Can the very exercise you’re doing to slim down be sabotaging your weight-loss efforts? It’s a shocking notion, I know. And I am in no way suggesting that exercise is bad for you (in fact, you could fill an entire book with reasons to get your daily move on!).

But if you’re a cardio fanatic—and 71 percent of you are, according to a new poll on weight loss that Reader’s Digest conducted with Yahoo! Health—your go-to workout may not be the best way to spend your time in the gym.

I of all people should know. From 1998 to 2006, I was the executive editor of Fitness magazine. Studying fitness research and trying the trends were all part of my job. For years, I believed that I could eat anything I wanted because I was exercising so much. I was spending nine or more hours a week running, walking, biking, lifting weights, crunching my abs, relaxing and stretching my limbs in yoga, doing Pilates, and more.

I exercised like a fiend. And I ate like a linebacker. But I’m here to tell you, the more I exercised, the hungrier I was. And the more I ate, the more I needed to exercise to maintain a healthy weight.

Here’s what happened: I saw a steady increase in my body weight of a pound a year.

After digging into the research more, I was shocked to learn that focusing solely on continuous cardio might actually have been contributing to my weight gain. (Seriously? I hear you say. Yes, seriously.) Aerobic exercise, the kind that makes your heart pound and your body sweat, demands that you increase your energy output. Because your body is always trying to stay in balance, this type of movement may actually act as a biological cue to make you eat more. Researchers also believe that cardio may cue additional eating because it depletes glycogen stores in the liver and muscle in order to make glucose available for fuel.

Besides making you eat more, continuous aerobic exercise isn’t nearly as effective a weight-control strategy as surprising your body with aerobic interval training (short bursts of high-intensity, heart-pounding work) or strength training (push-ups, squats, anything that builds muscle and power). That’s why a HIIT workout (that stands for High intensity Interval  Training) workout is the only one I recommend in my new Digest Diet book, in addition to basic walking. Even better, this kind of exercise is so efficient at burning calories and fat, you can get reap full benefits in just 12 minutes. Twelve minutes!

Get started today with a few of my favorite at-home strength moves. They’re also great to add to your current routine to up your workout.

1. Basic Move: Squat

A. Stand in front of a chair with your feet hip-width apart and hands clasped at chest level.

B. With your heels flat on the floor and keeping your back straight, bend your legs and slowly lower your bottom until it’s nearly touching the chair’s seat, but don’t sit down. Keep your arms extended in front of you for balance. Return to the starting position to complete the move. Do 10 to 12 reps.

Make It Harder: Jumping Squats >>

2. Basic Move: Step-Up

A. Stand in front of a low step or at the base of a staircase. Place your right foot on the second stair.

B. Step up and tap your left foot lightly on the second stair. Keeping your right foot on the stair, step down with your left leg to complete the move. Do 10 to 12 reps with each leg.

Make It Harder: Weight-For-It Step-Up >>

3. Basic Move: Chair Dip

 A. Sit in a sturdy, armless chair with your feet flat on the floor. Place your palms on the edge of the seat beside your hips and extend your legs so that only your heels are on the floor.

B. Walk your heels forward until your butt is just in front of the chair and you’re supporting your body weight with your arms. Keeping your elbows pointed behind you, bend your arms to lower your body about 6 inches. Extend and straighten your arms to complete the move. Do 6 to 8 reps.

Make It Harder: Double-Chair Dip >>

It’s March 21, 2012! Today is Kick Butts Day!

Y Street in Virginia celebrates Kicks Butts Day 2012 in this featured video reminding us that Big Tobacco spends one million dollars every hour to recruit kids as “replacement smokers” for the over 400,000 Americans killed each year by tobacco.

Find Kick Butts Day Events Near You

Check out these state-specific press releases and look for Kick Butts Day events in your state on the Google Map.

What’s Kick Butts Day?

Kick Butts Day is March 21, 2012, a day for activism when thousands of youth in every state and around the world will STAND OUT … SPEAK UP … and SEIZE CONTROL AGAINST BIG TOBACCO. If you are a teacher, a parent running a scout troop, or a youth leader, you can hold your own Kick Butts Day event as well.

• Download the 2012 Kick Butts Day Activity Guide.

• Get other activity ideas.

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While here, don’t forget to download new printable templates for Kick Butts Day 2012 bookmarks and stickers and check out the stylish new Kick Butts Day gear.

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Stand Out. Speak Up. Seize Control Against Big Tobacco.

I love my work. I mean I really LOVE my work. Do you? Are you creative and compelled to excel? Do you find happiness in relationships with your work-friends and colleagues? Do you like being part of something bigger than yourself? Me too. Work is fun and meaningful and I am completely dedicated to writing, leading my team and advising leaders whom I respect.

And then there’s life — so much more important than work. It’s true, right? Work doesn’t even run a close second to the beautiful little children in your life, or even the teenagers who get on your last nerve. Work pales in comparison to your love for your partner or relationships with family and friends. I even include my dogs and cats in the more-important-than-work list. I love Tula, Keiki, Pika, Tiko and Tiger (also known as Mikey). And then there’s spirituality, learning, dedication to making our world a better place — all these make life worth living.

Some of us are lucky — we love our work and we have full, rewarding lives. It’s a wonderful thing. But we are busy. No breaks, no boundaries — texts from kids, tweets pouring in, emails all night… It never stops. Most of us have no idea how to manage it all.

There is no such thing as work-life balance. But we keep trying to live up to that impossible standard until finally we lose it. Or I should say, we lose ourselves.

We lose ourselves to the “sacrifice syndrome” — a condition that is more than burnout. It’s a way of life. Maybe it’s familiar: You’ve been behaving in ways that don’t fit with who you are. You snap at loved ones, make bad decisions, rarely smile, miss out on life. Or you move at the speed of light like super-man-woman-mom-dad. Maybe you take pride in your super-humanness, but deep down you know you’re in trouble. You self-medicate: two 16-ounce cups of coffee? Really? How many martinis or glasses of wine? Stress-eating? You are completely worn out, you feel trapped and you see no way out.

The sacrifice syndrome doesn’t strike out of the blue. It starts with an insidious form of chronic, intense stress that comes along with lots of responsibilities. We call it “power stress.” Leaders are especially susceptible because of the 24-7 nature of our jobs, too many toxic work environments, unhealthy competition and out-of-control achievement drives. This kind of stress is brutal.

Stress arouses the sympathetic nervous system and triggers the release of powerful substances like epinephrine, norepinephrine and corticosteroids.^[1] Blood pressure goes up and large muscles prepare for movement or battle.^[2] The immune system is compromised and the brain shuts down non-essential neural circuits, so we don’t take in as much information.^[3][4] We become less creative and old habits of thinking prevail. All of this has direct impact on our performance. We feel anxious, nervous or even depressed. This has direct impact on, well, everything.

Stress isn’t all bad — a certain dose contributes to focus, excitement and readiness for hard work and play. But we’re not wired to deal with “power stress” and when we are bombarded day in and day out for years, stress is dangerous.

It’s an epidemic. A Google search on stress resulted in 73,000 new or updated websites containing news articles, blogs magazines, programs or advice on stress in life. The Grant Thornton International Business Report survey of business leaders found that the net increase in work-related stress increased 28 percent globally in 2011 (less than 2010’s 45 percent increase, but still). A research study picked up in several South African news outlets reported a loss of R3bn — or more than $300 million, U.S. — due to the effects of stress on workers. The Chartered Institute of Personnel and Development reported that for the first time in the organization’s history, stress was the most common cause of employee absence.

This epidemic won’t go away until we learn how to interrupt the sacrifice syndrome. Our companies can’t do it for us, neither can doctors, counselors or loved ones. We need to heal, and healing starts with learning how to balance sacrifice with renewal.

Managing the “cycle of sacrifice and renewal” begins with prioritizing well-being. You can start by cultivating practices that allow you to re-engage with yourself, focus optimistically on the future and connect compassionately with other people. You can start with mindfulness — tuning in to yourself, your environment and others.

Mindfulness is the first step toward renewal. And no, you don’t have to meditate for two hours a day, or attend a yoga class before work (nice, but impossible). You can start small. Find a few minutes every day — and I do mean every day — to be quiet, to breathe, to take in nature. Breathe and focus on gratitude, love and hope.

Like mindfulness, hope is a powerful antidote to stress. A vision of a better future, optimism and the belief we can make it happen helps to calm our nervous system. Think about your dreams. Help someone else achieve theirs. Pick up trash on the way to work. Talk to a child about what he or she wants to be. Actions like these, done mindfully and often will make a difference.

These actions tap into hope and your desire to help others. You can renew yourself by slowing down long enough to get in touch with your most primal and powerful nature — your concern for others and your desire to connect with them and lend a hand. That’s compassion. It’s as simple as asking someone how they are in the morning and waiting long enough to hear the answer. Find someone to mentor, and give them your time. Stop managing performance and start coaching.

Learning to live mindfully and to focus on hope and compassion will help you to ward off stress and balance yourself. It might not be easy, at first, because it is truly a new way to live. You’ll need to change old habits and resist the urge to pursue an impossible goal — work-life balance.

Remember — there really is no way to balance all that we do, until and unless we balance ourselves. You’ll find yourself having more energy, your relationships will be stronger and you will be happier.

References:

[1] Dickerson, S. S. and M. E. Kemeny (2004). “Acute Stressors and Cortisol Responses: A Theoretical Integration and Synthesis of Laboratory Research.” Psychological Bulletin 130(3): 355-391. [link]

[2] Roozendaal, B., B. S. McEwen, et al. (2009). “Stress, memory and the amygdala.” Nat Rev Neurosci 10(6): 423-433. [link]

[3] Segerstrom, S. C. and G. E. Miller (2004). “Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry.” Psychological Bulletin 130(4): 601-630. [link]

[4] Roozendaal, B., B. S. McEwen, et al. (2009). “Stress, memory and the amygdala.” Nat Rev Neurosci 10(6): 423-433. [link]

For more by Annie McKee, click here.

For more on mindfulness, click here.

For more on stress, click here.

The personality trait narcissism may have an especially negative effect on the health of men, according to a new study.

“Narcissistic men may be paying a high price in terms of their physical health, in addition to the psychological cost to their relationships,” said Sara Konrath, a University of Michigan psychologist who co-authored the study published in PLoS ONE.

Earlier studies by Konrath and others have shown that the level of narcissism is rising in American culture, and that narcissism tends to be more prevalent among males. The personality trait is characterized by an inflated sense of self-importance, overestimations of uniqueness, and a sense of grandiosity.

Take a Narcissistic personality self-test

For the new study, Konrath and colleagues David Reinhard of the University of Virginia, and William Lopez and Heather Cameron of the University of Michigan examined the role of narcissism and sex on cortisol levels in a sample of 106 undergraduate students. Cortisol, which can be measured through saliva samples, is a widely used marker of physiological stress.

The researchers measured cortisol levels at two points in time in order to assess baseline levels of the hormone, which signals the level of activation of the body’s key stress response system, the hypothalamic-pituitary-adrenal (HPA) axis. Participants were not asked to complete any tasks that would elevate their stress. Elevated levels of cortisol in a relatively stress-free situation would indicate chronic HPA activation, which has significant health implications, increasing the risk of cardiovascular problems.

To assess participants’ narcissism, the researchers administered a 40-item narcissism questionnaire that measures five different components of the personality trait. Two of these components are more maladaptive, or unhealthy—exploitativeness and entitlement; and the other three are more adaptive, or healthy—leadership/authority, superiority/arrogance, and self-absorption/self-admiration.

“Even though narcissists have grandiose self-perceptions, they also have fragile views of themselves, and often resort to defensive strategies like aggression when their sense of superiority is threatened,” Reinhard said. “These kinds of coping strategies are linked with increased cardiovascular reactivity to stress and higher blood pressure, so it makes sense that higher levels of maladaptive narcissism would contribute to highly reactive stress response systems and chronically elevated levels of stress.”

Reinhard, Konrath and colleagues found that the most toxic aspects of narcissism were indeed associated with higher cortisol in male participants, but not in females. In fact, unhealthy narcissism was more than twice as large a predictor of cortisol in males as in females.

They also found that there was no relationship between healthy narcissism and cortisol in either males or females.

“These findings extend previous research by showing that narcissism may not only influence how people respond to stressful events, but may also affect how they respond to their regular day-to-day routines and interactions,” Konrath said. “Our findings suggest that the HPA axis may be chronically activated in males high in unhealthy narcissism, even without an explicit stressor.”

Why should narcissism affect males differently? “Given societal definitions of masculinity that overlap with narcissism—for example, the belief that men should be arrogant and dominant—men who endorse stereotypically male sex roles and who are also high in narcissism may feel especially stressed,” Konrath said.

In future research, she hopes to examine why narcissism is not as physiologically taxing for women as it is for men, and also to examine the potential links between maladaptive narcissism and other physiological responses related to stress and poor coping, including inflammatory markers such as C-Reactive Protein.

Konrath is an assistant research professor at the U-M Institute for Social Research (ISR) and is also affiliated with the University of Rochester Medical Center.

If you want to get healthy, you just might not want to go to a doctor. You might instead, go to church. The power of community to create health is far greater than any physician, clinic or hospital. You are more likely to be overweight if your friend’s, friend’s friend is overweight than if your parents are overweight. Your social networks may matter more than your genetic networks. But if your friends have healthy habits you are more likely to as well. So get healthy friends.

In the fall of 2010, I had dinner with Rick Warren, the pastor of the 30,000 strong Saddleback Church in Southern California. He came to see me to get healthy – and he got religion about health. Over a healthy dinner of beet and cabbage autumn soup and a salad, he described his extraordinarily successful experiment for sustained personal growth and change. Rick encouraged his congregation to form 5,000 small groups that met every week in their community to study, learn and grow together.

In a flash, in that moment, I envisioned using those same small groups as a means of creating healthy lifestyle change. Out of that meeting, with Drs. Mehmet Oz and Daniel Amen, we created The Daniel Plan, a roadmap for physical and spiritual health and renewal that would be delivered through the small groups. Rick named it “The Daniel Plan” after the first health support group created by Daniel and his friends who resisted the temptation of the King’s rich food and were healthier for it.

On the day we launched The Daniel Plan at Saddleback Church on January 15, 2011, over 8,000 people signed up to participate in small groups, track their progress and be part of a research study. Within a week over 15,000 had signed up. The groups are supported by a weekly curriculum, learning objectives, videos, webinars, seminars and online support. In the first year the congregation has already lost over 250,000 pounds and it changed the entire culture of the church almost overnight.

Community: The Best Medicine for Change

The seed of this idea started in my mind when I went to Haiti after the earthquake in January, 2010. Paul Farmer and Partners in Health have created a powerful and successful model for treating drug resistant tuberculosis and AIDS in the most impoverished nations in the world. The brilliance of the vision wasn’t coming up with a new drug regimen or building big medical centers, but from a very simple idea: The missing ingredient in curing these patients was not a new drug, but the community. They needed someone to “accompany” them to get healthy. Recruiting and training over 11,000 community health workers across the world he proved that the sickest, poorest patients with the most difficult to treat diseases in the world could be successfully treated. The community was the treatment.

The same vision can be applied to our current diabesity epidemic. Solutions are not coming from governments, health care institutions or corporations. What has been proven to work over and over, in different settings–workplaces, community centers, faith-based centers, schools–is building a community-based support system to guide people toward sustainable behavior and lifestyle change.

The cure for obesity and diabetes is not a mystery, just as the most effective drug regimen for tuberculosis or AIDS is not a scientific mystery. Knowing how to effectively get it to the individual has eluded most experts. But the data is in about lifestyle change, we know how to deliver the information and make it stick. We have to help each other, not look for outside solutions from large institutions.

What the Research Shows: Community Support Works Better then Medication

Here’s what the data show to date with more studies coming in every day. Community is more effective than any medication, even though many still use less than optimal and outdated nutritional advice and lifestyle interventions. I believe much more could be accomplished by translating the latest science into effective treatments and community-based support groups as I have done in my new book The Blood Sugar Solution.

The landmark 2002 study based on the Diabetes Prevention Program(i) and a ten year follow up study(ii) sponsored by the National Institutes of Health proved that lifestyle intervention is much more powerful than any other treatment such as medication to prevent diabetes in those with prediabetes. With regular lifestyle support and education, participants lost 5 percent of their bodyweight and reduced their risk of diabetes by 58 percent. This lifestyle-based approach was also proven very effective in the large Finnish Diabetes Prevention Study.(iii)

The current Look Ahead Study funded by the National Institutes of Health is a 13-year study of 5,000 people comparing an intensive group lifestyle change program for diabetes prevention and treatment has been show to be remarkably more effective in lowering weight, cholesterol, blood sugar, and blood pressure than conventional medical care.(iv) Once this study is completed, it will completely change our way of thinking about how to treat disease. Group models of intensive lifestyle change like the one modeled by Dr. Dean Ornish for heart disease(v) and prostate cancer,(vi) are more effective and will save more lives and more money than using medication and surgery for diseases caused by lifestyle and environmental factors.

Many other community-based programs have been proven to work better than our current conventional treatment approach based on one on one counseling visits with diabetic educators or registered dietitians.

Here’s what some of the studies showed:

1. The Montana Cardiovascular Disease and Diabetes Prevention Program(vii)proved diabetes prevention research could be applied successfully in real world setting in groups of 8 to 30 people supported by a trained health care team. Education was delivered in 16 weekly classes and optional twice a week exercise classes. The average weight loss was 7 percent of body weight, and blood pressure, cholesterol, and blood sugar all dropped significantly.

The Healthy Living Partnerships to Prevent Diabetes (HELP PD)(viii) study in North Carolina trained community health workers (patient’s peers) to support long-term lifestyle change. The community health workers received a 36-hour training program given by registered dietitians. It’s a train the trainers model. These community health workers help groups of patients succeed in a 16-week core curriculum using videos, handouts, a treatment manual, and a toolkit. After the initial 16 weeks of meetings, there is weekly phone support for 8 weeks and monthly support for 18 months. The program addresses not only nutrition, exercise and lifestyle, but ways to transform obstacles to behavior change rooted in beliefs and attitudes about self-efficacy and self-care. The initial results of this National Institute of Health sponsored study of 300 people found that the people who had the usual care of individual counseling lost only 1 percent of their body weight compared to 7 percent of body weight for people who were in community health worker supported groups. The cost to deliver this program was only 400 a year.

The DEPLOY study(ix)successfully partnered with local YMCA’s, trained their staff and started group programs based on the Diabetes Prevention Program.

Group programs have also been delivered with success via a large academic hospital.(x)

The Logan Healthy Living Program(xi) successfully used telephone delivered support for dietary and physical activity to socially disadvantaged patients with Type 2 diabetes and high blood pressure. They provided a workbook and 18 calls over 12 months.

The Healthy Lifestyle Change Program (xii) in California found that in more than 400 developmentally disabled participants with obesity or at high risk for diabetes they could achieve significant improvement in weight, waist circumference and an increase in physical activity in a seven-month, twice weekly group education program. What was most remarkable was that peer “mentors” led this group intervention.

The PATHWAYS study(xiii) delivered a 14-week weight loss program aimed at diabetes prevention for African American women at risk for diabetes delivered through churches and led by lay health facilitators (or community health workers). The women lost an average of 5 percent of their body weight, enough to reduce their risk of diabetes by 58 percent.

In other studies scientists also effectively implemented a group model for diabetes prevention and weight loss using both volunteer health care professionals(xiv) and lay people(xv) in African American churches.

Group school lifestyle change programs in the poorest, most overweight states like Mississippi have shown significant improvements in weight, body, fat, fitness level and eating habits.(xvi)

 

Building Connection and Community to Create Health

This movement is starting to spread. Doctors frustrated with the failure of medication to treat their patients with chronic illness, obesity, and diabetes are starting small groups with eight to 30 patients and meeting weekly to teach them about nutrition, cooking, shopping, exercise, stress management and more.

Two Portland doctors came up to me after a lecture I gave and told me about their program for poor undocumented Hispanic women with chronic symptoms, obesity, and diabetes. For very little money (about $15 per person), they successfully guided these women to health in a program they called Reclamado su Salud (or reclaim your health) using the program based on The Blood Sugar Solution (which I have taught at many medical conferences). Their group of 20 women met weekly for five classes, then every two weeks for a total of eight three-hour classes. The weight loss ranged from five to 20 pounds, blood pressures dropped an average of 10-20 points and depression and inflammation scores dropped significantly.

Much can be done with a little help from your friends.

These examples represent just the beginning of what is possible when we work together. We are social beings and thrive with connection. I met with human resource and benefits executives at Google to advise them on creating a healthy workforce. A survey of their “Googlers” discovered that most of them wanted more ways to connect with each other.

Social networks and groups are spontaneously sprouting as a support system for lifestyle change. Facebook and Twitter cannot only help facilitate democratic revolution in countries like Egypt, they can link communities together in a common purpose to reclaim their health. Think “Occupy Health Care” or “Wellness Spring.”

With the shift in health care policy prohibiting insurers from excluding sick patients (or cherry picking), canceling insurance and the mandate for universal coverage, they can no longer shift responsibility for prevention and health promotion. Large insurers like United Health Care(xvii) and CIGNA are scrambling to create innovative community based programs to address the tsunami of disease and costs they can no longer avoid.

This community based group approach solves many enormous obstacles to reversing this epidemic faced by the health care system. Even though doctors are the main place where people receive health care with diabesity, they have no training in lifestyle change, lack the time, resources, and support team, and they do not get paid for helping patients create sustainable lifestyle change. Currently physicians and health care organizations have nowhere to refer patients and have no clear, well documented proven solution to provide their patients. Telling their patients to eat better and exercise more is just not enough.

You need to build yourself a support system to succeed long term. You need a team working together toward the same goals. It might be just one person, a self-guided support group, one led by a health coach, wellness champion or community health worker, or a health professional, or even an online community that can support, encourage and guide you.

I strongly recommend you develop this kind of community for yourself for two reasons.

1. Success requires it. As we have seen, studies show that the best way to overcome diabetes and obesity is through groups and community support.
2. Our world needs it. If we don’t do something about the diabesity epidemic, our world will suffer for it. Remember, projections suggest that by 2020 half of the population will have prediabetes. We have to work together to avert this disaster.

Start by finding people who will do the program with you. Create a small group, even if it is just one friend, who can support you through the process. Ask your friends, family, coworkers, and spiritual community members to join you. You can still be successful following this program by yourself, but it will be more fun, powerful and sustainable when done with others in community.

My new book The Blood Sugar Solution, which comes out at the end of February is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society. Obesity and diabetes is a social disease and we need a social cure.

My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our diabesity epidemic.

To learn more and to get a free sneak preview of the book go to www.drhyman.com.

To your good health,

Mark Hyman, MD

(i) Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346 (6):393-403.
(ii) Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.
(iii) Ilanne-Parikka P, Eriksson JG, Lindström J, Peltonen M, Aunola S, Hämäläinen H, Keinänen-Kiukaanniemi S, Laakso M Valle TT, Lahtela J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group. Effect of lifestyle intervention on the occurrence of metabolic syndrome and its components in the Finnish Diabetes Prevention Study. Diabetes Care. 2008 Apr;31(4):805-7.,
(iv) Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and Lahtela J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group.cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010 Sep 27;170(17):1566-75.
(v) Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7.
(vi) Ornish D, Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, Mattie MD, Marlin R, Simko J, Shinohara K, Haqq CM, Carroll PR. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74.
(vii) Amundson HA, Butcher MK, Gohdes D, Hall TO, Harwell TS, Helgerson SD, et al. Translating the diabetes prevention program into practice in the general community: findings from the Montana Cardiovascular Disease and Diabetes Prevention Program. Diabetes Educ 2009;35(2):209-4. 216.
(viii) Katula JA, Vitolins MZ, Rosenberger EL, Blackwell C, Espeland MA, Lawlor MS, Rejeski WJ, Goff DC. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Contemp Clin Trials. 2010 Jan;31(1):71-81.
(ix) Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Am J Prev Med 2008;35(4):357-363.
(x) McTigue KM, Conroy MB, Bigi L, Murphy C, McNeil M. Weight loss through living well: translating an effective lifestyle intervention into clinical practice. Diabetes Educ 2009;35(2):199-204. 208.
(xi) Eakin EG, Reeves MM, Lawler SP, Oldenburg B, Del Mar C, Wilkie K, Spencer A, Battistutta D, Graves N. The Logan Healthy Living Program: a cluster randomized trial of a telephone-delivered physical activity and dietary behavior intervention for primary care patients with type 2 diabetes or hypertension from a socially disadvantaged community-rationale, design and recruitment. Contemp Clin Trials. 2008 May;29(3):439-54.
(xii) Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D; WRC Project Oversight Team. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. Am J Prev Med. 2009 Dec;37(6 Suppl 1):S201-8.
(xiii) McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The PATHWAYS church-based weight loss program for urban Aftrican-American women. Diabetes Educ 2001; 27(2):231-238
(xiv) Quinn MT, McNabb WL. Training lay health educators to conduct a church-based weight-loss program for African American women. Diabetes Educ 2001;27(2):231-238
(xv) Boltri JM, Davis-Smith YM, Seale JP, Shellenberger S, Okosun IS, Cornelius ME. Diabetes prevention in a faith-based setting: results of translational research. J Public Health Manag Pract 2008;14(1):29-32.
(xvi) Greening L, Harrell KT, Low AK, Fielder CE. Efficacy of a School-Based Childhood Obesity Intervention Program in a Rural Southern Community: TEAM Mississippi Project. Obesity (Silver Spring). 2011 Jan13.
(xvii) United Health Center for Health Reform and Modernization, The United States of Diabetes, November 2010 (accessed online)

Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.

For more from Mark Hyman, M.D., click here.

For more on personal health, click here.

January 25, 2012, 12:01 am

A Scientific Look at the Dangers of High Heels

By GRETCHEN REYNOLDS

Not long ago, Neil J. Cronin, a postdoctoral researcher, and two of his colleagues at the Musculoskeletal Research Program at Griffith University in Queensland, Australia, were having coffee on the university’s campus when they noticed a young woman tottering past in high heels. “She looked quite uncomfortable and unstable,” Dr. Cronin says.

Some observers, particularly women, might have winced in sympathy or, alternatively, wondered where she’d bought stilettos. But the three researchers, men who study the biomechanics of walking, were struck instead by the scientific implications of her passage. “We began to consider what might be happening at the muscle and tendon level” in women who wear heels, Dr. Cronin says.

How shoes affect human gait is a controversial topic these days. The popularity of barefoot running, for instance, has grown in large part because of the belief, still unproven, that wearing modern, well-cushioned running shoes decreases foot strength and proprioception, the sense of how the body is positioned in space, and contributes to running-related injuries.

Whether high heels might likewise affect the wearer’s biomechanics and injury risk has received scant scientific attention, however, even though millions of women wear heels almost every day. So, in one of the first studies of its kind, the Australian scientists recruited nine young women who had worn high heels for at least 40 hours a week for a minimum of two years. The scientists also recruited 10 young women who rarely, if ever, wore heels to serve as controls. The women were in their late teens, 20s or early 30s.

The scientists asked the heel-wearing women to bring their favorite pair of high-heeled shoes to the lab. There, both groups of women were equipped with electrodes to track leg-muscle activity, as well as motion-capture reflective markers. Ultrasound probes measured the length of muscle fibers in their legs.

All of the women strode multiple times along a 26-foot-long walkway that contained a plate to gauge the forces generated as they walked. The control group covered the walkway 10 times while barefoot. The other women walked barefoot 10 times and in their chosen heels 10 times.

It was obvious, as the scientists had suspected watching the woman during their coffee break, that the women habituated to high heels walked differently from those who usually wore flats, even when the heel wearers went barefoot. But the nature and extent of the differences were surprising. In results published last week in The Journal of Applied Physiology, the scientists found that heel wearers moved with shorter, more forceful strides than the control group, their feet perpetually in a flexed, toes-pointed position. This movement pattern continued even when the women kicked off their heels and walked barefoot. As a result, the fibers in their calf muscles had shortened and they put much greater mechanical strain on their calf muscles than the control group did.

In that control group, the women who rarely wore heels, walking primarily involved stretching and stressing their tendons, especially the Achilles tendon. But in the heel wearers, the walking mostly engaged their muscles.

That biomechanical distinction is important, says Dr. Cronin, who is now a researcher at the University of Jyvaskyla in Finland. “Several studies have shown that optimal muscle-tendon efficiency” while walking “occurs when the muscle stays approximately the same length while the tendon lengthens. When the tendon lengthens, it stores elastic energy and later returns it when the foot pushes off the ground. Tendons are more effective springs than muscles,” he continues. So by stretching and straining their already shortened calf muscles, the heel wearers walk less efficiently with or without heels, he says, requiring more energy to cover the same amount of ground as people in flats and probably causing muscle fatigue.

The obvious question raised by the findings, though, is so what? Does it fundamentally matter if a woman’s calf muscle fibers shorten and she neglects her tendons while walking, especially if she loves the looks of her Louboutins?

That question is difficult for a biomechanist to answer, Dr. Cronin admits. Aesthetics are outside the realm of his branch of science. But the risk of injury is not. “We think that the large muscle strains that occur when walking in heels may ultimately increase the likelihood of strain injuries,” he says. (This risk is separate from the chances that a woman, if unfamiliar with heels, may topple sideways and twist an ankle or bruise her self-image, which is an acute injury and happened to me only the one time.)

The risks extend to workouts, when heel wearers abruptly switch to sneakers or other flat shoes. “In a person who wears heels most of her working week,” Dr. Cronin says, the foot and leg positioning in heels “becomes the new default position for the joints and the structures within. Any change to this default setting,” he says, like pulling on Keds or Crocs, constitutes “a novel environment, which could increase injury risk.”

It should be noted, he adds, that in his study, the volunteers “were quite young, average age 25, suggesting that it is not necessary to wear heels for a long time, meaning decades, before adaptations start to occur.”

So, if you do wear heels and are at all concerned about muscle and joint strains, his advice is simple. Try, if possible, to ease back a bit on the towering footwear, he says. Wear high heels maybe “once or twice a week,” he says. And if that’s not practical or desirable, “try to remove the heels whenever possible, such as when you’re sitting at your desk.” The shoes can remain alluring, even nestled beside your feet.