Ageing Focus - Make Balance a Habit!

Introduction

Last week’s post, though perhaps an amusing romp, wasn’t very responsible. I mean, why showcase my bad habits? Whose idea was that, anyway? I hope I didn’t come across as condoning any of those behaviors (though honestly, as odd as they are, you’d have to be some kind of kook to adopt them). This week I hope to provide a whole-grain, high-fiber, wholesome corrective. I’m offering up sincere and helpful advice here and I will try my best to make it amusing somehow.

Some background

My younger daughter is home for the summer and perhaps being around her vivacious youthfulness emphasizes how fricking old I’ve gotten. I guess I’ve reached the age where I worry more about my advancing decrepitude than reveling in whatever vigor I still have left. Sure, I can still make my bike go pretty fast when I dig deep, but I also dread the prospect of, say, my back going out for no good reason. (A buddy of mine, though he is still athletic and does all kinds of yoga, threw out his back putting on a sock.) I contemplate how to preserve my physical faculties over the last few decades of my life.

Strength and heart health are all well and good, but I lately I’m putting more focus on balance. Seventeen years ago I read a fascinating New Yorker article about the role balance plays in graceful ageing, and I’ve been thinking about it ever since. The article, by the doctor/professor/writer Atul Gawande, is called “The Way We Age Now.” (My friend P— and I have a running joke about Atul Gawande. P— is a doctor, and I fancy myself a writer, and we complain to each other how Gawande is a better doctor and writer than both of us, and is also better looking; we naturally assume he’s even seduced our wives at some point.) In the article Gawande describes how he tagged along with a Dr. Bludau, a geriatrician, during a routine physical exam of an 85-year-old woman:

It seemed to me that, with just a forty-minute visit, Bludau needed to triage by zeroing in on either the most potentially life-threatening problem (the possible metastasis) or the problem that bothered her the most (the back pain). But this was evidently not what he thought… The danger for her was losing what she had. The single most serious threat she faced was not the lung nodule or the back pain. It was falling. Each year, about three hundred and fifty thousand Americans fall and break a hip. Of those, forty per cent end up in a nursing home, and twenty per cent are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness. Elderly people without these risk factors have a twelve-per-cent chance of falling in a year. Those with all three risk factors have almost a hundred-per-cent chance.

What is to be done?

How do I address these three risk factors?

1. Being an athlete is a non-negotiable part of my lifestyle, because cycling is a) fun, b) something I have enough experience in that it’d be a shame not to do it, and c) my number-one way to burn off stress. Cycling addresses the strength part of my ageing, to a point. (I know that ideally I should do core exercises, join a gym, do yoga, etc. and I’m trying to muster the resolve to take those things up.)
2. In terms of prescription medications, I’m not sure how feasible it is for any of us to avoid needing them when we’re old. It’s not like we can just resolve to go without. I’m lucky enough to be blessed with low cholesterol, and my blood pressure is decent, and so far I have no risk factors for diabetes, but you just never know what I may need for this or that ailment in my codger years.
3. Balance: this is the area where I think I can make the biggest difference.

How can we improve our balance?

I’d like to think that being a cyclist automatically gives me great balance, and of course it can’t hurt, but I don’t think it’s actually enough. I learned this when I was doing physical therapy after breaking my femur. As we began my regimen, my physical therapist asked me what my goal was for the therapy. As I’ve explained in these pages, I’m not actually that into goals, but this time I had one. “I want to come out of this better than I was before,” I declared. After all, I had a gym to work in and an expert to guide me … why not dream of shoring up some of the classic deficiencies of the pure cyclist?

To start with I had to learn to walk all over again, and realized in the process just how complicated walking is. With every step, the back leg has to swing forward, the knee bent so your foot doesn’t hit the floor, and then you have to plant that foot and swing the other leg forward, and that swinging is more rhythmic when we realize. But because I didn’t trust my bad leg to bend properly, I was kind of swinging it around sideways so I could keep it straight, and thought I was doing pretty well until my physical therapist, laughing, told me to walk toward a mirror and watch myself. I looked like a drunken zombie.

After relearning how to walk, one of the toughest things I did in that gym was a toe-tapping exercise on a fairly unstable platform. It was basically a square plank of wood with a half-cylinder under it (i.e., a half-circle cross section), kind of like a teeter-totter that you stand on. I would start by standing on the plank, balancing so it wouldn’t tip forward or back. Then I’d tip the plank forward until its front edge tapped the floor, and then rock back until the plank was level again, the slower the better. I’d do this ten times, and then I’d switch to rocking back, to tap the back edge of the plank on the floor, return to level, and do that ten times. Once I mastered that with both feet, I learned how to do it standing on just one foot. Oddly, I was no better at this with my good leg than my recently healed one, but in time I went from incompetent to totally proficient, even after adding in a barbell in one hand to put me slightly off balance. I cannot tell you how stoked I was to have learned a new trick that I couldn’t have done before my accident. I actually was better than before.

So now, with Gawande’s article in mind, I want to continue that trajectory of actually improving my balance. The fun way is to ride indoors with my bike on rollers, when it’s too dark and/or wet to ride outdoors. The less fun, but logistically easier, way—and, more importantly, the way I can recommend to you, albertnet reader—is to do the PT balancing trick on a balance saucer. You can buy one of these (one manufacturer’s product name is “Wobble Balance Board”) for about $20. This is even harder that what I did in physical therapy.

The regimen

The great thing about the balance saucer is that you can do your whole routine in 5-10 minutes. (I suppose this duration will vary as you become more proficient, and based on how much you want to do.) My current regimen consists of the following exercises, in sets of 10 repetitions each:

• Standing on both feet, tap the front edge of the saucer on the floor
• Standing on both feet, tap the rear edge
• Standing on one foot, tap the front edge
• Standing on one foot, tap the rear edge
• Standing on both feet, tap the right edge
• Standing on both feet, tap the left edge

I hold a barbell in one hand, and after the first five reps I pass it to the other hand. If I feel like it, I pump the barbell in the air for extra exercise and instability. (I plan to figure out other cool things to do on this saucer, maybe even incorporating my upper body.)

Since a picture is worth a thousand words, and five movies totaling two minutes at 60 frames per second is therefore worth about 7.5 million words, here are videos showing the exercises:

(Video credit to my daughter, expertly wielding her superfly non-phone camera.)

Don’t be surprised if it takes a while to get good at this. When I started up again (over a decade after my physical therapy days), I was pretty wobbly and struggled for a while.

Make it a habit

Did you notice in that video that I wasn’t in a fancy studio with mirrors and mats, wearing PrAna yoga pants and fancy workout shoes and headphones and a fitness tracker? All you need for this is the saucer and a pair of shoes with good, grippy soles. With worn-out or loose-fitting shoes, I have a lot of trouble, and if I try to do this barefoot my feet slide off. But other than that, no special gear or preparation is required, not even a warm-up. That said, this activity is oddly strenuous given how low-impact (actually, zero-impact) it is. During winter, when I’m working from home and stuck at my desk with my blood congealing, almost like suspended animation, I like to take a break and do my balance regimen to get my blood flowing. It really warms me up.

Making this a habit is key. Initially you’ll need plenty of repetition to develop the balance needed for these exercises, and then you’ll want to maintain that consistency so that five, ten, and twenty years from now you won’t have lost the ability. It’s kind of interesting to ponder how well we could maintain this, if we do it daily … can you imagine having this kind of balance at 80? Assuming we don’t, at least we’d be declining from a pretty decent height of capability. I think that’s well worth pursuing.

Postscript

A few more notes, as I have used this thing for a couple years now:

Make sure your shoes are not only grippy enough not to slide, but are completely dry before doing your balance regimen. I started in on my routine once, months ago, when my shoes were a bit wet (though I thought I had wiped them enough on the mat). My saucer squirted out from under me and I fell, wanging my wrist. Not all saucers have the same anti-slip texture; my brother has one (from the same manufacturer as mine, but newer) that is much grippier. I will probably buy some of that sandpapery-textured tape you put on stairs and add it to my saucer. So be careful!

Not all these saucers have the same depth, so get one that is appropriate for your balance level (which may have a lot to do with your age). I recently tried my mom’s saucer and it’s far shallower than mine, which makes the exercises vastly easier (too easy in my case, but probably much better for, say, an octogenarian). Mine is four inches deep; I have seen three-inch versions and even 1.5-inch versions available online.

This article (also available in a schlockier form here if you get blocked by a paywall) suggests that a good measure of your body’s effective age is how long you can stand on one leg, especially your non-dominant one. The doctor who wrote the article cites Mayo Clinic research and concludes (as paraphrased by ChatGPT), “While balance tests offer a simple method to gauge physical aging, incorporating balance training into regular exercise routines is crucial for sustaining overall health and mobility.” Running the calculation cited in the article, I have determined that a typical person my age ought to be able to stand on his or her non-dominant leg for about 22 seconds. That seemed way low to me, so I tried it out. I stood on my left leg for a couple of minutes, no problem, and then I started to get bored so I passed the time by doing the Wordle, then added stickers to my Wordle snapshot before sending it to my daughter, and finally, after over eight minutes on one foot, I was really bored and my leg and foot were starting to hurt so I bagged it. Needless to say, this balance regimen really works!

Another postscript

More recently I came across an article suggesting that a good balance challenge is to tie your shoe while standing on one foot. This capability is said to bode well for preserving balance into old age. I didn’t find this much of a challenge, and decided that tying my shoe while standing on the balance saucer would be a better trick. It is, and now I’ve incorporated it into my saucer regimen. Check it out:

If you perceive that the above video ran a bit long—i.e., that it took me longer than necessary to tie my shoe—it’s because of the role vision plays in balancing. As it turns out, where we look has everything to do with balance. If you close your eyes while on the saucer it’s almost impossible to do the taps, etc. described in this post. And I’ve found that looking at my shoe while balancing on the saucer totally messes me up. Something about locating ourselves in space is instrumental to balance. Only if I look out into the room can I tie my shoe while on the saucer.

Give it a shot and let me know how it goes!

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I Drank a Gallon of Water a Day for a Week - Here’s What Happened

Introduction

What follows is a work of fiction. All characters, situations, observations, and insinuations are fictitious, coincidental, or accidental. The characters were pulled out of thin air and have nothing in common with any human being who ever lived, nor any zombie or otherwise undead individual. Nothing that happens in this story ever happened to a real person, or ever will. In fact, this story is practically science fiction, except that it’s totally unscientific and doesn’t have spaceships or aliens or anything. That said, any similarity of any character to an actual space alien, past present or future, is (obviously) purely coincidental or conjectural.

I drank a gallon of water every day for a week – here’s what happened

I was casting about for a New Year’s Resolution but nothing was coming to mind. Last year I resolved to dance like nobody’s watching, and I even bought a new Bluetooth speaker, but I found the dancing made me sad, because I live alone and there was nobody to watch me. A one-man dance party doesn’t feel much like self improvement.

So this year I decided to try drinking a gallon of water a day. Supposedly hydration is really important, and after all, what have I got to lose? Because I’m in an apartment building, my water bill is the same no matter what I do.

I thought about buying one of those graduated gallon water bottles with motivational phrases on them—you know, starting at the top with “GOOD MORNING” then “HYDRATE YOURSELF” then “REMEMBER YOUR GOAL,” etc., down to “ALMOST FINISHED” and then finally “YOU DID IT” at the bottom—but then I’m like dang, that’s $25 I’d rather not spend. Plus, I know myself, and I respond better to the whip than the carrot, if you catch my drift. So I washed out an empty gallon milk jug and wrote on it with a sharpie:

7AM GET COFFEE
9AM NO EXCUSES
11AM THIS IS NOTHING
1PM DON’T BE A LOSER
3PM NO PITY PARTY
5PM OOH, BIG MAN
7PM EVERYONE GETS A RIBBON
9PM BIG WHOOP

I set everything out the night before, feeling pretty excited. I hadn’t felt such keen anticipation since I started charging my new Bluetooth speaker at about this time last year.

Day One

At 9am I filled my big jug and then poured about a pint of it into my teakettle. This is the hardest part since there’s some sloshing and trial-and-error involved but I think it’s the genius of my method. See, others who do this drink only out of their $25 graduated jug and drag it around with them, like wearing a badge of honor so everyone will ask about it and they can start taking credit for their awesome resolution in advance. That’s not for me, I don’t need to brag. Plus, I don’t need the ruggedness of the Motivational Bottle … I don’t worry about leaks since I’m mostly at home. When I go out I’ll fill some smaller, more reliable vessel from the main one and then return for refills.

Some say it’s bad to hydrate with coffee but if I gave that up, I’d be doing two New Year’s Resolutions and I don’t want to boil the ocean here. I’m trying to tackle something I can actually achieve, so as to be more compassionate with myself (my Resolution from two years ago that I’m still struggling to keep).

Well, things were going fine until about 11am, when I’d peed so many times I felt like I was wearing out the carpet between my armchair and the toilet. I was peeing so much it seemed like the bowl would be completely full by nightfall. I’m of the “if it’s yellow keep it mellow, if it’s brown wash it down” school, in terms of flushing, except “keep it mellow” never made sense—I mean, what’s non-mellow about flushing? So I think of it as “if it’s brown, flush it down, if it’s jaune leave it alone.” (I am considering putting that on a placard above the toilet, with a little translation of “jaune” from the French.)

Just to divert my mind from the constant awareness of my pestering bladder, I went to the park and sat at my favorite bench for a while, watching life go by, and then this man came up to me, sat down, and said, “Hey, are you one of the dads?” I was like, “No,” and he said, “So you just like sitting and watching kids on a playground?” and I just stared at him, like, isn’t that obvious? He went on to say, “Look, a couple of other parents and I have talked about this and we all agree, we’re gonna have to ask you to leave.” So I shot back, “I was leaving anyway, I have to pee!” I have to admit, it was nice to have a really good comeback for once.

In terms of the more tangible benefits of all this drinking, I have to say that by 9pm, I’d never felt so good. My skin seemed better, I felt stronger in my body, my posture was more erect … even my hair felt better. Totally worth all the peeing.

Day Two

My bladder woke me up from a dream in which I was touring this old Victorian mansion that they’d turned into a museum, and I had to pee (yes, even in my dream) and found this tiny little half-bathroom, but instead of a toilet it just had a little portal to pee into. Halfway through my business the whole room started to move, slowly lowering toward the ground floor, and I realized it wasn’t a bathroom, it was an elevator! Yikes! I was like, “When I reach the next floor, the door’s gonna open and I’d better be finished!” Then I woke up.

The drinking itself was still pretty easy today and I nailed the pour into my teakettle, first try. If anything the constant peeing was even worse, though, and beyond that, by lunchtime I started getting pretty bored of drinking plain water. I’d been warned by drink-a-gallon-a-day websites not to have any sugar, though, because it’d throw off my electrolytes. Then I realized hey, if I make Top Ramen soup and drink the broth, that’s two cups of water right there! So I did that.

Big mistake! OMG, all the salt in that ramen totally bloated me! I should have known! Salt is an electrolyte! I stood in the mirror looking in horror at my bloated (and unfortunately hairy) belly (though not hairy due to drinking water, I hasten to add). I looked kind of like ET. Out of habit, I also scrutinized my face in the mirror, and as I looked closer I realized hey, my eyebrows are looking good! I flicked them with my finger a few times and realized, wow, drinking all this water has totally cured my eyebrow dandruff! Bonus!

All the afternoon water drinking eventually brought down the bloat, and after my final 9pm pint—nailed it!—I was ready for some yoga. I put in my video and (literally) went through the motions. I still can’t even come close to the Yogi Squat, but it’s only the second day of my new hydration regimen.

Day Three

I have hit my stride. The more I drink water now, the more I love it. In fact I doubled up on my 9am pint, drinking a whole quart, and it felt so good. I paid a price, though: I immediately had to pee, and then afterward, the sensation of water on my hands as I washed them made me have to pee again immediately, and for a second it looked like a vicious cycle I’d never break out of.

I went for a little hike and had to pee so bad halfway through. Alas, the outhouse at the trailhead was still at least thirty minutes away, which was like two pees worth, and there were so many hikers! I couldn’t find any privacy! I bushwhacked off-trail for a bit, and then my sneakers lost traction and I slid down into this ravine, and at the bottom I discovered—to my shock and horror—a dead body! It looked like some young adult hiker, halfway claimed by the earth. I scrambled up that slope so fast I couldn’t believe it. Surely my excellent hydration gave me wings. Problem was, just before reaching the trail again I slid on some leaves and tumbled all the way back down there. Then I looked more closely at the body and realized it was just an old shirt tangled around a fallen tree limb. Silly me.

Day Four

Another peeing dream woke me up and for a terrifying moment I thought I’d wet the bed. But I hadn’t … just a little leakage which is totally normal when you drink a gallon of water a day.

In addition to the better skin, relief from back pain, and higher energy, all of which I’d secretly hoped this hydration would give me, I got a big surprise: I got a job! My first in years! It’s selling tickets at the Events Center. The ticket window opens hours before the game and things start off really slow, so peeing wasn’t a problem at first—I’d just put the “BACK IN 5 MINUTES” sign out and go do my business. But once the rush started, no dice. I could not leave my post. It got worse and worse to where people were asking, “Are you okay!?” I guess my face was getting contorted. But then I realized I could just pee in this wastebasket without even getting out of my seat! Don’t worry, the wastebasket has a liner. All the wadded-up paper napkins in there dampen the sound down to almost nothing. I did have to sit pretty far forward in my chair to, well, eclipse everything, but nobody was the wiser.

Now, if you think I’m trying to connect the dots between drinking water and getting a job, I totally am. Those may seem unrelated but if I hadn’t been so hydrated, I wouldn’t have had the confidence to accept the offer.

The health benefits continue. I did an experiment: I looked in the mirror, located a zit, studied my face carefully to remember exactly where it was, drank a pint of water, and then looked again. Sure enough, the zit was gone! Water is like a miracle elixir!

Day Five

Other gallon-a-day blogs had warned me that I’d get bored of drinking water. Well, so far they’re wrong, but you know what is boring? All this peeing! It’s getting so old! Also, even though practice normally improves one’s prowess at practically anything, I seem to be getting worse at not spattering the rim. Either that, or I’m just more observant. I have to mop up the rim pretty much every time now. And my hands are starting to get a bit raw from all that washing, like with OCD people. The rest of my skin is positively glowing from all the water, but for some reason not my hands. I was reading on this one blog about smearing lotion on my hands and then putting on disposable rubber gloves, right before bed, so I’m considering that.

I showed up to work today but nobody was there. I searched everywhere and finally found my supervisor, and it turns out I misunderstood about the job: it’s not a daily thing, but only as needed, when they have a big game and somebody calls in sick. Oh well. I have a small passive income and it’s better to focus on my blogging anyway.

I fell asleep today and had one of those marathon naps where it’s hard to move afterward, so I missed one of my drinking sessions. I chugged a quart after that and was back on track.

Day Six

Not so much to report, actually. Drinking water, even a gallon a day, turns out to not actually be that complicated. One highlight: the hydration is helping my vision. If I really squint, I can read the kitchen clock from the kitchen nook table without my glasses.

Day Seven

This has gone so well, I woke up this morning thinking about continuing my gallon-a-day habit for the whole month, or more. This would give me a good blog topic while continuing to improve my health in umpteen different ways! But I’ve also been thinking a lot about the new Avatar movie, which is over three hours long. I really want to see it in the theater, and I’m sure the crowds have thinned out by now, but there’s no way I could make it through without getting up to pee at least six times. Who knows how many plot points I’d miss. And I’ve been looking forward to this movie for a long, long time.

And that got me thinking that, just like with last year’s dancing, achieving this Resolution is making me a little sad. Why, you may ask? Well, at some point I’ll have reaped all the health benefits, and then I’ll have nothing left to look forward to. So I think after I polish off my last pint tonight, I’ll call it quits, and keep the optimal hydration project in my back pocket for later. It’ll be like my ace-in-the-hole, my Plan B, the card up my sleeve. Next time I’m feeling really low, I’ll just start back up the gallon-a-day, and things will start to get real, real good again!

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Further reading

• New Year’s Resolutions
• One-Size-Fits-All New Year’s Resolution
• New Year’s Resolutions - Dental Hygiene Edition
• New Year’s Resolutions - Let’s Get It Right This Time
• A Wide Net Approach to New Year’s Resolutions
• The DUMB Approach to New Year’s Resolutions

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Email me here. For a complete index of albertnet posts, click here.

Ask a Morning Person

Dear Morning Person,

This early rising habit … is it so you can watch the sun rise? 

Justin D, San Francisco, CA

Dear Justin,

That’s a nice idea, but honestly, I can’t say that I do. It would be pretty hard to swing that, as the timing is a moving target and I need to keep my routine, well … routine. But once in a while I do luck out, such as this morning. (I wish I’d reached Inspiration Point just a couple minutes sooner, actually…)

Dear Morning Person,

My wife says I could become a morning person if I just “applied myself.” I say morning people are born, not made. What’s your take?

Brandon D, Portsmouth, NH

Dear Brandon,

Did you know that the average morning person’s hematocrit is more than 10% higher, her lactate threshold more than 5% higher, her IQ at least a dozen points higher, and her eyelids 15% thinner than those of a non-morning-person? No, of course that’s not true. Look, there’s no special talent for getting up early. Your wife is right … it’s possible some people take to rising early more easily than others, but anybody can do it.

Dear Morning Person,

Are you a caffeine addict or are you lying?

Alexa A, Isla Vista, CA

Dear Alexa,

That’s kind of a loaded question. First off, “addiction,” as the term is most commonly used, implies that the psychological or physical dependency is on something that produces adverse consequences. Being aware and alert, of course, is a good thing. Meanwhile, if I go without coffee I do miss it, in the sense of not having something I enjoy, but I don’t get a headache or anything. Where caffeine gets a bad rap, I think, is when people use it in place of sleep, in which case they build up a tolerance to it and need increasingly high doses, like you see with classic drug addiction. Myself, I have a big mug of coffee first thing in the morning and another in the early afternoon and that’s about it.

(Of course, I could be lying … whether to you, to myself, or both. And it must be said, coffee is, so often, the lynchpin of a morning person’s routine.)

Dear Morning Person,

Are all morning people as insufferably self-satisfied and annoying as you are?

Peter S, Golden, CO

Dear Peter,

No, I’m particularly bad. That being said, we morning persons probably just seem annoying to thin-skinned late-risers with chips on their shoulders. Like yourself, apparently.

Dear Morning Person,

I am fascinated by the very idea that anybody willingly gets up early on a regular basis. Is this like some pissing contest among you freaks? Do you, like, get together at Morning Person conventions and brag, share tips, etc.? And what’s the most extreme case of morning-person-ism you’ve encountered?

Tasha M, Port Townsend, WA

Dear Tasha,

If there’s a National Association of Morning Persons, I’m not aware of it. Look, we’re not like superheroes or anything and there’s no accreditation involved. Some people get up early on a regular basis, that’s all. As for as the most extreme case, my family did a house-swap with some Glaswegians some years back, and the window blind in the master bedroom was obviously brand new and installed for our benefit. The first time I tried to use it I pulled the whole thing down, because the anchor screws were only like half an inch long. I didn’t get around to buying proper molly bolts and reinstalling the blind until the end of our stay, meaning we were awake with the sun every morning for two weeks. That was brutal: Glasgow is so far north, civil twilight started at like 4:00 a.m. The fact that this family didn’t see the need for blinds or curtains demonstrates their commitment to early rising. (For the record, yes—both the husband and wife are total world-beaters.)

Dear Morning Person,

In a previous column, addressing the ubiquitous soul-crushing torpor suffered by many morning persons, especially us middle-aged ones, you called out caffeine as the single greatest coping mechanism available. That’s all well and good for you, but I can’t have coffee—my wife won’t let me. She says it’s “bad for you.” Any advice for me?

Clark H, Asheville, NC

Dear Clark,

It really sounds to me like your wife could be an honest-to-God sociopath. No scientific study has ever proven that coffee is a risk factor for any disease. In fact, efforts to link coffee with health problems invariably end up showing that it actually decreases the risk. As documented in this article by the Harvard School of Public Health, coffee consumption has been shown to lower the risk of cancer, type 2 diabetes, heart disease, depression, Parkinson’s disease, gallstones, and early death. (The only established health “risks” associated with coffee are insomnia and jitteriness, which are easy to avoid if you’re not an idiot.) Assuming you’ve already tried to reason with your wife and gotten nowhere, you should seriously consider leaving her. She sounds crazier than a pet raccoon and possibly evil.

Dear Morning Person,

I made a new year’s resolution to exercise in the mornings before work two to three days a week, and so far I am just not sticking to it. I’m sure you get this question a lot, but do you have any advice for people like me?

Whitney P, Casper, WY

Hi Whitney,

First off, I’m really impressed that you’re still working on your resolution this far into the year. Now, as far as tips and tricks, I’ll give you my three favorites.

1. Don’t try to wake up early only on those days you want to work out, and then sleep in on the other days, as you’ll be stuck between two habits and nothing will feel normal. If this workout routine is really important to you, try waking up early every morning, or at least most mornings. On the non-exercise days you could read a book, do some housekeeping, snuggle with your cat or dog, or start accepting more 8:00 a.m. EST (i.e., 6 a.m. your time) meeting invitations.
2. Set out all  your workout gear the night before, in a prominent place, so that if you wimp out and go back to sleep after your alarm, you’ll feel like a jackass later when you have to put away your stuff unused.
3. Ideally, find likeminded athletic morning persons to work out with. Standing them up would be embarrassing, and if they’re good friends they’d shame you mercilessly. I have three friends who regularly force me out of bed early on the weekends for “dawn patrol” bike rides, and this keeps me in the early bird habit for my solo weekday rides.

Dear Morning Person,

My husband really likes to unwind by curling up on the couch with me to watch a movie before bed. I enjoy this too, but by the time we’re done with dinner and the dishes, it’s usually at least 9pm and—being a morning person—I want to start getting ready for bed. I don’t want to be antisocial but I need my sleep. Any pointers here?

Angel L, Waco, TX

Dear Angel,

Ah, that’s a tricky divide … you sure don’t want your useful habit to mess up your marriage. I deal with this a bit myself. I have two suggestions. First, instead of a full-length feature film, you might try a comedy show (there seem to be an infinite number of them) that runs under half an hour. (When your husband begs you to watch a second one, relent.) Or, you could kill two birds with one stone and sleep while “watching” the movie. Good cinematic choices for this second option include Andrei Rublev, Last Year at Marienbad, Melancholia, 2001 – A Space Odyssey, and Remains of the Day.

Dear Morning Person,

Is it possible for a teenager to be a morning person? My kids are never out of bed before 9 or 10 during the summer and they’d probably sleep until noon if I let them. My friends say their teenagers are just the same and this is perfectly normal. In fact, a few years ago our school district pushed out the start of the school day by an hour based on recent studies about fundamental differences in teenagers’ circadian rhythms. So it seems impossible for them to do what you do, i.e. rise before dawn.

Charles D, Ross, CA

Dear Charles,

That’s all nonsense, and another sign that our youngsters are being needlessly coddled by well-meaning but maladroit parents. Haven’t you ever read Farmer Boy? Myself, I had a paper route as a kid and got up at quarter to six every morning to earn less than two dollars. Not only was it doable, but it was a hell of a lot easier then than it is for me now. These modern kids have really had their way with our modern parenting cohort, convincing us that permissiveness is good parenting. Don’t get me wrong, my own daughters sleep in late too, but I don’t kid myself that this is Mother Nature’s intent.

Dear Morning Person,

Be honest … don’t you look down your nose a bit at us non-morning-people, who waste the best part of the day sleeping?

Elisa B, Berkeley, CA

Dear Elisa,

If I were to look down on people with different habits, I’d have to first establish that they’re accomplishing less than I am, which is a pretty absurd assertion. So if non-morning-people are able to get everything done and still get to sleep in, I actually envy them!

It’s also a bit tricky to call these early morning hours “the best part of the day.” When I do my bike rides just before dawn, it’s cool and foggy whereas I’d much rather ride in the warm sun. That said, some aspects of my routine have kind of grown on me. For one thing, before I head out I’ll often get a few minutes of quality time with my cat, who is normally too twitchy to spend much time in my lap. Also, the regulars I see along my cycling route are amusing. There’s this one baby-faced guy in a neon green safety vest I always encounter along Wildcat Canyon Road, walking along the other side of the road toward me, and although I’ve greeted him with a slight chin nod and a quiet “Mornin’” many hundreds of times, he refuses to acknowledge my existence … he just continues on his way, wearing a contented Mona Lisa smile. There’s also the incredibly old woman, all bent over with a cane, I see walking, also on Wildcat, practically every time I ride. She’s gotta be in her nineties, making her way along the edge of the road. And then there are the middle-aged twins on their road bikes, grinding along slowly, never together, usually one a couple minutes behind the other, both looking grim and resolute, and never returning my greeting. I’ve seen these two along my route for more than twenty years and they’ve never been together. The closest I’ve seen was just last week, when they were neck and neck but one was riding all the way over on the wrong side of the road, as if refusing to be anywhere near her sister.

I find these people charmingly bizarre and bizarrely charming. But I can’t look down at my nose at you for missing this because it’s pure blind luck that I have these people in my lives … I could not have engineered this situation, and for all I know the late morning or early afternoon randos are even more uplifting.

Dear Morning Person,

Will you always be a morning person?

Morgan B, New York, NY

Dear Morgan,

No. As soon as I reach retirement, I’m gonna start sleeping in!

A Morning Person is a syndicated journalist whose advice column, “Ask a Morning Person,” appears in over 0 blogs worldwide.

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Should You Eat Less Salt?

Vlog

I would love to have an albertnet podcast, but the fact is, I don’t know how. I would have to learn some new platform, and figure out how to make it available to the 4.3 billion users of the Internet, and I simply don’t have the time. Knowing that many people would rather passively listen to podcasts than scroll through large bodies of text, I’m providing the next best thing: a vlog version of the following post. If you aren't enthralled by the sight of me pretending not to read, just close your eyes. Or open another tab and look at pictures of Gal Gadot while you listen. Or bite the bullet and scroll down for the text. Your call.

Introduction

I am not a doctor or nutritionist, nor a scientist of any kind. I’m not in the business of making specific health recommendations to anybody. That said, I think blanket advice from nutrition experts to the population at large can be imprecise. This post examines the question of whether you, dear reader, need to worry about your salt intake. I don’t know who you are, of course, but I aim to slice and dice the question of “who” more finely than other sources you might encounter. I also review here the results of a simple survey I sent out to my cycling friends. You won’t (and shouldn’t) come away with a new approach to your diet, but perhaps with a few good questions and some (low-fat, all-natural, free-range) food for thought.

Why do I care?

Humans need salt. And so does food. As a dumb kid I thought salt just made food salty, but that’s wrong. Salt makes food yummy. As I learned to cook I was astonished at how you can have a dish 99% done and it won’t taste right until you salt it, and then suddenly it can go from edible to delicious. The end result doesn’t necessarily taste salty; it just tastes right.

Now, if salt were utterly, incontrovertibly bad for you, I might consider it a necessary evil. I’m not willing to go without it, despite being sufficiently health conscious that I’ve essentially given up bacon and other cured meats. But the amount of added salt needed for a complete gastronomic apotheosis doesn’t need to be large. Have you ever tried to eat unsalted peanut butter? It’s revolting. I’d rather eat my scabs. Hell, I’d almost rather eat your scabs. If salted peanut butter had twice the FDA’s recommended daily allowance of sodium in it, and cost twice as much as unsalted, I’d still choose it.

But you know how much sodium regular peanut butter actually has? A mere 140 mg, just 6% of the recommended daily value. (Note that trying to go lower than this wouldn’t necessarily be beneficial: humans actually need about 500 mg of sodium a day to conduct vital functions, as described here.)

So why does unsalted peanut butter exist, other than as a specialty product for sufferers of hypertension? I’ll tell you my hunch: many people who buy it are reacting to the vague sense that less sodium is always better for you. And peanut butter is just one example of this phenomenon. It breaks my heart that well-meaning people are eating inferior meals based on rule of thumb that may or may not apply to them.

[Above: this PBJ was such a work of art, my daughter asked for a bite and then made off with half of it. This never would have happened in my household growing up. More on this later.]

Does sodium actually increase blood pressure?

I won’t bother to provide a wide survey of the science on this, but here are the high points of an article from the Harvard Medical School, based on an interview with Dr. Nancy Cook, a professor of medicine there:

• On average, Americans eat too much salt
• Whether or not sodium is bad for everybody, vs. only those with certain risk factors, has been a matter of some debate
• There is a fairly undisputed effect of sodium on blood pressure, and it’s stronger in people with hypertension
• People respond differently to salt, one to the next

Regarding the mechanism of sodium’s effect on blood pressure, Cook explains, “When you eat too much salt, your body holds on to water in an effort to dilute it. This extra water increases your blood volume, which means your heart works harder because it’s pushing more liquid through your blood vessels. More strenuous pumping by the heart puts more force on the blood vessels. Over time, this increased force can raise blood pressure and damage blood vessels, making them stiffer, which increases the risk of stroke, heart attack, and heart failure.”

Now, I don’t know about you, but when I read that, I didn’t immediately have an “Oh, shit!” reaction. Perhaps my salt intake does cause water retention, but not for long because every time I exercise, which is generally around four times a week, I sweat a lot, and in fact after a particularly hard ride I’ll get these head rushes every time I stand up—a classic symptom of low blood pressure—until I rehydrate. Not that I expect Dr. Cook to base her guidelines on my particular case. Given that a fairly recent CDC study concluded that only 22.9% of Americans get enough exercise, it’s not hard to see why Dr. Cook would advocate for reducing sodium intake when addressing the general public.

Meanwhile, the CDC reckons that “Americans consume an average of more than 3,400 mg of sodium each day,” which is far more than the 2,300 that the U.S. Department of Health recommends. Clearly, overconsumption of sodium is a public health problem in this country.

But does this mean you and I and everyone should all cut down? I think that would be a problematic conclusion. If Americans by and large use too much petroleum and create too much pollution by driving giant SUVs, then yeah, I can try to mitigate the damage by driving a Prius. But if someone eats too much salt and doesn’t exercise enough, I can’t help him by lowering my salt intake. In other words, I may or may not be implicated in this public health crisis. (Again, I can’t fault the article; the safe bet when advising a wide audience is to advocate caution and restraint.)

As is so often the case, there’s a bit of a conundrum here: the people who are concerned about their health and go looking for dietary advice are often not the ones recklessly eating a lot of processed food, fast food, and salty snacks, and thereby creating frightening statistics around widespread hypertension. A good many conscientious folks may heed these general warnings about salt and reduce their consumption, thus depriving themselves of its goodness for no legitimate reason.

My own experience

In brief, I’ve been seeing borderline high systolic blood pressure readings since high school, while my diastolic numbers are always nice and low. Meanwhile, my blood fats (cholesterol etc.) are remarkably good, my body mass index is spang in the middle of normal, and my resting heart rate is in the low 40s. I’ve never had a doctor recommend a change in diet, and over time my systolic reading has come down a bit. I chalk this up to being less of a hothead than I used to be. In general I suspect the benefits of life balance, of stress release achieved through exercise or yoga, and of emotional hygiene such as self-compassion are underrated. Modern life has people working too much, exercising too little, over-consuming news and social media, and then trying to undo all the damage by eating less salt. Nice try.

My survey

I surveyed a bunch of my cycling pals, because they’ve always been an insightful and amusing bunch. Being cyclists, most of them seem to eat basically whatever they want, and they’re all pretty much fit as a fiddle. That said, they take their health seriously, which statement I base on a couple of decades of riding and eating together, and also on their reactions to a couple of articles that have come out about too much exercise possibly damaging your heart. I was curious about my cycling team’s approach to salt so I emailed them this simple question: Do you make any effort to limit your salt intake for health reasons?

Of the 23 responses I got back, 17 were some version of no (i.e., they eat all the salt they want) and 6 were yes (they limit their salt). Of course I got some interesting comments, too:

• No, but I’m also pretty naturally salt-averse. One of my most frequent complaints about restaurant food is that it’s too salty, and one of my family’s most common complaints about my cooking is that there’s not enough salt in it.
• No. But then again, I don’t really make any effort to limit my intake of anything. I’m a gluttonous hedonist. What could possibly go wrong with that philosophy???
• I double down on salt - I’ve got low blood pressure and find getting light headed when I stand up a bit irritating.
• How can a person cook without salt? It’s my understanding (possibly inaccurate) that salt is only a problem if you have high blood pressure, so not really an issue for healthy people with normal blood pressure.
• Switched to dry brining with kosher salt. Definitely healthier and tastes better but I cannot speak to any metaphysical benefit.
• I’m casually aware of salt intake but never limit myself vs. what tastes appropriate. I don’t buy potato chips very often but when I do I want ‘em salty.
• No. But I know when I’ve had too much and I don’t necessarily enjoy that feeling.
• No. Well, maybe. I salt liberally from the shaker/cellar, but I do try to be aware of how much sodium certain prepared foods contain, and err on the side of less is better there…
• Well, occasionally I think about limiting my salt intake but it doesn’t really happen.
• Yes and yes - Simply put, Salt= Hypertension, Sugar= diabetes. Controlling these substances through diet can extended the life of several organs. It’s no secret that food companies fill processed food with these as a preservative and as a sales angle. We don’t even realize how much is added … I haven’t added salt to anything in years.
• Several years ago, I went to the doctor and my blood pressure was slightly higher than it used to be, almost 140/70. (Getting older sucks...) Since then I’ve generally cut back on the Mexican and Korean foods, and now it’s back to 120/60. However, if I ride 4+ hours in the heat, then I’ll always reward myself with some Mexican food.

My favorite comments were from the two MDs in my survey:

• I maximize salt intake!
• Salt is not a major contributor to hypertension. The processed food that contains a lot of salt probably is. (I spent a 1/3rd of a course in college studying sodium.) However, from a public health perspective, telling the public to limit salt probably has beneficial effects.

Now, there are (at least) two conclusions I could draw from these results. One, I could assume that by not worrying about salt whatsoever, we are consuming huge amounts of sodium and yet somehow getting away with it. On the other hand, we could be well within the recommended range of sodium consumption quite by accident. Granted, we cyclists love us some big, rich meals, but we tend to cook them ourselves. I’ve never known any of these pals to eat fast food, and as health-conscious types we avoid processed food like frozen entrees, “lunch meat,” and snack foods, because of all the other crap in them (trans fats, nitrates, refined flour, artificial flavors, etc.) and because we’re frankly too epicurean. (I get frozen pizza for my kids a couple times a year as a guilty pleasure, and indeed, only the scarcity of it makes it a treat.)

Honestly, the Recommended Daily Value of sodium, 2,300 mg, seems pretty generous. I tallied up the amount of sodium I get from my typical lunch, and found no cause for alarm. Lunch is often my biggest meal of the day, and it’s invariably a big burrito (basically homemade but with canned refried or whole beans and store-bought tortillas). Look, here’s one now.

I just read some labels and have calculated that one of my big-ass burritos contains about 1,400 mg of sodium. Of the US Recommended DV of not more than 2,300 mg, that leaves just 900 mg free for dinner (since I don’t eat breakfast). This is probably okay because my wife does most of the cooking and seldom resorts to things like canned beans. Besides, even if I’m a bit over the guideline, I’m a big guy and my daily caloric intake is very high—some would say legendary. But I guarantee I’m far from the 3,400 mg of sodium that the average American takes in, without even trying … that is, without compromising the tastiness of my food.

According to the CDC, “Most of the sodium Americans eat comes from packaged, processed, store-bought, and restaurant foods. Only a small amount comes from salt added during cooking or at the table.” A Harvard medical school article concurs: “At least 75% of the sodium in the average American diet comes from processed foods, such as cold cuts and cured meats, pizza, burgers, and sandwiches.”

This makes perfect sense, of course. Food is big business, and if sacrificing the health of consumers is what it takes to ensure shareholder value, so be it. Take the case of Campbell’s soup: they were famously required by the FDA to desist using their old slogan “Soup is good food” because their soup had too much sodium to be called “good.” More recently, Campbell’s experimented with lowering sodium, but then reversed course when sales dropped. As described here, their new CEO announced at an investors’ meeting, “For me it’s about stabilizing [sales] first.” Campbell’s contends that “the proposed nutritional principles ‘describe products that manufacturers will not produce because children and teens will not eat them.’”

Obviously we can’t stake our health on the companies that pander to philistine tastes. But that doesn’t mean when we cook at home we should gild the lily and err on the side of blandness. If anything, that will just tempt us to eat out more. And with restaurants, of course, all bets are off.

Conclusion

Again, I’m not a doctor or a nutritionist, but I think I can you give this bit of advice: before you automatically seek to lower your sodium intake based on the general messaging we get from the FDA, CDC, etc., find out what your own blood pressure is and ask your doctor if you’re at any risk. And if you do have a need to keep an eye on your sodium intake, do so with precision, by reading labels and knowing what goes into your food. It could well be, for example, that a person with mild hypertension could still afford the amount of sodium in regular peanut butter, and doesn’t need to be shaking Mr. Dash on his or her dinner.

Appendix A – salt in peanut butter

I grew up eating a lot of PBJs. My mom was a great cook, but these sandwiches were atrocious. The bread was fine, and the jam (generally homemade) was great, but the peanut butter was awful. It was a brand called Deaf Smith, and as detailed here, it was the first organic peanut butter on the market. It came in a giant plastic bucket—it had to be at least a few gallons—and it looked like a cross between diarrhea and that old-fashioned Dijon mustard with all the seeds in it. It was a roiling, gritty, grainy, wet mess and we called it quicksand because if you lost your grip on the knife (which happened a lot because it’d get oily), the knife would quickly sink and you wouldn’t see it again until you eventually got to the bottom of the tub and there’d be like five knives there.

But you have to understand, my brothers and I were not picky eaters, and all this would have been completely forgivable if Deaf Smith didn’t taste so damn bad. It was just awful. We suffered through those PBJs because we had to—we were growing boys, after all—but it was just so gross. As soon as I moved away from home I switched to Skippy and discovered that peanut butter could be delicious.

A few decades later, though I’d moved on to natural, non-hydrogenated peanut butter, usually Adams or the Trader Joe’s brand, I was still totally digging it. And then one day my wife bought unsalted by mistake. The horror! It tasted exactly like Deaf Smith! Completely disgusting—I was right back in my miserable elementary school lunchroom! This was an epiphany. I realized that there had never actually been anything really wrong with Deaf Smith except the lack of salt. This omission was totally unnecessary and surely not why my mom chose that brand. She has always maintained that salt won’t hurt you if you don’t already have high blood pressure—it can only exacerbate it. She probably chose Deaf Smith simply because it was organic and available in bulk. So why did Deaf Smith eschew salt? Probably because they were a bunch of hippies and salt seemed evil to them somehow.

Postscript to this sad tale: a year or so later I mixed up a fresh batch of Trader Joe’s peanut butter (yes, this mixing is a pain in the ass and I do miss the hydrogenation of Skippy at times), and then made a PBJ. Yuck! Foiled again! Staring, enraged, at the label, wondering why my wife would poison the family again by buying more unsalted peanut butter, I realized this jar wasn’t actually labeled as unsalted. It was their organic variety, which had just 40 mg of sodium per serving, vs. 140 mg in the normal version. I guess they decided those who like organic food automatically want less sodium. I wrote an angry email to Trader Joes, which I’ve just found and reread. It ends, “When this jar is empty I will probably remove the label and burn it in effigy.” (In fairness, Trader Joe’s did apologize and gave me a refund.)

Appendix B – fact-checking the Deaf Smith tale

I fact-checked the bit about Deaf Smith peanut butter with my mom, to confirm that lowering our sodium intake wasn’t her goal in choosing it. This she corroborated, but she denied that we ate it that much. “I got it from the co-op, and hadn’t tried it before,” she said. “I think I only bought it once, and had no idea it wouldn’t be salted. It probably just seemed like we got it a lot, because it took so long to get through that giant drum.”

I thought this might have been wishful thinking … after all, no mother wants to admit she tortured her offspring for a protracted period. So I asked my brother Bryan. He responded, “It was just for a time as I recall, we didn’t really like it because it was so natural, and it separated so badly that the last few gallons of it were like concrete.”

My brother Max had a host of other memories around the Deaf Smith. “As I recall, the Deaf Smith was from ‘the co-op,’” he told me (via text). “That’s where those ginormous cylindrical loafs of Colby and Colby-Jack cheeses came from as well. I think there was more than just one five-gallon tub of Deaf Smith that came through [our household]. The Deaf Smith was really good in rice crispy squares. I remember that! When we complained about the Deaf Smith mom would laugh … for some reason she just didn’t believe that we really hated it.

“Remember the story of how Deaf Smith became deaf? He was a San Francisco kid and he had to take the trolley to school. One day he was a little running behind, as they say, and the trolley was already taking off. He ran up to the trolley and a man, who was just trying to be helpful, used the young Smith’s ears as handles to haul him up onto the trolley and he was deafened.”

At this point I replied, “I do not remember that story. Is that from the archives or did you just make that up?” Max’s answer: “True story as I remember it. I recall feeling that we had to eat this peanut butter because mom felt sorry for Deaf Smith. It may have been that the man ‘boxed’ his ears to punish him for his tardiness. I remember asking Mom what that meant, boxing the ears. I guess it was common back then for men to box the ears of wayward youths. As she described it, boxing the ears involves essentially punching a kid in both ears at the same time with the fists turned inward so the contact with the ears is made with the fleshy part of the hand between the wrist and bottom knuckle of the pinky finger.

“I recall that she may have been unsure whether the man dragged him up by his ears or dragged him up and then boxed his ears, but either way it resulted in two sure things: Smith became deaf and there was nothing more for him but to make peanut butter.

“Everyone who buys this product feels a bit guilty and a bit absolved simultaneously. I always tried to like the Deaf Smith out of guilt for the human condition. I’d think about the trauma that that kid endured, having his life ruined by some a-hole on the trolley, and how he had to crush peanuts for the rest of his miserable existence.

“It had to have been a miserable existence. If he had made any sort of meaningful recovery, he might have put some sugar or at least some salt in the peanut butter. It was almost as though he accepted being boxed in the ears. As though he deserved it for being late. That peanut butter was practically a punishment. Austerity in a five gallon tub.”

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Can Too Much Exercise Damage Your Heart?

Introduction

I get a lot of bike-related articles in my e-mail, mostly via my bike club.  When I get an article from two separate feeds, I know it’s something big.  So it was with a recent front-page story in Velo magazine, “Cycling to Extremes.”  (I read the online version, available here.)  The subtitle:  “Are endurance athletes hurting their hearts by repeatedly pushing beyond what is normal?”

What is normal?  Alas, for American adults “normal” is almost nothing; a CDC survey found that nearly 80% of adult Americans get less than 2.5 hours of exercise a week.

But forget about averages and those who don’t exercise.  The point of this Velo article is that ageing endurance athletes—i.e., guys like me—seem now to be in danger.  The article declares, “In the case of endurance athletes who have competed for years — whose hearts have exceeded the threshold of normal heart rates for decades — going above what is normal defines them.  But it may also be killing them.”

In this post I examine the reactions of my pals to this disheartening article; indulge in some knee-jerk denial; examine some other anecdotal evidence; evaluate the article’s claims on the basis of the literature cited; and (perhaps most importantly) provide a scheme for greatly advancing the study of exercise-induced heart complications among the middle-aged.

 Reactions

My first reaction to seeing this article was, “Oh, crap.  I hope nobody forwards this to my wife.”  (She’s the designated worrier of the family, which leaves me free to pooh-pooh everything.)  But then, I’ve got people depending on me, so I thought I better take the article seriously.  First I looked at how my pals were reacting.  “Hummmm....this is a little scary,” one e-mailed.  Another replied, “Yeah very scary.  I routinely get dizzy when I get up - something that’s happened my whole life but” and here his e-mail ended abruptly.  (Had he collapsed mid-sentence?)  One guy mentioned an athletic 50-year-old pal who suffers from a heart issue like what’s described in the article.  Other responses:  “I have to admit, this article gave me pause, especially the way I like to ride bikes ... hung over, and hammering as hard as possible,” and “Alas, all along I thought I was doing something good for myself.”

Of course it’s tempting to deny the whole thing.  The article has some serious flaws—which I’ll get to in a minute—and I almost shrugged and thought, “Typical FUD, designed to sell magazines.”  But I resisted the urge.  After all, just because an article is flawed doesn’t mean its central assertion is false.  Besides, I respect the cautious position my pals have taken, and this isn’t the first time I’ve pondered the mystery of brilliant athletes suddenly dropping dead.  The article mentions two marathoners who died while running, and I also recall Matt Wilson, a local rider who died while cycling in 2011, and Steve Larsen, a guy I raced with as a junior, who died while running in 2009.

Never mind that my own heart has behaved perfectly my whole life (at least, as far as I know).  It’s possible I’m doing damage now that will only become a problem in ten years.  After all, I know guys who have smoked for years but don’t have lung cancer.  Yet.

I mulled over this article for about a week and a half, and just when it was starting to drift toward unconscious dismissal, I mentioned it to a cycling friend (my age) who said, “Oh, yeah, someone told me about that but said maybe I shouldn’t read it ‘cause it might bum me out.”  Why would it?  Turns out this guy has had a heart problem for some time now:  he’ll be riding along, just cruising, and suddenly his heart rate will go from like 140 up to over 200 and stay there for 30, 40 seconds.  Uh oh.

The “lumping” problem

My chief difficulty in deciding how much to worry, and whether or not to change my approach to cycling, is that of “lumping.”  Is it right to lump myself in with the guys cited in the article, and with the marathoners, and with Steve Larsen?  Is it right to lump runners in with cyclists?  And is it right to lump various heart problems together and treat them like one phenomenon?

Let’s take that last question first.  The Velo article uses two case studies to make its case:  Lennard Zinn, who while bicycling suffered symptoms of “his heart [flopping] like a fish” and beating way too fast; and Mike Endicott, who collapsed and lost consciousness during a cross-country ski race.  Was Endicott’s heart also racing?  Well, not at first.  Endicott’s words:  “Something was beating inside my chest.”  The Velo writer describes it as “his heart still doing something strange inside his chest” which led, after an hour or so, to ventricular tachycardia and “an immediate, unexpected loss of heart function.”  This seems a lot different from what Zinn experienced.  Were these two suffering from the same specific heart problem?  It’s not clear.

The article states that Zinn was diagnosed with multifocal atrial tachycardia, but Endicott’s exact diagnosis isn’t given.  The article talks a lot about atrial fibrillation (AF):  is this the same as tachycardia?  Again, it’s unclear (though this FAQ suggests not).  Moreover, the main study the article cites concerns “myocardial fibrosis, a condition that involves the impairment of the heart’s muscle cells, called myocytes, through hardening or scarring of tissue.”  Does myocardial fibrosis lead to tachycardia and/or fibrillation?  Do Zinn and Endicott suffer from myocardial fibrosis?  Once again, the article doesn’t say.

It’s not just this article that’s vague about this stuff.  I did a tiny bit of research on Steve Larsen’s death, and turned up something surprising:

Google’s big-font summary makes it pretty clear this was a heart attack—but it wasn’t, according to the first article cited.  Nothing else has been written to further clarify this matter; the autopsy itself apparently ruled out heart attack.  And yet people seem to remember it as such.  Two years after Larsen’s death, when I was corresponding with a friend about Matt Wilson, my friend wrote, “Steve Larsen was the guy who had a [fatal] heart attack two years ago here in Bend.”  Meanwhile, I’d always remembered Wilson’s death as having been from a heart attack, but in researching this now (for example, here), I can find no specific cause of death.

A dearth of data

Let’s get back to that Velo article.  My temptation, when presented with such ambiguity, is to read the research articles on which the article is based.  But the article, while making lots of vague references to unnamed studies, doesn’t provide much.  For example:  “Over decades of exertion, the myocardial cells of the heart begin to simply fall apart, and you’re left with an unhealthy ticker. Or so these new studies suggest.”  And:  “Long-term endurance exercise results in a five-fold increase in the risk of developing AF.  A review of the relevant research finds many small studies that correlate long-term sports activity with AF....  While none is conclusive, collectively they indicate a pattern.”  What studies?  What relevant research?  There are no citations given here; no footnotes; no hyperlinks.

The article does cite two specific studies.  One involved rats, and I’m going to dismiss that.  (My heart is bigger than a rat’s; rats don’t live 40 or 50 or 60 years, which is the age group I’m trying to learn about; humans cannot be made to exercise as hard as rats.)  Velo also cites a study published in The Journal of Applied Physiology:  “MRI studies revealed that some 50 percent of the veteran [>50-year-old] athletes had myocardial fibrosis....  In age-matched controls — people of the same age who didn’t compete — and young athletes, there were zero cases of the disease. Furthermore, the fibrosis was significantly associated with the number of years spent training, and the number of marathons and ultra-endurance marathons they had completed.”

Okay, now we’re getting somewhere!  I looked at the study itself to get more information.  You can read it here.  My big issue with this study is that it only included 12 veteran athletes.  Of these, 2 had previous heart conditions (1 probable previous mycarditis, 1 probable previous silent myocardial infarction).  The Journal study is candid about its limited scope, acknowledging that “Like many studies of this type, the numbers of veteran athletes are small (largely because this is a small and unique population), and generalization is difficult.”

And yet, without the ability to generalize, what are we supposed to do with this (largely anecdotal) information?  My frustration is that I feel I ought to evaluate and possibly modify my own behavior based on these cautionary tales, but I have no solid basis for assuming that my behavior matches the profile of the overworked athlete who may be damaging his heart.

Velo addresses this problem of definition by quoting Dr. John Mandrola, a heart rhythm doctor:  “What’s too much? That’s the $64,000 question. Though I will say it’s a little like what the judge said about indecency: ‘I know it when I see it.’”  Well, this just doesn’t do me much good, because I’m not about to go to Kentucky to visit this doctor, in the absence of any symptom of any problem.

I see four possible ways to respond to this information. 

1. I could completely ignore it—but I think that’s irresponsible. 
2. I could simply err on the side of caution, and ride less often and less hard than I currently do—but isn’t this completely arbitrary, since somebody who rides twice as much as I could similarly tone it down “a bit” and still be riding way more than I? 
3. I could continue riding exactly how I currently do, while adding myocardial fibrosis to the pile of things I regularly worry about (which will increase my cortisol levels to the detriment of my health) while feeling guilty for being such a poor custodian of my body.  No thanks. 
4. I can try to get more information about this, with a whole lot more data, so I can more reasonably evaluate and (if necessary) modify my behavior.

Number four wins, and that’s where my proposed solution comes in.

The solution

We need more information!  We need more than two anecdotes and a lot of vague references to “these new studies” and “the relevant research.”  We need more than studies on rats, and we need studies of more than 10 veteran athletes.  By “we” I mean “society,” and actually society is already really, really good at harnessing massive amounts of data and crunching them to derive useful judgments.  Think of how effectively Amazon predicts what we’ll want, and how well the advertising industry can anticipate, and create, our desires.  What if we could find a ready source of “big data” for studying the effect of gonzo endurance athleticism on heart health?

But we have it already!  It’s called Strava!  This social network has 8 million registered users, of which 1.2 million are active and something like 190,000 have premium accounts.  (These are estimations since the company doesn’t reveal these numbers; click here for details.  Suffice to say, this is a lot deeper pool of data than 10 test subjects.)

 The number of Strava users isn’t even the best part.  It’s the quality of the data set.  Consider the type of athlete who goes so hard, and so long, and so often, that he or she is actually at risk of causing heart damage.  How many of this type wouldn’t be on Strava?  The gung-ho Strava cyclist is exactly the kind of person who might overdo his or her training.  In other words, Strava members comprise the perfect group for studying this stuff. 

I’m envisioning a splash screen that pops up when the Strava user logs in.  It asks, “Are you willing to participate in an anonymous study about heart function and rigorous aerobic exercise?”  I’d guess most users wouldn’t have a problem with this.  And anybody who’s having heart trouble would probably be eager to participate, to better understand it all, and could indicate the nature and frequency of his or her problem.  Such a study could quite feasibly have millions of workouts per day to crunch (the average workouts logged per day being around 6 million last year, as detailed here).  You’ve got your control group and your heart-oddity group both covered, right off the bat.

And what great data there’d be to crunch!  You get exercise frequency; exercise duration; heart rate; and history (e.g., how much a rider’s performance is improving or deteriorating).  You could start to develop very precise profiles of those whose hearts are misbehaving.  Is there an age threshold beyond which these symptoms most commonly present?  Are there frequency, duration, and/or intensity thresholds below which no errant heart behaviors are observed?  What is the rate of heart trouble for riders exactly my age, who ride (on average) just as often, and in exactly the same heart rate zones I work out in?  Of those who work out like I do but who are 10 years older, how many have developed heart trouble?  Five years from now, when we see an even more comprehensive integration of “big data” into our lives, we’d probably have even more ways to correlate the data.  (We might know, for example, whether frequent purchases at Starbucks or BevMo factor in to the cardio health equation.)

Conclusion

For now, I’m going to assume that the hectic pace of my life, my many familial obligations, my relative sloth, and my unaggressive riding style will keep my heart in good shape.  I’m not going to bother shopping my Strava idea around, because I’m confident  that the Strava folks themselves, looking for a way to actually make some money, are bound to get the attention of the insurance people, who I assume are always looking for ways to avoid open-ended batteries of complicated tests.  I envision all of this happening without any effort from me, probably years before I start getting into the dangerous years where my heart starts “doing something strange inside [my] chest.”  And if you want to forward this link around to speed up the process, please be my guest!