Oct
15
2016

Commuting Affects Your Health

A research report from Great Britain was recently reviewed by CNN; it revealed that commuting affects your health.

The longer we commute to work and back the more downtime we have where we do not move our muscles. But we also are exposed to more unhealthy snacks and sugary drinks that make us deposit more fat. The original research report was published here. What were the elements of this study?

Commuting affects your health, study design

Three consecutive annual waves of the British Household Panel Survey were utilized. These are longitudinal surveys of nationally representative households in Great Britain. The sample years were 2004/2005, 2005/2006 and 2006/2007. There were 15,791 participants in the study; of these 4,056 entered the study. The main mode of travel to work was determined at each time point. The self-reported height and weight was taken to calculate the body mass index (BMI) at baseline and at 2 years. Attention was paid to switches of transportation mode (that is from active to sedentary and vice versa).

Commuting affects your health, results of study

  1. Switching from car commute privately to active travel (walking, bicycling) or public transport resulted in a significant loss in BMI. There were even larger reductions of BMI’s in those who enrolled in the first year in active transportation, because of the longer exposure. Those with the longest journeys who used active transportation had significant weight losses.
  2. A group of 787 people switched from active travel or public transport to the use of their private cars as transportation. This resulted in a significant BMI increase.
  3. The study concluded that any interventions that would allow private car commuters to switch to an active mode of transportation could contribute to the population’s BMI being reduced significantly.

Commuting affects your health, Cambridge experiment

In a 2016 study from Cambridge (Great Britain) a similar experiment was done. They studied traffic patterns in the county of Cambridgeshire. The city compared 1143 adults working in the city with 1710 people who used the Cambridgeshire Guided Busway. The public had access to a new bus network that has connections with pedestrian pathways and cyclists since 2011. Longer commuting journeys incorporated walking and cycling, for which otherwise people used a private car and public commute. When officials explained the benefit of active travel to people, there was a 1.8-fold increase of active travel. There was also a 2-fold decrease of commuting solely by car. The weekly cycling commuting time had increased to 1.34-fold compared to the previous level.

Active commute most beneficial

People who at baseline were the vast majority in being inactive in their commute, were the ones who appreciated an active commute most. There was an association of active commuting, greater overall physical activity with an improvement of health and weight loss.

Commuting affects your health, US study

A multi-city study involved the largest 3,914 municipal jurisdictions, which were located in 473 of the most populous U.S. counties. This involved 48 states and the District of Columbia. In order to encourage more active commuting (walking, cycling) many municipalities developed pedestrian zones or pedestrian-friendly zones with adjacent bus transportation. A new concept of transit-oriented developments or districts (TODs) was adopted. TODs are higher density areas that are compact. They are mixed use areas, which you find around transit stops. This encourages walking. The study was completed in 2016. It showed that the TOD zones had higher occupancy rates. Many house owners had no car as they commuted using public transportation only.

Summary about transit-oriented developments or districts (TODs)

TOD zones were more populous, people in it had higher income, and they were more racially diverse and younger. The occupants of TOD zones had a 2.1-fold higher rate of using public transportation and they also had a 2.48-fold higher rate of using active transportation to work.

Commuting affects your health, general comments

The majority of commuters in England and Wales spent 56 minutes in their cars going to and from work in 2013. In London this daily commuting time is 79 minutes. The US data are similar.

With a well-developed public transportation system the authorities developed various programs designed to replace at least some part of the commute by active commuting. This is good for your metabolism, it is good for your cardiovascular status and it gets you away from snacking junk foods driving in your car.

Commuting leads to stress

A survey from London, England polled more than 1500 commuters. 55% reported increased stress levels, 33% reported increased snacking, 29% admitted to fast food consumption, 36% complained about sleeping problems, 41% said that they reduced physical activity and 44% reported that they had less quality time with their friends and family. 58% felt that flexible work hours would improve their health and wellbeing. Remember that how you are commuting affects your health.

My own experience watching commuting in various cities

Over the years I have traveled extensively in Germany, Austria and the US. In Europe it is interesting how many years ago the pedestrian zones in the old town centers have reshaped the commuting. The U-Bahn (subway) and commuter trains have intermingling networks that shoot you out to pedestrian zones. There is no escaping from it, you have to walk before you can catch a connecting bus or tram.

Vienna (Austria)

Vienna (Austria) for instance allows you to get out at the U-Bahn station of Stephansplatz, which is a pedestrian zone around the Stephan’s Church (Stephanskirche). There is an amazing array of shops and in a side alley you can even find a Starbucks, if this is what you are looking for. When you walked enough, you hop onto any of the U-Bahn connections. This brings you where you need to be. If you are too far from your goal, hop onto a tram and enjoy the sightseeing. There are also buses that can get you there. It is all covered under the same Vienna card, which I appreciated as a visitor. It is best to park your car in the periphery and use the commuting network to get you to where you want to go.

Munich (Germany)

Munich (Germany) has a lot of cycle paths, which run parallel to the pedestrian paths. I was interesting to see business people in black suits cycle to work. Otherwise there are the U-Bahn, S-Bahn, trams and buses that all interconnect.

Münster (North Rhine-Westphalia, Germany)

Münster (North Rhine-Westphalia, Germany) has an extensive network of cycle paths and pedestrian walks. Buses and trams are also constantly running. The old historic town is a pedestrian zone, but anybody can commute to anywhere between walking or using the bus/tram. I found it astonishing this spring when I visited; there were hundreds of people, young and old cycling to and from work. The employers are providing huge metal racks where people can attach their bikes to with a lock.

Berlin

Berlin is another multi level commuting city in Germany. You can use the U-Bahn, S-Bahn (commuter train), bus or tram to get to work. Here is an informative video that explains.  I did not see many cyclists there. But hundreds of people are walking. Yes, there are many pedestrian zones and they interconnect with all of the commuter options. Berlin spreads over a vast area, so the S-Bahn, which is a local commuter train is particularly important. For the shorter connecting trips people commute by the U-Bahn (subway). Buses and trams plus walking do the fine-tuning to get to your destination.

Vancouver (BC, Canada)

Vancouver (BC, Canada) has some cycle pathways in the West end, close to Stanley Park. Otherwise there is a network of buses, the Skytrain, Sea Bus (between North Vancouver and downtown) and the West Coast Express (a commuter train). For the size of the city I think that Vancouver could benefit from studying some of the transportation modalities in Europe to entice the car travelers to use public transportation. When I travel to Vancouver, I use my own car, as it is so much faster to reach any goal. Public transportation is at this point not effectively connecting all the areas in this city.

Commuting Affects Your Health

Commuting Affects Your Health

Conclusion

In the past we often heard that there was nothing that could be done about traffic jams and commuter stress. Think again. Revitalization of city cores all over Europe, Great Britain and in the US has taken the TOD concept to heart and active commuting has become a reality. Whenever you can, use alternatives like cycling, walking and public transit to get to and from work. Studies have even shown that when you become an active commuter you likely will also become more active after work. Even using public transit makes the commute more active, as you are not sitting for an hour or more in your vehicle.

Use public transit, not your own car to commute

You have to get out and walk in order to catch a connection. This all helps to keep you physically more fit than the commuting style, where you sit in a vehicle and possibly dip into junk food. It is not only about body mass index reduction and decreasing your waistline. Active commuting is also a lot less stressful than the passive modality, where traffic jams add to frustration and stress at the beginning and at the end of a workday.

Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Sep
07
2013

Preserve Your Muscles And Joints

Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

Brief intro regarding the anatomy of joints and muscles

Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

Wear and tear with aging

It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

What causes joint deterioration?

Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

Preserve Your Muscles And Joints

Preserve Your Muscles And Joints

What helps joints?

Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

Below are more general steps that will help your joints, ligaments and muscles.

Maintaining health of joints and muscles

a)    It starts with good nutrition.

Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

b)   Supplements:

Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this).  DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

c)   Watch your weight:

It has been shown that the rate of degenerative arthritis (=osteoarthritis) in obese people is much higher when compared to slim people.

d)   Exercise:

You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

e)  Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

Conclusion

In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

More information on fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

References:

1. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014