Throw Away Your Shoes

by pribut on August 30, 2009

Sense and Sensibility

Note: There are several comments, but the interface on word press blogs will only show them if you click on the title and view only this blog entry.

The media seems to have decided that barefoot running is the trend that can’t be stopped, and should perhaps be encouraged. “Throw away your shoes” seems to be the dominant theme, if not the only thing we hear. And no one wants to stand against the tide and seek balance.  I’ve run barefoot on the beach for miles, and enjoyed it. And I’ve done that for years starting in middle school. During high school, I enjoyed barefoot running along the beach during the run up to soccer season. And, even at that time professional football teams were said to do the same. But the current persistent hyping of barefoot is as balanced as are the discussions on health care reform. Some years back, HMOs were touted as the solution to all of our health care needs. But, they aren’t singing that tune any more.

Now we are told that we evolved to run barefoot. Shoes are tiny coffins for feet and have stopped evolution. Tiny coffins that stopped evolution? Really? Evolved to run barefoot? Well, yes we did evolve to run barefoot. But we’ve had 30,000 years to develop body coverings and improved aids to motion, comfort and speed. We’ve made shoes – one shoe fits either foot, domesticated horses (and even tamed elephants) to catch  a ride, added lifts to our sandals to move faster in battle (Caesar), made steam and coal powered engines for trains, boats, sailboats, steam boats, shoes – designed for right or left foot, made cars, bicycles, airplanes and rocket ships that have carried us to the moon.

We’ve gone from eating nuts and greens to meat and back to nuts and greens. We’ve made other aids like glasses, robot flown drones, satellites to explore the rest of the solar system. But wait, did we evolve for this? Or is it wrong? Should we be barefoot and living in trees or in caves? Could we run faster without shoes?

It is said that shoes don’t help prevent injuries. But does running barefoot? Does wearing “unbalanced” shoes help? Do those shoes help you burn more calories? One person’s opinion quoted in the NY Times was that they did, they made her legs sore, so they must burn more calories. To me, that just shows that she overdid it and was a victim of the “terrible too’s” – too far, too fast, too soon, (too often and too little rest).

Could we run faster without shoes? Since 1960, only at the Mexico City Olympics,  has the Olympic marathon been won as slowly as Abebe Bikila ran it while winning in Rome in what was a world record time in 1960 (2:15:16, an impressive time). In 1964, Bikila wore (Puma running) shoes in Tokyo, ran faster, and set another world record. He took 3 minutes off of his previous world record, running 2:12:11. The current world record of 2:03:59 is held by Haile Gebrselassie, who does wear shoes while racing. Of course the shoes the elite runners wear during races are usually racing flats. During training, there will be some variety, and some elite runners incorporate barefoot drills into their regimen.

Running barefoot should strengthen the intrinsic muscles of the foot. Those are the muscles that start in the foot and end in the foot. It could also have a strengthening effect on muscles in the leg. And for those who do need more support, it could have these muscles working harder than they should and not feel very good. Running barefoot or with minimalist shoes helps balance and joint position sense. Over cushioned shoes are distinctly bad for joint position sense (proprioception).  So yes, running shoes can cause many problems through bad fit, bad design, mismatch of foot to shoe, and in many other ways. That has been the subject of many lectures and articles. Unfortunately, there no longer seems to be a balance in approach to shoes versus barefoot, when it should be shoes and barefoot.

Looking at 30,000 (ya) year old to 2 (mya) million year old bones will tell you where we’ve been, but won’t tell you where we are as a species now. Wired magazine had a recent article quoting a renowned anthropologist who felt that running barefoot was the way to go, and that evolution would have taken care of plantar fasciitis and runner’s knee. Unfortunately, that may be a nice hypothesis, but we are all built differently and have different needs. Some are knock kneed, some are bow legged, some legs are just right. Some people have high arches, some have low, and some are just right. Some of us have 20/15 vision and can fly jets, others could run barefoot and naked in the sun without sunscreen and never get a melanoma, but that is not wise for most of us. Some can run a marathon in 2:05, others in 3:05 or 5:05, but there are vast differences between them.

In evolution there are many expressions of genes called “phenotypes”. There is no one size fits all. Regarding melanoma, skin color and vitamin D, an excellent example of evolution is apparent. With Africa the presumed origin of the genus homo, migration from Africa led to genetic (genotype) changes in the genes that affected melanin. Putting it simply, the northerners had a mutation that led to less melanin in the skin and a lighter mutation. This allowed for better absorption of UV and production of Vitamin D in the northern climes (less light, less intense solar impact). It is another example of differences through evolution and adaptation to the environment with survival of those best suited to the environment.

While some wonder if human evolution has stopped, many believe it continues in many ways. Social relations, altruism, tribalism, and many things have deep roots, but also morph and change. There are differences between us and among us. We all aren’t prepared to comfortably run barefoot. But some of us are. Those who are and those who want to should start slowly with a few minutes and gradually build on that. Don’t look at it as necessarily a cure all for everything. It will feel great for some, and not so great for others. It may solve some problems in some, it may create problems or not solve problems in others. So, no, I am not claiming that barefoot is all good, all the time, for everyone. And I’m not claiming that barefoot is awful,  bad for everyone, something for everyone to avoid, always. (There is no simple answer, there are few informative studies. But, to quote Leigh Peele with her classic and often used statement “it depends“).

On the subject of barefoot running, my views have evolved. My first interview on this topic was with a journalist who wanted everything black and white and refused to accept the possibility that in my opinion some may have a foot better designed for barefoot running than others. There was a refusal to accept that while I didn’t think barefoot was all good, I didn’t think it was all bad. The quotes used in that article didn’t reflect a nuanced approach but were couched as a warning not to run barefoot. This was not what I felt was correct for all. Not long after that another journalist got it right. I pointed the second journalist to the same barefoot subject pictured in the first article. The runner was shown with beautiful “C” shaped, mud covered feet after completing his first marathon barefoot. She wrote about it in the Orlando Sentinel, along with suggestions on how to start barefoot running. (The Philadelphia Inquirer and Washington Post within the past few months had recent quotes on starting barefoot running slow and easy and a little at a time in the context of a review of “Born To Run”.)

But, as we look at the one size fits all solution, we see a trend in approaches to a variety of injuries. While many years ago, people were told to stop running, they then were told that almost all injuries came from foot problems. Now it is core weakness. No one solution fits all problems. Each problem is really solved only by a “total approach” that looks at the injury in a multi-faceted way, and looks for what changes can be made in training, equipment, muscle imbalances, stretching and strengthening. One “fix” is not enough to get it right.

Insulin is a nice medicine. We don’t all need to inject it though. L-Dopa is good for Parkinsons, but we all don’t need to take it as a supplement.  Prozac is helpful for many, running does it for others. One size doesn’t fit all, nor does one solution.

NY Times Article

Best quote:

“In 95 percent of the population or higher, running barefoot will land you in my office,” said Dr. Lewis G. Maharam, medical director for the New York Road Runners, the group that organizes the New York City Marathon. “A very small number of people are biomechanically perfect,” he said, so most need some sort of supportive or corrective footwear.”

Pithy quote:

“The shoe arguably got in the way of evolution,” said Galahad Clark, a seventh-generation shoemaker and chief executive of the shoemaker Terra Plana, based in London. “They’re like little foot coffins that stopped the foot from working the way it’s supposed to work.”

Related Posts:

Comments on Chris McDougall’s fine book at http://www.drpribut.com/blog/?p=325

Bipedal Beginnings: http://www.drpribut.com/blog/?p=331

Evolution and Exercise: What Made the Brain Get Bigger: http://www.drpribut.com/blog/?p=368

Walk This Way: Oldest Bare Footprints – 1.5+ Million Years Old: http://www.drpribut.com/blog/?p=215

For more information and to visit a community forum I recommend the Runner’s World Barefoot Runners Forum with links and discussions on all things barefoot.

Music: Barefoot by Ray Collins Hot Club

To view comments please click on the title of this entry. There are several comments, but we are currently having some interface issues. For more discussion visit the active Runner’s World Forum linked to above.

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67% – 33% Health Care Reform Wins Among Insured

by pribut on August 30, 2009

The Numbers You Can’t See

These are the hidden numbers. This is the truth from the recent Washington Post/ABC poll on opinions entitled “What Do Insured Think of Health Reform”. Three questions asked and three answered by a significant majority who clearly are positive on health care reform  in spite of all the negatives spun every hour on every station and in every newspaper. And we wonder why other polls have the papers dying, surviving only on life support.

Here are the numbers graphed from the poll.

Majority favors health care reform. Minority in panic mode.

Majority favors health care reform. Minority in panic mode.

Those are the real numbers which include those who believe their coverage, costs, and quality of care will be the same, no better, no worse, with the proposed health care reforms. A solid majority still believes that health care reform will not leave them worse off, not cost more, and will not provide worse quality of care. Every hour we hear and read more and more misleading information.

Today’s Washington Post quoted Robert J. Bendon of Harvard’s School of Public Health and Kennedy School of Government as saying “recent polls show most Americans do not anticipate any aspect of their health care improving if the president’s health-reform proposals were enacted.” This is not exactly the truth. It is as true as last weeks misleading graph shown on This Week with George Stephanopoulos. “This Week” was informed that their graph omitted significant numbers and declined to respond or correct their misinformation.

Here is an image of the misleading graph, missing those who felt that their care would remain as good as it is today. The numbers and missing numbers speak for themselves. No wonder people aren’t sure what to think. They are not being given reliable, accurate, and truthful information by those whose charge it is to do so. Anyone care to explain the constant “grin” by some of those delivering the misleading figures?

Misleading Graph, Missing Data

Misleading Graph, Missing Data

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Rush Limbaugh and Time Magazine Are on the Same Page

by pribut on August 14, 2009

While you wouldn’t think so, Time Magazine and Rush Limbaugh are on the same reality denying page. Neither the magazine nor Rush are looking at the facts and being fair and balanced on the topic of exercise. Rush, not

Time For Exercise

Time For Exercise

that long ago, implied that exercise was not necessary, didn’t add to your health, and increased the cost of health care since all those exercising were injured so frequently. Time magazine denigrates the value of exercise and espouses the twisted thought that exercise will not help with weight loss and may lead to weight gain because after you eat, the author felt, you’d be hungrier and would eat donuts and other junk food.

But we have some big problems that are too often overlooked. This is a society where a town, Elgin, is deemed the fattest in Illinois offers $1,000 grants to encourage exercise and fitness and no one applies. We have a county where a public health doctor  is fired who while working for a county agency feels that it is his duty to distribute healthy messages such as “Donuts = Diabetes” and “America Dies On Dunkin” since one of the county commissioners is part owner of a donut shop (and said 2 attorneys were threatening to sue). Dunkin’ Donuts declared themselves happy over the doc losing his job.  And it is the place where a respected weekly magazine hypes on its cover page an anti-exercise piece.  And here we are Rush and Time magazine agreeing strongly on the same wrong headed, mistaken issue and leading people down the path to increased sickness and disease, to osteoporosis, sarcopenia, dementia, colon cancer, congestive heart failure, diabetes, metabolic syndrome and an early death. Those are some of the health problems of which the risks are greatly decreased.

We  are lucky to have Mike Huckabee and President Obama talking about the benefits of  exercise and healthy life habits in lowering the cost of care and improving life quality. We are not lucky in how some of our media portray the importance of exercise, diet, healthy body weight and body composition in improving our health and our lives.

We are a nation with an obesity rate 3.5 times that of Sweden and 10 times that of Japan. Of all large industrialized nations we have the highest rates of overweight and obesity. 65% of our population are overweight or obese. How can we wonder why we spend more on health per individual than most other countries and don’t always have as much to show for it. Health reform seems to scare some of us. Are some scared that healthy habits will be encouraged? Is just feeling good about yourself enough? Or should you be working on healthy living so you can really feel good and reduce your risk of chronic disease?

Recent studies have made it quite clear how healthy life habits can have a major impact on our well being. Studies have also shown that only about 3% of Americans follow 4 simple healthy life habits. (Reeves and Rafferty 2005). Exercise is about more than losing weight. As far as losing weight goes it is considered so important that HHS and the American College of Sports Medicine came out with extensive documentation and guidelines within the last year. Recent research has been so clear I didn’t think anyone could be so foolish that they would deny clear and obvious evidence. But this seems to be a year in which many seem to look for whatever evidence supports the point of view they want to believe, even if the evidence is weak and their point of view doesn’t hold up to critical examination.

We evolved to move and I’m sure that we evolved because we moved and we are still meant to move and exercise. Without movement we become less healthy, get sick, and die short of what should be our full, healthy life span. A few recent studies  have demonstrated “Sitting Disease” and also found that excessive television watching was associated with serious illness and an increase in mobidity and mortality.

The “modern hunter-gatherer” who commutes to work by walking, running, or biking is far healthier than the bus taker, metro using, or car driving worker. The authors conclusions were that “Active commuting was positively associated with fitness in men and women and inversely associated with BMI, obesity, triglyceride levels, blood pressure, and insulin level in men” (Active Commuting and Cardiovascular Disease Risk: The CARDIA Study. Gordon-Larsen, Penny PhD; Boone-Heinonen, Janne PhD; Sidney, Steve MD, MPH; Sternfeld, Barbara PhD; Jacobs, David R. Jr PhD; Lewis, Cora E. MD. Arch Int Med Volume 169(13), 13 July 2009, p 1216–1223

On the podcast “Fitness Rocks”  Robert Salas, M.D., past president of  ACSM said “Our patients will take rat poison to live longer. Can’t we convince them that exercise is good for them?” The rat poison Salas referred to is Coumadin, a blood thinner.

Quick look at exercise, diet, and weight loss:

1)   calories in – calories out are what gives weight change. You should maintain a healthy body weight. And a good body composition too.

2)   Eat multi-colored servings of fruit and vegetables each day.

3)   Don’t smoke

4)   Exercise 30 – 45 minutes 5 days a week. Strength train 30 minutes 2 days a week. And stretch just a bit for good luck.

Facts without hype or hyperbole:

Looking at just a few recent studies we see:

Exercise and Fatness Gene: Amish who have the gene for FTO (one of many obesity genes) have the entire effect of the gene negated by adequate exercise. They don’t become overweight with enough exercise. Moderate exercise such as folding laundry counts, but it takes an incredible amount of exercise to work in this case; 4 -5 hours of moderate exercise per day.

Lifetime risk of heart failure reduced by 50%. (Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure Luc Djoussé, MD, ScD, MPH; Jane A. Driver, MD, MPH; J. Michael Gaziano, MD, MPH JAMA. 2009;302(4):394-400.)

Survival and exercise capacity

Survival and exercise capacity

Those who followed healthy life habits had their risk of heart failure reduced from 50% going from a lifetime risk of about 20% to 10% by adhering to 4 healthy life habits.

Inability to exercise at a vigorous intensity compared to those who are fit is associated with a 260% decline in long term survivability. Or put another way 2.6 times  increase in chance of death. The study compared those only able to exercise or reach a maximum effort level of 5 Mets in comparison with those over 7.1 Mets and 10 Mets.  (Circulation. 2008;117:614-622. Exercise Capacity and Mortality in Black and White Men. Peter Kokkinos, PhD; Jonathan Myers, PhD; John Peter Kokkinos; Andreas Pittaras, MD; Puneet Narayan, MD; Athanasios Manolis, MD; Pamela Karasik, MD; Michael Greenberg, MD; Vasilios Papademetriou, MD; Steven Singh, MD)

There are many more examples of why exercise and healthy life habits are important and vital keys to your future health, well being, and life. Each week more studies are published demonstrating this. Earlier this month I gave a lecture at the annual American Podiatric Medical Association meeting in Toronto entitled “Exercise: Good For What Ails You”. References and links to resources are available at the previous hyperlink. If I sit still long enough, I may be convinced to voice over the lecture and post the slides online.

References:

Healthy Lifestyle Characteristics Among Adults in the United States, 2000 Mathew J. Reeves, PhD; Ann P. Rafferty, PhD. Arch Intern Med. 2005;165:854-857.

Active Commuting and Cardiovascular Disease Risk: The CARDIA Study. Gordon-Larsen, Penny PhD; Boone-Heinonen, Janne PhD; Sidney, Steve MD, MPH; Sternfeld, Barbara PhD; Jacobs, David R. Jr PhD; Lewis, Cora E. MD. Arch Int Med Volume 169(13), 13 July 2009, p 1216–1223

Circulation. 2008;117:614-622. Exercise Capacity and Mortality in Black and White Men. Peter Kokkinos, PhD; Jonathan Myers, PhD; John Peter Kokkinos; Andreas Pittaras, MD; Puneet Narayan, MD; Athanasios Manolis, MD; Pamela Karasik, MD; Michael Greenberg, MD; Vasilios Papademetriou, MD; Steven Singh, MD

Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer. Katzmarzyk PT, Church TS, Craig CL, Bouchard C Med Sci Sports Exerc 2009 Apr 3

Rampersaud, E., B. D. Mitchell, et al. (2008). “Physical activity and the association of common FTO gene variants with body mass index and obesity.” Arch Intern Med 168(16): 1791-7.

Outside Link:

Tom Venuto on Why Time Magazine Owes the Fitness Community a Big Fat Apology

Bonus Music:

Anime: Move Your Body

Old School Moving: Rolling Stones – You Got To Move

Audio Reference: Rush On Exercise

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Amputation Costs and OPS (Obama Panic Syndrome)

by pribut on August 13, 2009

When Obama speaks a certain segment of the population seems to get red in the face and lose control. This seems to be a serious manifestation of OPS (Obama Panic Syndrome) which is difficult, if not impossible to treat. When Obama talked about Diabetic amputations he did make a mistake in the specifics of payment but was correct in the general cost. He said that the surgeon was paid over $35,000 immediately for the surgery. Surgeons never are paid immediately, and they receive nowhere near that amount. The American College of Surgeons states that Medicare payment to the surgeon for a foot amputation is under $800.

The cost that Obama mentioned was the total cost as declared in numerous articles, studies, and reviews on diabetic foot and limb care. The $35,000 – $50,000 or more cost of an amputation is often used. It just is not the amount the surgeon receives. When I listened to news clips, I misheard what he said as total cost. But he did mistakenly say this was what the surgeons received. Some felt that doctors and surgeons had been impugned. I did not feel that way. I believed Obama was again mentioning the benefits of limb preservation and preventative care in Diabetes as he has done before. Perhaps not as artfully as previously, but still an important and valuable reminder of the value of preventative care, which is not handled as well as it could be by many private insurance plans and even Medicare. So a reality check and a quick web search shows that Obama was mistaken about the surgeon reimbursement, and he must have meant total cost, and not physician reimbursement. There was no cause for OPS to set in.

Diabetes is a serious illness that requires careful management, dietary support, and exercise to minimize complications. The complications from diabetes can include painful neuropathy, renal failure, eye and vision problems and limb amputations. Diabetes is the major cause of the majority of non-traumatic amputations. More than 50% of those who have had one limb amputated go on to have the other amputated within 5 years.

According to Hospital Management Magazine ( and echoed by many other sources): “the direct cost of an amputation associated with the diabetic foot is estimated to be between $30,000 and $60,000. The estimated cost for three years of subsequent care for individuals whose ulcer has healed without the need for amputation has been estimated to be between $16,000 and $27,000.”

“With relatively low investment the number of amputations can be significantly reduced. Aggressive management of the diabetic foot can prevent amputations in most cases. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. Education of people with diabetes and healthcare providers is essential. Healthcare providers need to be trained in order to detect problems early and take appropriate action.”

Medscape reports similar numbers and notes that 57,000 amputations per year (about 150/day) are performed. They also note that 5 – 17% will die during the surgery and an additional 2-23% will die within 30 days of the surgery. The 5 year survival rate is only 40% and 25% in the elderly.

If you listen closely, you’ll hear others talk about the cost of diabetes, diabetic ulcerations, and amputations in diabetics. You’ll hear them talk about preventative care and the importance of maintaining a healthy body weight, eating healthy, not smoking, and regular exercise ( 30 minutes moderate exercise x 5 days/week, 2 days/week strength training). I recently heard Mike Huckabee speak about these very issues at the Annual meeting of the American Podiatric Medical Association.  If I recall correctly he did mention the same numbers as total cost of an amputation. Huckabee also mentioned that he thought maintaining healthy life habits was worthy of an insurance discount. He said this to cheers from those assembled. When Obama says the same thing, OPS sets in, and instead of cheers, I often hear mumbles asking how will the government measure this, and why will they be in our business and private lives.

My opinion is that both the media covering this could use more physicians to help them discern truth from lie and Obama needs more physicians to help review his examples, analagies, and specifics. And we all need to rise above special interests, people who represent and are paid by special interests and keep a cool and objective head as we examine this difficult problem. Maintaining a balance between a “public” option and private insurance firms is important as is determining a fair and proper way to pay for changes. But this is clearly the time for change.

Changes – David Bowie

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The Road To Aerobic Improvement

by pribut on August 12, 2009

The road to improvement, like any journey begins with your first steps.  And it really happens by examining your last few steps. You have to know where you are to know what you have to do next to improve. Slow, gentle beginnings and graduated additions to that will get you in shape and prepared to do more so that you can  become the best you are capable of at that moment.

This post is for Jason who asked about improving Max VO2.

So, in following the road to improving your aerobic capacity. It does depend on what shape you are in when you start. Simplifying things just a bit: For some, exercising at 65%-85% of your maximum heart rate for 30 – 40 minutes is a good place to start. And if you need to build up to that.

For others interval work will be helpful. Mile repeats, 800’s, 400’s, 200’s all have a role to play. Fartlek or hills should likely come before the interval work. The aerobic distance running build up for competitive runners, even those doing 10Ks, will include runs of 10-12 or more miles. But of course everything depends on your goals and the distance you plan to compete at.

Getting out of your comfort zone, and avoiding injury while doing so are the two most important components to raising your VO2 max to the highest level it can be for you. The goal is also to improve your ability to expand your aerobic limits so that you can run faster and longer before reaching your lactate threshold and running in an anaerobic zone.

Generalized, a tad over simplified, and quickly written down and with great respect to the grand daddy of all coaches, Arthur Lydiard. Here is the outline of a plan ( perhaps clearer than macrocycles and microcycles). And for those looking to excel, a personal coach may be extremely helpful.

Outline Of The Road To Improvement

First phase -Long Distance build up

Second phase – Fartlek, Hills (preparation for intervals)

Third phase – Intervals, Lactate Threshold Runs

Fourth phase – Specialty runs for your distance
- over distance for shorter/mid distance track runs (= other speedwork)
- long runs for the marathon, with appropriate rest between long runs (and Yasso 800’s)

Fifth phase – taper for race or race season

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Losing Big Time With Your Private Insurance Drug Plan

by pribut on August 11, 2009

The following is based on a quick twitter chat with someone who needed to obtain 2 Valium for a Lasik eye procedure.

How could you go wrong? You have a fine insurance plan. You can obtain any prescription you like for only meeting a $30 deductible. That goes for the $80 athlete’s foot prescription to the $180 antibiotic/steroid combo ear drops. You are set. No government big brother socialist between you and your money, your doctor or your pharmacist. Only you and that plastic card separate you from the medicine you need. The marketplace is a wonderful thing. And of course there is no such thing as an aberrant market. All markets are perfect or they wouldn’t be markets, they’d be cooperatives or something we don’t understand at all.

Here you are pharmacy assistant. My super duper pharm discount card is yours for the asking.

2 10mg Valium…. How much is that and yes, generic is fine.

$30?? …. (expletive deleted)!!!

Well, where did things go wrong? It seems that Valium according to the Epocrates Database should cost about $4 per tablet for the brand name and 40 cents for generic. Something seems to be wrong with this picture. The charge was $30. The way the pharmacy views this and the way it is likely defined is that the $30 is a co-payment or processing fee for submitting the prescription to your private insurance health plan (which you never want to leave home without or trade in for something unknown that might even have death squads waiting for you).

Many prescriptions cost more than $30 so a $30 co-payment is not awful. But it is awful if your big chain pharmacy is charging you $30 for an 80 cent prescription. They should have informed you that it would be much cheaper to purchase the medicine without submitting it to your insurance carrier. I recommend going back to the pharmacy and complaining to them of this unethical behavior. You should also ask them where they are sending the data with your name, social security number, address and dosage of the medication without ever asking your permission.  Apparently this seems to happen often. I had heard that the drug information was separated from name but read just this week, that apparently it is not.

The take away lesson is to first ask how much the medicine costs without a prescription card, and how much it is with the prescription card. Then you’ll know if you are saving or losing money by using the prescription card. This will be the same, most likely whether you are in a government operated program such as medicare, or a “you pay your way and premium” public option plan.  There should be a safeguard to prevent you from being charged more on a “co-pay” then the cost of the prescription, but it isn’t there yet. Of course that could ruin the perfect market place we are said to have.

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Evolution and Exercise: What Made The Brain Get Bigger

by pribut on August 3, 2009

Stimulating Brain Development: Evolution Of The Brain Spurred By Movement (a speculative hypothesis)

We previously mentioned the early hominid development of upright, obligatory, habitual bipedal posture mentioning the richer protein and calorie dense food which may have enabled better brain development. We’ll expand on that a bit with a “big think” and take it down a slightly different road. And we can have a bit of fun with a speculative hypothesis.

My thought (and hypothesis) is that exercise, viewed as aerobic movement, was the spur to development of a larger brain as is found in later hominids and modern humans. Tool making, enhanced socialization, all other more modern features and the larger cortex itself derive from motion, movement, and the positive effect that “exercise” has on the chemistry of the brain.

As we stop and think about what made the brain enlarge we hear those who say that bipedal movement freed up our hands. Now you can walk and juggle or do other tricks.  Another theory posits that early hominids could now carry food back to their tribe, make tools, ultimately jewelry and developed other useful talents. Whatever occurred likely was multi-factorial and not a simple single means event.

In keeping with Darwinian principles, it is incorrect to say that the environment created changes. We need to look to see what environmental features were taken advantage of by those best prepared to do so. Mutations are random, selection is purposeful, and geared towards the survival of those most fit for the environment. There are a variety of phenotypes present at any time, and those exhibiting desirable and helpful characteristics do survive and pass on those useful genes.

Mammalian brains produce BDNF (brain derived neurotrophic factor) which assists in neural plasticity and in the creation of new neural cross links. Humans today moving at high rates of oxygen uptake show that at up to 60% of maximum VO2, several things come into play. The first is an increase in Cerebral Blood Flow (CBF). The CBF increases as does the production of  BDNF and other compounds that among other effects stimulate brain growth and development. These other compounds include IGF-1 (insulin growth factor 1), VEGF (vascular endothelial growth factor), and FGF (fibroblast growth factor).

Bathing the brain in this enhanced biochemical “miracle grow” mix, likely would have resulted in superior neural growth and response for those who were best able to respond to this physical and neurological environment.  This seems to have been a contributing factor in the maximal development of the early hominid brain, and continued down through the hominid line.

Those most able to respond to the biochemical results of their activity of  motion, movement, and gathering would have become the smartest of the lot and been most likely to survive . They would be better suited for survival and more able to pass on their genes.  Bipedal movement in hominids was first to be short in duration. Lasting for only a limited distance and allowed for limited scavenging.  Ultimately it resulted in habitual and obligate bipedalism of longer duration, and finally in walking and then, later, running.

There have been debates over the energetics of bipedal motion versus brachiation and advantages over older forms of quadripedal locomotion. But with the thought that nothing gets wasted, if the energetics don’t balance perfectly it is probable that the energy itself that may not have been optimally efficient for walking, certainly was put to excellent use in the development, enhancement, and gradual evolution of the hominid and ultimately modern human brain.

Bipedal walking allowed the former tree apes a  better and more easily sustained motion. This  over the course of time, possibly led to persistence hunting, or at the least an expanded range for gathering, foraging, and then much later hunting. And the migration out of Africa was another sustained effort and may have stimulated brain development.

Sensory stimuli, socialization, diet, and many factors went into brain evolution and development. Then, as now, it is likely that the sustained efforts of moving increased focus, attention, and concentration. Creating mental maps of where they had been, and how to return home gave their small brains a work out. And speculating a bit, ultimately mental maps led to many other things and perhaps even primitive games of hide and seek.  Later came blind folded chess and google maps.

Many facets of evolutionary thought are interesting and valuable. Socialization and network theory, the role of sensory stimulation all are explorable, viable theories and played a major role in evolution. Here we’ve brought into play another facet of hominid evolution not previously described. The energetics and resultant neurochemical (and other changes) as a result of  motion, movement and exercise is a contributing and driving force for brain development and evolution. Put this in the context of the fact that everything moves and there is nothing entirely still in the universe, we have another small factor to consider about our world and how we and it have evolved.

So it seems we weren’t just born to walk or run. We were born to think, develop and evolve. In fact, we’ve evolved to evolve. And evolution continues today. If your thoughts stop with barefoot running, and you think our evolution stopped then, you’ve got a lot more thinking and catching up to do. Exercise and movement are good for what ails you, and assisted in the development of today’s modern human brain.

(Outline presented at American Podiatric Medical Association Annual Scientific Seminar. August 1, 2009. Toronto, Canada)

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Toronto: Conference & Lecture Supplement

by pribut on August 1, 2009

I had the opportunity to speak at the American Podiatric Medical Association’s Annual Scientific Seminar this weekend. The American College of Podiatric Sports Medicine also held it’s annual meeting here in Toronto. The meetings were excellent. And, as always, it gave me the opportunity to see many people who I cannot often visit with. Old friends, new friends, very old friends, and students from many years ago were all a pleasure to see. There were several people who because of time constraints all we could manage was a hello. The lecturers were excellent. And the ones I enjoyed the most were given by friends I’ve heard lecture many times. But, of course, I did enjoy some other lecturers who I had not heard speak before. Unfortunately, there is never enough time to really visit the city in which the conference takes place. But the people I met in Toronto were all great and friendly.

My lecture was titled “Exercise: Good For What Ails You”, but that was the take off point. I promised there would be resources online that I’d link to and the start of that is available. I plan to place large parts of the lecture including the text (minus some images) of the slides, along with a recording of it (minus some of the humor) online. Hopefully in an expanded version.

In the meantime, I’ve placed selected references and links to articles that cover some portions of the lecture. Many of those articles were here on the blog. More are in the making.

Supplemental materials for “Exercise: Good For What Ails You”

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What’s My Age Again: The Telomere Tick Tock

by pribut on July 25, 2009

Many people have played the facebook game “What’s Your Real Age”. My guess that those who played it wanted to feel they were younger than their biological age. Telomere length seems to be the real way to determine actual “biological age”. These are the real “biological clocks”. Telomeres are repetitive sequences at the ends of chromosomes that shorten with age and also shorten in certain metabolic and disease states. They are sometimes called the protective “caps” on the ends of chromosomes. Because of the manner in which chromosomes are replicated during cellular division, a bit of the telomere is not copied with each subsequent cellular generation resulting in a gradual shortening of the telomere restriction fragment (TRF) length.

Telomeres Shorten With Age

Telomeres Shorten With Age

A recent study showed that people who perform more leisure time physical activity have longer telomeres. Another recent study, with an admitted low subject number, demonstrated that eating processed meat  such as sliced bologna would also slice down the size of your telomeres. This study, published in the American Journal of Clinical Nutrition did not find other expected dietary associations.

The Cardiovascular Health Study (2007) found inverse correlations (shortened telomeres) between TRF length and fasting glucose level, fasting insulin level, systolic and diastolic blood pressure, carotid intima-media thickness, interleukin-6, high BMI, overweight (in men).

Some studies including one with “voluntary running” in mice showed the production of telomere protective compounds with the “voluntary” running. On a side note,  I’ll have to look closer at this study. If we can can get mice to  voluntarily participate in a “fitness” program, maybe we can figure out the secret to get more people to do so. Perhaps cheese is the answer.

Aubert and Lansdorp (2008) published an excellent review of  the biology of telomeres and aging. They noted that Barbara McClintock, in her 1983 Nobel acceptance speech pointed out the significance of cellular response to stress and dangers. “In the future attention undoubtedly will be centered on the genome, and with greater appreciation of its significance as a highly sensitive organ of the cell, monitoring genomic activities and correcting common errors, sensing the unusual and unexpected events, and responding to them, often by restructuring the genome. We know about the components of genomes that could be made available for such restructuring. We know nothing, however, about how the cell senses danger and instigates responses to it that often are truly remarkable.”

Short Telomeres Trigger Cellular Defences

Short Telomeres Trigger Cellular Defences

The shortened telomeres are likely sending more “damage” signals to the cells which lead to a number of biochemical pathways which degrade the contents of the cell. Studies on cellular senescence, apoptosis, and research on genomics is leading us to a better understanding, but we have a long ways to go. The complexity never ends, but it continues to unwind. And you can almost hear the tick tock of the biological clock. Your best means of slowing up the ticking are life habit changes: exercise regularly, maintain healthy body weight, don’t smoke and eat a healthy diet.
What’s my age again? – Blink 182

What's My Age Again?

What's My Age Again?

References:

Lynn F. Cherkas, PhD; Janice L. Hunkin, BSc; Bernet S. Kato, PhD; J. Brent Richards, MD; Jeffrey P. Gardner, PhD; Gabriela L. Surdulescu, MSc; Masayuki Kimura, MD, PhD; Xiaobin Lu, MD; Tim D. Spector, MD, FRCP; Abraham Aviv, MD. Arch Intern Med. 2008;168(2):154-158.

Annette L. Fitzpatrick1, Richard A. Kronmal2, Jeffrey P. Gardner3, Bruce M. Psaty1,4, Nancy S. Jenny5, Russell P. Tracy5,6, Jeremy Walston7, Masyuki Kimura3 and Abraham Aviv . Leukocyte Telomere Length and Cardiovascular Disease in the Cardiovascular Health Study. American Journal of Epidemiology 2007 165(1):14-21; doi:10.1093/aje/kwj346.

J. A Nettleton, A. Diez-Roux, N. S Jenny, A. L Fitzpatrick, and D. R Jacobs Jr. Dietary patterns, food groups, and telomere length in the Multi-Ethnic Study of Atherosclerosis (MESA). Am. J. Clinical Nutrition, November 1, 2008; 88(5): 1405 – 1412

Liza S.M. Wong, Hisko Oeseburg, Rudolf A. de Boer, Wiek H. van Gilst, Dirk J. van Veldhuisen and Pim van der Harst.. Telomere biology in cardiovascular disease: the TERC–/– mouse as a model for heart failure and ageing. Cardiovascular Research 2009 81(2):244-252; doi:10.1093/cvr/cvn337

Aubert, G. and P. M. Lansdorp (2008). “Telomeres and Aging.” Physiol. Rev. 88(2): 557-579.

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Congress Fail: Shortage Looms as No Facilities In US to Produce Tech-99m

by pribut on July 25, 2009

For several years Canada has been the primary souce of production of technetium-99m, an isotope that according to the New York Times is used in more than 40,000 medical procedures a day in the United States. The procedures are important and critical to good medical care. The procedures include tests for cardiac disease, bone cancer, metastatic bone cancer (from cancers such as breast cancer and prostate cancer) and kidney function in children. I often order this test for suspected stress fractures. Bone scans are much less expensive than MRIs and at times will show subtle bone activity missed by the MRI. (Of course the MRI sometimes detects bone stress injuries that the bone scan does not, and MRIs include a different kind of detail and information on cartilage, ligaments and tendons.)

Ontario, Canada was the home to the 51 year old reactor primarily used in production. It has been shut down until at least the end of the year  for safety reasons. The next most frequently used production facility, a 47 year old reactor in Holland, is scheduled to be shut down for maintenance shortly.

A few years ago congress had to pass legislation to allow the export of Uranium 235 to Canada to manufacture the Technetium-99m. At that time they were well aware that there were no U.S. facilities available to manufacturer this critically needed medical compound. Plans were bandied about at that time to start construction of new facilities that would take about 5 years to build. Apparently nothing was passed, since new legislation is being discussed at this time. It is time to get cracking on this and not to pat yourselves on the back for the fine job being done. Scanning for simple tests will soon not be as inexpensive, uncomplicated, and simple as it is today. More expensive and in some cases more complicated procedures will need to be performed.

In view of the tainted Heparin, for which no clear answer was ever offered, perhaps we shouldn’t be surprised at the slow response.

This is another failure to maintain domestic manufacturing capacity for needed materials and products. Apparently in the nuclear plant production area there is a tremendous lack of interest, knowledge, and desire about the production of new plants. When 10,000 scientist members of the American Academy for the Advancement of Science (AAAS) were recently polled,  the scientists were found to favor the new production of nuclear plants by 70%, while the public favored this by only 51%. There were a number of other interesting items in the survey, including political affiliations, evolution, and global warming. The suvey may be viewed online at the Pew Research Center.

Perhaps the take away lesson is that when you know there is impending disaster in the near future, you need to carefully consider what actions are needed. But you must act. You can’t table resolutions  and delay action while taking money from special interests and missing the big picture.

Pew Research Survey On Science

Pew Research Survey On Science

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