Be Healthy, My Friend

Sunday, January 2, 2011

Be Healthy, My Friend 

The word "Health" has become almost meaningless.

This is due to a number of factors, but one of the chief ones, I suspect, is marketing.
It helps to sell things as "healthy" if there is no clear idea what that actually means.
I will resist the temptation to get into that whole topic...

What I do want to do is try to remove some of the abstraction, by breaking it down into its constituent parts. While the term itself eludes a single precise definition, there's a list of components that are part of it, and those parts are reasonably concrete.

-A lack of, resistance to, and/or ability to recover from infection (by viruses, bacteria, protozoa, fungus, or parasite)

Even a healthy person may get the occasional cold, but they will get better more quickly

-A lack of, resistance to, and/or ability to recover from non-infectious-disease (such as diabetes or angina)
-A lack of, resistance to, and/or ability to recover from injury
-Longevity (how long you live)
-General fitness*
-Mental/emotional health - I wholeheartedly acknowledge that this is a very important part of overall health; however there is so much to cover just considering physical health that I won't mention mental/emotional here any further than this sentence.

Many people seem to get obsessively caught up on just one or two components, sometimes to the complete exclusion of considering the others. And as a result there are raw-foodists who can't do a single push-up, athletes who eat junk food, people who take all manner of drugs and vitamins, and others who take herbs and supplements and "superfoods", both thinking health can be reduced to just what you ingest.

When someone, be it a friend or an ad or even a doctor, claims that X food, Y herb, or Z activity, is "good for you" or "unhealthy" or whatever, ask exactly in what ways does it contribute to health? Which of the above elements does it affect, and how? Personally, I suspect that extremely few of the millions of things passed off as "healthy" stand up to that sort of test.

Just to complicate things again, some of these components can sometimes conflict with others. For example, while strength leads to resistance to injury and pathogens, the process of exercise itself is sometimes the cause of injury, and intense exercise (which is the only effective kind) tends to lower immunity (although only temporarily). Similarly, exercise lowers the risk of most non-communicable disease, but at the same time higher metabolism rates accelerate aging.

Since some components can be considered in conflict with each other, it would be hard to say in absolute terms what is the healthiest a person can possibly be. None-the-less, there is clearly a range, from someone who is sick all the time, can't walk far without being winded, and dies at 50, to the people who are still running marathons at 70.

There was a time when pathogens were the single greatest threat to human life. Undeniably, since the advent of cities, modern sanitation has made all the difference in human health. Closely following sanitation in significance would be the discovery of vaccines. Between these two, communicable disease has gone from the largest threat to all human existence to (at least in the developed world) mostly just an annoyance. While there have been times in the not-all-that-distant-past that viruses or bacteria might have killed 1 out of every 3 people you knew, about the only experience we have with them today is getting a cold or flu for a few days a year. Modern medicine has effectively eliminated the risk of death, allowing us the luxury of fighting symptoms instead of the disease itself, and even of (ironically enough) rebelling against modern medicine and deliberately returning to the superstition cures of yesteryear (so-called "alternative medicine")

Granted, there are legitimate problems with mainstream modern medicine - namely, that it has become nearly 100% for-profit, which means making money takes precedence over making people healthy. Research is biased. Unfortunately, alternative medicine, instead of rejecting the for-profit model, instead rejects science and research in favor of superstition. And so you have little white pills for $10 each made by Pfizer and GlaxoSmithKline on the one hand, and homeopathy, acupuncture, and chiropractors on the other. And as it stands today, at least in the US, those are pretty much the only options.

We have come a long long way since Smallpox killed 50% of the population of an entire country. We have basically stagnated, having cured nearly all deadly diseases, and making little progress on the rapidly mutating cold and flu viruses. There is extremely little by way of drugs (pharmaceutical or natural) that can do anything at all about infection. Before exposure, there are vaccines - the opposite of a cure, they are a small sample of the disease itself, and are designed to teach your own immune system how to kill it if it ever sees it again. For bacteria based diseases there are antibiotics. That's it.

For viruses there is nothing. Cold medicine does not fight the cold itself. It fights the symptoms. And the symptoms are actually your bodies way of fighting the virus. You get a fever because viruses thrive at 98 degrees, and don't operate as well at 101 degrees. You get a runny nose because the mucus helps block any other viruses from getting into your body while it's busy fighting whats already there. You feel tired because your body's energy is going into fighting the cold. Your body wants you to lie in bed and recover. When you take something - whether its OTC cold medicine, herbal tea, grandma's secret recipe, or even a netty pot, which reduces the symptoms so that you can feel better (in the moment) you are actually fighting your body, not the virus. Which means, essentially, that you are helping the virus. The more you fight the symptoms, and try to carry on with life as though you weren't sick, chances are, the longer it will take for you to actually get better. For some reason we have gotten it into our minds that it is absolutely imperative that we feel comfortable at all times, even to the point where treating our symptoms leads to us actually staying sick. The full list of substances which actually make you better, faster, is extremely small. The evidence for each is not terribly strong - they work in some trials, and not in others - and they only seem to work when taken immediately at the first signs of symptoms.  They are Vitamin C, zinc, and echinacea. . That's it.  And when you take it, you won't feel better (in the moment) at all.

Aside from those 3, the things which help our bodies fight viruses are simply sleep and water.
Any other medicine or remedy you take is either fighting your body, or its just a placebo.

With all of our technology, humans have not figured out a better way to fight viruses than natural evolution already did. Sanitation is really just an issue of us not making things worse. Vaccination stimulates the bodies own immune system. And Vitamin C doesn't actually attack the virus itself, but, again, supports the body's immune system.
While we can't actually cure sickness, what has been shown to prevent it, and minimize it when it does occur, is overall health and fitness*.

There are some things that modern medicine can do better than nature. Before the defibrillator was invented, a heart-attack was a guaranteed death sentence, while now people live on to have several heart-attacks in a lifetime. Vaccines have essentially eliminated the threat of true epidemic. If you have appendicitis, having it surgically removed can save your life. We have invented glasses and hearing aids and prosthetic limbs, antibiotics can cure infection. Prior to the advent of modern medicine, one of the largest killers was being born; a major threat to both mother and infant. For these reasons and many more, access to quality medical care is a extremely significant factor in the ability to stay healthy. However, like with the common cold, the vast majority of medical interventions deal with treating symptoms, not with curing the disease itself. They make the patient feel more comfortable, while not making them any healthier. With limited exceptions, modern (or traditional) medicine can't do better than the 5 billion years of evolution (or God, if you prefer) that created our bodies.

Many (non-infectious) diseases have a large genetic component. Some are entirely genetic. Some are caused or exacerbated by fetal or early childhood environmental conditions. Obviously we, as individuals, have no control over that (and as a society, unless eugenics ever becomes politically feasible, we have no control on any level).
However most of the common ones - heart disease, stroke, diabetes, asthma, and most forms of cancer - are determined primarily by individual choices.

One of the largest factors that determines how quickly a person recovers from a broken bone or a deep cut is age. But overall health is a significant factor as well. In addition, the stronger and more flexible a person is - at any age - the less likely they are to suffer injury in the first place.

Obviously longevity can not be definitively determined in advance. It is, none-the-less still a measure of how healthy you were.

Some people say that they would rather have shorter lives of full enjoyment rather than long lives on dialysis, but in reality, the people who die young have the same health problems as people who die old - they just have them at a younger age.

Significant caloric restriction is the one and only thing that has been scientifically proven to extend life span (by as much as 40%!). Good news for anyone trying to lose excess body fat, but a problem for athletes eating more in an attempt to gain muscle.

*Fitness is a component of health. But the word has become just as abstract as the term "health" itself. What is "fit"? How do you determine who is and who isn't? Well, to start with, consider the word itself. In any other context, it is meaningless without context. Something can be fit for a particular purpose. A compact car is fit for commuting. An SUV is fit for traveling off-road. It would make no sense to ask "is this car fit?" without knowing what task you have in mind for it.
In the same manner: who is more fit: a power-lifter who can bench-press 400lbs, an ultra-marathoner who can run 52 miles in one day, a gymnast who can do a double back layout, or a sprinter who can run a 100meters in 10 seconds?

It's a silly question. What would be more telling would be to ask whether the sprinter would be better at lifting weight than the power-lifter is at running; vice-versa and etc.

But what ultimately matters is what a person can actually do in real life. Outside of competitive sports, there is no reward for extreme specialization. The reality is day to day tasks require strength AND stamina AND flexibility AND agility AND balance. Emergency situations even more so.
Going back to the question of "fit for what", the answer is: "fit for real life. Fit for emergencies. Fit for everything."

Getting "in-shape" isn't about one's shape (or at least it shouldn't be). It shouldn't be about appearance or even what your doctor says you should do. It is about quality of life. Fitness can't be measured just in terms of mile times and weight lifting totals, nor in terms of fat percentage or aerobic capacity. All of those things are related, all of them are factors, but it comes down to a question of: what can you do?

Not everyone needs to be an athlete. Fitness is a quality of life issue. A person should be able to carry a big bag of groceries in each hand and walk home from the store. You should be able to sprint two blocks for the bus when you see it pulling up to your stop. To carry a baby around all day. To walk up 17 flights of stairs when the elevator is out. Open a jar that's stuck on really tight, move the furniture around, climb a fence. Join in on a random game of pick-up soccer with your friends at the park. Fitness is being able to land on your feet if you fall off a shaky ladder, or the agility to dodge out of the way when you're crossing the street and a drunk driver runs the red light. Fitness can mean the difference between escape/fighting back and being a victim. Fitness can mean the difference between saving lives in an emergency, or being one of the people who needs saving.

As those examples demonstrate, fitness itself needs to be broken down into just as many separate categories as the term "health" to be meaningful:

-Strength (of ALL of the major and minor muscle groups, including stabilizers)

-Aerobic capacity

-Endurance
-Flexibility
-Agility, Coordination and Balance

Being fit means having ALL of them. Having a lot of one does not imply having the others. Which means it is very possible to have a power-lifter, ultra-marathoner, or sprinter who isn't really "fit" in the general sense of the word. A great many exercises - including many that are very common - won't improve general fitness. Some don't improve any area of fitness at all.

The thing to look for is well rounded forms of exercise. The key word is "functional". Gym machines and exercise classes tend not to simulate anything you would ever do in the real world. In fact, most gym machines, developed with body-building in mind (which is mostly about looking strong, not actually being strong) deliberately isolate body parts.

The following chart has an absolutely excellent set of strength tests that correlate directly to being able to move around and do things in the real world, and it scales to anyone because the levels are in terms of your own strength-to-weight ratio, not some arbitrarily static number of pounds to lift:

http://www.crossfitnorthatlanta.com/total-capacity-levels/

or

http://www.crossfitseattle.com/Skill%20Levels%20poster.pdf

Unless you plan to compete in the Olympics, there is really no point in trying to get to 'level 4'. Even level 3 will be out of reach of all but the most dedicated athletes. However, everyone should be able to do the items in level one, just as a minimum level of fitness. Below that will affect quality of life in ways which a person may get used to and not notice, but will be significant none-the-less. Once a baseline of fitness is established (if you can accomplish some things on level 1 but not others, focus on improving the weak points before moving on) striving for level 2 is a reasonable goal.

Crossfit is a chain commercial gym (or class within established gyms) which better exemplifies the concept of functional exercise than any other system (not counting their many copy-cats). If you were planning to join a gym anyway, it's what I would recommend. However, you don't have to spend any money to get fit. They have many great resources online (including in-depth essays on the principals of fitness, daily suggestions for exercises, and YouTube videos which show exactly how to do each exercise.) I personally like their style. Whatever you do, the important things are that it includes both aerobic and strength training, and that it vary at different times in order to activate different muscle groups. Stay away from all weight or aerobic machines which artificially constrain you to a fixed range of motion. Focus on exercises which use multiple different body parts at once. Especially if you are just starting out, calisthenics will provide plenty enough resistance without investing in any equipment. Push-ups, sit-ups, pull-ups, dips, squats, handstand push-ups, lunges, burpees... with zero investment in equipment, classes, or memberships, it is entirely possible to gain well rounded fitness that will improve health and allow you to do more activities in daily life with ease - all from the comfort of your own home.
That truth right there eliminates a whole lot of excuses. You just have to do it! I can't make you do it.

There is lots of information online about number of repetitions, sets, ways to make exercises easier or harder (scaling), recovery time, etc.  If you don't have a lot of free time, look up "Tabata", a technique for getting some intense exercise in just 4 minutes. You can do any exercise tabata style. You can get a free tabata timer online:

http://www.beach-fitness.com/tabata/

Truth is, it doesn't matter which theory you end up using, as much as that you actually do it, and do it consistently. Whatever exercise, what ever style you go with, do it intensely and be consistent!

Don't injure yourself working out - if the point is improving fitness and health, injuring yourself by over-training is totally counter-productive. Being competitive can be a great motivator for many people, but it also tends to encourage over-training.

If it is comfortable, you aren't doing it right. If, immediately after you finish an exercise, you can still do more, you weren't doing it right.  Do a little more.

Most people - especially those who are sedentary - would be surprised to find out just how much exercise is recommended, not for athletes, but for regular everyday people, just to maintain minimum levels of general health and fitness. Not for competing, not for losing weight*, just to be an ordinary healthy person. The CDC recommends a MINIMUM of 75 minutes per week of intense aerobic exercise, in addition to regular strength exercise. They go on to say that what would be better is 150 minutes of vigorous exercise in addition to strength training. This breaks down to 20 minutes a day, 7 days a week (or 30 minutes a day, 5 days a week), of running, swimming, basketball, etc, plus weight-lifting and/or calisthenics a few days per week, for at least as much time. I say that this should be the minimum everyone demands for themselves.
Every single day?
Yep.
Like, not just until I lose 5 lbs or can run a 5 minute mile, but, forever?
Like clock work.  (I mean, you do brush your teeth every day, right?)
Really, it's not that bad. Think of it as preventative health care.

That volume is to maintain health. If a person is trying to get stronger, or faster, or lose weight*, or whatever, that amount needs to be increased even more.

We want it to be something we do every now and then, when we feel like it, when we "have time".
It doesn't work that way.

The truth is, everyone, no matter how busy, has time. 30 minutes a day really isn't that much. Even if a person has a full-time job, is a student, and has a long commute, there are three 10-minute slots of free time somewhere in a day, currently filled by TV or internet or getting ready a little slow or waiting for something or someone. Spend 15 minutes eating on a lunch break, and it leaves 30 minutes for a little exercise. Riding a bike to work or running to the bus instead of walking combines commute time with work-out time.

It comes down to priorities. There are many things we do to take care of ourselves every single day. We don't just skip eating because we don't have time. We use the bathroom every day, no matter how busy we are. We sleep everyday. It is the priority. The other things in life get scheduled around it. We brush our teeth every single day, not because all our teeth will fall out over night if we don't, but because we care about the long term health of our teeth. We make time for it. The health of our bodies shouldn't be any different. If we decide that we are going to exercise 30 minutes a day, 5 days a week, then other things in life have to work around that, and that's just it. Friends come to visit, parents call, boss wants you to work late? You wouldn't skip meals or sleep for them. Don't skip exercise either. Other things can wait.

Total time spent is really important. It can't be substituted for. Doing one really intense hour on the weekend simply isn't enough to provide tangible benefits.
But simply spending enough hours isn't enough either.
Those 75-150 minutes of cardio and 45-90 minutes of weight-lifting or calisthenics exercises per week need to be intense.
A lot of what passes for exercise isn't challenging enough to stimulate improvement in the body.

As the great Hunter Thompson said, if a thing is worth doing, it's worth doing right. No where is that more true than fitness. If you don't put forth the full effort, you won't really improve. And in that case, what really is the point? You end up sweaty and tired, with nothing to show for it.

The potential benefits, not just to fitness, but to overall health, in just about every component, are outstanding! It extends from there to the ease of completing everyday tasks, like the list I had above, which improves overall quality of life. It makes a person feel better about themselves, increases the feeling of well-being in general. It has, for example, a direct, measurable effect on depression - not far behind prescription drugs for effectiveness (and with lots of positive side-effects). And if getting sick less often, being able to do more things, reducing risk of disease, recovering from injury faster, living longer, and feeling happier all weren't enough, as an added bonus it even makes a person look better too.
That's a lot of benefit.

Fortunately, it requires less sacrifice than it may seem like at first. The two main reasons people who acknowledge the benefits don't exercise enough anyway is 1) how unpleasant it is, and 2) lack of time. Time I addressed already. There is always time; the only issue is what one chooses to prioritize. The perception of unpleasantness has some basis in the physical feeling of being exhausted and sweaty and sore, but much of it comes from the sort of exercise that dominates popular culture because they are what make commercial gyms the most money.

A lot of why people burn out on exercising and give it up is because these activities are terribly boring, and on top of that they fail to produce significant results. Fortunately those exercises - repetitively moving weight machines' handles back and forth or going for miles on a treadmill or exercise bike - aren't really productive from a perspective of comprehensive fitness. In fact, even just in terms of burning calories to support weight* loss, they are not a very productive use of exercise time. Good, well balanced, comprehensive exercise tends to be much more complex (and interesting). It should actually be fun. Things like sports or martial arts, rock climbing or CrossFit. For some people, especially if they get endorphin induced "runners high", can zone out and enjoy running. Some people get into cycling for the new scenery or the camaraderie. Whatever it is, it should be something a person looks forward to, not dreads.

Another reason for the sense of unpleasantness is that modern American's, through money and technology, have the option to totally eliminate discomfort from life, and as a generation that has grown up with this option, we feel we should be comfortable at all times. We can get through life rarely if ever feeling too hot, too cold, hungry, thirsty, or tired.

I personally never really noticed how accustomed I am to the luxury of being comfortable until I spent 2 months at military bootcamp. I learned that it is actually quite tolerable to be uncomfortable. You stand in formation in full uniform in 95 degree heat. You stand there, perfectly still, while it is pouring rain and just over 40 degrees with wind chill. You stand and experience mosquito and gnats land on your face, take their meals, and fly off, without swatting at them. At bootcamp when you are hungry, too bad, it isn't meal time. And you deal with it. If it is time designated for running, or swimming, or whatever, it doesn't matter if you feel tired, you just do it. What you feel is irrelevant. And to people who have always had the ability to feel comfort, it may sound like pure hell, but the reality is that it is very easy. It is uncomfortable, to be sure. But it is temporary. It doesn't kill you.

And in the end, when you felt like you might throw-up or pass-out and you just kept pushing anyway, a little bit faster, a little bit farther, and in the end you don't collapse, you make it, you have an unparalleled feeling of accomplishment. It makes the idea of "willpower", of "mind over matter", into a real life thing. It means YOU have control over your life, over what you do, not the whims of your feelings.

I recently read a statistic that said that only 7% of people who attempt to stop smoking actually last a full year smoke-free before relapsing. That says something about our will power. But what was more interesting is that of those who do successfully quit, 80-90% of them quit 'cold turkey'. Quitting cold turkey is more effective than all other methods combined. No drugs. No replacement nicotine in the form of gum or patches or vaporizers. No gradual tapering down to fewer cigarettes over time. The physical withdrawal symptoms are very real, tangible, not only uncomfortable, but with measurable effects on the body. All of the various methods are designed to lessen those withdrawal symptoms as much as possible, to make a difficult process more tolerable. And yet, the people who experience the most intense withdrawal of all are also the people most likely to get through it. Instead of trying to feel comfortable, they acknowledge from the outset that it is going to be hard. They just jump right in and do it. They feel like shit, and they keep doing it anyway, and they come out the other end victorious. It isn't even about willpower, per say. Its about mindset.

The same thing applies to every area of life where modern life makes excess more easily available than it has been ever before in human history, whether it's choosing not to take something to easy cold symptoms, exercise, dieting, or impulse shopping.

Never before in history have humans needed to go out of their way to exercise. In the past exercise would be in the form of getting from place to place (even the bicycle is a recent invention), gathering and chopping firewood, digging and plowing and harvesting in the garden, pumping or carrying water, hunting... today we have machines to walk for us, to do manual labor for us, we have computers and internet that allow us to potentially never leave our rooms - at all! Heck, I'm on a computer right now! We even have remote controls so we don't have to walk all the way across the room to change the channel when we're sitting passively watching TV. We have headsets so we don't have to reach all the way into our pockets to retrieve a ringing phone, and then have to hold a heavy cell phone to our heads. We have power steering so that, even when we already have a car doing our running for us, we don't have to make the effort of turning the steering wheel. We have machines to wash our dishes, our clothes, our cars, and even robots to vacuum the floor. What isn't fully automated, if we can afford it, we hire someone else to do. At the hardware store the other day I found about 200 devices designed to make it easier to open a tight jar. Our technology has made us extremely lazy.

But it is what it is, and we are where we are. The only question is if that is what you want for yourself. Since most of us aren't going to abandon the city and become Luddite farmers, we have to take the time to make sure we get exercise. And if we are going to do that, we may as well do it smart.

The best way to tell, over a long period of time, whether what you've been doing is really helping, is to keep records. Push ups and sit ups in a minute, mile times, weight* and measurements (you need to take measurements to determine fat percentage - weight alone is meaningless because muscle weighs more than fat), maximum press and bench and deadlift and clean weights, even things like medical complaints or overall outlook on life. Taken over a long period of time, looking back at old notes and seeing the trend of improvement can be a major motivator to continue.

In the short term there are simple benchmarks: for strength exercises, you should be at least a little sore the next day. If you aren't at all, you weren't really working out. You were just doing repetitive movements and killing time. For aerobics the feedback is even more immediate: you should be sweaty and out of breath. If you can hold down a conversation, you aren't working hard enough.

A few very common things which really don't count as exercise:

-walking
-yoga
-lifting weights so light that you can easily do 15 or more reps without rest
-anything which is supposed to encourage "tone, not bulk"
-treadmill, elliptical, or stationary bike at a low resistance or low speed

-cruising around on a bicycle on flat roads, coasting half the time

This isn't to say these activities have no value at all. Burning some calories is better than none at all, and yoga has significant benefits to flexibility (and for many people for stress reduction). But they aren't exercise. You could do them for 5 hours a day and you won't increase your aerobic capacity or get any stronger. You would burn a few calories, but less than you would from doing a more intense activity for a smaller amount of time. And there are only so many hours in the day.

An efficient exercise gets you as tired as possible in your limited work out time. It activates major muscle groups, core stabilizer muscles, and the cardio-pulmonary systems all at once.
A short list of examples of real exercise, (along with the calories they burn in an hour of continuous activity):

running upstairs/hill (1000)
running (600-1000 depending on speed)
rock climbing (650)
jump rope (600)
burpees (550)
boxing / martial arts (400-600)
elliptical/stationary (400-600 on high resistance, at high speed)
mountain biking (500 cross-country)
rowing (500 roughly 2min/500m rate, level 5/med)
aerobics (450-500 depending on the class)
jogging (430)
moving furniture (400)
swimming (370)
yoga (300)
sex (300)
skating (300)
bicycling (250 road, flat-lands, non-racing)

weight lifting (150-350 depending on weight)

stationary machine (100-200 at low to moderate intensity)

All of the calorie burn levels vary by weight and gender and fitness level, but the relative values stay the same. Plus, more intense activities tend to raise metabolism for longer and longer times after the activity is over (up to several days!) so that the net totals are even higher.

Muscle burns calories even when at rest, so having a higher percentage of muscle means your overall calorie use rate goes up permanently. For this reason lifting weights (or doing push-ups and the like) considered over the long-term belongs much further up the list.

Rather unfortunate, then, that so many people spend their time on stationary gym aerobic machines at low to moderate intensity for the specific purpose of burning calories. For gaining aerobic capacity, improving overall fitness, or losing weight*, stay near the top of the list (or find other activities which are as much work, like a game of soccer, being a forest fire fighter, or military bootcamp). Again, this is not to say that low intensity exercises don't have value. But don't expect to get results by taking the easy route. And then again, it is perfectly possible to make the activities lower on the list intense... its just that it is very easy to do them less than all out, to coast on the bicycle, to swim at a relaxed pace, while running up hill or doing burpees is inherently challenging, even if you try to do them slowly.

Spend some time doing the highest intensity exercises for 30 minutes without resting, to get a feel for what real exercise feels like.

(NOTE: if you are over 40, have been totally sedentary for years, or have medical issues, you may want to consult a doctor, or at least a personal trainer, first)

Once you know how it should feel, you can substitute pretty much any activity, so long as you do it at a level that is equally as difficult. And it is ok to occasionally do low impact work as well. Just keep in mind that if an exercise is 1/4th the intensity, you have to do it more than 4 times as long to get the same benefit.

Sometimes, though, it makes more sense to do moderate intensity exercises. Say you are going for a hike anyway, or doing some gardening or running around with small children. All movement and everything active counts. Its just that it only counts for half as much time toward the total. If you have an active enough life, such that you spend an hour a day or more doing moderately intense activities (you can have a conversation, but not sing) you can get away with only doing more intense exercise a couple days a week (along with the strength building exercise a few days a week).

If your goal is to not just maintain health but to increase athletic performance and/or lose weight*, then total time and intensity level become even more important. Increase the minimum at least 50%, AND make all the work intense.

***There was originally a sub-section here on managing excess fat. Because it is such a complex subject, and so relevant to the health of most Americans today, it quickly grew too long to just be a sub-section. So, it has been removed from this essay all together, and will be posted separately as part 2

Nutrition is touched on briefly in part 2, because it is especially important for anyone deliberately limiting food intake to pay attention to nutrient density and making sure to get enough of what the body really needs. But everyone needs to eat! It seems the only people who really pay attention to nutrients are dieters, athletes, and those obsessed with health. The latter group, in particular, often seems to think that what one eats is the only thing that determines health, which is just plain silly (hopefully I have demonstrated that by now).

Maybe it is another symptom of our easy answers culture. If health is just a question of eating the right superfoods, we make sure to eat some of it each day, and blam, instant health!

Sometimes it seems that there isn't much room for middle ground - either someone is obsessed with nutrition, or else they don't give it a second thought. Which is unfortunate, because its really important, and its also really simple.

Until relatively recently, most foods which exist in the world weren't available in most places. For most of human history cultures have survived on a small variety of local staples, and for the most part they lived perfectly healthy lives. No one food can possibly be vital if people in most places for most of time have got along just fine without it.

Each time some new food fad comes out, this anthropological fact gets forgotten, as every health conscious person scrambles to buy acai / coconut oil / algae / quinoa / goji / soy / bee pollen / pomegranate / and of-course (though we all know its mostly a convenient excuse) wine and dark chocolate. All of these things are local to a specific region. Until a few years ago, they were simply unavailable in most of the world.

Not to mention a plethora of vitamins, oils, and herbs which are partially the all natural equivalent to the pharmaceutical industry making pills to block symptoms instead of addressing causes, and are partially nothing more than marketing by the companies that sell them.

There are some things marketed as health food which have no effect on us at all. A perfect example is enzymes. We do not need to eat enzymes. The body produces its own enzymes. In fact, enzymes which are ingested get broken down by the stomach anyway, so the only function they can possibly have is digesting some food in the stomach before they are destroyed. The only time this is useful is if a person is eating something they have no natural enzymes for; most commonly lactose pills for those who can not digest dairy. Another solution, of course, would be to simply avoid eating dairy.

True, eating vegetables and plants and (low mercury) fish and whole grains - instead of food filled with sugar and butter and mammal meat - will have an enormous impact on just about all measures of health, from disease resistance to fat percentage. But there is no particular magic bean that can do something no other food can do. As long as a diet is well balanced, and contains more food that are dense in nutrients than foods that are dense in calories, a person will get proper nutrition. With limited exceptions, if you need to take anything in pill form, that's a sure sign you aren't eating the right foods.

It is possible for an adult human to stay alive for years on nothing but glucose drippings. It would not be an ideal life, nor would it be healthy by any definition of the word, but it demonstrates that we will not simply drop dead from a few days without any specific nutrient. People have gone on fasts for various health, religious, and political reasons throughout history with no ill effects if done for a moderate amount of time. The human body evolved in a world where no one food source was ever guaranteed, and so, at least to some extent, it evolved the ability to ration. Over the long-run it is important to get all of the vital nutrients. Getting each and every one in every meal is not.

There was a time when nutrition deficits were a genuine threat. Before the days of refrigeration sailors on long sea voyages would get scurvy, from a lack of vitamin C in the diet, because they would eat no fruits at all for months at a time. A severe lack of vitamin D, especially in childhood, will cause rickets. A lack of iron causes anemia and lack of iodine causes goiters. Not having enough B3 in the diet leads to pellegra. Chances are you have never heard of pellegra. This just goes to show how small the threat of malnutrition actually is in this country, even though we have the worst diets in the world.

(American's eat more fast food per capita than any other country)

What we lack in nutritional density we make up for by eating more food total. As long as a diet is at least reasonably balanced we eventually get the nutrients the body needs - it just takes more calories to get there. The body keeps feeling hungry until it's nutritional needs are met, whether it has enough calories or not. The reason for eating nutrient dense food is not that we will be malnourished without it, but rather that we can meet our needs with fewer excess calories.

What those nutritional needs are has been known for a long time by nutrition science, but is still often misunderstood by lay people.
We need two essential macro-nutrients: Protein and fat.

(Carbohydrates are also a macro-nutrient, but there is no essential minimum intake)

We need 13 vitamins: A, B (8 kinds), C, D, E and K. But we only need a tiny amount of each. Ingesting more than the required amount usually won't do much harm (although too much of some can be toxic); but having more than the tiny amount present in a healthy diet doesn't do any good either.

We also need 13 trace minerals, primarily potassium, chlorine, sodium, calcium, phosphorus, and magnesium (in that order). The other 7 we need only in tiny amounts. (4 others, in even smaller amounts, may have some function, no one knows for sure yet)

Most of us actually get more of many nutrients than we actually need. The excess just gets filtered out by the kidneys in the case of vitamins and minerals (leading to the quote by a nutrition doctor about American's having "the most expensive pee in the world") or stored as fat in the case of fats.

Protein, in particular, gets a lot of attention as an essential nutrient, especially by athletes and vegetarians. Its certainly true that we need a certain amount of protein daily. What fewer people know is that American's actually consume far too much protein, at a level which is actually mildly toxic. A full grown adult only needs 60 - 120 grams of protein a day (depending on age, size, and activity level, with the high end only applying to hardcore athletes). There is protein in almost every food, not just the meat and soybeans that immediately come to mind.

If over the course of the day you eat one pancake, a cup of fruit, half a cup of yogurt, two pieces of bread, a 1 ounce slice of cheese, a slice of avocado, a small vegetable salad with no toppings, a cup of pasta, a cup of vegetables, and a baked potato, you have had about 65 grams of protein, already more than enough for most people.

That's without eating a single so-called "protein source"!!
Unless you are vegan, pregnant, a bodybuilder, or anemic, there is never any need to make a point of eating a "high-protein" food with every meal, or even every day.

There are different amino acids (the building blocks of protein) which the human body needs, and which not all plant proteins have. However, unless one eats literally just one type of food, the American diet is varied enough to cover it without making a point of it.

Getting enough of each amino acid is as easy as eating rice with one’s beans, so even for vegans who eat no processed food, it requires only minimal thought and effort.

I personally am vegetarian. To be honest, this is more out of habit than anything else. There are a lot of very important environmental and ethical reasons I could argue for vegetarianism, but this specific essay is about health. There isn't really any health reason to eliminate all meat from the diet. However, the volume American's eat most certainly is unhealthy. Its inclusion in the diet should be limited, sort of like this:

http://www.drlam.com/pictures/pyramid/pyramid_web.gif

(Please note that no diet will keep you from aging. Only a time machine, cryogenics, or some sort of freeze ray can do that. The only thing which has been shown to increase longevity is calorie restriction. Also, as covered previously, a healthy diet should not need supplements.)

or this:

As this pyramid notes, the foods highest in nutrients just happen to be those lowest in calories. Another thing to notice is that it is almost the exact inverse of the typical American diet! Then we make up for it with vitamins and supplements. Or, we make up for it by eating a whole bunch, because even with junk food, once you eat enough of it, you get your nutritional needs met. Eating food which is low in nutrients (even if it is low-calorie "diet" food) means you need to eat more to get the minimum intake of vitamins and minerals.

Just to show how futile it is to try to find the “perfect” diet, consider the existence of anti-nutrients. These are (naturally occurring!) compounds which destroy or draw needed nutrients such as minerals or proteins out of the body. They are found in otherwise healthy foods. Some, such as bio-flavanoids (the active ingredient of green tea, dark chocolate, and wine, with supposedly magic health powers), have been shown in some studies to prevent cancer… and in others they have been implicated in potentially causing it! Certain vegetables known to be high in calcium may drag more calcium out of the body than they add to it. And yet, despite the contradictory nature of food, people are able to be healthy.

The overall point is that there is no need to stress over the details of nutrition.

Common knowledge covers it. If a person eats a varied diet, based primarily on vegetables, fruit, seeds/nuts and grain, (whether eaten straight or cooked / processed into something) with occasional (not necessarily daily) animal products, one will get their basic nutritional needs met. If a diet has regular hamburgers, pizza, ice cream, comes from fast food restaurants or the snack food section of a convenience store, it will either have too few nutrients, too many calories, or both.

Eating junk food (whether home made or purchased) once or twice every few months won’t do any particular harm. We all know the consequences of eating it more often than that. No one needs some blogger to write a section on nutrition to go into the details.

So that’s about it.

Nothing revolutionary:

• Get enough sleep
  (This varies by the individual.  The average is 8-9, but anywhere from 6 to 10 is in the range of "normal".  If you need to use an alarm clock to wake up, you aren't getting enough sleep.  If you sleep in on the weekends, you aren't getting enough sleep.  If you need coffee to feel awake in the morning, you aren't getting enough sleep)
• Exercise a lot more. For most of us, a whole lot more.
  (For a few - those who workout so much as to cause occasional injury - a little less. You know who you are.)
• Eat lots of healthy food, and minimize unhealthy food.
• Don’t smoke, and avoid most or all alcohol and drugs.
• Avoid stress.

Start young, while you are still healthy, because it is MUCH easier to maintain than it is to rebuild!

Skip the 1001 gimmicks that promise to instantly transform your body using the “latest secret” in diet / exercise machine / magnetic massage stress relief…

(seriously, I just saw that in a catalog!)

and skip the pills and supplements and anti-oxidant drinks.

Use the money saved to invest in a tax-advantaged health savings account in case universal health insurance never does go through and you lose your commercial coverage someday.

Get regular doctor (and dentist) check-ups, just to make sure you don’t have something going on inside that you can’t see or feel.

But if you follow the advice above, the chances are much better that there will be nothing much for your doctor to find.

For many people some of this may seem like an overwhelmingly big step.

If you choose to ignore everything you just read, you’ll get no disrespect from me.

To each their own.

My recommendation is to try it, just for one month. Eat right, go to sleep early, and exercise, 7 days a week, for 4 weeks. If you don’t feel better, physically and emotionally, by the end, write or call or add a comment to my blog to tell me I am an idiot. I may even take you out to the junk food place of your choice (offer limited to people I actually know – also, you have to have actually done it for 28 consecutive days).

Ultimately, no matter what restrictions genes, luck, and age have put onto you, much of your health is in your own control.

Like saving money for retirement, healthy choices is an investment in your future happiness.

Do what makes you happy, but choose wisely.

Be healthy, my friend.