The silent killer

Osteoporosis has for years been known as “the silent thief”. But silent killer? It may seem a bit dramatic, but take a look at the numbers.

Specifically, if one is 70 years old and they break their hip, 10% will be dead in three years. For those over 80 years old, the mortality is close to 33% within a year[i].

“By the time you are 75, the risk of death from a fall is enormous. It’s not as high as Alzheimer’s disease, cancer or heart disease, but it comes in pretty much just after that.” Dr. Peter Attia

Where does osteoporosis come in? 80% of all fractures over the age of 50 are caused by osteoporosis, defined in the Oxford Dictionary as “a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D”.

Almost 2 million Canadians are living with osteoporosis, with 1 in 3 women and 1 in 5 men suffering from an osteoporotic fracture within their lifetime.

Now before you say, “Phew!” because you aren’t even close to that age, think again. It may seem like an “old age” problem, but it is not an “old age” problem.

It's all about bone mineral density (BMD), which starts to decrease in our mid 30s. One doesn’t want to wait until they are 60 to start thinking about bone health, as by then our bone density may already be below normal. Especially in women.

We have to take steps to now to prevent injury later.

A quick bone recap

Bone is a heavily vascularized, living tissue. It’s actually an organ that plays a very important role in a number of different things – support, mobility, protection of our organs, and mineral storage - especially calcium, which plays a role in every one of our cells.

Our bone marrow, found in the centre of bone, is beyond critical. It produces our white and red blood cells. As well, in our “post” COVID world, it’s key to remember that the immune cells that keep the virus at bay (memory B cells and memory T cells) reside in our bone marrow.

What is the difference between osteoporosis and osteopenia?

The difference between the two is all about progression of the reduction of BMD. With osteoporosis, the reduction in bone mineral density is approximately 25%, whereas in osteopenia it is approximately 10%.

And although both men and women start to lose BMD in their mid 30’s, the pace for women increases as they approach menopause, with anywhere from a 2-5% BMD reduction per year.

Why “the silent thief”?

The reason osteoporosis is known as the silent thief is because there aren’t any symptoms associated with it. Often the way people find out is by… breaking a bone. And if you are 50 years of age or older, as mentioned above, there is a good possibility it is due to osteoporosis.

How and when do we test for Bone Mineral Density?

We are able to determine our BMD with a DEXA scan. They are safe (very low radiation), painless and effective. It takes about 10 minutes for your body to be scanned.

In Canada, it is recommended that all men and women 65 years of age and older get a bone mineral density test (which, in my mind, is too late). One exception is for younger, post-menopausal women who have other risk factors for fractures, including parents who have had hip fractures and parents with a history of osteoporosis; high alcohol intake, and low body weight (under 132 lbs). It’s definitely worth reading the full list.

So what to do?!

Increase your awareness
Overall, we should always be thinking about bone health rather than taking it for granted (which is easy to do, especially with no symptoms). And not only thinking about us, but also laying the foundation with our kids (all ages) is very important.

Menopause
As women, we want to REALLY start thinking about our bone health during both perimenopause and menopause, but especially during menopause. Estrogen plays a key role in bone health. It promotes the activity of osteoblasts (cells which build bones), and slows the natural breakdown of bone.

Estrogen levels fluctuate during perimenopause, and then decrease dramatically during menopause, the 12 consecutive months of no period.

Given that the average age of menopause is 51, if you have a fragility fracture (a fall from standing height or less) between the ages of 50-65, ask for a DEXA scan (although your doctor should automatically suggest it in these instances).

Men and Estrogen
Men lose estrogen as they age as well, but at a far more gradual rate than women, which is why women experience more bone loss, putting us at a great risk of osteoporosis and osteopenia.

Things that lower bone density

• Family history – red flag if either parent has a history of a hip fracture

• Genetics – accounts for up to 50%

• Smoking

• Alcohol

• Low calcium intake (from diet)

• Low vitamin D intake

• Female endurance athletes

• Certain medications (including corticosteroids (ie – prednisone), “heartburn” drugs (ie – proton pump inhibitors over the long term), breast and prostate cancer drugs, antiepileptic drugs, excessive thyroid replacement therapy, etc.)

• Lack of exercise

• Others

Lifestyle steps to take to increase bone mineral density

1. Resistance Training – the single most important tool
LOAD YOUR MUSCLES – muscles are attached via tendons to your bones, so when you are loading your muscles your bone senses they need to support a greater force, and in response to that it remodels by depositing more and more bone tissue.

Bone mass increases in the presence of stress. The more it strains your muscles, the better it is for your bones. Dr. Peter Attia

Examples include:

• Strength training

• Lifting heavy objects

• Climbing stairs or walking uphill

• Walking downhill

• Rucking (my new favourite way to walk!) – walking with weight on your back, as in a backpack with weight in it (use your own pack and be creative with what you pack it with).

Unfortunately, low weight bearing, low impact, aerobic activities and sports like walking (without weight), swimming and cycling don’t really seem to maintain or improve BMD much. Even the data on running isn’t all that positive, although some studies say that low to moderate running has a slight positive impact on BMD. Long distance endurance running, however, may have adverse effects on BMD.

2. Nutrition and Supplements
There are three important micronutrients, and one macronutrient when it comes to bone health:

• Calcium

• Vitamin D (D3 specifically)

• Magnesium

• Protein

Calcium
We should be getting 1000mg-1200mg per day. I strongly recommend (as does Osteoporosis Canada) to get your calcium from food. It is best absorbed that way, and we never have to worry about getting "too much" calcium if from food. Best sources include:

• Dairy

• Dark green, leafy vegetables, including broccoli, kale, collards

• A serving of canned salmon or sardines (it’s the small bones that contain calcium)

• Calcium fortified soy, almond and rice beverages

If you eat dairy, you should be able to get enough – if not, you may have to look at supplementing. Calcium citrate and calcium carbonate are two good options. Speak to your health care practitioner before taking, and definitely don’t take too much. There are many who don’t support calcium supplements. Finally, if you do need to supplement, don’t take more that 500mg at a time as our body can’t absorb more than that in one sitting. NOTE – read this and this before you start supplementing.

Vitamin D3
Vitamin D3 is essential for the absorption of calcium into our bodies, hence is essential for bone health. Due to its limited availability in food, and our limited exposure to sun in Canada, it’s recommended that we supplement. Osteoporosis Canada suggests 19-50 years of age supplementing between 400-1000iu’s, and if over 50 (or with a history of osteoporosis, fractures, etc.) supplementing with 800-2000iu’s.

Magnesium
60% of the magnesium in our body is found in our bones. It is essential for bone health with respect to how it interacts with calcium and vitamin D (as well as phosphorus and our parathyroid hormone, which in itself is responsible for regulating calcium in our body). In effect, bone health is a team effort of nutrients!

Many of us are deficient in magnesium, and although we can get it from foods (including certain nuts, seeds, legumes and whole grains) it’s often tough to get the recommended amount (minimum ~500mg daily), so I often recommend people supplement with it. Magnesium carbonate and glycinate are what I suggest, but magnesium citrate and oxide are also good especially if you want to speed up your bowels!

Protein
Protein gives our bones strength and flexibility, and the nutrients it needs for building and repairing. As we age we tend to eat less protein – especially women. Less protein means more fragile bones and weaker muscles – both of which can be serious issues as we get older.

We want to eat protein at every meal - our body and brain need it on demand, plus protein is utilized as soon as it is ingested and can’t be stored, so having it all at one meal doesn’t work.

The MINIMUM we want to have is .36 x body weight (in lbs). So if you weigh 140lbs, you would need a MINIMUM of 50g of protein per day, evenly distributed over the course of the day. But most experts in the field say that is not enough, and recommend anywhere between .5g and 1g per pound of body weight.

Did I mention minimum?! I’ve included a list of foods with protein amounts here.

3. Menopause Hormone Therapy aka Hormone Replacement Therapy (HRT)
As many of you know, this is becoming more widely accepted nowadays, after it’s been shown that the Women's Health Initiative Study was flawed in many ways (this was the study that purported that the risk of breast cancer and cardiovascular disease went up with the use of HRT).

Having said that, within the study, there was no ambiguity that fracture risk was decreased in the women taking HRT.

This is all to say that one might want to consider taking HRT, to help with peri and menopausal symptoms, which are debilitating for many, as well as to help with bone health. There are two good books on the topic of HRT, Estrogen Matters and The Estrogen Window . You may want to consider reading one or both of these books to get a better understanding of it all.

If you are considering HRT, talk to your doctor, and/or, if you’d like to talk to a menopause specialist, reach out to Teresa Isabel Dias at MenopausED. She is excellent.

Summary
Whew! I know I've just thrown a lot of information at you, but I feel it’s so necessary to get the word and information out there so one knows both the risks and the steps one can take. I don’t feel that bone health is spoken about enough given the risks, but also given the fact that it can be addressed through lifestyle.

If you have any thoughts or feedback on the above information, please feel free to share with me.

Thanks for reading :)

Gillian xx
PS - for those of you in Toronto and surrounding area who simply want an intro-session on nutritional and lifestyle recommendations, think about booking my Walk & Talk Wellness Reset. A one hour walk - you talk, I listen. Let me help you set some goals - nutrition, sleep, cognitive health, stress management, and movement - and put some systems in place to help take your health to the next level. You can reach me by replying to this email or at gbwellness.ca.

[i] Haentjens.et al., Ann Intern Med, 2010

Your brain matters

It's time to talk about our brains... again.

That is because today, September 21st, is World Alzheimer’s Day, and also because recent stats state that one million Canadians will have Alzheimer’s by the year 2050. Hence, I thought it would be timely to kick off my post-summer monthly newsletter by talking about our brain.

As I’ve said on many occasions, Alzheimer’s is a lifestyle disease. Of course there are other contributors… hearing loss and social isolation being two big ones. And yes our genetics play a role, although depending on which genes we have, genetics may not play as big a role as we think.

Today, I want to focus on a key element of lifestyle - the food we put in our mouths.

How does food affect our brain? A quick recap.
There is a direct link between our gut and our brain (creatively known as the gut-brain connection ;-). This link is facilitated by our vagus nerve, along with other pathways between the two.

We have trillions of bacteria in our gut – many good, some not so good. The ones we feed become dominant. And if it’s the bad bacteria that become dominant, they can cause a myriad of issues all linked to inflammation (depression, anxiety, cardiovascular disease, obesity, diabetes, chronic headaches, memory problems, cancer, auto-immune diseases, and yes, Alzheimer’s).

What we eat not only dictates how we think and feel - it can also increase the risk of Alzheimer's disease.

Not only that, women are dealt a double whammy. Perimenopause and menopause also play havoc with our brain, given the big drop in estrogen we experience. So what we eat becomes even more important.

Alzheimer’s disease, from what we understand to date, is a result of a build-up of amyloid plaques in the brain. This build up can start years, even decades, before we see symptoms. In fact, Dr.Rudy Tanzi, a Professor of Neurology at Harvard and the founder of the first AD genetic marker, states that amyloid is to Alzheimers as cholesterol is to heart disease, in that cholesterol develops decades before we have a heart attack. Alzheimer's starts in our brain years, even decades, before we see any symptoms.

How to avoid neuro-inflammation thru eating?
We all know by now that what we put in our body matters. And yet many women still struggle with this. And I understand – there are so many barriers when it comes to eating a healthy diet - cost, lack of time, stress, lack of comfort in the kitchen, long-term negative behaviours around food… the list goes on.

So the best place to start? Just choose one thing. Whether it’s taking something out or adding something in – whatever it is, make sure it's something you can do without crazy resistance or barriers. Over time, feel that success, and then look to tackle something else.

The key is starting, no matter how big or small the change.

The Med Diet Protocol
Richard Isaacson, world renowned neurologist and presently a researcher at the FAU Centre for Brain Health, states the number one most evidence based way to eat for a healthy brain is the Mediterranean style diet – vegetables, fruit, whole grains, beans, nuts, seeds, olive oil, with moderate fish, meat and dairy.

Green leafy vegetables
And within that, Dr. Isaacson states green leafy vegetables are the most evidence based brain healthy carbohydrates (yes, vegetables are carbohydrates!) that a person can eat. And the darker the greens, the better for the brain.

Fibre is key
Fibre is food for your good bacteria. If they are happy, they will produce chemicals that make your brain happy. Fibre also helps keep your blood sugar balanced, avoiding the blood sugar spikes which over time increase inflammation and insulin resistance, ultimately accelerating amyloid production and deposition.

For fibre, think vegetables, fruits, nuts, seeds and whole grains. In fact, vegetables should make up half your plate at lunch and dinner.

What else? Diversity.
Our gut microbiome thrives on diversity.

The ultimate goal, outlined by the American Gut Project, is to eat 30 plants a week. And before you scream, “That’s impossible!!!!”, hear me out. Plants include: beans, legumes, nuts, seeds, tofu, other soy products, vegetables, fruit, herbs and spices.

Having said that, yes, it’s a lofty goal, so other ways of increasing diversity are:

• Eating as many different coloured vegetables as you can

• Including both raw and cooked vegetables

• Roasting vegetables – an easy way to get many colours in at the same time (and a great way to use up little bits and pieces of vege before they go bad). Toss in olive oil, throw in a bit of rosemary or any other herb/spice (fresh or dried), 400 for 20 minutes, and you’re done

• Thinking outside the box

  • bokchoy and shaved brussel sprouts are great in salads

  • if you are don’t have greens, make a “salad” out of whatever vegetables you have

  • add beans, legumes and nuts/seeds to your salads

• Make soup more often – you only need onion (a bacteria fave), vegetable(s), broth (or water) and a blender (optional)…easy peezy.

• Use frozen vegetables - their minerals and fibre remain intact (although they may lose a few vitamins)

Now before you think it's all about food, it's not. As mentioned, there are a variety of different lifestyle contributors when it comes to Alzheimer's, and for some experts, exercise is actually at the top of the list. Hence, to be continued!

In the meantime, take advantage of the colourful fall harvest at your neighbourhood farmers market... a great way to kickstart whatever you plan to embrace going forward.

Happy eating :)

Gillian x
PS - for those of you in Toronto and surrounding area who want to kickstart your health in a bigger way, my Walk & Talk Wellness Reset is up and running. It's a fantastic way to get the therapeutic benefits of a walk in nature while getting personalized nutritional and lifestyle recommendations. Let me help you set some goals - nutrition, sleep, cognitive health, stress management and/or movement - and put some systems in place to help take you to the next level. You can reach me by replying to this email or at gbwellness.ca.

Hara hachi bu for health and longevity

The Okinawan Japanese have a saying: hara hachi bu, which means, roughly translated, “Stop eating when you are 80% full”. 
 
The French say, “J’ai assez mangé", translated to “I have eaten enough”. 
 
North Americans? We tend to say, “I’m so full”.
 
Sadly, this is one of the reasons so many people in North America are struggling with chronic illnesses and weight gain. Simply eating too much.
 
Now – truth be told - I don’t have any proof that the French phrase, “J’ai assez mangé” has led to healthier lives in France, but given that cheese, bread and wine are the fabric of their eating culture, and yet their obesity rates are the lowest in the OECD, my guess is yes.  But, there has definitely been a great deal of interest in hara hachi bu, and the health outcomes of those who practice it.
 
Hara hachi bu

Hara hachi bu is a Confucian teaching and cultural practice from Okinawa, Japan. Literally translated, it means, “eat until you are 8 parts (out of 10) full ”.
 
Okinawa is one of the world’s Blue Zone regions, where its people have one of the longest life expectancies in the world, and they have been practicing hara hachi bu for almost a thousand years.  Dan Buettner, the man behind the research on The Blue Zones, says that if you have ever had the privilege of dining with an Okinawan elder, you would hear them "intone this Confucian-inspired adage before beginning the meal". 
 
Of course it’s not the only reason for their health and long life expectancy, but it’s definitely part of the reason.  That’s because it is a form of calorie restriction, but without the negative connotation.  
 
Reducing caloric intake increases health, cognition and longevity

Research has shown that reducing our caloric intake can boost cognitive capacity, reduce cellular aging and promote longevity.[i]  It’s based on the premise of nearly a century of scientific data that stressing our bodies and brains through caloric restriction (in a society where we eat more than we need) increases the resilience of our cells, making them stronger. 

It’s like our muscles – the more we stress them the stronger they get.  From another angle, it’s also one of the reasons cold water therapy is so popular – stressing our bodies to make us more resilient. 
 
But back to food.  Not only can reducing caloric intake increase the body and brain’s cellular resilience, but, for women especially, it can help us keep a healthy and stable weight, which in turn helps us avoid insulin resistance, diabetes, heart disease and even hot flashes – all things that are aggravated by excess body fat. 
 
How to eat like an Okinawan

Whole plant foods make up 90% of the traditional Okinawan diet, but to specifically help prevent overeating, here are some tips below:
 

• Manage your blood sugar levels – Are you getting enough protein and fat?  How many refined carbohydrates are you eating during the course of a day?  Try to stick with whole grains, always pair them with a protein or fat, and try to have carbs at just 1-2 meals instead of 3.  Then go wild on vegetables and leafy greens :-)

• Slow down your eating - Drink a glass of water 15 minutes before eating, and/or snack on vegetables and hummus (or another healthy dip) while preparing your meal.  This curbs your appetite, getting rid of that “hangry” feeling, and allows you to eat more slowly instead of "shovelling". It takes about 20 minutes before leptin, our satiety hormone, triggers our brain to tell us we are full, so slowing down our pace of eating helps avoid overeating before our brain signals we are full. Starting with the vegetable also knocks off a vegetable serving, something I recommend we should always strive to do.

• Focus on better sleeps – Having poor sleeps disrupts our energy balance hormones.  Ghrelin, known as the "hunger hormone", signals us to eat, and leptin, the satiety hormone, directs us to stop eating.  These hormones become disrupted when we lack sleep, where it feels like ghrelin is constantly being triggered (we want to eat non-stop, especially carbohydrates) and leptin is nowhere in sight. 

• Opt for smaller plates – this seems almost too simple but it is very effective.  The larger the plate / bowl, the larger the serving. Period. 

• Sit down when you are eating, and be mindful of what you are putting in your mouth – Standing up or walking around while eating disrupts our digestive process, potentially leading to bloating and poor absorption of nutrients, and often overeating.  Sit down, take a couple of deep breaths, recite hara hachi bu to yourself, and enjoy your meal.

 
Ikigai and Moai

Eating in moderation by following the practice of hara hachi bu can absolutely take us to the next level of health, but of course nothing is done in a vacuum.  I felt compelled to share two other Okinawan practices attributed to their longevity, even though I am ending on a bit of a tangent.  

Ikigai translates to “reason to live” - what we would consider purpose.  And Moai?  It refers to having a group of lifelong friends. 

At the end of the day, it's important to consider all the pillars of health, including those that are food for our soul, like Ikigai and Moai.  

Thanks for reading :)

Gillian xx

PS - If you are struggling with a health issue, feel free to reach out for a discovery call.  Let me help you set some goals - nutrition, sleep, cognitive health, stress management and/or movement - and put some systems in place to help take you to the next level. You can reach me by replying to this email or at gbwellness.ca.

[i] Mattson MP, et al. J Nutr Biochem 2005;16: 129-137

Wise words from Kurt Vonnegut

Hello!

Yes, it’s been a while.

I'll be honest – I sometimes find it difficult to get inspired to write. Being immersed in this field of nutrition and lifestyle, I assume that everyone else is immersed in it as well. Hence I feel at times my words are only adding to the deluge of information already out there.

But yesterday I was inspired - albeit from a different angle. The message is short, important, and compliments the solid, science-backed information I will continue to share with you going forward.

The following is advice from Kurt Vonnegut Jr. back in 2006 (he was 84 years old at the time), in response to a student’s request for advice on life. The student sent the request to hundreds of authors. Only Mr. Vonnegut responded.

The key line in his response is as follows, although I strongly recommend that you read Kurt’s full letter included here (it's very short and worth the read):

“Practice any art, music, singing, dancing, acting, drawing, painting, sculpting, poetry, fiction, essays, reportage, no matter how well or badly, not to get money and fame, but to experience becoming, to find out what’s inside you, to make your soul grow.”

So how does this relate to our health?

I think the answer is in the following quote, which was in the comment section of a YouTube video (formerly a TED Talk video), titled: What you can do to prevent Alzheimer’s by Lisa Genova, Neuroscientist, Speaker and Author of Still Alice.

“My mother died of Alzheimer’s at age 88, but lived 17 years of meaningful life after diagnosis. I attribute her amazing resistance to the onset of debilitation to her voracious appetite for news, walking, reading, politics, being a wordsmith and her lifelong discipline of moderation in food and alcohol intake, and love of classical music.”

I've bolded everything except the reference to moderation of food and alcohol for a reason.

Yes, good nutrition plays a critical role in Alzheimer’s risk reduction, as it does in the prevention of chronic diseases (often referred to as "diseases of aging"), where 44% of Canadian adults over 20 years of age have at least 1 of 10 common chronic conditions.

BUT...

In our effort to "get healthy", we often overlook the intangibles - the food for our soul (voracious appetite for news, reading, being a wordsmith, love of classical music...), in addition to the food on our plates.

Something that motivates us, gives us purpose, puts a smile on our face; learning, being curious; something within which we are so immersed that all of life’s challenges disappear during those moments; where we get the immediate, deep satisfaction of achieving something, whether it’s ripped up immediately afterwards or not (see Kurt's letter).

It's important to recognize that the pursuit of something that touches our soul could be just as important as the four pillars of health (nutrition, sleep, exercise and stress reduction). Maybe the fifth pillar of health? And perhaps this pursuit could even inspire us to change our behaviours around food and lifestyle, helping us lead a healthier life overall.

So read (or reread) Mr. Vonnegut's letter, and if you aren't already doing something that "makes your soul grow", then give yourself permission and time to figure out what that might be. And then just do it.

Thanks for reading :)

gillian xx

Why Alzheimer's is a Women's Issue

As Brain Health Awareness week comes to an end, I thought I would talk about the most dreaded form of brain illness, Alzheimer’s Disease. Many people think of Alzheimer’s as an “old age” disease. Please think again.

Yes, age is the biggest risk factor, and yet we are all living longer, so our risk automatically goes up. But it’s not an “old age” disease.

That’s because Alzheimer’s starts in the brain decades before symptoms start to show.

Not only that – some of the biggest risk factors for Alzheimer’s Disease (AD) are very prevalent nowadays – high blood pressure, high cholesterol, obesity, and of course diabetes.

Another risk factor? Being a woman.

Some sobering facts

Every 65 seconds another person develops Alzheimer’s disease, and of these “newcomers”, two-thirds will be women.

In 2020, there were 5.7 million people diagnosed with Alzheimer’s (the most common form of dementia) in the US (the rates are similar in Canada). If rates continue at the present pace, the numbers will triple by 2050.

Did I mention that two out of every three Alzheimer’s patients are women?

In fact, a study from The Netherlands of more than 12,000 people found that women at 45 years of age had a 25.9% risk of going on to develop dementia, compared with 13.7% for men.

Finally, women in their 60s are about twice as likely to develop Alzheimer’s over the rest of their lives as they are to develop breast cancer.

These are serious statistics.

Sadly, research has lagged behind, especially when it comes to research on the female brain. For years we have been lumped into the “one brain fits all” category.

Thankfully, that’s changing, in part thanks to the research of Lisa Mosconi, a neuroscientist and Director of the Women’s Brain Initiative at Weill Cornell, and Dr. Richard Isaacson, a world-renowned neurologist and Director of the Centre for Brain Health at Florida Atlantic University (both of whom I’ve mentioned in past newsletters).

The critical role of hormones, especially estrogen

Women’s brains become more vulnerable to Alzheimer’s in the years leading up to and after menopause, with estrogen playing the lead role. In fact, estrogen is a major, if not the major, hormonal driver of women’s brain health.

Estrogen, among many of its roles, is a neuro-protective hormone, boosting the brains immune system. With the decrease of estrogen and other hormones during menopause, we not only experience many of the symptoms associated with menopause (which, by the way, originate in the brain, not the ovaries), we also lose key protective elements in our brains.

As per Lisa Mosconi, for most women these changes manifest themselves as a host of symptoms associated with menopause, but for some women, hormonal changes diminish the brains ability to resist diseases like Alzheimer’s.

The good news?

Alzheimer’s starts in our brain decades before any symptoms start to show. In fact, studies say that 46M Americans have Alzheimer’s in their brain right now with no symptoms. It’s referred to as Stage 1 – the presymptomatic stage or preclinical stage.

And why is this good news? Because THIS is the time where we can make a difference in our brains – both with respect to Alzheimer’s, as well as cognitive decline in general. We have the power to potentially change the course of this debilitating disease through lifestyle.

Risk factors

Given that diabetes is one of the pathways to Alzheimer’s, the presence of three or more of the following markers could suggest prediabetes (often referred to as metabolic syndrome), so it’s very important to know your numbers:

• elevated fasting glucose

• elevated triglycerides

• reduced HDL

• high blood pressure

• obesity

• excess belly fat

Other risk factors include lack of social connection, hearing loss and long term sleep deprivation.

As well, having the APOE4 gene increases our risk (approximately 25% of the population has this gene), but it doesn’t mean we are destined to get it. Having multiple risk factors along with the APOE4 variant, such as high cholesterol, does increase the risk though.

As does being a woman.

So what to do?

There is no effective cure in sight. But evidence, through brain scans and an increasing number of studies, is showing that lifestyle plays a critical role in both preventing or postponing Alzheimer’s. Some researchers would even venture as far as saying that lifestyle could reverse AD.

So at this point the key is to do everything we can to not only reduce our risk of developing the disease, but to simply avoid cognitive decline as we age - even enhance it.

In subsequent newsletters, I will delve into specifics (especially exercise, which, for many researchers is at the top of the list). But for now, broadly, I will sum up things we can do in five key points, based on the mnemonic NEURO, coined by Dean and Ayesha Sherzai, authors of The Alzheimer’s Solution:

NUTRITION – The Sherzai’s believe that a plant-based diet gives us the most protection for our brain, in part because they feel plants have all the nutrients we need for our brain to operate at an optimal level, and in part their belief that animal products are highly inflammatory for the brain.

On the other hand, Richard Isaacson and Lisa Mosconi are supporters of the Mediterranean diet (or versions of it such as the MIND diet) for cognitive health.

BOTH agree that sugar intake should be minimized.

EXERCISE – As mentioned, this is at the top of the list for many researchers, including Dr. Isaacson:

“If there is one single thing that you can do today to improve your mind, to optimize cognitive function and reduce your risk of Alzheimer’s disease, by far, hands down, the number one thing you can do is physical exercise”.
Excerpt from the Mastering Brain Health Series, Physical Exercise and Habits

Exercise, including BOTH strength training and aerobic, has an enormous impact on brain health, boosting cognitive function by increasing blood flow and other chemicals. Long periods of inactivity mean less blood flow to the brain.

UNWIND – Chronic stress keeps our cortisol levels high, affects our hunger centres, our immune system, other hormones and ultimately our brains. Breathing, meditation, yoga, social connection and having purpose are all ways to help decrease stress levels.

RESTORE – As we all know by now, restorative sleep is critical for good health. It is necessary for memory consolidation and removal of toxic by-products, like amyloid, which build up in the brain.

OPTIMIZE COGNITIVE ACTIVITY – I read a great way of describing this recently, “We should all live at the overlap of complex, purpose and challenge”. Learn something multi-dimensional, like dancing, learning a new language, writing a book or learning a new instrument. We need to truly engage our brains.

These recommendations are broad, and I look forward to getting into more detail on both exercise and nutrition, as there are some key takeaways within those areas that I feel will be helpful.

The place to start right now? If you haven’t done so already, get your blood tests done. And take your blood pressure (all pharmacy's offer this). Then do your research to find out if you need to take some steps to better your numbers. As I mentioned in a recent newsletter, the ranges on our lab tests in terms of what is considered “normal” provide a bit too much leeway.

I listened to an excellent podcast recently by Dr. Casey Means, MD, Stanford-trained physician, Chief Medical Officer and Co-founder of the metabolic health company Levels Health. She provides some solid guidelines on what we should be aiming for when it comes to our key lab test results.

Summary

We have to be active participants in our health care, whether it be prevention of Alzheimer’s disease, enhancing our cognitive health or taking care of our overall health. We know that lifestyle modifications make a difference.

And as women, we need to be extra-vigilant when it comes to our brain health. The key? Start now.

Thanks for reading :)

Gillian x
PS - for those of you in Toronto and surrounding area, Spring arrived today (!) and my Walk & Talk Wellness Reset is up and running. It's a fantastic way to get the therapeutic benefits of a walk in nature while getting personalized nutritional and lifestyle recommendations. Let me help you set some goals - nutrition, sleep, cognitive health, stress management or movement - and put some systems in place to help take you to the next level. You can reach me by replying to this email or at gbwellness.ca.

How to live a long and healthy life!

We are living longer. Not only that, there is a massive scientific push in the field of longevity to live to 150 years old. And that’s just the beginning.

I’m not here to discuss the pros and cons of living to the ripe old age of 150 (I, for one, have no interest in living that long), but there is very good reason to listen to HOW we could reach that age. That is because the ramifications can have a very positive impact on other diseases that are literally “taking us down” as we age (often referred to as “diseases of aging”) – cancer, heart disease, Alzheimers and type 2 diabetes to name a few.

Regardless of how long we can prolong our livelihoods on this planet, the key is to be healthy for the ride.

Lifespan vs healthspan

Lifespan is the total number of years we live (longevity) whereas healthspan is how many years we remain healthy and free from disease. They are inextricably linked.

Both are affected by a myriad of factors, often falling under the umbrellas of emotional factors (loneliness, emotional stress, personality, outlook on life, etc), and/or biological factors. My focus here is from the biological perspective – think genes and DNA, specifically when it comes to food (exercise also plays a big role, but that’s for a future newsletter).

David Sinclair, author of the book Lifespan: Why We Age and Why We Don’t Have To, is a professor in the Department of Genetics and the co-director of the Paul Glenn Center for Biology of Aging Research at Harvard Medical School. He is best known for his work on understanding why we age and how to slow its effects.

David’s overall recommendation would be this:

The key to longevity when it comes to food is to eat less often.

(Note - when I use the word longevity, I am also talking about healthspan – how we can stay healthy as we age. The recommendations for longevity are the same as they are for staying healthy during that time).

Eating less often

This is not about eating fewer calories (although it could mean that), nor is it about calorie deprivation. It’s more about eating calories within a shorter period of time.

And it is the period of not eating that is the focus here, because that period of “hunger” is critical to boosting the body’s defences against aging, and in turn maximizing health and longevity.

Hormesis

So how is being hungry a good thing?

Eating less often triggers longevity genes in our body, and it does this by stressing our system - known as hormesis.

In the field of biology and medicine, hormesis is defined as "an adaptive response of cells or organisms to moderate (usually intermittent) stress." (1)

Or, more blatantly, what doesn’t kill you makes you stronger. That is, in effect, what exercise is all about – breaking down muscle in order to build it back up again, even stronger.

But in this case we are talking about food – or lack thereof. By stressing the body through taking longer breaks between eating times, we can activate our longevity genes - critical for helping us age well.

Longevity Genes

There are three classes of longevity genes, each triggered by external stimuli/stressors. I will give a brief overview of each, but feel free to jump to the bottom of this newsletter for recommendations if your eyes start to glaze over ;-)

1. Sirtuins – a sirtuins role is to extend lifespan (and support healthspan) by protecting our DNA and making sure that genes stay turned on when they are supposed to be on (trust me, this is very important).

Sirtuins are activated by low energy - specifically lower glucose levels. When we don’t eat we have lower glucose levels.

(Note that we evolved this way - the hunter-gatherers were not running to the fridge every time they got hungry. Getting food was a serious undertaking.)

2. AMPK – AMPK stimulates the body to make more mitochondria, which are the power plants of every cell and create energy for all of our biological processes. Hence AMPK is critical for longevity, especially since we lose mitochondria as we age.

AMPK, like sirtuins, is activated by low energy – when we are hungry, we make more of it.

3. mTOR – mTOR activates autophagy. Autophagy is a process of removing damaged parts of cells and recycling others – like cellular housekeeping.

In the case of mTOR, it recycles old proteins (a good thing). The twist is that mTOR is activated by amino acids (protein), and yet we don’t want mTOR to be activated. By downregulating the activity of mTOR, we get the benefits of autophagy. Aka, eating less protein.

So… what is the best way to activate these genes when it comes to food?

Basically, some sort of fasting.

But for the purpose of this newsletter, I only want to focus on Time-Restricted Feeding (TRF - often referred to as Intermittent Fasting). For more details on different types of fasting, refer to one of my earlier blogs titled, Why intermittent fasting is all the rage.

With respect to time-restricted feeding, there are varying eating windows, with 12/12 and 16/8 being the most common - the first number reflects the hours you aren’t eating, and second reflects the eating window where you are eating.

For example, a 12/12 would be if you finished eating dinner at 8pm in the evening, and started your breakfast at 8am the next morning.

Is there a TRF window that is considered "the best" for longevity?

Yes. Studies have shown that in order to most effectively trigger the sirtuin and AMPK pathways, you want to have at least 16 hours of not eating (if not longer). That would mean if you stopped eating at 8pm in the evening, you wouldn’t eat until 12noon the following day. It would take your body a couple of weeks to adapt to this in order to overcome the feeling of hunger during the time of non-eating (where you normally would be satiated).

The secret? Liquids – lots of water and herbal teas. And if there are days where hunger pangs are too much to handle, the best option is to have a handful of nuts (the fat in nuts doesn't affect your blood sugar).

The shorter the eating window, the more effective it is for longevity, states David Sinclair. For example, only having one meal a day, as he does, would essentially be a two hour window of eating and a 22 hour window of fasting.

For me, given food is one of my biggest pleasures in life, this option is definitely not on my list, no matter how many years it may add to my life!

On that note, it is very important to understand that I’m not actually recommending any type of fasting. Not only am I not allowed to do so in this forum, but more importantly, we are all individuals. We have different lifestyles, different tolerances, different sexes, different microbiomes, different health histories… the list goes on. Diets and ways of eating affect everyone in different ways. There is no one "right" way.

Rather, my goal (always) is to provide information and for you to make your own choices.

There are definitely benefits associated with time restricted feeding (TRF), even if doing the minimum 12 hours eating and 12 hours fasting (which is recommended in general, as it gives your digestive system a break and depletes your glycogen (glucose) stores before loading up on them again). Benefits include:

• Lower blood sugar levels

• Improved blood pressure

• Improved heart function

• Weight loss, especially stubborn belly fat

• Increased cognition (reduced brain fog)

• Enhanced aerobic capacity

As an aside, it’s no wonder that Intermittent Fasting (TRF) is the most popular “diet” right now in the US. It’s inexpensive, accessible to everyone and can have a big impact on our health, healthspan and longevity.

What about cutting back on protein?

In order to trigger (or not trigger in this case) mTOR, the other longevity gene, it is suggested that we avoid/cut back on super high proteins – think meat. Otherwise, the autophagy, in this case the recycling of protein that low mTOR stimulates, won’t be initiated.

Nowadays, the concept of cutting back on meat isn’t too much of a surprise… the focus of both the Blue Zones and the Mediterranean diet. We know that amino acids (the building blocks of protein) are essential, but taking the proper steps, we can get all the protein we need from diets such as the Med diet, or with a vegetarian or vegan approach. It just takes work to ensure our protein (and other nutritional needs) are covered.

Legumes, nuts, soy and quinoa are all good sources, plus all plants have a certain amount of protein. Finally, certain combinations of foods (ie - rice and beans together) provide a full amino acid complement. These Blue Zone recipes provide great suggestions if you want to go down that path.

Are there certain types of foods we should be concentrating on wrt to longevity and healthspan?

For sure - the same foods I talk about all the time - eat more vegetables, berries, legumes, whole grains, nuts, olive oil, good fats (and a splash of red wine of course ;-). And minimize sugar and processed foods. As for meat... there is much research being done on how plant based diets enhance longevity (compared to other approaches), but as always it's a personal choice.

Summary

I've thrown a lot of information at you. But in fact, the key elements to remember with respect to longevity and healthspan are pretty straightforward:

• Eat less often* – for best effects, skip one meal a day, either breakfast or dinner. Think of hormesis - how stressing the body (within limits) strengthens it in the long term. It puts our body into a state of "want" in order to fight diseases of aging, such as cancer, Alzheimers, heart disease and T2D, to achieve ultimate health in old age and enhance longevity

  • drink lots of liquids (water and herbal teas) to reduce feelings of hunger

• Try to avoid snacking - have a handful of nuts if necessary

• Reduce meat intake

*NOTE: it’s always best to work with a professional when doing any sort of fasting. Plus it is not recommended if you are pregnant, suffer from disordered eating or having any adrenal/thyroid issues.

Remember – the average lifespan is getting longer, but not necessarily better. We want to ensure those extra years are as productive as possible. In order to do this, we need our health. So let’s start thinking in terms of BOTH healthspan and lifespan.

Thanks for reading :)

Gillian xx
PS - for those of you in Toronto and surrounding area, my Walk & Talk Wellness Reset is up and running. It's a fantastic way to get the therapeutic benefits of a walk in nature while getting personalized nutritional and lifestyle recommendations. Let me help you set some goals - nutrition, sleep, cognitive health, stress management or movement - and put some systems in place to help take you to the next level. You can reach me by replying to this email or at gbwellness.ca.

How to Make Lasting Change

Happy New Year!

And as we move into 2022, many of us are setting intentions / resolutions / goals with a fire in our belly because THIS is the year we are actually going to achieve them!

But in order to do so (sadly approximately 80% of people fail in achieving what they have set out to achieve), we need to understand that much of what we accomplish (or don’t accomplish) revolves around our habits.

I was watching the news last night, and feeling sick for all the businesses that have had to close down because of the latest rise in COVID cases. There was a photo of an empty gym, and my immediate reaction was that gyms will really be hit hard because they are missing out on their biggest month of the year – January – when everyone signs up and the gyms are packed… for three weeks.

When it comes to our health, more often than not we know what we are “supposed” to be doing. And if we don't, we have all the information we need at our fingertips. And then some.

This is the crazy part – even when we are suffering and have all the information we need:

We. Still. Don’t. Do. It.

Why is that?

Because change is hard! We are creatures of habit, even when we are uncomfortable. In the book, Change or Die, one example cites 1.5M people in the US with heart disease having undergone traumatic heart surgery to unblock arteries, and being told afterwards that if they didn’t change their lifestyle, the heart disease (which would eventually come back) could kill them.

90% of those people didn’t change their lifestyle.

The thought of change can be overwhelming. And we know we aren’t alone because so many books have been written on habits (critical for change), two of the most recent being the best selling books Atomic Habits by James Clear and Tiny Habits by BJ Fogg.

Back to setting New Years resolutions…

One (of many) things in Atomic Habits that resonated with me was James' perspective on the setting of goals (resolutions), and I’m hoping this perspective might be helpful for you going forward this year with respect to your health (or any area of your life).

Think about a health goal that you have set for this year. It could revolve around sleep, weight, exercise, stress reduction, nutrition… anything. And if you don’t have a health goal, then choose any goal you might have.

Goals vs Systems

From James’ perspective, goals are great at setting direction as they represent the result you want to achieve, but they aren’t necessarily helpful in achieving those results. It’s the systems you put in place that are key.

Systems are the processes you create that lead to the results you want. Not only that, systems build lasting change, aka new habits.

A goal is effectively a one-off solution - a momentary change.

For example, let’s say you set a goal of losing 10lbs in a month. You pull out all the stops - cut way back on food intake, start exercising daily, no wine for a month, etc. And bingo - you achieve it! Everyone notices of course – they comment on how great you look – and you feel like a million bucks. And yet slowly but surely the weight creeps back.

That’s because you haven’t made any real, lasting change. You haven’t really created any new habits over that short period of time. Not only that, there is a good chance you have felt deprived during the month and can’t wait for that first glass of wine (or two)!

Let’s try to lose 10lbs with a system (a realistic system) in place. Obviously systems are very personal, but it may include no snacking in the evening, going out for a 20 min walk every morning and following the 80/20 rule when it comes to eating a meal (eating until you are 80% full). And for good measure, you may include having a strategy for what happens when you miss a day or two of these small, incremental changes you are making.

Over time, you will lose weight. You may not notice after a month, but perhaps after three months it becomes apparent. People will assume it all happened suddenly, but you know that’s not the case. That’s what your system was all about - small, purposeful, incremental changes.

Small incremental changes

In order to effect meaningful change, it’s very tough to “go big”. For most people, it’s best to incorporate small, incremental changes over time as part of “system” or set of processes to achieve what you want to achieve.

These small little habits appear to make no difference in the short term, but over time (and what can appear to the outside world as “suddenly”) a breakthrough occurs. It’s like compounding interest –the effects of your habits multiply as you repeat them.

The dreaded plateau

But here-in lies the challenge – the fact that these small, incremental changes don’t reveal their benefits in the short term. If we are fixated on a goal (losing 10lbs) and after 3 weeks we haven’t seen any change, then it’s easy to give up. You want to throw in the towel.

Here again is where having a system is key. If you are solely focused on the goal, you will think you have failed and potentially give up. But if you have stuck with the system you have put in place, then trust you are going in the right direction and it will pay off in the long run. Ultimately, habits need to persist long enough to break through the plateau.

The difference a tiny improvement can make over time is astounding. James Clear has done the math – if you can get 1 percent better each day for a year, you will end up thirty-seven times better by the time you’re done. Not only that, you will have created new habits that are there forever – and like any habit you do for long enough, you won’t even think about it.

I can say all this because I’ve been there and experienced it. I spent years and years going on every diet imaginable, and it was only when I stopped my bouts of dieting (in between the bouts where I would either graze all day or binge eat) and implemented a system of eating three meals a day. That's it. And over time, everything started to fall into place. And then I made some more incremental changes - but only when I was ready for them.

Note this could be about starting a business, writing a book, running a marathon, or learning a new language.

So as we move into 2022, and are excited about all the goals / intentions / resolutions we have set, remember that it’s the systems we put in place that are key. They will help us develop the new habits critical to our success, and at the same time create lasting change.

Let's do this!

Gillian xx
PS - for those of you in Toronto and surrounding area, my Walk & Talk Wellness Reset is up and running. It's a fantastic way to get the therapeutic benefits of a walk in nature while getting personalized nutritional and lifestyle recommendations. Let me help you set some goals and put some systems in place to make 2022 a stellar year!