Health & Fitness

As holistic health gains hold, a number of ancient wellness practices are being embraced and promoted. According to a March 2, 2020, article¹ in The Guardian, many of these practices are rooted in the European wellness culture. Following is a sampling of ancient holistic health traditions making a comeback. How many of them have you tried?

The Siesta

Spain has a long history of taking a siesta during the hottest time of the afternoon. To this day, many Spaniards will take a break from work in the afternoon and work later into the evening to compensate. The Guardian quotes Paul Joseph, founder of Health and Fitness Travel:²

“Even just slowing down for a short period of time allows you to disconnect from the world and subsequently boost energy, focus and creativity.”

The research on napping is mixed, however, with some studies showing benefits such as lowering the prevalence of heart disease (particularly among working men),³ improving learning,⁴ boosting emotional stability and lowering blood pressure, while others show it may actually increase the risk of high blood pressure, diabetes and cognitive decline, especially in older adults.⁵

While it’s unlikely that naps are directly causing these health problems, the association exists nonetheless, and more research is needed to determine who benefits from naps, who doesn’t and why. 

The Nordic Diet

You’re probably familiar with the Mediterranean diet, but the Nordic diet, with a focus on fish, may be part of why Iceland “consistently ranks highly in metrics such as life expectancy and blood pressure,” The Guardian states, adding:⁶

“The Nordic diet shares some similarities with the life-extending Mediterranean diet, although it is lower in fruit and vegetables, advocating moderate consumption of fat and protein along with canola oil (a type of rapeseed oil), wild berries and root vegetables.

A diet high in fresh fish, and therefore omega-3 fatty acids, is considered key to a healthy diet in Iceland. Haddock, herring and cod — including the cheeks and tongues, the most prized parts — are all dietary staples. Fermented shark is a national dish.

It is also common for Icelanders to take a daily supplement of cod-liver oil during the winter months, when it is difficult to get enough vitamin D from sunlight alone.”

The EPIC-Potsdam study,⁷ published in 2018, compared the Nordic and Mediterranean diets, assessing the ability of each to lower the risk of Type 2 diabetes, heart attack, stroke and cancer.

Looking at data from 27,548 participants who were followed for 10.6 years, they found the Nordic diet “showed a possible beneficial effect on [heart attack] in the overall population and for stroke in men, while both scores reflecting the [Mediterranean Diet] conferred lower risk of [Type 2 diabetes] in the overall population and of [heart attack] in women.”

Small fatty cold-water fish such as herring, anchovies, sardines and mackerel are excellent sources of marine-based omega-3 fats. If you don’t fancy these types of fish, consider taking an omega-3 supplement such as krill oil, which has several benefits over regular fish oil.

Krill is also the most sustainable form of omega-3, as harvesting is strictly regulated. You can learn more about this in “Research Demonstrated Superiority of Krill Oil Compared to Fish Oil.” 

Mud Treatments 

Mud treatments and mud wraps, which have been used therapeutically for 25 centuries,⁸ were popularized by the Italians during the Roman Empire. Mud therapy is often referred to as fangotherapy, after the Italian word “fango,” which means “mud.”

Mud is generally advertised as having cleansing and relaxing, antistress effects, but science suggests its health benefits may be far-reaching. As reported in the Spanish journal Anales de Medicina Interna:⁹

“Mud has a place as a non-pharmacological tool in certain clinical settings, such as degenerative articular processes, skin disorders, and others. … Fangotherapy in arthritis patients seems to cause variations in amino acid involved in cartilage homeostasis, and also produce reduction in pain ratings in gonarthrosis.

Mud modifies nitric oxide, myeloperoxidase and glutathione peroxidase serum levels in arthritic patients and beta-endorphin and stress hormones in patients affected by osteoarthritis by reducing inflammation, pain and therefore diminishes the cause of stress.

[It] has been confirmed that the thermal stress associated with Fangotherapy activates the pituitary gland … Furthermore, steroids and antimicrobial activity of certain therapeutic mud has been suggested.”

Contrast Therapy

Contrast therapy typically involves the use of sauna followed by cold-water immersion, either in a lake, pool, shower or bath. In the winter, immersing yourself in snow is another option. Sauna bathing has a long history in Finland.

To this day, most homes in Finland have a built-in sauna. Sauna bathing has been shown to strengthen heart health and offer significant protection against cardiovascular diseases,^10,11 and adding the contrast of a cold dip afterward can further magnify those effects.

Sauna bathing is one of my favorite therapies as it generates heat shock proteins that repair protein misfolding, which is a major part of aging and disease. I believe this is why all-cause mortality is so radically decreased in Finns who sauna more than five times a week.

Sweating in a sauna will also help eliminate toxins, improve blood circulation, kill disease-causing microbes and improve your mitochondrial function. Research has even shown that regular sauna use correlates with a reduced risk of death from any cause, and may help stave off Alzheimer’s disease and dementia.

For example, researchers in Finland found that men who used a sauna four to seven times a week for an average of 15 minutes had a 66% lower risk of developing dementia, and 65% lower risk of Alzheimer’s, compared to men who used the sauna just once a week.^12,13

Recent research¹⁴ has also demonstrated that sauna bathing helps modulate your autonomic nervous system, which governs your stress responses.¹⁵ This helps explain why most people feel “nice and mellow” afterward.

As detailed in “The Many Health Benefits of Cryotherapy,” there’s a compelling body of evidence showing exposure to harsh conditions can be highly beneficial and that extreme temperature variations help optimize many biological functions.

Like exposure to heat, exposure to cold boosts mitochondrial function and numbers. Cold thermogenesis has also been shown to:^16,17,18

Strengthen joint tissue and improve	Support weight loss efforts by increasing metabolism
Increase blood circulation	Reduce symptoms of depression and anxiety by at least 50 percent19
Speed rate of recovery following joint or muscle injury20	Provide temporary relief lasting about 90 minutes from pain associated with arthritis21
Reduce pain and swelling following injury	Reduce your risk of developing cognitive decline and dementia by reducing inflammation and oxidative stress22
Reduce inflammation	Improve symptoms of eczema23
Enhance benefits of physical therapy	Reduce pain associated with migraines when applied to the back of the neck for about 30 minutes24
Improve muscle function and strength	Boost mental focus and attention by increasing production of norepinephrine in your brain. Norepinephrine can be increased twofold just by getting into 40-degree F. water for 20 seconds, or 57-degree water for a few minutes

Forest Bathing and Uitwaaien

Forest bathing is the English translation of the Japanese term “shinrin-yoku.” As the term suggests, it refers to the restorative and “cleansing” effects of spending time in forests and other nature spaces. In Japan, it’s a revered and long-standing tradition known to promote health and well-being.

The benefits of forest bathing go beyond the obvious. As explained in the film, “Call of the Forest,” trees have medicinal properties. For example, limonene, produced by trees, is an anticancer compound used in chemotherapy.

Linolenic acids aid brain functioning and pinenes have antibiotic properties. Inhaling these and other compounds emitted by trees can provide a mildly narcotic effect while boosting immune function and relaxing your body. The soil of the forest also has healing powers, including soil bacteria shown to improve mood, so don’t be afraid to get your hands dirty.

The Dutch word “uitwaaien” is a similar term, but refers more specifically to spending time outdoors in “wild, windy weather.” According to The Guardian:²⁵

“By replacing ‘bad air’ with ‘good air,’ it is believed to leave you feeling clear-headed and refreshed. ‘It feels exhilarating — wind is distracting, so it’s sort of meditative, in the sense you cannot think about anything else,’ says [Global Wellness Institute research director, Beth] McGroarty.”

Without doubt, spending more time in nature is one of the simplest ways to improve your general well-being and emotional health.

A massive study²⁶ involving data from more than 140 trials and 290 million people revealed exposure to greenspace — defined as open, undeveloped land with natural vegetation — led to significant reductions in diastolic blood pressure, salivary cortisol (a physiological marker of stress) and heart rate, along with significant decreases in Type 2 diabetes and mortality from all causes and those specifically related to the heart.

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It’s important to not only pay attention to what you eat, but also when you eat. In past years, experts have made numerous dietary recommendations, including eating three full meals a day, grazing throughout the day, eating a high-protein snack at night and following a low-fat diet. Despite changing recommendations, the number of overweight and obese individuals continues to climb.

According to the World Health Organization,¹ the number of people who are obese nearly tripled from 1975 to 2016. In 2016, 39% of people 18 years and older were overweight. Unfortunately, in 2018 this health hazard affected 40 million children under the age of 5.

Obesity Action² reports there's an estimated 93 million Americans who are obese, which increases their risk for problems with mobility and a higher rate of death. Of the 22 industrialized countries worldwide, the U.S. has the highest number of citizens who are obese.³

This condition leads to high blood pressure, insulin resistance and high cholesterol and triglycerides. As body mass index rises so does the potential for developing Type 2 diabetes and high blood pressure. One counter records 751.4 million people worldwide who are obese.

Choose Breakfast, Not a Late-Night Snack

Researchers from Vanderbilt University were interested in determining whether the timing of meals has a bearing on how efficiently energy is burned.^4,5 They tested the hypothesis that a circadian rhythm regulated how food would be metabolized during the day as compared to at night.

To measure this, middle-aged and older participants stayed in a respiratory chamber in two separate 56-hour interventional sessions. During each session they were offered three daily meals. In one session they were given breakfast, lunch and dinner and in the other they were given lunch, dinner and a late-night snack.

During each session the participants received the same amount of food and used the same amount of energy. At night, their respiratory exchange rates were measured. This unexpectedly revealed a difference related to the timing of meals without any relationship to physical activity or core body temperature.

It appeared that the timing of their meals had an influence on lipid oxidation (LO). Those eating a late evening snack experienced lower fat burning during the night as opposed to those who ate breakfast without a late-night snack. The amount of time the participants fasted between the last meal of the day and the first meal the next day was the same for both sessions. The researchers concluded:⁶

“The timing of meals during the day/night cycle therefore affects the extent to which ingested food is used versus stored. This study has important implications for eating habits, suggesting that a daily fast between the evening meal and breakfast will optimize weight management.”

Ultimately, this means that despite the number of calories eaten and calories burned being the same in both groups, those who ate at night would theoretically gain more weight than those who ate breakfast.

Weight Loss Alone Doesn’t Fix Health Problems

There are several factors that contribute to weight loss, such as sleep habits, the gut microbiome, what you eat and when you eat it. You might think that if you're able to stay lean then you're healthy, but weight loss alone is not a path to optimal health.

While you might look healthy on the outside, you could have some of the same health challenges as those who are overweight or obese. “Skinny fat” is a term used to describe individuals who may look thin on the outside but are metabolically fat due to a poor diet, unhealthy habits and lack of sleep.

Being overweight is a known risk factor for diabetes, yet researchers are finding that people with Type 2 diabetes who are at a normal weight have a higher mortality risk than those who are overweight or obese.⁷ This is known as the “obesity paradox” and it is being found in other chronic diseases as well.⁸

Some experts report that as many as 25% of those who are within a normal weight range have prediabetes.⁹ This may be the result of a focus on getting thin instead of being healthy. In other words, paying attention to what's on the scale as opposed to getting quality sleep, reducing stress and eating a balanced diet may be leading to poor outcomes.

Researchers have been writing about metabolically obese normal-weight (MONW) individuals since as early as 1978.¹⁰ More recently, researchers have found that Type 2 diabetes in Asia is more frequently diagnosed in those who are not obese.

In a 2017 study researchers compared insulin sensitivity, insulin secretion, intra-abdominal, muscle and liver fat, and fasting and postprandial glucose and insulin concentrations in two groups.¹¹ MONW individuals and a control group of healthy persons were matched for age, total body fat and sex.

Compared to controls, MONW participants had nearly two times more visceral fat and four times more liver fat. While hemoglobin A1c concentrations were similar between the groups, the glucose and insulin concentrations after eating were higher in the MONW group than in the control subjects.

This led researchers to conclude that those with an MONW body type have a higher accumulation of fat in the intra-abdominal and liver areas and increasing insulin resistance with a greater insulin response to compensate for the resistance. This demonstrates that the total picture of health is related to more than just weight.

Fasting Is a Powerful Tool

Intermittent fasting is a powerful approach to facilitate better eating habits and weight loss and to reduce your risk of chronic diseases such as Type 2 diabetes,¹² heart disease¹³ and cancer.¹⁴

Intermittent fasting doesn’t have to be difficult and it can be started gradually to help increase your potential for success. Basically, it is a cycle of eating and fasting that attempts to mimic the eating habits of our ancestors who did not have access to food 24 hours a day, 7 days a week. This helps restore your body to a more natural state.

Eating throughout the day — the opposite of intermittent fasting — means your body adapts to burning glucose as a primary fuel, which downregulates enzymes used to burn and store fat. Unfortunately, you then become progressively more insulin resistant and efforts to lose weight can be ineffective.

It is important to remember that intermittent fasting does not have to be a form of calorie restriction. In other words, the practice should make you feel good, not weak and lethargic. As your body begins to burn fat as its primary fuel, sugar cravings begin to subside and you feel full for a longer period of time.

However, it is not advisable to use intermittent fasting if your daily intake is filled with processed foods. In other words, this practice is not a cure-all for poor health and excess weight when your diet is filled with non-nutritive foods.

There are several health benefits you may experience by practicing intermittent fasting, including the reduction of insulin resistance, the promotion of leptin sensitivity, the lowering of triglycerides and the prevention or reversing of Type 2 diabetes. You'll discover these and more in my previous article, “Top 22 Intermittent Fasting Benefits.”

Eating Keto Builds a Foundation for Cellular Health

The practice of nutritional ketosis is focused on eating high amounts of healthy fats. Aim for 70% to 85% of your total calories from healthy fat and 1 gram of protein for every kilogram of lean body mass. Focus on keeping your net carbohydrates at no more than 4% to 10% of your daily calories.

The variation in net carbs considers energy requirements that are different from person to person, depending on physical activity. There is no set amount of fat you can eat but you need to limit carbohydrates and protein for a standard ketogenic diet.

Following a ketogenic diet often increases your level of energy and helps you lose and maintain weight loss. Far greater than weight loss, it also helps support your mitochondrial health and reduces inflammation.

This may play a role in reducing chronic and neuropathic pain.¹⁵ Many aging factors are impacted by low-grade inflammation, so a ketogenic diet may help reduce your risk of premature aging and chronic diseases.¹⁶ The diet also helps reduce insulin resistance, which is associated with heart disease, cancer, diabetes and Alzheimer's disease.

It has a positive effect on your immune system. A team from the Yale School of Medicine¹⁷ tested the theory that ketosis could protect against influenza.¹⁸ They found that infected mice that ate a keto diet were less likely to die from the virus than mice who were fed a standard diet.

Please note that while at least one of the study’s authors told news media that getting vaccinated against influenza is the optimal thing to do, there are other, better ways of fighting flu that I describe in "Will Eating Keto Help Prevent Flu?"

Fasting With Cyclical Nutritional Ketosis for Optimal Health

Using a cyclical approach to a ketogenic nutrition plan will help increase the health benefits and allow you greater flexibility in your meal planning. There are three things you need to do to follow this plan.¹⁹

1. Restrict net carbohydrates (total carbs minus fiber) to 20 to 50 grams per day
2. Consume 50% to 85% of your daily calories from healthy fat
3. Limit protein to one-half gram of protein per pound of lean body mass

It is important to maintain these ratios until your body is burning fat for fuel. Use keto testing strips to confirm you are in ketosis and keep in mind it may take a couple of weeks to a few months until your body is effectively burning fat. Once you're in ketosis and this starts happening, begin cycling in and out by eating a higher number of net carbs once or twice a week.

On your high-carb days, triple the amount of net carbs to maximize the biological benefit of cellular regeneration and renewal. However, I caution you to choose healthy alternatives such as digestive-resistant starches. Forgo the potato chips and bagels.

Fasting is a powerful lifestyle tool to combat obesity and insulin resistance. When you combine the power of fasting and the energy of eating keto it creates a strong foundation for optimal health. You’ll discover more about how these two plans interrelate in “Why Intermittent Fasting Is More Effective Combined With Ketogenic Diet.” 

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There has been a lot of buzz lately about freezing — and no, we don’t mean winter temperatures in Boston. Freezing fat, known medically as cryolipolysis, is one of the hottest trends in noninvasive body sculpting — that is, losing pockets of fat without needles, knives, or real downtime.

The basics of body fat

Let’s start with the basics. Not all fat is created equal. We have two distinct types of fat in our bodies: subcutaneous fat (the kind that may roll over the waistband of your pants) and visceral fat (the stuff that lines your organs and is associated with diabetes and heart disease).

From here on out, when we refer to fat, we are talking about subcutaneous fat, as this is the type of fat that cryolipolysis targets. A recent study showed that the body’s ability to remove subcutaneous fat decreases with age, which means we are fighting an uphill battle with each birthday we celebrate.

From popsicles to freezing fat

Cryolipolysis — which literally translates into cold (cryo) fat (lipo) destruction (lysis) — was invented, in part, by observing what can happen when kids eat popsicles. No kidding here. The cofounders of this process were intrigued by something called “cold-induced fat necrosis” that was reported to occur after young children ate popsicles that were inadvertently left resting on the cheek for several minutes. Skin samples taken from pediatric patients like these showed inflammation in the fat, but normal overlying skin. Thus, it appeared that fat may be more sensitive to cold injury that other tissue types.

Using this concept, a cooling device was tested on pigs in 2007 to see if fat cells could be selectively destroyed. The results were promising and predictable; there was about a 1/2 inch reduction in the pig’s fat layer, without damaging the overlying skin, in the treated areas. By 2010, the first cryolipolysis technology approved for human use, named CoolSculpting, was cleared as a treatment for love handles. Clearance for treating other parts of the body, including the thighs, belly, bra fat, back, underside of the buttocks, and chin soon followed.

How does cryolipolysis work? No one knows for sure, but we think that a few days after treatment, the cooled fat cells die. Over the next several months, macrophages, part of the immune system’s clean-up crew, digest the dead fat cells.

A cool procedure

To date, there have been more than eight million CoolSculpting treatments performed worldwide. Unlike liposuction, which can require anesthesia and comes with risks of bleeding or serious infection, CoolSculpting is a relatively safe in-office procedure, with minimal pain and no downtime.

The treatment itself takes 35 minutes per application, and multiple applications may be needed to cover an area. For instance, four or more applications may be needed to ensure even fat removal from the entire front of the belly.

The most common side effects of treatment include redness, bruising, swelling, tingling, numbness, or darkening of the treated area. Most of these side effects, if present, will resolve within several months after treatment. Perhaps the most significant, albeit relatively rare, side effect of cryolipolysis is, paradoxically, increased fat growth at the treatment site. The exact incidence of this side effect is unknown; however, it appears to occur less than 1% of the time.

Results can be seen as soon as three weeks, with maximum benefit seen at approximately three months. Average reduction in fat ranges from about 10% to 25% per round of treatment, and there is no evidence of any body-wide side effects. A second round of treatment may be needed after several months, depending on the desired results.

Who’s a good candidate for fat freezing?

Cryolipolysis appears to be a safe and effective treatment for fat loss without the downtime of liposuction or surgery. But it is important to note that cryolipolysis is intended for fat loss, not weight loss. The ideal candidate is already close to their ideal body weight, but has stubborn, pinchable areas of fat that are difficult to get rid of with diet and exercise alone. Cryolipolysis also doesn’t target visceral fat, so it won’t improve your overall health. But it may help you fit into your favorite pair of skinny jeans.

Follow me on Twitter @NeeraNathanMD.

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Worrying about all the news on the new coronavirus and the illness it causes? Well, that makes good sense. If you’re wondering how to cope with anxious feelings that are surfacing, this blog post can guide you through steps that may be helpful to many people.

If you often struggle with anxiety, worries about your health, or obsessive thoughts and actions, you might need additional assistance, as I’ll explain in a later post.

Steady yourself around worries about the new coronavirus

Knowing how to manage your own anxiety always takes a little thought. Ask and answer these questions:

• What typically happens to your body when worries mount?
• How worried are you?
• What do you fear the most?
• What usually helps you handle worries?

When anxiety rises because we’re facing a distressing threat like the new coronavirus, we need to focus on what tends to work for us to ease anxiety — that, plus doing a little bit more of some actions and a little bit less of others.

Keep these thoughts in mind. You’re fully prepared to help yourself. You can take steps to calm and steady yourself. Remember what works for you — because as fellow humans we’re not so dissimilar, but we do tend to have our own preferences and best practices.

Try doing these things more

• Connect with friends and loved ones through video chats, phone calls, texting, and email. It really helps to feel the strength of your connections to your friends and loved ones, even though you may not be with them in person.
• Stick with sources of credible medical information, so you can avoid misinformation about the virus and the illness it causes.

Try doing these things less

Please don’t overdose on hype or worry or misinformation. I get some regular updates from credible sources in the morning and check again briefly toward the end of the day. There’s no need to stay tuned in 24/7 — it can actually make your anxiety much, much worse.

Take practical steps to lessen risk of catching the new coronavirus

Three healthy, sensible steps we can all take:

• Avoid unnecessary travel and crowds.
• Wash your hands often with soap and water (or an alcohol-based hand sanitizer) for 20 seconds (see video).
• Keep your hands away from your face, especially your eyes, mouth, and nose.

Many people infected by the coronavirus develop symptoms like a fever and dry cough during the incubation period. However, some people may not seem symptomatic. The virus can spread when an infected person coughs or sneezes. Viral droplets that travel several feet through the air may be breathed in or — much more likely — may land on surfaces that other people touch, such as a door handle or elevator button.

We do have to be careful and cautious. But once we adopt key precautionary measures, we can take a deep breath and do our best to calm ourselves. It’s not necessary or helpful to be on high alert all the time. This will wear you down emotionally and physically. So try to adjust your level of alertness to your immediate surroundings. Then once you come home, wash your hands really well and find ways to relax and feel safe. Safety is a basic need for all of us.

How can you relax despite coronavirus worries?

Here are some tried and true ways to relax:

• Yoga. Not a yoga person? No need to start now unless you’d like to try it. Sometimes trying new things and discovering new activities you can benefit from and enjoy can be a welcome, healthy distraction. Yoga Studio and Pocket Yoga are good apps to consider.
• Meditation. Regular meditation is very calming. Many apps teach simple forms of meditation, such as Headspace or Calm.
• Controlled breathing. One simple technique is called square breathing. Visualize your breath traveling along a square. As you follow the instructions to inhale, hold your breath, or exhale, count slowly to three on each side. Try it now. Inhale up the first side of the square. Slowly count one, two, three. Hold your breath across the top. One, two, three. Exhale down the other side of the square. One, two, three. Then hold your breath across the bottom. One, two, three. After a few minutes of this you should be feeling calmer and more centered.

Tap into other ways you like to relax, too. Maybe you like reading a good book or watching a good comedy. Eat the familiar foods that you always enjoy. Stay in contact with your friends and loved ones. Reaching out can help you and help them.

We’re all on this journey together. News about the virus will likely grow worse, then grow better. Listen to public health experts who can help us navigate the path ahead. Take sensible steps that can help us all: get your bearings, practice good hygiene, use calming strategies that work for you — and maybe try something new. Making healthy, reasonable choices about what to do and what not to do will make a big difference in being able to stay as safe and as well as possible.

For more information about the new coronavirus, please see Harvard Health Publishing’s Coronavirus Resource Center.

Follow me on Twitter @JohnSharpMD.

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