Sunday, May 23, 2010
Building & Protecting Bone: Odd Angle Exercise, Resistance, Movement (and shaking) Work
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A fear for many women is that as we age, we seem to be more vulnerable to the "Help Help, i've fallen and i can't get up" hip fracture and related. Awhile ago, i wrote about bone building, and what's known about strategies to keep it together and enhance it. Quick review: bone builds in response to demand. Woolf's law is "use it or lose it" - our bone is "remodeling" all the time. So while calcium, magnesium, zinc and vitamin d are all important, these nutrients alone don't really go into bone building mode unless there's demand on the bones. That means load. Likewise, even with strong bones, we don't stay upright if our movement is compromised by various aches and pains.
A new research survey on non-invasive approaches to bone building puts these points together in a really nice review called "Physical approach for prevention and treatment of osteoporosis" The nice thing is it's free.
Summary: Here's a summary of the approaches that look good for building up bone mineral density:
BONE BUILDING
Resistance training - that's good but it's also site specific. In other words, lower body work helps the lower body (hip/pelvis); upper body work helps the upper body (including the critical spine).
Impact Training - this is stop and start and "odd angle" activities like soccer or squash (not running so much), but also for the more frail, even dancing and ball games have been proposed as ways to help keep demand up on bones.
Combinations. Meta analysis of research suggests that the best approach, unsurprisingly is a mixed approach of resistance training and impact training. Fortunately such practice can be fun and have bone building effect.
Vibration. the next time someone pooh poohs force plates, you might want to suggest that they've been shown - repeatedly - to help build up bone. It's not a HUGE gain, but it could be an excellent modality for the initially infirm:
BALNANCE - Physical and Hormonal
T'ai Chi - does nothing for bone building at all, BUT helps get on with movement and balance and the breathing can help destress, so hormonally very helpful in supporting staying safe. Research has mainly focused on T'ai Chi for these effects, but it might be interesting to consider that other approaches that emphasize mobility, balance, de-stressing, and the whole sensory motor apparatus might not benefit here too?
BUILDING & REPAIR
New & Approved. The review also considers several other forms of "physical agents" like Low Intensity Pulsed Ultrasound (LIPUS) that has been shown to stimulate bone repair. Electrical stimulation has also now been approved by the FDA for "bone repair."
Experimental. Pulsed electro magnetic fields (PEMF) is a newer approach, nothing conclusive there yet. Low Level Laser Therapy is also being trialed in animal models, but again nothing yet in human studies.
Role for Movement Practice & Assessment?
Where we seem to be at is that concern about bone mineral density has two components: first is to ensure practices for maintianing and building BMD, but second is the development of practices to help people feel stable and mobile rather than vulnerable to falls - improving range of motion, visual accuity and balance. It's not just Range of Motion - thought that's important - it's the whole sensory-motor awareness package.
It doesn't matter if we're younger or older - we can have issues with our movement that can compromise our ability to respond with agility to a tricky situation. The entire functional movement screen program is based on the premise that there's no point building strength on top of dysfunction, hence the screen for movement issues.
But likewise, we can have issues with our balance or visual accuity or our brains ability to perceive our selves clearly in motion. Indeed, i've written quite a bit about the benefit of just kicking off our restrictive shoes to get more info to the brain about where we are in space, and how doing so has pretty big benefits for movement and also feel of one's own mobility (as the feet move more and better, it seems so do other joints).
So it seems pretty basic that as part of our quest for better bone health, a related quest for optimizing our body's ability to move in space is pretty important. I've said before, this awareness development is part of why i like I-Phase so much: it's prepping the body for the Real.
In other words, as we build better bones, there's a real benefit in openning up our body's awareness of itself in space, and simultaneously, it's ability to respond better to what's happening.
Simple example: better range of motion combined with better practice of movement into multiple positions, and better balance and visual processing means the brain has more knowledge about its being able to Zig rather than having to Zag around that wet spot on the floor, and thus, us not going for a tumble.
Stronger bones PLUS less risk of falling in the first place (and not being able to get up) - that seems to be more a complete package.
Conclusion: Why is osteoperosis such the women's issue?
One advantage that guys have is the size of their muscles puts more load on their bones so that the bones are under more demand. More demand on the bones, more continued adapting to load.
Women have not been encouraged to do as much manual labour or high resistance workouts as guys.
Similarly our formal worlds are increasingly desk bound, so less movement is part of our daily lives. As we age, this decrease in multi-plane motion seems to increase. Let us say phooey to this increasingly restricted mode of being.
It will be interesting to see as the culture shifts towards it being ok for gals to work out, and as muscle tissue can be built up at any age, that perhaps hip and related fractures will become a fate of a by-gone age.
Citation:
Related Resources
A fear for many women is that as we age, we seem to be more vulnerable to the "Help Help, i've fallen and i can't get up" hip fracture and related. Awhile ago, i wrote about bone building, and what's known about strategies to keep it together and enhance it. Quick review: bone builds in response to demand. Woolf's law is "use it or lose it" - our bone is "remodeling" all the time. So while calcium, magnesium, zinc and vitamin d are all important, these nutrients alone don't really go into bone building mode unless there's demand on the bones. That means load. Likewise, even with strong bones, we don't stay upright if our movement is compromised by various aches and pains.A new research survey on non-invasive approaches to bone building puts these points together in a really nice review called "Physical approach for prevention and treatment of osteoporosis" The nice thing is it's free.
Summary: Here's a summary of the approaches that look good for building up bone mineral density:
BONE BUILDING
Resistance training - that's good but it's also site specific. In other words, lower body work helps the lower body (hip/pelvis); upper body work helps the upper body (including the critical spine).
Impact Training - this is stop and start and "odd angle" activities like soccer or squash (not running so much), but also for the more frail, even dancing and ball games have been proposed as ways to help keep demand up on bones.
Combinations. Meta analysis of research suggests that the best approach, unsurprisingly is a mixed approach of resistance training and impact training. Fortunately such practice can be fun and have bone building effect.
Vibration. the next time someone pooh poohs force plates, you might want to suggest that they've been shown - repeatedly - to help build up bone. It's not a HUGE gain, but it could be an excellent modality for the initially infirm:
A 1-year prospective, randomized, double-blind, and placebo-controlled trial of postmenopausal women demonstrated that 20 minutes of a low-level vibration applied during quiet standing can effectively inhibit bone loss in the spine and femur. Placebo subjects lost 2.13% in the femoral neck over 1 year, whereas treatment was associated with a gain of 0.04%, reflecting a 2.17% relative benefit of treatment. In the spine, the 1.6% decrease observed over 1 year in the placebo group was reduced to a 0.10% loss in the active group, indicating a 1.5% relative benefit of treatment (40).
BALNANCE - Physical and Hormonal
T'ai Chi - does nothing for bone building at all, BUT helps get on with movement and balance and the breathing can help destress, so hormonally very helpful in supporting staying safe. Research has mainly focused on T'ai Chi for these effects, but it might be interesting to consider that other approaches that emphasize mobility, balance, de-stressing, and the whole sensory motor apparatus might not benefit here too?BUILDING & REPAIR
New & Approved. The review also considers several other forms of "physical agents" like Low Intensity Pulsed Ultrasound (LIPUS) that has been shown to stimulate bone repair. Electrical stimulation has also now been approved by the FDA for "bone repair."
Experimental. Pulsed electro magnetic fields (PEMF) is a newer approach, nothing conclusive there yet. Low Level Laser Therapy is also being trialed in animal models, but again nothing yet in human studies.
Role for Movement Practice & Assessment?
Where we seem to be at is that concern about bone mineral density has two components: first is to ensure practices for maintianing and building BMD, but second is the development of practices to help people feel stable and mobile rather than vulnerable to falls - improving range of motion, visual accuity and balance. It's not just Range of Motion - thought that's important - it's the whole sensory-motor awareness package.
It doesn't matter if we're younger or older - we can have issues with our movement that can compromise our ability to respond with agility to a tricky situation. The entire functional movement screen program is based on the premise that there's no point building strength on top of dysfunction, hence the screen for movement issues.
But likewise, we can have issues with our balance or visual accuity or our brains ability to perceive our selves clearly in motion. Indeed, i've written quite a bit about the benefit of just kicking off our restrictive shoes to get more info to the brain about where we are in space, and how doing so has pretty big benefits for movement and also feel of one's own mobility (as the feet move more and better, it seems so do other joints). So it seems pretty basic that as part of our quest for better bone health, a related quest for optimizing our body's ability to move in space is pretty important. I've said before, this awareness development is part of why i like I-Phase so much: it's prepping the body for the Real.
In other words, as we build better bones, there's a real benefit in openning up our body's awareness of itself in space, and simultaneously, it's ability to respond better to what's happening.
Simple example: better range of motion combined with better practice of movement into multiple positions, and better balance and visual processing means the brain has more knowledge about its being able to Zig rather than having to Zag around that wet spot on the floor, and thus, us not going for a tumble.
Stronger bones PLUS less risk of falling in the first place (and not being able to get up) - that seems to be more a complete package.
Conclusion: Why is osteoperosis such the women's issue?
One advantage that guys have is the size of their muscles puts more load on their bones so that the bones are under more demand. More demand on the bones, more continued adapting to load.
Women have not been encouraged to do as much manual labour or high resistance workouts as guys.
Similarly our formal worlds are increasingly desk bound, so less movement is part of our daily lives. As we age, this decrease in multi-plane motion seems to increase. Let us say phooey to this increasingly restricted mode of being.
It will be interesting to see as the culture shifts towards it being ok for gals to work out, and as muscle tissue can be built up at any age, that perhaps hip and related fractures will become a fate of a by-gone age.
Citation:
Lirani-Galvão, A., Lazaretti-Castro, M. (2010). Physical approach for prevention and treatment of osteoporosis Arquivos Brasileiros de Endocrinologia & Metabologia, 54 (2) DOI: 10.1590/S0004-27302010000200013
Related Resources
- What is z-health
- ck-fms - what is it
- the other side of the gym: developing sensory motor performance
- DO YOUR SHOES PASS THE TWIST TEST?
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Saturday, May 22, 2010
Real Chocolate Cake: how to make it? with 100% REAL cacao of course- "100% or go home"
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Chocolate is good for us. Really. It's got all sorts of health things going for it - particularly when it's as close to its pure cacao form as possible (here's a detailed overview of why). I really enjoy a square of Lindt 85% or 99% cacao bar for a taste treat in the evening - one of the advantages is that that's pretty much all a person wants: one square - very satisfying.
Recently i was welcomed to the next level of cacao bliss: baking with the stuff - pure 100% cacao. Oh wow. No offense to Baker's Chocolate, but my word, the taste difference of using real cacao is so incredible, my guess is once you try it you won't want anything else. Let me help you prove this to yourself.
In the UK, there is a company called Willie's cacao (no affiliation, and i'm sorry about the annoying flash site) that sells cacao in these chunky cylynders that's ideal for baking and cooking.
The chocolate itself supposedly comes from the owner's farm on the Other Side of the pond and to the south, while it's processed in the UK on 100 year old chocolate making equipment. Not sure how that makes it taste better, but oh well.
The point is that one can swap out cooking chocolate like bakers from any recipe, put this stuff in instead and suddenly the taste experience just goes up - exponentially.
By way of example, if you would really like to give this taste experience a chance, here's avariant on an old but delicious Baker's Chocolate Cake Recipe, that really, if you do this swap, you'll be well, on another plane of desert experience.
This is not a recipe that is shy of real serious ingredients. Use them; don't skip on making anything less fat than is called for. You're doing this because you know you can make this, freeze it and take out a piece from time to time. Seriously. IT's almost better (like Sara Lee cake if made by gods) post frozen.
Ok Here we go:
classic german chocolate cake (history of german choc. cake)
Prep Time: 40 minutes. Bake Time 30 minutes
a whole cylynder of the Peruvian Black Willie's Cacao (180g)
1,1/4 cup butter
2 1/2 cup granulated sugar (prefer organic castor sugar or nat. unrefined cane sugar)
6 eggs
2 cups all purpose flour
1tsp baking soda
1 cup buttermilk - no skimping
Coconut Pecan Icing
1 cup evaporated milk
1 cup granulated sugar
3 slightly beaten egg yolks
1/2 cup butter
1 tsp vanilla - real vanilla, please
1 1/2 cup schreded coconut - try to get flakes, and not fresh - that's too moist
1 cup chopped pecans
Cake:
1. nuke the chocoalate and butter in a big nuker bowl on high for about 2 minutes. stui until choc. is completely melted.
2. stir in sugar until well belnded . Add eggs one at a time, mix well. Beat in flour and baking soda alternately with buttermilk until smooth. Pour into bunt pan (here we break with tradition of the cake pans)
3. Bake in preheated 350F oven for 1hr10mi. Use the toothpick test if you wish to check readiness. for departure from over. Cool on a rack.
Icing:
Combine milk, sugar, egg yolks, butter and vanilla in saucepan. Bring to a BOIL. COok and stir over medium heat about 8 to 10 minutes or until golden. Remove from heat. Stir in cocnut and nuts. Cool, spread frosting over top of cake.
Now that last instruction is tricky. You'll have frosting left over most like which is fine as it can be used on the side by guests (or yourself depnding on mood) to add more like a spread should they wish - or decline and pretend to be healthier for declining extra icing.
Experience
Well what can i tell you? it's delicious the first day; it matures and tastes richer the seond, and post freezing, it's the gift that keeps on giving.
This is not a cheap cake - the chocolate alone is 6quid; ya'll know how much butter and high grade eggs cost, but really quality ingredients do make a difference. And if food is something you love, and for something that will be available for some time unless you go all gluttonish on it, it will be a wonderful experience for yourself, or you and the folks you love.
I'd be keen to hear if you can't get Willie's in your country, what options you've found for Cooking Cacao.
mc Tweet Follow @begin2dig
In the UK, there is a company called Willie's cacao (no affiliation, and i'm sorry about the annoying flash site) that sells cacao in these chunky cylynders that's ideal for baking and cooking.
The chocolate itself supposedly comes from the owner's farm on the Other Side of the pond and to the south, while it's processed in the UK on 100 year old chocolate making equipment. Not sure how that makes it taste better, but oh well.
The point is that one can swap out cooking chocolate like bakers from any recipe, put this stuff in instead and suddenly the taste experience just goes up - exponentially.
By way of example, if you would really like to give this taste experience a chance, here's avariant on an old but delicious Baker's Chocolate Cake Recipe, that really, if you do this swap, you'll be well, on another plane of desert experience.
This is not a recipe that is shy of real serious ingredients. Use them; don't skip on making anything less fat than is called for. You're doing this because you know you can make this, freeze it and take out a piece from time to time. Seriously. IT's almost better (like Sara Lee cake if made by gods) post frozen.
Ok Here we go:
classic german chocolate cake (history of german choc. cake)
Prep Time: 40 minutes. Bake Time 30 minutes
a whole cylynder of the Peruvian Black Willie's Cacao (180g)
1,1/4 cup butter
2 1/2 cup granulated sugar (prefer organic castor sugar or nat. unrefined cane sugar)
6 eggs
2 cups all purpose flour
1tsp baking soda
1 cup buttermilk - no skimping
Coconut Pecan Icing
1 cup evaporated milk
1 cup granulated sugar
3 slightly beaten egg yolks
1/2 cup butter
1 tsp vanilla - real vanilla, please
1 1/2 cup schreded coconut - try to get flakes, and not fresh - that's too moist
1 cup chopped pecans
Cake:
1. nuke the chocoalate and butter in a big nuker bowl on high for about 2 minutes. stui until choc. is completely melted.
2. stir in sugar until well belnded . Add eggs one at a time, mix well. Beat in flour and baking soda alternately with buttermilk until smooth. Pour into bunt pan (here we break with tradition of the cake pans)
3. Bake in preheated 350F oven for 1hr10mi. Use the toothpick test if you wish to check readiness. for departure from over. Cool on a rack.
cooling cake on rack
Icing:
Combine milk, sugar, egg yolks, butter and vanilla in saucepan. Bring to a BOIL. COok and stir over medium heat about 8 to 10 minutes or until golden. Remove from heat. Stir in cocnut and nuts. Cool, spread frosting over top of cake.
exemplar cacao enriched cake, dressed for festive occaision.
Experience
Well what can i tell you? it's delicious the first day; it matures and tastes richer the seond, and post freezing, it's the gift that keeps on giving.
This is not a cheap cake - the chocolate alone is 6quid; ya'll know how much butter and high grade eggs cost, but really quality ingredients do make a difference. And if food is something you love, and for something that will be available for some time unless you go all gluttonish on it, it will be a wonderful experience for yourself, or you and the folks you love.
I'd be keen to hear if you can't get Willie's in your country, what options you've found for Cooking Cacao.
mc Tweet Follow @begin2dig
Thursday, May 20, 2010
Should i do this next set? Pre-cognitive Fatigue Testing
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In a work out, how can you tell if you're sufficiently recovered to do another set or if your *nervous system* is too fried to try? How can we get a measure that you can't inadvertently cheat cuz we're so keen to get in our sets, we might be willing to kid ourselves?
Range of motion checks which are used in Z-Heatlh, and are becoming popular in approaches like Gym Movement (overview) are grand for many things, but they're cognitive: we can push a toe touch a little more or less between efforts; we need to think about whether this last test compares with this current test. That's fine, but sometimes, we might want something where we really don't have to think about it - especially when already pushing ourselves. We want something that's precognitve. Balance testing is one way to get at this nervous-system response.
Simple practice: before starting a set, stand on one foot, turn head sharply to the left; notice stability, then turn head sharply to the right; notice stability. The spin MUST be fast to get the fluid in the inner ear moving.
Now, do the same test with the other foot.
Repeat the whole sequence with eyes closed.
The important thing here is to benchmark performance - if standing on the left foot, ya kinda fall over with your eyes closed when turning right fast, that's ok; just make a note to self of how you performed.
Now go for your sets. (Thanks to tom robinson posing for the above demo)
Ready Ready? If you have a question mark about the next set planned, redo your balance tests right after your last set. If you're wobbly in new ways from the baseline, you know that you are NOT ready to continue another set - well, your nervous system isn't.
The key now is to wait your usual reovery time, and retest. Are you back to at least where you were when you came into the gym? No? wait longer. Retest. if by five minutes you're still unhinged, bag it.
Feedback. I've been using this approach for everything from skipping sets to pressing sets, and the results are better quality sets and better recovery.
Last night my workout said i had two more sets of presses and pistols to go, but my recovery test was still wobbly, so i bagged the sets. On another occaision, between skipping sets i was all over wobbly mid workout; waited to recover, and each time after that i checked balance i was way way more stable, and had some of the best sets i've had. Just from that mid-set breather.
I like this check because it's not debatable: if i've nearly fallen over in a closed eye test where i was stable before, that's telling me something about my sensory-motor capabilities at this moment. Why would i want to add load to that?
Resources for More Like This: This test and many many more are available on a new Z-Health DVD Mini Course: Essentials of Elite Performance. It's an actual course - what they're calling a mini-course, based on their 3day Essentials of Elite Performance workshop (overviewed here).
If you can't get to the workshop (calendar here), or just want to get going now on skills like these now, the DVD course has a whole TON of sensory-motor self-assessments and tune ups.
Please check the site for the full list of Good Things covered on the 3DVD/6.5 hours course.
And here's a cool thing: if you get the DVD, are smitten with the material, so you sign up for the full Essentials workshop or R-phase Z-Health course, you'll get 100 bucks off the tuition of that course. That's nice.
Anyway, i'd be keen to hear from you on how you find the balance test. Talking with some z-health master trainers, i've been reminded that different tests work differently in different contexts. If you're doing something where you're highly experienced, the balance test mayn't show fatigue as well as say a peripheral vision or range of motion test - it depends on the individual. Which is what makes this particualr DVD set cool: it provides a range of self-tests, as well as the rationales behind them, so we have good resources for our self-diagnostic tool box that are clear, unambiguous and repeatable.
But to repeat - please let me know how this one works for you and where you used it in what routine.
best
mc
Related Resources
Range of motion checks which are used in Z-Heatlh, and are becoming popular in approaches like Gym Movement (overview) are grand for many things, but they're cognitive: we can push a toe touch a little more or less between efforts; we need to think about whether this last test compares with this current test. That's fine, but sometimes, we might want something where we really don't have to think about it - especially when already pushing ourselves. We want something that's precognitve. Balance testing is one way to get at this nervous-system response.
Now, do the same test with the other foot.
Repeat the whole sequence with eyes closed.
The important thing here is to benchmark performance - if standing on the left foot, ya kinda fall over with your eyes closed when turning right fast, that's ok; just make a note to self of how you performed.
Now go for your sets. (Thanks to tom robinson posing for the above demo)
Ready Ready? If you have a question mark about the next set planned, redo your balance tests right after your last set. If you're wobbly in new ways from the baseline, you know that you are NOT ready to continue another set - well, your nervous system isn't.
The key now is to wait your usual reovery time, and retest. Are you back to at least where you were when you came into the gym? No? wait longer. Retest. if by five minutes you're still unhinged, bag it.
Feedback. I've been using this approach for everything from skipping sets to pressing sets, and the results are better quality sets and better recovery.
Last night my workout said i had two more sets of presses and pistols to go, but my recovery test was still wobbly, so i bagged the sets. On another occaision, between skipping sets i was all over wobbly mid workout; waited to recover, and each time after that i checked balance i was way way more stable, and had some of the best sets i've had. Just from that mid-set breather.
I like this check because it's not debatable: if i've nearly fallen over in a closed eye test where i was stable before, that's telling me something about my sensory-motor capabilities at this moment. Why would i want to add load to that?
Resources for More Like This: This test and many many more are available on a new Z-Health DVD Mini Course: Essentials of Elite Performance. It's an actual course - what they're calling a mini-course, based on their 3day Essentials of Elite Performance workshop (overviewed here).
If you can't get to the workshop (calendar here), or just want to get going now on skills like these now, the DVD course has a whole TON of sensory-motor self-assessments and tune ups.Please check the site for the full list of Good Things covered on the 3DVD/6.5 hours course.
And here's a cool thing: if you get the DVD, are smitten with the material, so you sign up for the full Essentials workshop or R-phase Z-Health course, you'll get 100 bucks off the tuition of that course. That's nice.
Anyway, i'd be keen to hear from you on how you find the balance test. Talking with some z-health master trainers, i've been reminded that different tests work differently in different contexts. If you're doing something where you're highly experienced, the balance test mayn't show fatigue as well as say a peripheral vision or range of motion test - it depends on the individual. Which is what makes this particualr DVD set cool: it provides a range of self-tests, as well as the rationales behind them, so we have good resources for our self-diagnostic tool box that are clear, unambiguous and repeatable.
But to repeat - please let me know how this one works for you and where you used it in what routine.
best
mc
Related Resources
- The other Side of the Gym: sensory motor tuning
- How's your Eye Fitness?
- Eye position for Rowing performance
- Efficient Movement - coming back to the Kettlebell Front Squat
- Arthrokinetic Reflex and the KB swing
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Excessive Daytime Sleepiness - Can be a Big Issue predictor.
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Sleep is so important. Sleepiness during the day may likewise be a really critical health marker. Sleepiness itself is usually taken as a sign that we just didn't get enough kip. Sometimes figuring out why is easy, and we can fix it; sometimes figuring out why is a little more elusive, and getting some knowledgable help is a great idea. Note: if you're considering seeing a trainer or coach, find out from them what kind of HISTORY they take about your wellbeing. If there's nothing in there about the qualities of what i've been calling our H2 Ratio, you may want to have a chat with someone else.
We know that chronic sleepiness in"older adults", is a marker of potential heart issues and mortality risk. It also seems to show up some specific correlations around mental and physical well being too.
While doing some work on sleep in our lab project on personal wellbeing tracking, i came across the following studies on EDS (excessive daytime sleepiness). The first is EDS as a marker of risk for "older adults"
Why folks feel sleepy during the day we know may stem from multiple causes. Nutrition issues, pain, breathing difficulties, lack of movement during the day, medication, sleep disorders. But it seems one of the highlights from this article is that it's REALLY IMPORTANT that if one is chronically sleepy, it's more than a good idea to check in about what might be causing that sleepiness and get it addressed.
Likewise, a more recent study looked at quality of life responses across ethnic groups relative to sleep disturbances/EDS. Here's what they report.
So as with the "older adult" study, sleep issues may be showing up as a consequence of related factors. THat's not a particular surprise. What we do know, however, is that crappy sleep in itself - that can show up as excessive daytime sleepiness too - is not good for health. We need quality z's.
A recent survey of evaluation approaches shows there are LOTS of ways to check in with a person about possible causes and developing a strategy towards getting better sleep. And, if you're interested more generally in what sleep is, and what some known sleep issues are, there's a nice current overview - free paper - called simply "Overview of sleep & sleep disorders."
Sleep Practice Feedback. In my group, we're doing research looking at the role awareness may play in wellbeing, health, quality of life. One of the devices we're using as a feed for the data is the Zeo. I've written about this before with a two part interview with Stephen Fabregas, sleep researcher, at Zeo. I'm also in the throes of prepping a review of using the device.
[EDIT - 2013: unfortunately the following kit is no longer available as zeo has closed down. THere are simple sleep monitors in commercial hardware like FitBit and Jawbone UP and also free actigarphy monitors on many phone platforms: these at least give an indication of time in bed/asleep and time restless. it's all about trends...]
Early summary: i really like it, and yes it's helped modify my behaviour to get better quality sleep. Why? because i can *see* it - my sleep cycles - i want to understand why i had less deep sleep or what's going on with low REM compared to how i usually sleep. What's different? Pretty simply it gives me a way to help make more grounded sense of how i'm doing. And it's making a difference.
There's also a sleep coach program that i'm just getting into, so that's why the review is not out yet - i want to see what that does, too. But even without the sleep coach, this device, compared with all the sleep info on the site, has been making a real difference to my perceived well being.
If you're interested, Zeo is offering a 10dollar off/free shipping deal with a coupon (here's the link). As said, i like it. I'm learning a lot. And am using it more than i do a heart rate monitor right now perhaps because this is such a new area of investigation for me.
Now, getting a zeo is not a replacement at all if one is suffering from excessive daytime sleepiness or related sleep issues in sitting down with a health pro to find out what may be going on with one's sleep - if there is some disease or drug or related Big Deal happening that requires attention. And sleep, as stephan said in the interviews, is SO crucial, and as the above research shows it's critical to get on top of it.
What a zeo can do is reflect back, pretty clearly, if those strategies are working, and if so, how well. That wee display can also help keep us honest about our practice, and help us tune that practice. So it's no replacement for real counciling (nor is it designed to be) around a chronic issue, but it's a great way to help dial in and feedback the practice.
For instance, some of the quesitons i've had are: all things being equal, does timing of exercise in the evening REALLY effect my sleep quality? Does doing two split workouts a day do better than one? Can i really see any difference on fasting or better quality eating days? Very personal tuning to be sure, but it wasn't really possible to ask these quesitons previously as i had no real, clear way of correlating sleep with these practices. There's a section on the site "for health pros" that lists the research on this puppy.
Summary: Daytime sleepiness especially if it starts to become a pattern is NOT a good thing. It's associated with everything from poor mental health to, well, death. So, it's very much worth getting sleep quality up (and daytime sleepiness down). Sleepiness during the day, especially in older adults, seems to be a strong marker of a potential issue.
If general healthy sleep practices aren't working, checking in with a health professional like one's GP about what factors may be influencing it, and getting on top of it, are really important. It's awful to have health issues already where more will be amplified by poor sleep. A vicious cycle that needs to be broken. A sleep monitor tool in these cases to give good feedback on how well strategies, once they've been developed, are working.
Absolutely check with your GP; if you are not being physical yet, getting one with starting movement can be a HUGE boon. Here's an overview of getting some Time under Movement
If you are already moving and experiencing sleepiness, working with a qualified practitioner /coach who can look at your movement, nutrition, sleep and related is a Good Thing. I personally work with folks in consultation with their GP's assessments. They go great together.
But main takeaway: chronic daytime sleepiness - it's our bodies talking to us in a BIG WAY to say something needs to change. Seek help in figuring out what things to tune and how. You'll love how you feel.
Citations
Sleep is so important. Sleepiness during the day may likewise be a really critical health marker. Sleepiness itself is usually taken as a sign that we just didn't get enough kip. Sometimes figuring out why is easy, and we can fix it; sometimes figuring out why is a little more elusive, and getting some knowledgable help is a great idea. Note: if you're considering seeing a trainer or coach, find out from them what kind of HISTORY they take about your wellbeing. If there's nothing in there about the qualities of what i've been calling our H2 Ratio, you may want to have a chat with someone else.We know that chronic sleepiness in"older adults", is a marker of potential heart issues and mortality risk. It also seems to show up some specific correlations around mental and physical well being too.
While doing some work on sleep in our lab project on personal wellbeing tracking, i came across the following studies on EDS (excessive daytime sleepiness). The first is EDS as a marker of risk for "older adults"
J Am Geriatr Soc. 2000 Feb;48(2):115-23.
Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group.
Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio T, Reynolds CF, Robbins J. University of Pittsburgh, Pennsylvania 15213, USA.
INTRODUCTION: As part of the baseline examination in the Cardiovascular Health Study, sleep disturbance symptoms including snoring and daytime sleepiness, were assessed as potential risk factors or precipitants of cardiovascular disease (CVD). Because of the association of sleep disturbance with poorer health and the possible associations of sleep apnea with CVD, we hypothesized that those with poorer sleep or daytime sleepiness may be at increased risk of mortality or incident CVD. SETTING: Participants (n = 5888) were recruited in 1989, with an additional minority cohort recruited in 1993, in four US communities for a cohort study designed to evaluate risk factors for cardiovascular disease. METHODS: An interview-administered questionnaire regarding health and sleep habits with ongoing ascertainment of total mortality and cardiovascular disease morbidity and mortality, including total CVD morbidity and mortality, incident myocardial infarction, and congestive heart failure. RESULTS: Daytime sleepiness was the only sleep symptom that was significantly associated with mortality in both men and women. The unadjusted hazard ratio was 2.12 (1.66, 2.72) in women and 1.40 (1.12, 1.73) in men. Men who reported difficulty falling asleep also had an increased mortality rate (HR = 1.43 (1.14, 1.80)) which was not seen in women. The risks were attenuated with adjustment for age but remained significant for daytime sleepiness in women (HR = 1.82 (1.42, 2.34)) and for difficulty falling asleep in men. (HR = 1.29 (1.03, 1.63)). Frequent awakenings, early morning awakening, and snoring were not associated with a significantly increased risk of mortality in these older men and women. Crude event rates were evaluated for total incident cardiovascular morbidity and mortality, incident myocardial infarction, and incident congestive heart failure (CHF). Incident CVD rates were higher in both men and women with daytime sleepiness. The aged adjusted HR was 1.35 (95% CI = 1.03, 1.76) in men and was 1.66 (95% CI = 1.28, 2.16) in women. Incident CVD was not higher in those with any other sleep disturbance including snoring. The risk of CVD events associated with daytime sleepiness was attenuated but remained significant in women after adjustment for age. Incident myocardial infarction (MI) rates were also higher in women with daytime sleepiness but were not significantly higher in men. Incident CHF rates were increased in both men and women with daytime sleepiness. In men, the age adjusted HR was 1.49 (95% CI, 1.12- 1.98) and in women, was 2.21 (95% CI, 1.64-2.98). Women reporting both daytime sleepiness and frequent awakening had a hazard ratio of 2.34 (95% CI, 1.66-3.29) for incident CHF compared with those with daytime sleepiness but without frequent awakening. This interaction was not found in men. CONCLUSIONS: In this study, daytime sleepiness was the only sleep disturbance symptom that was associated with mortality, incident CVD morbidity and mortality, MI, and CHF. These findings were stronger in women than men, i.e., the associations persisted for mortality, CVD, and CHF in women after adjustment for age and other factors. Thus, a report of daytime sleepiness identifies older adults at increased risk for total and cardiovascular mortality, and is an independent risk factor in women.The big deal here is the end of this abstract - the signs being described have much the ring of metabolic syndrome to them, don't they?
Why folks feel sleepy during the day we know may stem from multiple causes. Nutrition issues, pain, breathing difficulties, lack of movement during the day, medication, sleep disorders. But it seems one of the highlights from this article is that it's REALLY IMPORTANT that if one is chronically sleepy, it's more than a good idea to check in about what might be causing that sleepiness and get it addressed.
Likewise, a more recent study looked at quality of life responses across ethnic groups relative to sleep disturbances/EDS. Here's what they report.
J Clin Sleep Med. 2010 Apr 15;6(2):176-83.What the study suggests is that sleep disturbances and results like excessive daytime sleepiness (25% of the total cohort of over 5000 participants) seem to correlate with different effects on mental/physical health relative to (a) US Norms and (b) ethnicity. A key conclusion, however, is that, while these results are indicative, they may be part of "comorbid health conditions" - in other words, the sleep related problems and their associated responses may be part of a package of issues.
Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study.
Baldwin CM, Ervin AM, Mays MZ, Robbins J, Shafazand S, Walsleben J, Weaver T.
Arizona State University College of Nursing and Health Innovation, Phoenix, AZ 85004, USA. carol.baldwin@asu.edu
Abstract
STUDY OBJECTIVES: To compare health-related quality of life (HR-QOL) across subgroups defined by sleep disturbances and ethnicity. METHODS: Men (47%) and women (53%) Sleep Heart Health Study participants age 40 and older (N = 5237) underwent overnight polysomnography and completed self-report questionnaires on symptoms of sleep disturbances. The physical and mental composite scales (PCS and MCS) of the Medical Outcomes Study 36-item short form survey assessed HR-QOL and were compared to sleep data. RESULTS: Participants self-identified as Caucasian/White (n = 4482, 86%), African American/Black (n = 490, 9%), or Hispanic/Mexican American (n = 265, 5%). The prevalence of obstructive sleep apnea (OSA) was 17%, frequent snoring was 34%, difficulty initiating or maintaining sleep (DIMS; insomnia symptoms) was 30%, and excessive daytime sleepiness (EDS) was 25%. African American participants with frequent snoring, insomnia symptoms, or EDS had significantly poorer physical health compared to Caucasians (p < 0.001). Hispanics with frequent snoring, insomnia symptoms, or EDS had significantly poorer mental health than Caucasian participants (p <0.001). Neither PCS nor MCS scores differed significantly across ethnic subgroups for participants with moderate to severe OSA (respiratory disturbance index > 15, 4% desaturation). CONCLUSIONS: Across ethnic/racial subgroups, sleep disturbances are associated with worse physical and better mental HR-QOL than the U.S. norm, but this relationship may be moderated by comorbid health conditions. This study replicates and extends prior research indicating differences among minority and non-minority participants and highlights the need for future studies of sleep disturbances with larger samples of minorities that control for comorbid health conditions.
So as with the "older adult" study, sleep issues may be showing up as a consequence of related factors. THat's not a particular surprise. What we do know, however, is that crappy sleep in itself - that can show up as excessive daytime sleepiness too - is not good for health. We need quality z's.
A recent survey of evaluation approaches shows there are LOTS of ways to check in with a person about possible causes and developing a strategy towards getting better sleep. And, if you're interested more generally in what sleep is, and what some known sleep issues are, there's a nice current overview - free paper - called simply "Overview of sleep & sleep disorders."
Sleep Practice Feedback. In my group, we're doing research looking at the role awareness may play in wellbeing, health, quality of life. One of the devices we're using as a feed for the data is the Zeo. I've written about this before with a two part interview with Stephen Fabregas, sleep researcher, at Zeo. I'm also in the throes of prepping a review of using the device.
[EDIT - 2013: unfortunately the following kit is no longer available as zeo has closed down. THere are simple sleep monitors in commercial hardware like FitBit and Jawbone UP and also free actigarphy monitors on many phone platforms: these at least give an indication of time in bed/asleep and time restless. it's all about trends...]
Early summary: i really like it, and yes it's helped modify my behaviour to get better quality sleep. Why? because i can *see* it - my sleep cycles - i want to understand why i had less deep sleep or what's going on with low REM compared to how i usually sleep. What's different? Pretty simply it gives me a way to help make more grounded sense of how i'm doing. And it's making a difference.
There's also a sleep coach program that i'm just getting into, so that's why the review is not out yet - i want to see what that does, too. But even without the sleep coach, this device, compared with all the sleep info on the site, has been making a real difference to my perceived well being.
If you're interested, Zeo is offering a 10dollar off/free shipping deal with a coupon (here's the link). As said, i like it. I'm learning a lot. And am using it more than i do a heart rate monitor right now perhaps because this is such a new area of investigation for me.
Now, getting a zeo is not a replacement at all if one is suffering from excessive daytime sleepiness or related sleep issues in sitting down with a health pro to find out what may be going on with one's sleep - if there is some disease or drug or related Big Deal happening that requires attention. And sleep, as stephan said in the interviews, is SO crucial, and as the above research shows it's critical to get on top of it.What a zeo can do is reflect back, pretty clearly, if those strategies are working, and if so, how well. That wee display can also help keep us honest about our practice, and help us tune that practice. So it's no replacement for real counciling (nor is it designed to be) around a chronic issue, but it's a great way to help dial in and feedback the practice.
For instance, some of the quesitons i've had are: all things being equal, does timing of exercise in the evening REALLY effect my sleep quality? Does doing two split workouts a day do better than one? Can i really see any difference on fasting or better quality eating days? Very personal tuning to be sure, but it wasn't really possible to ask these quesitons previously as i had no real, clear way of correlating sleep with these practices. There's a section on the site "for health pros" that lists the research on this puppy.
Summary: Daytime sleepiness especially if it starts to become a pattern is NOT a good thing. It's associated with everything from poor mental health to, well, death. So, it's very much worth getting sleep quality up (and daytime sleepiness down). Sleepiness during the day, especially in older adults, seems to be a strong marker of a potential issue.
If general healthy sleep practices aren't working, checking in with a health professional like one's GP about what factors may be influencing it, and getting on top of it, are really important. It's awful to have health issues already where more will be amplified by poor sleep. A vicious cycle that needs to be broken. A sleep monitor tool in these cases to give good feedback on how well strategies, once they've been developed, are working.
Absolutely check with your GP; if you are not being physical yet, getting one with starting movement can be a HUGE boon. Here's an overview of getting some Time under Movement
If you are already moving and experiencing sleepiness, working with a qualified practitioner /coach who can look at your movement, nutrition, sleep and related is a Good Thing. I personally work with folks in consultation with their GP's assessments. They go great together.
But main takeaway: chronic daytime sleepiness - it's our bodies talking to us in a BIG WAY to say something needs to change. Seek help in figuring out what things to tune and how. You'll love how you feel.
begin2dig (b2d) on Facebook
Citations
Tweet Follow @begin2dig
Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio T, Reynolds CF, & Robbins J (2000). Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. Journal of the American Geriatrics Society, 48 (2), 115-23 PMID: 10682939
Baldwin CM, Ervin AM, Mays MZ, Robbins J, Shafazand S, Walsleben J, & Weaver T (2010). Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 6 (2), 176-83 PMID: 20411696
Boulos MI, & Murray BJ (2010). Current evaluation and management of excessive daytime sleepiness. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 37 (2), 167-76 PMID: 20437926
Chokroverty S (2010). Overview of sleep & sleep disorders. The Indian journal of medical research, 131, 126-40 PMID: 20308738
Tuesday, May 18, 2010
How Chefs think about Size - Portion Size that is (another b2d nugget)
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"Despite the focus on the increase in portion sizes and the possible role in the development of obesity, little is known about how portion sizes are determined in restaurants." This is how an intriguing discussion of Chefs and their restaurant food size practices begins. The study aslo notes that eating out has gone up from 2.3x's a week in 1981 to 5 times in 2000. Within that period we know that standard dinner plates have gone from 10 to 12 inch plates. So what do chefs - the folks in the restaurant it turns out who set portion size - think of as "regular" sizes?
Interestingly, chefs over 51 (trained in the smaller portion size era of the 70's) serve smaller sizes than younger chefs raised in the bigger portion period in which we find our super sized selves.
If you think that Chefs are in the know about nutrition when it comes to food prep, this may be a leap of faith. The authors write:
What Motivates Chef Portion Size Selection? Survey says, not surprisingly: "presentation of food", cost, customer expectations. Competition and calorie count had only "some influence." But intriguingly, competition with other restaurants was strongly correlated with portion size of say pasta and steak. What's wild (ok, to me) is that where "customer expectiation" was high, larger veggie side plates were served BUT when calories were perceived to be a biggie, that's when veggie portion sizes got SMALLER. That's rather an interesting insight for what chefs might be taught, no?
And indeed, from the text above on portion sizes, restaurants are serving larger than 2-3oz of veggies - when they serve veggies - and what's wrong with that? 1/2 a cup is nothing. Bring it on - as long as it's sans the oil, butter, deep frying and etc's. Have the condiments on the side and add as necessary. Or not. But that is a topic for another day.
Chef Perceptions: Here's something else interesting from the study: Chefs thought that patrons would notice if a serving size on their plate was 25% smaller - but a few things here: we are lousy at figuring size. And as we know from the last b2d post on energy density work, we can keep the plate looking just as full by using low energy dense foods, and folks can feel satisfied by same.
What does this lack of knowledge in the kitchen mean for eating out? Be not afraid to ask the kitchen to put together something for you closer to your spec, and your sizes, perhaps. Putting together a variety of sides (smaller by nature than their full meal counter parts) can often be great. If you're anything like me - if it's in front of you, you'll eat it (interesting related work showing i fear i'm not unique in this) - so an easier thing for me is just not to have the bigger size in front of me and say "serve it, i just won't eat all of it"
Are these findings a surprise? That chefs (600 surveyed; 80% response rate) seem not to understand that veggies are largely low cal foods, or that their portion sizes are so out of whack with any recommendations for such sizes? Or is it to be expected that chefs simply learn what tastes good and how to prepare it in an appetising way, with younger chefs going for bigger sizes?
Does this mean it is all the more surprising that it was a chef, Jamie Oliver, who noticed the appalling quality of "school dinners" in the UK & now the US? That if a chef noticed, they must be truly terrible?
But perhaps more than anything else, this kind of survey means: trust no one. WHile the study's authors want to investigate ways to help chefs get up to speed with nutrition relative to the food they prepare, in the meantime, we need to educate ourselves about what's healthy or not; an appropriate portion or not, and perhaps what seems is a particular challenge for some folks, to make specific requests of a restaurant when eating out, based on that knowledge.
External Resources:
CITATIONS
"Despite the focus on the increase in portion sizes and the possible role in the development of obesity, little is known about how portion sizes are determined in restaurants." This is how an intriguing discussion of Chefs and their restaurant food size practices begins. The study aslo notes that eating out has gone up from 2.3x's a week in 1981 to 5 times in 2000. Within that period we know that standard dinner plates have gone from 10 to 12 inch plates. So what do chefs - the folks in the restaurant it turns out who set portion size - think of as "regular" sizes?If you think that Chefs are in the know about nutrition when it comes to food prep, this may be a leap of faith. The authors write:
An unexpected finding of this study was that chefs who reported that calorie content was an important factor when determining portion size reported serving a smaller portion of a vegetable side-dish, such as steamed broccoli, compared with chefs who did not identify calorie content as being important. This suggests that chefs do not understand that such vegetables are low in energy density and can help customers moderate energy intake.So, as we saw in the last b2d post about energy density rather than portion size being a big factor in successful weight management AND meal satisfaction, there's a huge whack of chefs who are failing on both energy density and portion size.
Figure Above: When chefs were asked to describe their perceptions of the average portion size of foods served in their establishments (Figure 1), the majority (76% ) reported serving "regular" portions, and <20% reported serving "large" or "extra-large" portions. When respondents were asked to estimate the typical portion size of penne pasta served in their restaurant, 4 oz (27% ), 6 oz (32% ), and 8 oz (18% ) portions were most frequently reported, with 90% of respondents serving portions larger than United States Department of Agriculture's recommendation of 1 oz. For strip steak, 48% of the respondents indicated that 12 oz steaks were typically served in their establishment, and 28% reporting 8 oz portions as being typical, with 83% of respondents serving portions that were larger than the 5.5 oz that the government recommends should be consumed each day. Most respondents (38% ) reported serving 3-oz portions of a vegetable side-dish, with 31% reporting 4-oz portions. Forty percent of these respondents served vegetable portions larger than United States Department of Agriculture's recommendation of ½ cup (2 to 3 oz). When asked about the size of plates used in their restaurants, 38% reported using 9.25- to 11-inch plates, and 33% reported using 11.25- to 13-inch plates.
What Motivates Chef Portion Size Selection? Survey says, not surprisingly: "presentation of food", cost, customer expectations. Competition and calorie count had only "some influence." But intriguingly, competition with other restaurants was strongly correlated with portion size of say pasta and steak. What's wild (ok, to me) is that where "customer expectiation" was high, larger veggie side plates were served BUT when calories were perceived to be a biggie, that's when veggie portion sizes got SMALLER. That's rather an interesting insight for what chefs might be taught, no?
And indeed, from the text above on portion sizes, restaurants are serving larger than 2-3oz of veggies - when they serve veggies - and what's wrong with that? 1/2 a cup is nothing. Bring it on - as long as it's sans the oil, butter, deep frying and etc's. Have the condiments on the side and add as necessary. Or not. But that is a topic for another day.
Chef Perceptions: Here's something else interesting from the study: Chefs thought that patrons would notice if a serving size on their plate was 25% smaller - but a few things here: we are lousy at figuring size. And as we know from the last b2d post on energy density work, we can keep the plate looking just as full by using low energy dense foods, and folks can feel satisfied by same.What does this lack of knowledge in the kitchen mean for eating out? Be not afraid to ask the kitchen to put together something for you closer to your spec, and your sizes, perhaps. Putting together a variety of sides (smaller by nature than their full meal counter parts) can often be great. If you're anything like me - if it's in front of you, you'll eat it (interesting related work showing i fear i'm not unique in this) - so an easier thing for me is just not to have the bigger size in front of me and say "serve it, i just won't eat all of it"
Are these findings a surprise? That chefs (600 surveyed; 80% response rate) seem not to understand that veggies are largely low cal foods, or that their portion sizes are so out of whack with any recommendations for such sizes? Or is it to be expected that chefs simply learn what tastes good and how to prepare it in an appetising way, with younger chefs going for bigger sizes?
Does this mean it is all the more surprising that it was a chef, Jamie Oliver, who noticed the appalling quality of "school dinners" in the UK & now the US? That if a chef noticed, they must be truly terrible?
TED prize winner, Jamie Oliver, giving his TED talk
But perhaps more than anything else, this kind of survey means: trust no one. WHile the study's authors want to investigate ways to help chefs get up to speed with nutrition relative to the food they prepare, in the meantime, we need to educate ourselves about what's healthy or not; an appropriate portion or not, and perhaps what seems is a particular challenge for some folks, to make specific requests of a restaurant when eating out, based on that knowledge.
External Resources:
- Precision Nutrition - free overview about painless healthy eating heuristics
- Georgie Fear's "Dig In" cook book - healthy AND tasty.
CITATIONS
Condrasky, M., Ledikwe, J., Flood, J., & Rolls, B. (2007). Chefs’ Opinions of Restaurant Portion Sizes* Obesity, 15 (8), 2086-2094 DOI: 10.1038/oby.2007.248
Harnack, L., Steffen, L., Arnett, D., Gao, S., & Luepker, R. (2004). Accuracy of estimation of large food portions☆ Journal of the American Dietetic Association, 104 (5), 804-806 DOI: 10.1016/j.jada.2004.02.026
Wansink B, Painter JE, & North J (2005). Bottomless bowls: why visual cues of portion size may influence intake. Obesity research, 13 (1), 93-100 PMID: 15761167Tweet Follow @begin2dig
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