Take a Stand for Health

Women jumping

Take a Stand for Health

By now you may have heard the phrase “sitting is the new smoking.” Beyond being clever, the catchphrase, coined by Mayo Clinic-Arizona State University Obesity Solutions Initiative director Dr. James Levine, underscores a disturbing fact. According to Levine, we lose two hours of our lives for every hour we spend sitting. In fact, in an interview with the LA Times, Levine makes a further comparison: “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.”1 With the CDC’s National Health and Nutrition Examination Surveys showing that 50-70 percent of Americans sit for six or more hours each day, sitting has truly become an epidemic2.

The sitting epidemic is fueled by contemporary culture and lifestyle, particularly in the U.S. Our bodies and brains developed in response to particular environmental pressures and an active lifestyle. These days, most of us are not exposed to life-threatening scenarios on a regular basis. We exert little energy in our daily efforts to survive. Even our schools and workplaces promote the sedentary lifestyle: children are expected to sit still for hours upon end, and our workplaces have us sitting at desks, often typing away at keyboards for most of the day. Even our recreational habits have become less active: video games, instant access to movies and television shows, and virtual social environments tempt us to sit more and stand less.

The physical effects of this cultural shift are daunting. Excessive sitting has been linked to hormonal changes, increased inflammation, cardiovascular disease, diabetes, obesity, and cancer.3 From a chiropractic standpoint, sitting can distort the natural curvature of the spine, cause undue stress on nerves and ligaments, overstress muscle tissue, and compress the vertebral discs and spinal joints. As we age, too much sitting leads to disability. According to an NPR report, research out of Northwestern University found that, “For people 60 and older, each additional hour a day spent sitting increases the risk of becoming physically disabled by about 50 percent — no matter how much exercise they get.” With U.S. Census data revealing that nearly half of the population over age 65 have a disability, the impact on our aging population, their families, and their communities is significant.4

The science behind the sitting epidemic revolves around a neat acronym: NEAT. NEAT stands for non-exercise activity thermogenesis. Along with exercise activity thermogenesis, NEAT is the third component of human energy expenditure—calories burned during daily activity (basal metabolic rate, which is the energy required for basic body functions, and the energy needed to process food are the other two.) Some people have a “NEAT switch” that gets them up and moving after over-eating, while other people do not, which can lead to obesity. Surprisingly, the simple act of standing burns more calories than sitting, as noted in the table below.

Occupational Non-exercise Activity Thermogenesis (NEAT)*
Occupation type NEAT, cal/d
Chair-bound 300
Seated work (no option of moving) 700
Seated work (discretion and requirement to move) 1000
Standing work (eg, homemaker, cashier) 1400
Strenuous work (eg, farming) 2300
*Data based on a basal metabolic rate of 1,600 cal/d. Adapted from Black AE, Coward WA, Cole TJ, Prentice AM. Human energy expenditure in affluent societies: an analysis of 574 doubly-labelled water measurements. Eur J Clin Nutr. 1996;50:72-925

So what can we do about this national health crisis? Unlike with anti-smoking campaigns, we can’t tax chairs and benches, people can’t be banned from sitting in public spaces, and we can’t enact a legal sitting age. We can, however, actively participate in our own health. As shown above, just standing makes a difference. Some workplaces and even schools are using sit-to-stand desks, which allow the user to set their workspace at a different height in order to stand. If your boss is not quite there yet, or if you’re retired, here are some simple things to do to reduce the effects of sitting.

  • Stand. It seems obvious, but, as shown above, standing burns more calories. Instead of just sitting during a lunch break, try standing for a bit, or even doing some simple stretches like bending forward and reaching for your toes to get the blood flowing. Standing a little more each day not only increases your metabolism, it also helps tone muscles, burns calories, and increases blood flow.6
  • Walk. Directly related to standing, of course, is walking. You should get up and walk around every 20-30 minutes.
  • Stretch at your desk. Shrug your shoulders up to your ears and hold that position for several seconds before releasing. Gently stretch your fingers, hands, wrists and arms by bending at the joints. Straighten your legs and point and flex your toes. These simple stretches are great for multitasking: the person on the other end of the phone will never know!
  • Do eye yoga or eye palming to stretch and moisten your eyes. Try moving your eyes in circles of varying sizes, or doing a figure eight with them. Or you can stare at the tip of your nose—and no, your face won’t freeze like that. Eye palming is simply cupping your hands over your eyes and breathing. As well as giving your eyes a break, this can make your vision clearer and reduce headaches.7
  • Use good posture. Your mother was never more correct. Good posture goes a long way to preserving the overall health of your spine and reducing stress on the nervous tissue of the spinal cord (which provides nerve input to all your muscles and internal organs.) Maintaining and supporting the natural curves of the spine is paramount to spinal health. While sitting at your desk/computer, use a lumbar and/or a thoracolumbar support cushion height along with proper workstation ergonomics (correct workstation, chair, and monitor height, proper keyboard placement, etc.).
  • Exercise, exercise, exercise. With summer coming, it’s easier to jog, swim, or hike, and there’s always the treadmill or elliptical machines at the gym. While, by definition, exercising doesn’t affect your NEAT, it does help your overall metabolism and health.

Moving around during the workday not only benefits individuals, but companies and schools as well. Research shows that productivity and focus improve if employees and students have the ability to stand or move during the day.8 According to Dr. Levine, “This is about hard-core productivity. You will make money if your workforce gets up and gets moving. Your kids will get better grades if they get up and get moving.”9 Like ergonomic keyboards, standing desks are becoming a workplace necessity.

With summer coming, we’re likely to be more active outside of work. Warm weather tends to get us out-of-doors on the weekends and inspires us to exercise more overall. But after spending the weekend on the trail, don’t forget your body during the weekday grind. Take a stand for your health by taking a stand at work.

1MacVean, Mary. “‘Get Up!’ or Lose Hours of Your Life Every Day, Scientist Says.” Los Angeles Times, July 31, 2014. http://www.latimes.com/science/sciencenow/la-sci-sn-get-up-20140731-story.html.

2“Questionnaires, Datasets, and Related Documentation.” Accessed May 11, 2017. https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.

3“Sitting Disease: The New Health Epidemic.” The Chopra Center, August 14, 2014. http://www.chopra.com/articles/sitting-disease-the-new-health-epidemic.

4“Sit More, And You’re More Likely To Be Disabled After Age 60.” NPR.org. Accessed May 4, 2017. http://www.npr.org/sections/health-shots/2014/02/19/279460759/sit-more-and-youre-more-likely-to-be-disabled-after-age-60.

5Ibid.

6Just Stand “Burn Calories at Work.” http://www.juststand.org/Portals/3/literature/Burn_Calories_at_Work_Flyer.pdf Accessed May 11, 2017.

7 “Sitting Disease: The New Health Epidemic.” The Chopra Center, August 14, 2014. http://www.chopra.com/articles/sitting-disease-the-new-health-epidemic.

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“The Incredible Vitamin D”

Many of us know vitamin D as “the sunshine vitamin”.  It plays an important role in bone health, helping to absorb and use calcium.  It also helps to maintain normal blood levels of phosphorus, another key to bone-building.

The ideal way to get vitamin D is when our body converts it to the activated form after exposure to UVB rays in sunshine.  We also gain vitamin D from dietary sources and from vitamin supplements.  Even by obtaining the vitamin from three potential sources, Vitamin D deficiency is common today in children and adults.  In fact, more than 50% of women and men ages 65 and older in North America are vitamin D deficient, according to a consensus workshop held in 2007.  People who have trouble absorbing dietary fat, such as those with Crohn’s disease or celiac disease, can’t get enough vitamin D from diet no matter how much they eat (vitamin D requires some dietary fat in the gut for absorption).  People with liver and kidney disease are often deficient in vitamin D because these organs are required to make the active form of the vitamin, whether it comes from the sun or from food.

The discovery that most tissues and cells in the body have a vitamin D receptor and possess multiple effects on gene-regulation has provided new insights into the function of this vitamin.  So far, scientists have found approximately 3,000 genes that are affected by vitamin D.  Of great interest is the role it can play in decreasing many chronic illnesses including common cancers, autoimmune diseases; rheumatoid arthritis, multiple sclerosis, diabetes, infectious diseases; colds and flu, cardiovascular disease and high blood pressure.

Vitamin D deficiency can cause growth retardation, skeletal deformities and may increase the risk of hip fracture later in life.  Another symptom is pain and weakness in the muscles and bones.  Based on this fact, it has been suggested that some disorders diagnosed as fibromyalgia may actually be vitamin D deficiency.

A study published in the Archives of Internal Medicine in June 2008 showed low levels of vitamin D doubled the risk of death from cardiovascular causes in men and women (average age 62) referred to a cardiac center for coronary angiography.  Postmenopausal women who took 1,100 international units (IU) of vitamin D plus 1,400 to 1,500 milligrams of calcium per day reduced their risk of developing non-skin cancers by 77% after four years, compared with a placebo and the same dose of calcium. The 1,100 IU dose – nearly three times the 400 IU per day recommended in federal and other expert guidelines – was correlated with a 35% higher blood level of vitamin D, on average. A large study of aging in the Netherlands published in the May 2008 issue of Archives of General Psychiatry found a relationship between vitamin D deficiency and depression in women and men ages 65 to 95.

Vitamin D Dose Recommendations

So, how much Vitamin D is enough?  Based upon most recent research, the current recommendation for healthy vitamin D levels is 35 IU’s of vitamin D per pound of body weight.

For a child weighing 40 pounds, the recommended average dose would be 1,400 IU’s daily, and for a 170-pound adult, the dose would be nearly 6,000 IU’s.  However, it’s important to realize that vitamin D requirements are highly individual, as your vitamin D status is dependent on numerous factors, such as the color of your skin, your location, and how much sunshine you’re exposed to on a regular basis.

It is recommended you monitor your blood vitamin D levels regularly when taking oral vitamin D supplements to make sure you’re staying within the optimal range.  Your vitamin D level should never be below 32 nanograms per milliliter, or 32 ng/ml, and any levels below 20 ng/ml are considered serious deficiency.

The OPTIMAL value that you’re looking for is 50-65 ng/ml.  This range applies for everyone; children, adolescents, adults and seniors, and are based on healthy people in tropical or subtropical parts of the world, where they are receiving healthy sun exposures.

There are two blood tests that closely resemble each other: 1,25(OH)D and 25(OH)D.  25(OH)D, also called 25-hydroxyvitamin D, is the better marker of overall D status. It measures the precursor produced by the skin and converted in the body to vitamin D.  This marker is most strongly associated with overall health.   Please realize, however, that the “normal” lab range for 25-hydroxyvitamin D is between 20-56 ng/ml.  This conventional range is really a sign of deficiency and is too broad to be ideal.

Latitude and vitamin D production in the skin

Except during the summer months, the skin makes little if any vitamin D from the sun at latitudes above 37 degrees north (in the United States, the shaded region in the map) or below 37 degrees south of the equator. People who live in these areas are at relatively greater risk for vitamin D deficiency.

Dietary Sources of Vitamin D

Vitamin D can be found in foods like milk, eggs, fish and fortified orange juice, but you only get an average of 250 to 300 international units (IU) of vitamin D per day from dietary factors alone, which is rarely enough to maintain optimal levels.

If you take a vitamin D supplement, you want to take the natural D3 (cholecalciferol), which is the same vitamin D your body makes when exposed to sunshine.

You may want to consider booking that tropical vacation.  It might be exactly what your body needs!

Yours in health,

Marion M. Fraser, D.C.

Sources:

N Engl J Med 2007;357:266-81, Michael F. Holick, M.D., Ph.D., Vitamin D Deficiency

Harvard Women’s Health Watch, “Time for more Vitamin D”, September 2008 issue.  http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch

http://www.mercolaa.com/nutritionplan/ beginner_supplements.htm

The New York Times, “A Second Opinion on Sunshine: It Can Be Good Medicine After All”, June 17, 2003

Does consumption of carbonated beverages affect bone health?

Currently, about 30% of the beverages Americans consume are carbonated beverages.  This level of consumption surpasses that of all other beverages, including milk, coffee, and water. This percentage has been steadily rising since the 1970’s, and has serious potential to affect our health.  It is widely accepted that increased consumption of sugar-sweetened beverages is related to America’s rising obesity rates. It has also been said that drinking carbonated beverages reduces bone mineral density and decreases calcium absorption.

The Framingham study, performed in 2006, investigated the relationship between carbonated beverage consumption and bone mineral density.  They found that drinking cola every day resulted in a significant increase in bone fractures in girls younger than 17.  A positive relationship between reduced bone mineral content and carbonated beverage consumption in teenage girls has also been found, especially if the girls are physically active.  Other studies have found a similar relationship between cola consumption and bone density in young men.

While these studies have focused on the consumption of all carbonated beverages, cola beverages have been the most implicated.  It is believed that drinking high amounts of cola may limit calcium absorption because of its high phosphorous content.  This may not be the case for other carbonated beverages that do not contain high levels of phosphorous (all non-cola flavored sodas, as well as carbonated flavored waters).  The consumption of caffeine has also been associated with the reduction of bone mineral density, and may contribute to these findings.  Caffeine can be found in Coke, Diet Coke, Pepsi, Diet Pepsi, Tab, Mountain Dew, Dr. Pepper, and Sunkist.  If you’d like to know the amount of caffeine in your soft drink, check the nutritional label.

It is also possible that consumption of carbonated soft drinks replaces the consumption of milk, limiting calcium intake.  This might be a problem especially for children and teenagers, for we build 85-90% of our bone before the age of 20.  Maximizing peak bone mass during childhood and adolescence is important for preventing osteoporosis.  Replacing milk with soft drinks of any kind might interfere with this.

Considering this evidence, it is important to reduce or eliminate the number of carbonated beverages we drink on a daily basis, especially if we drink lots of cola.  Be sure to encourage the consumption of milk and water in children and adolescents in place of soda whenever possible.

References:

Kinney MA. (2002) Does consumption of cola beverages cause bone fractures in children? Mayo Clin Proc; 77:1005-1006

Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA and Kiel DP.(2006) Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: the Framingham Osteoporosis Study.  Am J Clin Nutr. 84;936-42

Kristensen M, Jensen M, Kudsk J, Henriksen M and Mulgaard C. (2005) Short-term effects on bone turnover of replacing milk with cola beverages: a 10-day interventional study in young men.  Osteoporosis Int 16: 1803-1808