 2 diabetes.

One thing on which I will agree with Professor Reid. Popping vitamin D pills is not the answer. Some the links between vitamin D deficiency and various conditions are undoubtedly related to changes in our lifestyle. Going out for a walk in nature will not only top up your vitamin D levels but will boost your cardiovascular fitness, strength, circulation, and promote overall mental health and wellbeing. The whole is always more the sum of its parts. And this is supported in the literature. This systematic review, for example, concludes that cancer prevention related to sunlight, cannot be fully explained by the vitamin D effects alone. Just like with our diet, we should aim to receive all the necessary nutrients naturally. Ideally we will get most of our vitamin D through sunlight exposure and, to a much smaller extent, diet. However many of us work indoors from 9am to 5pm without ever seeing sunlight. Supplementation is sometimes necessary.

Irresponsible reporting such as this can cost somebody their health.

 

The Dark Side of Anti-Sun Campaigns

AHS13 has been and gone. Hideous trans-Pacific jetlag is now over. I am off Twitter and other social media, apart from our Whole9 South Pacific page as part of our Personal Growth September (Jamie calls it the Antisocial Media September). I will write a post on it another day to explain why we decided to surrender to our antisocial introverted selves. The main benefit of not spending wasting time scrolling through a Twitter feed is time to think and time to write. I have come to the conclusion that my 20 minute presentation on melanoma at AHS was grossly inadequate to explain my thoughts and conclusions regarding sunlight and melanoma.

I first became interested in sunlight when I was preparing an Honours project on Vitamin D and Multiple Sclerosis in medical school. I never published but I kept the research, as well as the overall feeling that sunlight is good, is necessary, and is sometimes healing. This is in contrast to what I can only describe is the state of fear when it comes to the UV radiation in Australia. This paranoia is incredibly pervasive*. Those of you who do not live Down Under might not appreciate its true extent. Otherwise sensible adults get a look of panic in their eyes when melanoma is mentioned. Children at school are not allowed outside into the sun at recess or lunch unless they wear a wide-brimmed hat. Those whose irresponsible parents dare to forget one, stay in the shade, unable to play. Every preschool and school excursion involves long sleeved rasher shirts, tubs of sunscreen applied liberally on each child and, again, hats.

*I am not talking about whether this is clinically justified as yet, merely describing the situation.

The public awareness campaigns are omnipresent. The iconic Slip!Slop!Slap! campaign launched in 1981 is widely touted as one of the most successful campaigns in the Australian history. From the SunSmart website:

Cancer Council believes its Slip! Slop! Slap! campaign has played a key role in the dramatic shift in sun protection attitudes and behaviour over the past two decades.

Wow! That’s fantastic. That campaign must have saved thousands of lives and stopped cancer in its tracks! From Melanoma Institute Australia website:

Melanoma rates have doubled in the 20 years from 1986–2006.

Awkward.

It is quite fascinating that most people in Australia like to talk quite expertly on the topic of melanoma. We are so well “educated” by various health campaigns that any self-respecting TV owning Aussie off the street will tell you that sunlight causes melanoma. Total strangers will point out that the visible burn on your nose from the weekend SUP adventures is practically cancer waiting to happen. And heaven forbid you mention you had blister burns in childhood. People just shake their heads and look away, as if you are not long for this world.

I like to compare that unshakeable assurance to the society’s view on saturated fat. Your Auntie Madge just KNOWS that butter on your broccoli will clog up your arteries (while she is completely safe with her low fat banana bread) and cause a heart attack. Just like she KNOWS that going out in the sun without sunscreen will result in your untimely death.

Researchers in dermatology may argue about photocarcinogenesis for another 20 years. As far as the  public goes, the sun has already been condemned.

For those of us who have come to question and ultimately reject the conventional wisdom as it relates to the diet-heart hypothesis, it is almost too easy to reject this other “undisputed truth”.

It doesn’t help the cause of the sunlight fighters that they use emotional blackmail and scare tactics to “warn” the population about the dangers of that bright orb in the sky. Let me give you an example. For those of you living in Australia this will be very familiar as you have no doubt seen these “health announcements” on TV multiple times.

The self-professed aim of these campaigns is to discourage the pro-tanning attitude of the younger generation. I don’t know about you, but I feel quite uncomfortable about the imagery used in this commercial. A healthy cell transforms into a black tentacled monster which burrows its way into a blood vessel and multiplies, seeding the body with its progeny. Children will have nightmares. I realise this is a pictorial representation but this is not what happens. Hard-hitting messages are sometimes necessary but you need to be absolutely sure that your message is 100% backed up by solid evidence.

And this is where we hit a little snag.

This particular commercial seems to imply that tanning increases the risk of melanoma. Let’s examine this assertion in a little more detail.

1. Having a tan is generally associated with chronic sun exposure. Chronic (occupational) sun exposure has been repeatedly shown to be protective against melanoma (Elwood and Jopson, 1997).

2. Tanning and sunburn are two different things. The evidence on sunburn and melanoma is not foolproof but there seems to be a slightly increased risk.

3. The ability to tan is first and foremost influenced by your skin phenotype which is genetically predetermined. When it comes to melanoma, your skin phenotype is one of the recognised risk factors. In other words, those who are able to tan are at less risk than those (unfortunate redheads) whose skin seems to go from “pale blue” to “scorched red” to “ginger peel” with not a hint of a healthy glow. So the very fact that you are turning a nice chocolatey brown the minute you expose an inch of flesh may indicate that you have a favourable phenotype. But, of course, not everyone with skin type I develops melanoma either!

4. All tan is not the same. Although they look identical, skin tans induced by different UV wavelengths have different mechanisms. UVB-induced tan causes dramatic increases in melanin synthesis. In contrast, UVA has no effect on melanin content. The tan produced by UVA is due to the distribution and oxidation of pre-existing melanin precursors. (Miyamura et al (2011) The deceptive nature of UVA-tanning versus the modest protective effects of UVB-tanning on human skin, Pigment Cell Melanoma Res). Melanin = photoprotection. Hence UVA and UVB have totally different protective qualities.

Maybe to be on the safe side we should stay indoors and avoid the sun altogether. But it seems that those who work indoors and bask under the cool office lights are, in fact, at higher risk of melanoma.

Godar et al (2009) Increased UVA exposures and decreased cutaneous Vitamin D3 levels may be responsible for the increasing incidence of melanoma. Medical Hypotheses 72:434-443

“Paradoxically, although outdoor workers get much higher outdoor solar UV doses than indoor workers get, only the indoor workers’ incidence of cutaneous malignant melanoma (CMM) has been increasing at a steady exponential rate since before 1940.”

“In fact, outdoor workers have a lower incidence of CMM compared to indoor workers”

In diagnosed melanoma cases, previous exposure, intermittent or chronic, is associated with lower mortality. Which seems to make no sense at all if you subscribe fully to “sunlight causes melanoma” argument.

Rosso et al (2008) Sun exposure prior to diagnosis is associated with improved survival in melanoma patients: results from a long term follow up study of Italian patients. European Journal of Cancer 1275-1281

“Time spend on the beach during adulthood (on average 3 weeks/years for 19 years) was inversely associated with the risk of death…”

There are plenty of grey areas in the UV-melanoma story but tanning is certainly not one of them. I would love sending a public message to the organisation who sponsored the ad, requesting to show a single study linking suntan with melanoma.

Here is my new anti-Sun campaign suggestion. I think we are not far off that.

 

Evolution of Reading

Most of you are incapable of reading this post attentively from start to finish. In fact, you will probably just skim the first paragraph, then quickly scroll down, your eyes will skip to the text in bold for a fraction of a second, then you will hover of the picture, and then, convincing yourself that you got the general gist, you will speed off to click on the next tab on your screen.

photoYep, this is the stunning conclusion that Nicholas Carr comes to in his book ‘The Shallows: What the Internet is Doing to Our Brains’. One damning fact at a time he builds a case proving that the Internet is not just a mindless database of knowledge, passively waiting to be accessed and researched. It is an active medium which has the ability to change the very way we think, structure our ideas, the way we learn and the way we communicate.

Hang on, you say. Isn’t that taking this whole ancestral thing a little too far? Am I firmly on the path of giving up on smartphone and flush toilets to live in a hippie paleo commune on a Pacific island, farm coconuts and wipe with a leaf? (in the words of the timeless King Julien: ‘Who wipes??’). Bear with me for a little while.

I used to be an avid reader. I discovered books at a tender age of 3 and started reading ferociously. My mother used to joke that I swallowed books whole and it was not that far from the truth. Written (or rather printed) word had such power of me that when I did not have a fresh fiction text I would read an encyclopaedia. Fiction had the ability to keep me enthralled to the point of danger. I distinctly remember the night when I was supposed to “watch over the stove” while my mother went to see our neighbour. The 8 year old me was engrossed in “Jane Eyre” and only vaguely registered my Mum’s screams at the room full of smoke and the stove on fire on her return. I was in another world, oblivious.

My eyesight started failing early. Blaming my reading obsession, my parents waged war on books, sneaking up on me in the middle of the night (and taking away the torch from underneath my pillow), locking the crime book cupboards when I needed to study, even checking my school bag in the morning for stealthy novels between textbooks.

I continued to read books when I came to Australia but the love somewhat lessened. The language barrier made it more exhausting initially, then I didn’t really know any good authors, and then I needed to work and study. Fiction reading became a rare indulgence. Non-fiction reading was a necessary chore.

In my first degree I owned a little laptop which I used purely for document editing purposes. My knowledge base was still acquired from a printed text. The massive (and expensive) tomes on microbiology, biochemistry, anatomy and physiology were covered in multi-coloured bookmarks with text underlined in pencil. (Yes, in case you haven’t figured it out, I am a nerd). I memorised anatomy structures by drawing them with pencils (multi-coloured, of course) and writing sheets and sheets of text next to the diagrams. I still remember what a writer’s cramp feels like although I haven’t had it for years.

My computer use stepped up a level in medical school. Buying textbooks for a huge variety of subjects was not feasible plus the underground student online book share was supplying me well. I struggled initially reading textbooks online. My eyes would get tired quicker, attention waver at the slightest provocation, I missed my coloured pencils and bookmarks, I missed being able to curl up on the couch with a cup of tea.

At least this last problem was resolved when I got an iPad. Man, I love(d) this thing. My own personal window to everywhere. Not a bulky laptop with a charger, 5 minutes wind up time and somewhat disturbing warmth radiating to my groin. Coupled with a snazzy blood-red cover, this thing was the shiz.

Word processing to emails, to world wide web, to online learning, to blogging, to social media – I am amazed at how quickly my reading and Internet habits changed. I have found the world of Ancestral Health, although the search was initially triggered by a book (Gary Taubes ‘Good Calories Bad Calories’), this world would be unknown to me if it was not for blogs and social media. I have so much to be grateful for: meeting like minds like Dallas and Melissa, and being able to take our combined knowledge to the people in my part of the world. Heck, I would have never met this awesome guy if it wasn’t for the Internet.

However, recently I have been noticing some things that started to concern me. Far from being engrossed by books, I have become inattentive and distractable. Instead of looking forward to a blissful escape, picking up an old-fashioned printed book seems a chore to my concentration. When I click on a new promising link posted by someone on Twitter I skim it quickly. If scrolling down reveals a huge document I get inwardly annoyed. Frequently I get caught in the comments to the blog post, rather than the blog post itself, clicking on more links and letting my opened tabs multiply. My reading in general has become less reflective and more reactive. My interaction with those “like minds” has reduced to 140 character snippets, not the long intellectual discussions.

As for research, it’s getting harder and harder. One search on Pubmed opens you to a spiderweb of articles. One wrong turn, one wrong click – and you are caught in a labyrinth. My innate curiosity encouraged by an easy availability of information leads me away to the point where I forget what it is that I was looking for in the first place. The sheer volume of information is overwhelming. Every study on the benefits of fibre is counteracted by the study deeming it useless. If I feel lost and confused at times, what of the people who rely on popular media for their health advice?

And there is the interwebz conflicts. You never have as many opponents in your real life as you will have on the Internet. When every snippet is available for judgement, when people do not know you as a person, when your printed word is not accompanied by your tone or body language, it is all too easy to wilfully/accidentally misinterpret and cast your vote. I watch the deterioration of a healthy discussion on Facebook into crazytown bitchfest and want to go away to that Pacific island. The reality is, you wouldn’t say half of this to a person to their face, but the ability to instantly type up a knee-jerk reaction in a witty response is hard to pass.

My escape plan

My escape plan

‘The Shallows’ could not have come at a better time for me. Exhausted from meaningless internet jibes, wary of loss of own concentration and feeling the lack of intellectual stimulation, I wanted to understand what was happening. I don’t blame the Internet (neither does the author). I merely concede that to sharpen the signal I need to reduce the noise. I already keep my Twitter account private but I think it is time to take a holiday altogether. I would like to close the comments on this blog. Not because I don’t value my readers or their opinions – far from it. But I would like to concentrate my time and energy on the work that requires a 100% of me. For those who would like to stay in contact – feel free to email me. Those whose opinions I value and cherish (you know who you are) I want to stay more connected, I want to give our interaction more than just a cursory glance on my phone screen. Let’s chat, let’s exchange papers, let’s Skype. Let’s use this powerful force to what it can be – bringing minds and passions together. I am done with wasting time on anything less than that.

The weight loss conundrum

Disclaimer: this post expresses my personal opinions. Fancy that. On my personal blog too. And guess what, this opinion may even be different to yours. You can let me know if you agree or disagree with the views expressed here. You might even go as far as to tell me that I am wrong. I may or may not care about that. Enjoy reading.

Phew. Now that we got that out of the way let’s talk weight loss. Everyone on the internet knows that the best way to get traffic is to tag your pearls of wisdom  “weight loss tips” and “Jessica Biel’s diet secrets”. I have neither. Sorry. But this post was mostly brought on by the frustration that the topic of losing body mass is still a priority not just in conventional women’s magazines but in ancestral health community.

You know the one: “Yes, I’ve given up grains because Robb Wolf told me to, I don’t eat refined carbs after reading Gary Taubes, I stopped sugar after watching that Lustig’s video and I force down a tablespoon of fermented cod liver oil since attending Weston A.Price conference. I feel great but… How do I lose another 10kgs?”

And of course there is no shortage of available experts on the interwebz:
– eat less carbs
– eat more safe starches
– introduce interval training
– stop HIIT to salvage your burned out adrenals
– eat sauerkraut for healthy gut
– calories don’t matter
– calories matter
– start IF
– use FitDay to track your daily intake
et cetera.

It’s all very sad.

In the meantime the average long term success of most weight loss strategies is around 1%. Yeah, sure, most people do it wrong. They choose the wrong diet (Lemon Detox, anyone?), they choose the worst possible exercise (if you are a female with a cup size C and above, for god’s sake stop running). And they just don’t have the willpower that the new dieter has (sarcasm font). Because the new dieter knows that he/she will be different. I will be in that 1% who does it right and stays skinny ever after. The End.

There are numerous reasons why weight loss strategies fail. And there are numerous reasons why they succeed. Temporarily. You can lose weight in literally thousands of different ways: Paleo, low fat, low carb, low calorie, ketogenic, vegetarian, aerobic exercise, HIIT, IF, bariatric surgery, liposuction…

That’s why the to and fro arguments on which approach is better for weight loss is kinda pointless. YES! YOU CAN LOSE WEIGHT EATING MARS BARS AND DRINKING COKE! (feel free to leave this page at this point and celebrate).

We have this love and hate relationship with a number that determines our body mass. Lily Allen famously said: “And everything’s cool as long as I’m getting thinner”. There is another number that we have become very preoccupied with in the last few decades: serum cholesterol. Chasing that number (down) is the name of the game, mostly by pharmacological means. Of course, you could tilt this snow globe upside down and decide that the number per se is not very meaningful and in fact represents some other pathological process in the body. Ideally you would choose an intervention that both addresses the cause of the problem and pushes that number in the direction you want. A nutrient-rich diet free of processed junk and pro-inflammatory toxins accompanied by reasonable physical activity is likely to address the chronic inflammatory state that leads to dyslipidaemia and therefore drop the dreaded cholesterol numbers down and please your conscientious doctor.

But sometimes it doesn’t get you to the magic 5.5 mmols that your doctor wants to see. Just like your 6 month foray into the Paleo diet fails to get you to that elusive number that determines your weight, size and consequently happiness. Time to go on PaleoHacks and shout for help.

I am not having a go at the desire to be slimmer. Sure, I wouldn’t mind losing a few kgs. I also wouldn’t mind losing my freckles or having bigger hands (it sucks trying to find surgical gloves that fit). Neither affects my sense of self worth.

So for what it’s worth, these are my ideas in relation to weight loss (note, doesn’t say FOR weight loss):

I am overweight? Oh thank you, kind sir, I wish I knew this earlier! Let me just switch to a healthy diet and start running.

1. If your primary focus is weight loss you are already behind the eighth ball. If being skinny was a powerful motivator we wouldn’t have 2/3rds of Western world overweight or obese. Wanting to lose weight tends to screw with people’s heads even with the best foundation: they start stressing (excess cortisol=bad), they start reducing/counting/starving/hating their bland food/exercising at 5am and generally stop listening to the bodies.

Things are quite different when you eat to nourish every cell in your body. Shift your focus to wellness and flip the switch.

1a Unless you have congestive heart failure or chronic kidney disease, chuck your scales. Like now. Get up and throw them in the bin.

2. Start with having a nutrient-rich diet and get rid of junk. Use whatever framework takes your fancy: Paleo, primal, perfect health diet, whole30, Mediterranean, vegetarian (gasp! ). Minimize the “healthy” versions of unhealthy food, you don’t want any food holding you emotionally hostage.

Until you have that down pat, forget the words “Do you have these pants in a smaller size?”

3. Find a regular consistent physical activity you enjoy. I know exercise is supposed to be about torture. That’s ok if you enjoy torture, no judgement here. Do something you can see yourself doing regularly in a year. Or five.

3a. Do not ramp up the volume/intensity of the said activity to accelerate weight loss beyond the level you see yourself comfortably doing long term. Did I hear you say “bootcamp”? Pfft.

4. You cannot fix self esteem issues with weight loss. The two have very little to do with each other.

4a. In the same vein, having weight loss as a dangling carrot in the future can derail your enjoyment of today. Don’t put off activities, clothes or happiness until you get thinner. See point 1.

5. It seems that the thoughts of weight loss frequently return when people are still longing for a six pack in spite of measurable improvements in their physical and mental health. This is where we hit a little snag.

Let’s say you start off in the obese category. Up to a certain point weight loss and health gains go together. Then you reach a state where your body is happy, healthy and well-nourished. To lose more subcutaneous fat from this point will not gain any further health benefit. In fact, you may dip down into negative territory. If you are body builder, dancer, gymnast or any athlete dependent on low body mass this is the risk you have to take. If you are a suburban mother of 2, disappointed she doesn’t look like her graduation photo any longer, you may be playing a dangerous game. If you still choose to continue down this path that’s cool. Your choice. It’s way harder to shift the happy-healthy weight so you may have to pull out all stops. Some of those deviate even further from the path to long term health and wellness. Obviously if you are naturally lean and small you have to flip this scenario 180 degrees. Getting massive past the point of diminishing returns may not be optimal for your body either.

When I see an obese patient I do not have an overwhelming desire to help them lose fat. To me their weight is nothing more but an external manifestation of serious internal issues.  I worry about their risk of heart disease, diabetes, Alzheimer’s and autoimmune conditions. I feel the same level of concerns for the skinny-fat: normal BMI with little muscle and obvious visceral adiposity.

Incredibly sexist and quite offensive to naturally thin women. However we don’t think twice when the ads are turned the other way around.

For a health-conscious and somewhat rebellious community we are still remarkably superficial and eager to conform to the current body image stereotype.

Minimalist shoe review and Sunday primal living

Sunday posts are not supposed to be sciency right? Having a weekend off is a luxury and I like to treat it as such. Hence I decided to be a lazy tart and sleep in till 7.30am. A vat of coffee, a quick social media catch up and I was out the door to test my new Lucy VivoBarefoots.

I abhor the term “barefoot technology” because it sounds just a gimmicky as ShakeIt weights but I do agree with a concept that walking on 3 cm of very expensive rubber, otherwise known as “conventional sneaker”, is utter nonsense.

VivoBarefoot EvoII in their better days

I never got into Vibrams (I don’t like the idea of rubber between my toes or people jeering in glee as they point to my feet) but I own a pretty nice pair of VivoBarefoot EvoII which I wear to the gym or operating theatres. Which is pretty much the same thing. Their only problem is that they are damn slippery when you leave the safety of the indoor environment, especially if you like jumping on rocks. So to avoid ending up in my own emergency department I normally wear Sketchers. Yeah yeah, I know, don’t judge me.

I really didn’t want slippery soles here

My usual long walk is around 2.5 hrs which takes me down the coast and back, and has a good mix of beach walking, rock hopping, trekking up and down the hills between coves and a few steep sections through the rainforest. The sole of the Lucy is supposed to be ultra thin (3mm) and puncture resistant but it doesn’t feel quite as paper thin as the EvoII, which together with a pretty thick top covering adds to the sturdier feel. The first climb up the rocks went without a slip up but I did slide down a steep path on gravel a couple of times, gracefully landing on my buttocks, although I don’t know whether it was the shoe or my slightly tired quads. The harder top lining started to put a little pressure on my Achilles tendon after 2 hrs but wearing socks helped. The toe cage is wide enough for my narrow foot but if yours is on the wide side you may find it a little constricting.

Terra Plana sizing tends to run small. I normally wear 38 but ordered 39 in these and they were perfect with a sock. Interestingly, I also ordered VivoBarefoot Mary-Janes and they were a bit big in the same size.

Overall, a good walking shoe which feels more like a conventional shoe although does provide the benefit of good proprioception and a light feel.

The rules of the game: get to the other side without touching the sand. GO!

As always, my weekend walk provides me with a few excitements (I am a simple creature and get excited easily). A huge 1.5m goanna decided to leisurely cross my path causing a temporary bladder spasm and a jerky and too-slow reach for the camera. Gotta love Australia.

A young bright gen-Y sitting on a rock overlooking the ocean spreading Nutella on several pieces of white toast. I kid you not.

The usual quick eyes-on-the-sand dash through the nudist beach was again unsuccessful. The happy-in-his-bare-glory gentleman spotted me and jumped out of the bushes to take a lazy stroll towards me. Exhibitionism ain’t nudism.

Fun times.

As I finish off this post I notice that Victoria Prince has also recently written about her hiking adventures. Which makes me think that we have either all run out of science to talk about (unlikely), we are sick and tired of banging our heads against the wall (quite possible) or we are just moving past the obsessive food-will-cure-all-ails mentality. While it indeed starts with food, there is more to health and wellbeing than what you put in your gob.

Also a topic of our recent presentation at Whole9 seminar in Boston, non-nutrition lifestyle factors are starting to become a more prominent feature in this community. Thank heavens for that. At one stage it looked like we were turning into indoor nerds glued to our computers, obsessively arguing over minute details of the latest Pubmed offering, occasionally emerging from the social media dramas to bash our bodies in the variety of HIIT smashfit pursuits. Whaaat? Somebody still doing that? Crazy folks.

 

Rainforest stair sprints. Or walks.

Anyway, the majority of my activities nowadays are slow intensity performed in a glycogen-depleted state (and when Jamie finally writes up his AHS presentation I will have something to reference!). I try to go for 20-30min walk most days before work, fuelled by caffeine and nothing else; do yoga and strength training once or twice a week. Going for longer and more challenging walks on the weekend fits right into this schedule. So that’s my Slow Movement covered.

 

My shadow is not taller than me = vitamin D production

Sun exposure is another area I consider a powerful factor in overall wellbeing. Vitamin D is certainly the shiz nowadays but let’s not forget about other benefits of sun exposure: mood enhancing qualities, pain relief, better sleep, eye and skin health.

And finally, there’s something about the expansive vistas, the sound of the ocean and the smell of the rainforest that we, as humans, have long felt a connection with. We have seen a few studies emerge showing the benefit of being close to nature (Mark Sisson has written a good overview about it. What hasn’t this man written about???). But I like to look at this from another point of view. It’s not that being close to nature is better for us, it’s just our indoor artificially-lit air-conditioned existence is so very bad. Going back to nature is…well, natural. It’s another one of these instances when feeling “low level crap” has become the norm.

 

Well-deserved: scrambled eggs with lox, avocado, duck pate and local vintage cheddar

Hope you can find some restorative activity, sunlight, fresh air, awe-inspiring views and simple pleasures in your Sunday.

As if you need another AHS wrap up post…

 

There have been a few wrap up posts on AHS already, some complimentary, some provocative. I will try to add my bit which will be purely my opinion on the event I have been looking forward to since last year and my impressions of it.

For those who are in the dark about what I am on about (gasp!) here is a good “AHS for dummies” round up. Also Beth has put together quite a list of AHS wrap ups for all your evolutionary medicine science and gossip needs.

Boston Gardens

To start with, I went this year in a purely observatory capacity. If you wondering why anyone would endure 24 hr flying time plus layover in 3 cities, here is my main reason. Evolutionary medicine in Australia is still for weird hippies and charlatans, not for Sydney University-trained doctors. Being in a group of passionate people, some including distinguished scientists, medical professionals and clinicians, was gratifying and encouraging.

*And before I get accused of ignoring minorities and lay folk: I see AHS as a primarily academic event designed to open the doors to new hypotheses, share scientific research and help move evolutionary medicine into mainstream consciousness. I think PaleoFX and its organisers, Keith and Michelle Norris, filled the niche of taking theory to practice very efficiently, and if I can ever afford 2 trips to the US a year (poor medical resident here) I would not hesitate to go. I think it’s fantastic that AHS is open to the lay public (let’s face it, the discerning Paleo “lay public” keep everyone on their toes) but I wouldn’t want for the conference to lose its academic edge. And if I ever want a Paleo group hug I will go to a Paleo meet up.*

Recalling my inability to sit through University lectures, I knew I couldn’t attend every talk so I tried to hedge my bets and pick from the program. Some I got right, some I didn’t. A few times, I opted to hear the “big names” only to miss out on a fascinating talk from a less known figure in the other room. I have already marked the ones I would like to download to watch on video.

The dairy debate continued in the ice-cream parlour

Rating on some memorable talks I saw in no particular order:

1. Dan Lieberman on evolutionary principles. A great talk to open up the symposium and a must-see for anyone as an Evolution 101 refresher. It set a nice tone to the event, steering it away from the romanticised hunter-gatherer image.

2. Dr Peter Attia gave an awesome lecture on cholesterol. This was probably the most sciency talk of the whole seminar and in my opinion the best. I wish I had a lecture like this in medical school! I will definitely re-watch this one on video, this time taking thorough notes. Highly recommend regardless of your knowledge level, you will learn something anyway.

3. Jamie Scott spoke about using evolutionary principles for endurance training. He effectively melted a few brains by stating a strong case for low intensity work performed in glycogen-depleted state. For the crowd largely indoctrinated enthusiastically involved in Crossfit it was a hard sell but I think he got a few converts.

4.  Dr O’Keefe on the effects of prolonged endurance exercise on cardiovascular system. He described exercise-induced cardiomyopathy in ultra-endurance athletes. As a runner himself, his position was a little biased toward running and in my view his recommended dosages (45-60 min 5 times a week) were still too high. Also he didn’t mention the significant degenerative joint effects and chronic inflammation on the body. Overall, the talk was very interesting and definitely something that running-obsessed Americans need to see (OMG, do you, people, do anything else other than run???)

5. Chris Kresser on iron overload. Chris gave a good view of haemachromatosis, its diagnosis, manifestations and treatment. Most of this material had been extensively covered in my medical school lectures (yes, believe it or not, they DO teach us something). I would have liked to hear a theory on the evolutionary explanation of haemachromatosis and Seth Roberts, I think, asked Chris that question but I didn’t gleam much from the response. Worth watching if you think that Paleo is a free pass to eat meat like it’s going out of fashion.

6. J. Stanton on hunger. JS presented very convincing evidence that hunger is a normal physiological response to the lack of nutrients to the cells (who would’ve thunk it, huh?) rather than a massive character flaw possessed universally by the fatties. It was a great complement to his series of posts on hunger (which are excellent to read). JS is, ahem, an unusual personality with a brainpower that makes the rest of us feel like schoolchildren. He was openly critical of the food reward theory during his presentation, however, when we all went out for dinner that night, he was extremely gracious and kept saying that he felt very honoured that people like Stephan (Guyenet) attended his talk. You can read Stephan’s review of this talk here.

7. Dr Terry Wahls gave an inspiring talk about managing own multiple sclerosis with MS. However, I was already familiar with her very excellent TED talk (which you should definitely see if you have been under a rock somewhere) and not sure I got much more out of this presentation.

8. Robb Wolf‘s talk about implementing Paleo diet principles at Reno municipality is inspiring to watch especially if you are interested in public policy and how to bridge the gap between a Paleo community, often seen as alternative and (let’s face it) weird, and real world. Big picture stuff.

9. Dr Emily Deans have a presentation on food and mental health. She gave a good overview of how fructose and trans fats affect us not only metabolically but also psychologically. It was fascinating to see the diametrically opposed views on sugar and mental health: does it make you happy or not?

10. Dr Andreas Eenfeld was a surprise to me. Even though he presented on carbohydrate controversy (yawn) he managed to make it entertaining (yes, really) and light-hearted. I thoroughly enjoyed it.

Watching squirrels was somewhat more entertaining than a safe starch debate

By the way, I think the whole audience was tweeting. It was absolutely surreal to listen to one talk and read tweets from the next room with people raving about the speaker I was missing.

Talks I cannot wait to see on video:

1. Peter Gray on the role play in the development of social and emotional competence. Here is a great example of his work and if I knew he was in the next room I would have dumped Stephan Guyenet in a heartbeat (sorry!)
2. Ubuntu: a paleolithic perspective on human community and health by Frank Foresich
3. Oxidative stress and CHO intolerance by Chris Masterjohn
4. Paleo nutrition and the brain by David Pendergrass.

Overall impression:
It was disappointing to see a few negative posts from attendees, in particular some who felt not included due to their age, appearance, weight, or some other factor. I was not aware of any such tension during the conference, except to note that people were quite naturally gravitating towards their friends and acquaintances, and of course “Paleo celebrities”. I find this community remarkably inclusive but then I am not an idealist and generally do not expect much of people. I certainly would never anticipate Robb Wolf to come up to me and strike up a conversation. Being quite introverted, I spoke to people who approached me or were introduced by others, and relaxed in the courtyard when the crowds got too much.

I would love to come back next year and reconnect with some new and old friends.

A few thanks:
To Ann and Dave Wendell – for making the most of the Aussie-Kiwi rivalry and teasing the hell out of us.
To Victoria Prince – for feeding us home cooked meals, taking us berry picking and showing us the green and luscious part of New Jersey
To J Stanton – for challenging our brain cells and being a very exciting dinner guest
To Jude – for her Aussie accent, sense of humour and constant and inappropriate swearing
To Melissa and Dallas Hartwig – for great conversations, amazing (very well organised!) meals, unwavering support and a hefty dose of inspiration

Many more Twitter names came alive (hey, these people do actually exist) and I fear I’ll miss someone if I start naming them but I enjoyed meeting all of you.

See you all next year.

Musings on a 40 hour week

Curled up on the couch with a massive cup of coffee, I am wrapping up one of the most horrific weeks since starting work. Having to deal with between 30 and 40 newly admitted patients daily, my pager going off every 5 minutes (god, I hate that sound), I’m on call tonight (please please please do not call me to rechart meds at 2am) and not having seen sunlight since last weekend makes me count the days (14…) till my trip to the US to AHS12.

The tension in the hospital is almost palpable by the end of the week. The conversations are shorter, comments are snarkier and the only smiles you see is when there is the obligatory Friday junk food fest is involved. Somebody is leaving floor 1 for floor 2 so we all have to subject our bodies to a sugar coma to honour this momentous occasion. Maybe this will help us survive the end of the week without killing someone. By the way, in medicine this is not a metaphor.

Child laborers in a coal mine. Source: The History Place photograph of American child labourer from 1908-1912 by Lewis Hine

Let’s talk working hours. I want to know what genius came up with a 40hr working week.  I am not that strong in history but I grew up in the Soviet Russia and the 8 hr day was celebrated a source of pride and a supreme achievement by unions and blue collar workers. The Industrial Revolution of the 18th century had a lot to answer for with explosion of factory-based manufacturing and resulting insane working hours. The British Factory Act of 1833 went soft and regulated child labour, limiting the work day of 14-18 year olds to 12hrs and 9-13 yo to 8 hrs. They were so concerned with kids’ education that they told under 9s to stay at school. In comparison to those conditions my working week seems like a walk in the park. Our civilised society is way more civilised nowadays and we should be grateful, right?

Well, actually, who says that a 40hr week is evolutionary appropriate at all? In 1966 an anthropologist by the name of Marshall Sahlins wrote “Notes on the Original Affluent Society” in which he described the lifestyle of modern and ancient hunter-gatherers, estimating their work day to be between 3-5 hrs to the total of 14-20hr working week. Closer to home, Jamie Scott wrote a nice report on the lifestyle of Vanuatu and he also mentioned that the villagers there seemed to have a lot more leisure and play time.

Now I am far from an expert on anthropology and by no means advocate discarding our society, culture and coffee machines to go live in the bush and eat ‘roos or whatever you can catch in your part of the world. But, dayam, a 20hr week sounds way more attractive than a 70 hr limit for hospital doctors recommended by the Australian Medical Association (which is successfully circumvented by hospitals and doctors themselves).

For those interested in an overview of the working conditions of Aussie doctors-in-training (or hospital residents and registrars) read this report on safe working hours from Andrew Lewis, an industrial relations advisor for AMA. Good thing they got a non-doctor to write it. Because doctors are masters at bitching about  their lack of sleep, nutritious food and any resemblance of personal life. However, that whining tends to come with a whiff of hidden pride. The expectations of our seniors (“back in my days we slept in the elevators”), peers and patients make this screwed up lifestyle “a rite of passage.”

Of course, doctors and nurses don’t have a monopoly on insane working conditions. But the media prefers juicy stories of sleepy surgeons armed with a scalpel than  tired cranky lawyers (armed with a Monblanc pen?). The talk inevitably becomes a tad hysterical as it turns to the risk to the community: “jeopardising patients’ safety… Impaired judgement…”  Fair enough, I say. I’d be worried too if I knew that a guy who is about to do a lumbar puncture on my daughter has been working for the last 17hrs. Apparently being awake (not just working, but AWAKE) for 18 hrs is comparable to a blood alcohol level of 0.05. Cool, I can come to work after a bottle of Shiraz and nobody will notice anything different.

Still, forgive me if I am more interested how this lifestyle is affecting my body and my mind. We all know it’s bad but how bad? Can you suck it up for a few years and hope to repair the damage when you have the money to afford holidays in the Pacific and a personal chef? Or is it something that we can mitigate by sleeping in till 8am on the weekend (oh, the luxury!)?

Not a place to be when you are stressed…

Here are some studies that I personally found quite interesting.

1. Acute sleep deprivation resulted in increased hunger and the activation of anterior cingulate gyrus reflected hedonic stimuli in the absence of fasting blood glucose changes. In other words, if you are sleep deprived, those cookies in the jar will call your name with an irresistible siren song. http://www.ncbi.nlm.nih.gov/pubmed/22259064?dopt=Abstract

2. Adults working more than 40hrs a week were 5 times more likely to have suboptimal glycemic control as measured by HbA1C >= 7% than those who worked 20hrs or under. So if your diabetic or pre-diabetic your working hours alone will make your doctor frown and reach for the script pad. http://www.ncbi.nlm.nih.gov/pubmed/21246586?dopt=Citation

3. An observational study of nearly 17000 Australian full time workers looked at the relationship between working hours and increased BMI. They found that the relationship between long hours and obesity seemed to be mediated by the lack of sleep. This might make you think that it is possible to mitigate the effects of long hours by just increasing your sleep time however…

http://www.ncbi.nlm.nih.gov/pubmed/20734126?dopt=Citation

4. …a study of Japanese white collar workers found that longer working hours had a negative effect on total sleep hours, sleep efficiency and daytime dysfunction. The effect was noticeable at 50hrs a week and the more hours they worked the worse their sleep quality was rated.

http://www.ncbi.nlm.nih.gov/pubmed/20561174?dopt=Citation

Just a note, the whole patronising “Just sleep more” really tends to push my buttons. It’s a bit like “Just eat less and move more” in its sheer unhelpfulness. Do we really think that those poor buggers who lie in bed for hours struggling to nod off because they like it? You can’t get that deep recovery sleep by willpower alone. Try telling any doctor on call that they should stop tossing and turning and get back to their restorative snooze… with a pager next to their ear.

5. Markers of oxidative stress were increased after a 16hr shift in medical residents and an 8 hr shift non-healthcare workers (so once again, you don’t get a free pass if you are in another field). http://www.ncbi.nlm.nih.gov/pubmed/20811270?dopt=Citation

6. Psychological stress has been found to cause very real physiological phenomena contributing to many diseases. This excellent review of the role of stress in the gut disorders concluded: http://www.jpp.krakow.pl/journal/archive/12_11/pdf/591_12_11_article.pdf

From Konturek et al ” Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options”

“1) exposure to stress (especially chronic stress) is a major risk factor in the pathogenesis of different diseases of gastrointestinal tract including gastroesophageal reflux disease (GERD), peptic ulcer, functional dyspepsia, inflammatory bowel disease (IBD), irritable bowel disease (IBS), and other functional disorders of GI tract;

2) the dysregulation of brain-gut-axis plays a central role in the pathogenesis of stress- induced diseases;  

3) Stress increases intestinal permeability, visceral sensitivity, alteration in GI-motility and leads to profound mast cell activation resulting in release of many proinflammatory mediators

These articles are just a few in a sea of plenty. The scientific evidence is pretty conclusive and pretty overwhelming. Long hours = bad, psychological stress = very bad, lack of sleep = very very bad.

So it’s kind of bewildering that we choose to bury our heads in the sand and carry on with a stiff upper lip. Good luck repairing your leaky gut and undoing the oxidative damage with your superhuman willpower. I’m not suggesting that you should give up your career and go all hippie, greeting sunrise in the nude and weaving loin cloths out of bush plants. Sometimes the acknowledgment that this is not just in your head, but in your gut, your nervous, endocrine, immune and cardiovascular systems, can go a long way.

Imperfect Day

 

When people embark on a new venture, like a new nutrition program, they do not expect to fail. Full of vigour and enthusiasm, they feel ready to improve their diet, exercise and lifestyle. But if you ask them how they imagine their new life, almost inevitably you will get a picture of a PERFECT day. The day where they bounced out of bed early to go for workout (or at the very least, an energising walk), had all their meals prepared for the day, felt perfectly satisfied and full after each one, managed their work stress, astonished their work colleagues with own weight loss and vitality, had enough energy to attempt a deadlift PB in the evening, spent quality time with their family, browsed through at least 20 Paleo blogs, meditated, mastered a homemade jerky recipe and had a restoring 8 hour sleep undisturbed by blue light.

Nobody wants to think that one day they will want to throw their alarm clock across the room in the morning. Or that their work pressures will pile up over the course of the day culminating in a massive verbal punch up with a co-worker. Or that they will have a fight with their boyfriend and the thought of a pity party for one, complete with a tub of ice-cream and Lindt chocolate balls (ahem), seems like a perfectly reasonable idea.

Because that would be failure. And it wouldn’t happen. And, anyway, if it did, you would know exactly how to deal with it. Sure, 99.99% of people in your situation, would crumble and lose the plot. But you are different. You are SPECIAL. You have superhuman willpower, steely determination and you totally mean it this time.

Sorry to break it to you, a unique snowflake you are not.

But I was soooo strong…

Reality will bite you on the arse just like everyone else. Human physiology trumps willpower every single time. If you are working shift work, don’t expect to have energy for daily WODs. If you are stressed at work, don’t marvel at your increased appetite, and for God’s sake, don’t hover around a muffin platter. One of you is going to lose, and it ain’t gonna be the muffins.

So my new theory is, prepare for a IMPERFECT day. Think of everything that can go wrong (yes, I know, it’s a bit morbid) and work out a strategy of how you are going to overcome it, minimize it or at least mitigate the damage.

Here are a few of my strategies:

1. Too tired to cook healthy food at night -> Do a massive cook up prep with cut up veggies and pre-cooked meats Melissa Joulwan style on Sundays
2. No motivation to work out -> go for a long walk on uneven terrain, accelerate on a few stairs and recover in the open air
3. Fatigue/stress/frustration building in the afternoon -> take a 5 mins break outside, preferably on the open air, and take 20 deep breaths with your eyes closed
4. Cold/sore throat/cough/fever -> (I can’t believe I have to write this) please do not go to the gym. If energy levels are still ok, go for a short walk. If feeling tired, go home and curl up on the couch. Please.
5. Everything went wrong for you today, personal life in shambles, work has been shit, you want to cry, watch soppy movies and eat chocolate -> cry, watch soppy movies and eat the best goddam chocolate you can lay your hands on.